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Health Care Reform In Peril; Lieberman Threatens Filibuster Over Medicare Buy In

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What makes the new turn even more outlandish in the eyes of leadership and others is that Lieberman ran for Vice President on a platform that included a Medicare buy-in for people not-yet eligible for the program. Last week, he and Reid clashed when Lieberman began raising less definitive objections to the plan.

This afternoon, on Face the Nation, Lieberman said that, to get 60 votes, "You've got to take out the Medicare buy-in. You've got to forget about the public option. You probably have to take out the Class Act, which was a whole new entitlement program that will, in future years, put us further into deficit. And you've got to adopt some of the cost containment provisions that will strengthen cost containment, that all of us favor."

Soon thereafter came the confrontation in Reid's office, and that's left the prospects of the Medicare buy-in--and the greater reform bill--very much in doubt.

On Friday, Sen. Olympia Snowe (R-ME) told me and other reporters that she opposes the Medicare buy-in but, when pressed, did not make an explicit filibuster threat, saying instead that she'd make her final decision when CBO weighs in. A report is expected early this week.

This past Wednesday, Sen. Ben Nelson (D-NE)--who is now skeptical of the Medicare buy-in proposal--was singing a somewhat different tune. Though he insisted his ultimate support for the public option compromise was contingent on a passing CBO score, he told me that he and other health care principals liked the idea in theory. "I'm not aware of anything that was raising serious objections about it, I think it was about, 'Well, that sounds okay, let's see how it scores,'" Nelson said.

The very next day, he told reporters he was concerned the Medicare buy-in would become a vehicle for single-payer, and cast doubt on its ultimate viability. "I wouldn't be surprised if this thing does not become a viable option," Nelson said. "I think it is going to be the lesser of the popular things, but I am keeping an open mind."

I asked him about his swift change in tone late Friday.

"Conceptually, I am concerned about the Medicare buy-in, the more I've thought about it," Nelson said. "I think the numbers will be very disturbing if for no other reason you already have underpayment in Medicare right now for providers, so shoring that up has to be accomplished--where does the money come from and what have you."

With Lieberman out, and with Snowe and Nelson leaning no, that leaves Reid shy of the 60 votes he needs to seal the deal.

So what happens if he strips the buy-in? That may do him no good. Sen. Roland Burris (D-IL) has suggested he'll filibuster a bill without a viable public option, and Sen. Russ Feingold (D-WI) has said he can not support a bill that includes only private insurance options for consumers, who will be required to have insurance under the terms of the legislation.

And even if their cloture votes can be won, it's not at all clear if a health care bill with no public option and no Medicare buy-in can pass in the House. The only other way forward for Democrats, if all of the usual options are exhausted, is to pass health care reform through the filibuster-proof budget reconciliation process--an option leadership has all but foreclosed upon. In other words, it's going to be a long week. Stay tuned.

Late Update: Here's the video of Lieberman on Face the Nation.