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During his radio show today, Rush Limbaugh made a very blunt case we don't hear stated so clearly by Republicans -- that not going through health insurance is better than using it, because it creates a direct link between the patient and the price, and creates the incentive to shop around:

"You oughtta try this, folks, just a standard doctor visit, offer to pay for it yourself," said Limbaugh. "I guarantee it'll cost you less than if you use your insurance."

Josh Marshall commented on this idea yesterday: "To be clear, such an approach probably would cut costs because most people just couldn't afford to get a lot of care, which is a great way of cutting costs. But remember, the problem according to most Republicans in Congress isn't that there's not enough insurance or that it's not good enough. It's that there's too much. The problem is that you have insurance. And good policy will take it away from you."

The White House has released the following excerpts from President Obama's prepared remarks for tonight's address to a joint session of Congress on health care reform.

I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

Our collective failure to meet this challenge - year after year, decade after decade - has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can't get insurance on the job. Others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.


During that time, we have seen Washington at its best and its worst.

We have seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors' groups and even drug companies - many of whom opposed reform in the past. And there is agreement in this chamber on about eighty percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and counter-charges, confusion has reigned.

Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.

The plan I'm announcing tonight would meet three basic goals:

It will provide more security and stability to those who have health insurance. It will provide insurance to those who don't. And it will slow the growth of health care costs for our families, our businesses, and our government. It's a plan that asks everyone to take responsibility for meeting this challenge - not just government and insurance companies, but employers and individuals. And it's a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans - and yes, from some of my opponents in both the primary and general election.


Here are the details that every American needs to know about this plan:

First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.

What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies - because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

That's what Americans who have health insurance can expect from this plan - more security and stability.

Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange - a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It's how everyone in this Congress gets affordable insurance. And it's time to give every American the same opportunity that we've given ourselves.


This is the plan I'm proposing. It's a plan that incorporates ideas from many of the people in this room tonight - Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.

But know this: I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.

That is why we cannot fail. Because there are too many Americans counting on us to succeed - the ones who suffer silently, and the ones who shared their stories with us at town hall meetings, in emails, and in letters.

Is Heidi DeJong Barsuglia, the energy lobbyist named in press reports as being the subject of Mike Duvall's filthy sexual boasting, denying that she was involved with the married Republican lawmaker, who resigned this afternoon? [SEE LATE UPDATE BELOW]

Sempra Energy, where Barsuglia works, just released the following statement:

Sempra Energy takes very seriously any reports involving the conduct of our employees. We are investigating this matter and the recent media reports that named one of our employees. The employee has denied the speculative media reports. Our investigation will be conducted to ensure not only that our policies on employee conduct are strictly adhered to, but also that our employee is treated fairly.

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President Obama will be hitting the road to campaign for health insurance reform, in a sign that tonight's speech is going to be the opening round of a new wave of direct presidential involvement in the debate.

Obama will hold a rally for health insurance reform this Saturday in Minneapolis, Minnesota. The doors of the Target Center will open at 9:30 a.m. CT, with space given on a first-come, first-served basis, and no tickets required. The event will begin at 12:30 p.m. CT.

A progressive California group is calling for an investigation into whether "Hot Mike" Duvall sold his votes for sex.

"A vice-chairman of the Committee on Utilities and Commerce was literally in bed with Sempra Energy's lobbyist," said Rick Jacobs of the Courage Campaign in a statement. "Assemblyman Duvall's 'sex for votes' affairs have cheated Californians out of honest government. We call on the attorney general to investigate Mr. Duvall to see if he can be prosecuted for selling his votes."

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Well this probably won't make reformers very happy. White House adviser David Axelrod now says that, in his speech before Congress tonight, President Barack Obama will acknowledge the potential for compromise on the public option

"He believes the public [option] choice, within that pool that we're going to create for uninsured Americans and small businesses would be helpful in terms of bringing competition and choice. He thinks that could be good for consumers, and he's going to make the case for that, but he's also going to make the point that this is not--this is an ends to a means. It's not the essence of this debate. It's a part of--it's one of the tools, and there are other ideas out there that-to-bring competition and choice that are--that are worthy as well," Axelrod said.

Emphasis mine. Questioned further by Wolf Blitzer, Axelrod said Obama will nod at both of most commonly suggested public option alternatives: the co-op model, and the triggered public option.

"He will acknowledge [co-ops]," Axelrod said. "There's the idea of putting trigger on the public option so it goes into effect at some date when it's clear that a market is uncompetitive. There are a number of ideas, but what is very important is that we have the kind of competition and choice that will help consumers in many states in this country."

Mike Duvall, the California GOP lawmaker and married family values champion who just resigned after a hot mic picked up his graphic bragging to a colleague about two affairs, was in 2000 awarded the "Ethics in America" award by a local university, for his "demonstration of the highest standards of ethical integrity" as a community leader with the Yorba Linda Chamber of Commerce, according to a 2008 press release on Duvall's state government website (the site has now been dismantled.)

We'll let you make your own joke.

A new Rasmussen poll in Massachusetts finds that support has fallen for changing the law to allow for a temporary appointment to the Senate, and the question is now evenly split.

The numbers: 44% are in favor of a temporary appointment while waiting for the special election, to 43% against it, within the ±3.5% margin of error.

A poll taken nearly three weeks ago, shortly before Ted Kennedy's death, found that 52% supported an interim appointment, to 40% against. The news had just broken at the time that Kennedy had requested a change to the law, to allow Gov. Deval Patrick to make an interim appointment.

Numerous reports now suggest that President Obama's health care speech tonight will include a fairly ringing endorsement of--though not a demand for--a public option. And though from all accounts, Obama's position on the public option (supportive, but not insistent) will remain unchanged, the development might come as a surprise to those who were paying close attention to the news last week. And, if it's emphatic enough, it will be a welcome sign to reformers that the public option will fight another day.

On Wednesday, a number White House officials began whispering to members of the White House press corps that the public option was on its way out--a trial balloon that led George Stephanopoulos to ask, "What is "death with dignity" for the public option?"

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Sen. Chuck Schumer (D-NY), in an interview with The American Prospect, said he's "always favored using reconciliation for the good parts" of the health care reform bill.

"We've looked at it and you can't use reconciliation for everything, [but] you can use it for a good number of things," he said. "There's nothing wrong with using it for the places where you can use it and then trying to get the 60 votes on the places where when you can't. You'd be surprised -- the number of places where you can use it is larger than we first thought."

He declined to be more specific.

Schumer also said piece-by-piece reconciliation would strengthen the bill.

"I think that will get you the best bill, the strongest bill and the bill that will have the greatest positive effect on the American people. Ultimately, we'll be judged not by whether we pass the bill, but ultimately we'll be judged by whether it works," he said.

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