Senate Majority Leader Harry M. Reid presented an $848 billion health-care overhaul package on Wednesday that would extend coverage to 31 million Americans and reform insurance practices while adding an array of tax increases, including a rise in payroll taxes for high earners.

Democratic leaders were jubilant that the nonpartisan Congressional Budget Office determined that the Senate bill would cut federal deficits by $130 billion over the next decade. That projection, released shortly before midnight Wednesday, represents the biggest cost savings of any legislation to come before the House or Senate this year, but the measure’s effective date also was pushed back by one year, to 2014. Democrats said the savings could prove more significant in the long run, though the CBO said they “would probably be small,” amounting to around 0.25 percent of the overall economy, or no more than $650 billion between 2019 and 2029.

Those projected reductions could prove critical in winning the support of three wavering moderate Democrats whose votes Reid (D-Nev.) must secure to bring the legislation to the floor before the Senate breaks for Thanksgiving. But Reid also stacked the bill with provisions sought by liberals, including a public insurance option, albeit a version with an opt-out clause for states.

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Americans are worried about hidden costs in the fine print of health care overhaul legislation, an Associated Press poll says. That’s creating new challenges for President Barack Obama as he tries to close the deal with a handful of Democratic doubters in the Senate.

Although Americans share a conviction that major health care changes are needed, Democratic bills that extend coverage to the uninsured and try to hold down medical costs get no better than a lukewarm reception.

The poll found that 43 percent oppose the health care plans being discussed in Congress, while 41 percent are in support. An additional 15 percent remain neutral or undecided.

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There is an air of absurdity to what is mistakenly called “health-care reform.” Everyone knows that the United States faces massive governmental budget deficits as far as calculators can project, driven heavily by an aging population and uncontrolled health costs. Recovering slowly from a devastating recession, it’s widely agreed that, though deficits should not be cut abruptly (lest the economy resume its slump), a prudent society would embark on long-term policies to control health costs, reduce government spending, and curb massive future deficits. The president and his top economic advisers all say this.

So, what do they do? Just the opposite. Their sweeping overhaul of the health-care system””which Congress is halfway toward enacting””would almost certainly make matters worse. It would create new, open-ended medical entitlements that would probably expand deficits and do little to suppress surging health costs. The disconnect between what Obama says and what he’s doing is so glaring that most people could not abide it. The president and his allies have no trouble. But reconciling blatantly contradictory objectives requires them to engage in willful self-deception, public dishonesty, or both.

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“It’s our belief that it’s not just a political and economic issue, it’s a fundamental moral issue,” said David Liners, state coordinator for WISDOM, an interfaith coalition of about 140 Wisconsin congregations working to advance health care reform.

Despite near consensus in the call for reform, there remains widespread debate over who and what procedures should be covered – with undocumented workers and abortion as the main flash points – and at what cost; the role of government and whether the law or conscience should dictate a health care professional’s participation.

Alliances have emerged that reflect traditionally political divisions as much as faith, according to the Pew Forum on Religion & Public Life.

“It’s not a question of whether we need health care reform, but how we do it. And I don’t think government is the way,” said Mathew Staver, chairman of the faith-based coalition Freedom Federation, which opposes abortion and advocates a free-market approach to reform.”We believe individual liberties trump government-imposed obligations,” he said.

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What happens now? Democratic supporters of abortion rights need to accept that their House majority depends on a large cadre of antiabortion colleagues. They can denounce that reality or they can learn to live with it.

There is also a challenge for abortion’s foes, above all the Catholic bishops who have a long history of supporting universal coverage but devoted most of their recent energy to the abortion battle. How much muscle will the bishops put behind the broader effort to pass health-care reform? Their credibility as advocates for social justice hangs in the balance.

And if the Senate forces a change in the Stupak language, one obvious approach would involve a ban on abortion in the public plan — if such an option survives — and the application of Ellsworth’s rules to the private policies sold in the insurance exchange. The alternative would be Stupak’s original compromise offer to Pelosi. There are not many other options.

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The threats hanging over the central bank could compromise its independence, warn Fed watchers. Several crucial decisions are approaching, including how to continue phasing out its emergency efforts to support the economy. The Fed has already said it will wind down the purchases of mortgage securities in March after buying about $1.25 trillion worth. In the more distant future, to avoid the risk of inflation, the central bank will need to raise its target interest rate above the current level near zero.

Rate increases are always unpopular, particularly when the unemployment rate is still high. But the political environment could make the decision even tougher.

“The current unpopularity of the Fed will make it more difficult for them to raise interest rates when the economy recovers,” said Karen Dynan, a former senior Fed economist who now heads the economic studies program at the Brookings Institution. “With the Fed under such close scrutiny, any move to raise interest rates will be challenged even more strongly than in the past.”

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Injecting itself aggressively into the health-care debate, the Roman Catholic Church in America has emerged as a major political force with the potential to upend a key piece of President Barack Obama’s agenda.

Behind-the-scenes lobbying, coupled with a grassroots mobilization of Catholic churches across the country, led the House Saturday to pass an amendment to its health-care bill barring anyone who receives a new tax credit from enrolling in a plan that covers abortion, a once-unthinkable event in Democrat-dominated Washington.

The restriction would still have to be accepted by the Senate, where it will likely face a tough fight. The issue could sink the larger health legislation if the chambers fail to reach agreement, or if any consensus language leads supporters to defect.

The House vote, and the central role played by one of the country’s biggest religious denominations, stunned abortion-rights groups that had worked hard to elect Mr. Obama and expand Democratic congressional majorities. Activists on the left had thought social issues would take a back seat to economic concerns.

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But its narrow passage in the House, where the Democrats have a large majority, underscores the difficulties ahead. Senate Democrats are struggling to agree on how to pay for the overhaul and whether to create a new public insurance plan to compete with private insurers, as the House did. Friction over how the bill treats abortion, which almost derailed the House vote, is likely to divide the Senate too.

“If the public option plan is in there, as a matter of conscience, I will not allow this bill to come to a final vote,” Sen. Joe Lieberman (I., Conn.) said on Fox News Sunday.

With the passage of the House bill, Congress moved closer than ever to providing Americans with near-universal health insurance — a goal that has eluded many presidents since the days of Theodore Roosevelt.

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MS. [Rachel] MADDOW: So to the extent that this is going to actually cut the deficit, to the extent that this is designed to bring health costs down, we’ve got to do something. And I think people who vote against it are going to regret it.

MR. [E.J.] DIONNE: And 98 percent of small businesses are exempt from the taxes in this bill. This is a millionaire’s tax, basically, the biggest tax in this bill. And that the other thing is there are a lot of benefits in this bill that kick in right away. There’s a fund for people who have pre-existing conditions to get coverage right away. There are a lot of other provisions; no more recisions, so you can’t discover that, “Gee, I’m not covered after all.” They were smart enough to put a lot of things that kick in as soon as the bill is passed.

MR. [David] BROOKS: Rachel’s right that doing nothing is not fiscally responsible. But doing something that adds onto our current system without fundamentally changing our current system is fiscally insane. The idea that this is paid for is a political mirage. That tax surcharge on millionaires, that’s dead, that’s going nowhere in the Senate. The idea that we’re going to cut $400 or $500 billion in waste, fraud and abuse from Medicare, that’s historically unsupportable. We will never make those cuts, we’re never going to pull the plug on granny, all this stuff. It–most healthcare experts think that this fundamentally does not change the problem with healthcare system, which is the fee-for-service system which has been driving up costs for decade after decade.

Caught this on the way home from morning worship–read or watch it all.

The House of Representatives passed a sweeping health care bill Saturday night with a tight vote of 220-215, making it the biggest expansion of health care coverage since Medicare was created more than 40 years ago.

The Affordable Health Care for America Act, or H.R. 3962, restricts insurance companies from denying coverage to anyone with a pre-existing condition or charging higher premiums based on gender or medical history. It also provides federal subsidies to those who cannot afford it and guarantees coverage for 96 percent of Americans, according to the nonpartisan Congressional Budget Office.

However, turning the bill into law remains uncertain.

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Despite White House efforts to discount the importance of the loss of the only two governorships on the off-year ballot, especially in New Jersey, where Obama had campaigned heavily for embattled Gov. Jon Corzine, the implications were clear to other Democrats.

Rep. Jim Cooper of Tennessee, a leader of the moderate-conservative “Blue Dogs,” called the result “a wake-up call for Congress. A tidal wave could be coming.”

His fellow Tennessean, Republican Sen. Lamar Alexander, said that Obama “retains his personal popularity, but his policies, and those pushed by the congressional Democrats, are scaring the daylights out of people.”

Democratic pollster Peter Hart, in a memo to his clients, warned of the possible consequences of “the disappointment and disgust the American public feels toward Washington. It is as strongly negative as the period of 1979-80 and 1973-74.” Both those cycles saw wholesale changes in Congress, the Democrats benefiting in the latter and the Republicans in the former.

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What does all of this mean?

Populism is on the rise and conservatism is gaining steam, perhaps at its own expense. (If Hoffman loses in New York, it almost ensures that the Northeast will be almost exclusively Democrat-blue territory).

A sour mood exists among people, with close-to-10-percent unemployment, decreasing health-care benefits and rising taxes – and a view that the well-heeled get bailed-out but John and Joan Q. Citizen do not.

Because our political system was designed to be slow and laborious and to do little, that sour mood grows rather than dissipates.

These political conditions have made the difficult course of lawmaking become nearly impossible, and governing has become highly averse to coherent action.

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Legislation that would transform the nation’s healthcare system cleared a significant hurdle today as the Senate Finance Committee voted 14-9 for a sweeping overhaul.

Just one Republican, Sen. Olympia J. Snowe of Maine, voted for the bill. But that represented a victory for the White House, which had heavily courted Snowe, and it allowed overhaul advocates to claim that there was a vestige of GOP support for the measure.

“Is this bill all that I would want? Far from it,” Snowe said in announcing her vote. “But when history calls, history calls.”

The bill would require Americans to have health insurance, provide federal subsidies to help low-income workers buy insurance, establish new insurance marketplaces, regulate health insurer practices and expand Medicaid. The plan as drafted is estimated to cost $829 billion over the next 10 years.

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Yet this might just be where the president’s luck runs out. For precisely the power of his own party in Congress could prove to be a source of weakness rather than strength. On my most recent visit to Washington, I could not help being struck by the shift that has occurred from the imperial presidency of the Bush era to something like parliamentary government under Mr Obama. This president proposes; Congress disposes. It was Congress that wrote the stimulus bill and made sure it was stuffed full of political pork. It is Congress that will ensure the healthcare bill falls well short of being self-financing. Mr Obama recently snapped at an unnamed “Blue Dog” (conservative-leaning) House Democrat: “You’re going to destroy my presidency.” He could be right.

According to the polls, voters disapprove of Congress by 61 per cent to 31 per cent. What’s more, the two parties would be neck and neck if the midterm elections were held today. The reason is clear. While the stimulus package had a sound macroeconomic rationale, the growing structural imbalance between federal revenue and spending scares the hell out of voters. A recent USA Today/Gallup poll showed that 59 per cent of Americans think government spending is excessive. Mr Obama receives his lowest approval ratings for his handling of the federal budget deficit.

—Niall Ferguson, Laurence A. Tisch Professor of History at Harvard University and William Ziegler Professor at Harvard Business School

Concerns about the budget deficit may thwart efforts by Senate Democrats to pass legislation this month calling for the biggest expansion of the U.S. health-care system since the creation of Medicare in 1965.

The Senate Finance Committee, which had planned to approve its version as early as today, scrapped a vote to give the Congressional Budget Office time to complete a cost assessment. The delay threatens to dash plans by Senate Majority Leader Harry Reid to start debate in the full Senate next week after combining the measure with one from the health committee.

“CBO has a lot of work to do,” said West Virginia Senator Jay Rockefeller, one of the finance panel’s 13 Democrats. He said the panel’s vote may be delayed for at least a week. Committee Chairman Max Baucus, a Montana Democrat, said he’s still “hopeful” the CBO will deliver an estimate tomorrow.

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With the Senate Finance Committee set to approve its health care bill this week, Democrats are tantalizingly close to bringing legislation that would make sweeping changes in the nation’s health care system to the floor of both houses of Congress.

Party leaders still face immense political and policy challenges as they combine rival proposals ”” two bills in the Senate and three in the House. But the broad contours of the legislation are in place: millions of uninsured Americans would get subsidized health benefits, and the government would move to slow the growth of health spending.

Senior Democrats said they were increasingly confident that a bill would pass this year. “I am Scandinavian, and we don’t like to overstate anything,” said Senator Kent Conrad, Democrat of North Dakota and an architect of the Finance Committee bill. “But I have a solid feeling about the direction of events.”

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Perhaps no other issue Congress deals with touches every American as intimately as health care. Yet a new poll by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health finds that, so far, the public feels profoundly shut out of the current health overhaul debate.

“Most people don’t feel that they personally have a voice in this debate,” said Mollyann Brodie, director of public opinion and survey research for the Kaiser Family Foundation. “In fact, 71 percent told us that Congress was paying too little attention to what people like them were saying.”

Nancy Turtenwald is one of those people. The tourist from Milwaukee was walking around the sparkling new visitor center at the U.S. Capitol Tuesday. She was quick to agree with poll findings that the lawmakers debating the massive health overhaul bill just a few blocks away weren’t much interested in problems like hers.

“I don’t think they are people like us, you know?” she said. She thinks Congressional lawmakers know very little about the daily lives of the average American ”” and the health care costs they face. “How often do they go and buy gas and bread and stuff to see what it’s really like for the people like us?”

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The Senate Finance Committee voted down a government-run “public option” as part an overhaul of the nation’s health-care system Tuesday, rejecting the first of two amendments offered by Democrats.

The panel’s chairman, Sen. Max Baucus (D-Mont.), and four other Democrats sided with Republicans in opposing a public-option amendment offered by Sen. John D. Rockefeller IV (D-W.Va.). Baucus said he voted against the politically volatile provision because he feared that a bill including it would not get the 60 votes it would need to pass on the Senate floor. The committee voted 15 to 8 to reject the amendment.

After the vote, the panel began debating a second public-option amendment introduced by Sen. Charles E. Schumer (D-N.Y.).

“We are going to get at this, and at this, and at this, until we succeed, because we believe in it so strongly,” Schumer said in offering his amendment. He disputed Baucus’s contention that a health-care reform bill including the public option could never pass the Senate, saying the more Americans hear about its benefits, “the more they like it.”

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As if it were not complicated enough, the debate over health care in Congress is becoming a battlefield in the fight over abortion.

Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions.

Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation.

The question looms as a test of President Obama’s campaign pledge to support abortion rights but seek middle ground with those who do not. Mr. Obama has promised for months that the health care overhaul would not provide federal money to pay for elective abortions, but White House officials have declined to spell out what he means.

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Sen. Max Baucus spent the past few months trying to negotiate a compromise health care overhaul package that would have bipartisan support. But when Baucus, the Senate Finance Committee chairman, finally released the details of his massive bill on Wednesday, there was no sign of Republican backing.

Many Democrats are worried that Baucus offered far too many concessions to Republicans ”” most notably dropping the idea of a government-run health care plan to compete with private insurers ”” without securing any firm support from across the aisle.

The top selling point of the Baucus bill was supposed to be its bipartisan appeal. Without some Republican support, Baucus’ version could end up adding to the cacophony of competing proposals passed by several committees in the House and Senate.

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“God of grace and God of glory,” prayed the Rev. Cynthia Hale during a national conference call Aug. 19 on health care reform, “É We believe that it is your will that every man, woman, boy and girl receive quality health care in America.”

On that point, no religious leader would contest Hale, pastor at Ray of Hope Christian Church in Decatur, Ga., who offered the prayer at the kickoff of an effort by the faith community to mobilize religious support for the ideals of health care reform favored by President Obama.

From the pulpits and through public statements, religious leaders have been weighing in on various elements of what they say is a crucial moral issue. Catholic bishops in New Jersey, in letters to the state’s members of Congress, have lobbied against possible inclusion of abortion coverage in any federal health care plan, a possibility Obama dismissed in his prime-time speech Wednesday. The Episcopal Church USA passed a resolution favoring a single-payer system, while some Catholic bishops in the Midwest have publicly opposed any massive government effort.

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President Barack Obama’s address to Congress on healthcare reform was short on specifics and long on ideas he and his advisers had already floated this year.

The historic speech left some liberals wanting more details and conservatives emboldened to torpedo the president’s top domestic priority.

The big question of the night was how Obama was going to address the public health insurance option, but he largely repeated what he has said for weeks: He supports it, but will sign a bill that does not have it.

Read it all, and, yes, Joe Wilson should apologize–that was uncalled for.

While some were moved to tears by the president’s soaring rhetoric, others were moved not at all. Where some saw a new clarity, others saw more vagueness. And while some praised him for reaching out to Republicans, there were those who felt he was overreaching in some ways and not reaching far enough in others.

Americans listened intently to President Barack Obama’s much-anticipated speech on health care reform Wednesday night, and not surprisingly, their reviews varied. Few said they had changed their minds.

Matt Petrovick set his treadmill at a leisurely 2.8 mph pace so he could pay full attention to the television on the wall in front of him. He’s not sure the president’s words boosted his heart rate, but the speech certainly got him going.

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President Obama’s spirited defense Wednesday night of his broad healthcare goals avoided making concrete commitments on some of the most contentious issues, reflecting a guiding principle of his legislative strategy: to put off the most controversial decisions until the very last moment.

It is a strategy born of political reality. At this stage of the process, when neither the House nor the Senate has even begun a floor debate, lining up firmly on one side or the other of the hot-button issues invites gridlock or even defeat.

And so, though some liberal Democrats have threatened to revolt if Obama does not insist on a new government insurance option — the so-called public plan — the president told the joint session of Congress that he would consider other approaches to making coverage affordable for the uninsured.

“The public plan is only a means to that end,” he said, “and we should be open to other ideas that accomplish our ultimate goal.”

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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.

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With President Obama poised to deliver a nationally televised address to a joint session of Congress on health insurance reform Wednesday night, Senator Max Baucus, the chairman of the Senate Finance Committee, said that his panel would take up sweeping legislation and start voting on it in two weeks, with or without the support of Republicans.

“The time has come for action, and we will act,” Mr. Baucus said.

Mr. Baucus said Wednesday that he very much hoped to win support from Republicans with whom he has been negotiating for months. But he said he firmly intended to “mark up” a bill the week of Sept. 21.

“Irrespective of whether there are any Republicans, I will move forward,” Mr. Baucus said after meeting Wednesday with Democrats on the committee. “We have to move forward. If there are not any Republicans on board, I will move forward in any event.”

Mr. Baucus said his bill ”” the starting point for the committee’s work ”” would not include a new government-run health insurance program, or public option, because “a public option cannot pass the Senate.”

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After a nearly 40-day recess that was anything but restful, House Democrats are returning to work Tuesday still unsettled over pending health-care legislation and sure only that the people have had their say.

They are in almost the exact position they were in when they left the Capitol in late July. Conservatives are still leery of supporting a government-funded, or public, insurance option. Freshman lawmakers from suburban districts remain fearful of increasing taxes for their wealthy constituents to pay for the new measure and await alternatives from moderate Senate Democrats. And progressives, who are demanding the most far-reaching reform since the Great Depression, are still threatening to bring down the legislation if it does not contain a robust version of the public option.

In the lead-up to President Obama’s critical Wednesday night address to a joint session of Congress, interviews with a cross section of about 15 House Democrats and half a dozen aides show that there is still overwhelming support for some overhaul of the health-care system. But the caucus remains deeply divided over the details of the more than 1,000-page measure and now faces a public that is more skeptical than when House committees began drafting the plan two months ago.

“We knew a lot of work still needed to be done, so no, not a lot has changed,” said Rep. Stephanie Herseth Sandlin (S.D.), a leader of the Blue Dog Coalition, a group of 52 Democrats from moderate-to-conservative districts.

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Edward M. Kennedy, one of the most powerful and influential senators in American history and one of three brothers whose political triumphs and personal tragedies captivated the nation for decades, died late Tuesday at his home in Hyannis Port, Mass., at age 77. He had been battling brain cancer.

His family announced his death in a brief statement released early Wednesday. “We’ve lost the irreplaceable center of our family and joyous light in our lives, but the inspiration of his faith, optimism, and perseverance will live on in our hearts forever,” the statement said. “We thank everyone who gave him care and support over this last year, and everyone who stood with him for so many years in his tireless march for progress toward justice, fairness and opportunity for all.”

President Obama released a statement Wednesday morning, pointing out that “virtually every major piece of legislation to advance the civil rights, health and economic well being of the American people bore his name and resulted from his efforts. . . . Our country has lost a great leader, who picked up the torch of his fallen brothers and became the greatest United States Senator of our time. . . . Our hearts and prayers go out to” the Kennedy family.

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With so much evidence of wasteful and even harmful treatment, shouldn’t we instantly cut some of the money spent on exorbitant intensive-care medicine for dying, elderly people and redirect it to pediatricians and obstetricians offering preventive care for children and mothers? Sadly, we are very far from this goal. A cynic would argue that this can’t happen because children can’t vote (even if their parents can), whereas members of AARP and the American Medical Association not only vote but can also hire lobbyists to keep the money flowing.

One thing’s for sure: Our health care system has failed. Generational spending wars loom on the horizon. Rationing of health care is imminent. But given the political inertia, we could soon find ourselves in a triage situation in which there is no time or money to create medical-review boards to ponder cost-containment issues or rationing schemes. We’ll be forced to implement quick-and-dirty rules based on something simple, sensible and easily verifiable. Like age. As in: No federal funds to be spent on intensive-care medicine for anyone over 85.

I am not, of course, talking about euthanasia. I’m just wondering why the nation continues incurring enormous debt to pay for bypass surgery and titanium-knee replacements for octogenarians and nonagenarians, when for just a small fraction of those costs we could provide children with preventive health care and nutrition. Eight million children have no health insurance, but their parents pay 3 percent of their salaries to Medicare to make sure that seniors get the very best money can buy in prescription drugs for everything from restless leg syndrome to erectile dysfunction, scooters and end-of-life intensive care.

Read it all from yesterday’s New York Times.

Health and Human Services Secretary Kathleen Sebelius said providing citizens with the option of government-run insurance isn’t essential to the Obama administration’s proposed overhaul of U.S. health care.

“What’s important is choice and competition,” Sebelius said today on CNN’s “State of the Union.” The public option itself “is not the essential element.”

Asked if a cooperative plan is a possible replacement, Sebelius said she didn’t know what alternatives Congress would settle on among competing versions of the health legislation now under consideration. The Senate Finance Committee is discussing cooperatives, or networks of health-insurance plans owned by their customers, that would get started with government funds.

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