For Minnesota Democrats, no unalloyed joy in Christmas Eve health care vote

Despite Amy Klobuchar and Al Franken's expressions of satisfaction over Thursday's Senate health care vote, the subtext of their post-victory statements hinted that the bill is far from any Democrat's idea of perfection. Klobuchar praised the bill as "an important step forward," but also promised to "continue to push for a final bill that includes strong Minnesota-model cost reforms, deficit reduction, protections against insurance company abuses, and strong, stable Medicare coverage." Said Franken: "This bill does not fix all the problems with our health care system, but it will help begin to bring down costs and is a significant down payment toward the goal of quality affordable health care for all Americans." Both Minnesota Democrats might have wished for a bill that includes a public option, even if Klobuchar's support was more equivocal and contingent on ironing out disparities in Medicare rates across the country. Both also have expressed squeamishness about new abortion restrictions added to the bill. On balance, they suggested they got most of what they want: Klobuchar said the bill would "begin to rein in costs" by rewarding value over volume – something she and others in the Minnesota delegation pushed for with the Mayo Clinic; A proposed tax on the state's med-tech companies was halved; and a measure pushed by Franken would raise the portion of health care premiums that must be spent on health care – hence limiting profits. . As for cutting health care costs and premiums overall – something the Republicans insist the legislation will not do – Franken and Klobuchar will have some fresh decisions to make once a final bill gets negotiated with the House in January. Two things to watch, besides the ultimate fate of the public option: Some liberal House members are not crazy about the independent commission in the Senate bill that has power over Medicare rates; and organized labor hates the Senate plan to tax high-end insurance plans (the House plan taxes high-end earners instead). But given the delicate backroom deals that had to be cut to get the requisite 60 votes in the Senate (sort of reminds us of what was at stake in the Minnesota Senate recount), the smart money in Washington says the final product can't look much different than what the Senate passed on Thursday.