In a victory for President Barack Obama, the Democratic-controlled House narrowly passed landmark health care legislation Saturday night to expand coverage to tens of millions who lack it and place tough new restrictions on the insurance industry. Republican opposition was nearly unanimous.

The 220-215 vote (click here to see how each member voted) cleared the way for the Senate to begin a long-delayed debate on the issue that has come to overshadow all others in Congress.

A triumphant Speaker Nancy Pelosi likened the legislation to the passage of Social Security in 1935 and Medicare 30 years later. "Oh, what a night!" she proclaimed at the beginning of a press conference held after the vote. Obama issued a statement saying, "I look forward to signing it into law by the end of the year."

"It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it," said Rep. John Dingell, the 83-year-old Michigan lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.

In the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.

Ironically, that only solidified support for the legislation, clearing the way for conservative Democrats to vote for it.

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price fixing and market allocation.

At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.

A cheer went up from the Democratic side of the House when the bill gained 218 votes, a majority. Moments later, Democrats counted down the final seconds of the voting period in unison, and let loose an even louder roar when Pelosi grabbed the gavel and declared, "the bill is passed."

The bill drew the votes of 219 Democrats and Rep. Joseph Cao, a first-term Republican who holds an overwhelmingly Democratic seat in New Orleans. Opposed were 176 Republicans and 39 Democrats.

WATCH: THE FINAL VOTE

WATCH: THE POST-VOTE PRESS CONFERENCE

From the Senate, Majority Leader Harry Reid of Nevada issued a statement saying, "We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system."

In his written statement, Obama praised the House's action and said, "now the United State Senate must follow suit and pass its version of the legislation. I am absolutely confident it will."

Nearly unanimous in their opposition, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

United in opposition, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

"We are going to have a complete government takeover of our health care system faster than you can say, `this is making me sick,'" jabbed Rep. Candice Miller, R-Mich., adding that Democrats were intent on passing "a jobs-killing, tax-hiking, deficit-exploding" bill.

But with little doubt about the outcome, the rhetoric lacked the fire of last summer's town hall meetings, when some critics accused Democrats of plotting "death panels" to hasten the demise of senior citizens.

The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the nation's eligible population having insurance.

To pay for the expansion of coverage, the bill cuts Medicare's projected spending by more than $400 billion over a decade. It also imposes a tax surcharge of 5.4 percent on income over $500,000 in the case of individuals and $1 million for families.

The bill was estimated to reduce federal deficits by about $104 billion over a decade, although it lacked two of the key cost-cutting provisions under consideration in the Senate, and its longer-term impact on government red ink was far from clear.

Democrats lined up a range of outside groups behind their legislation, none more important than the AARP, whose support promises political cover against the cuts to Medicare in next year's congressional elections.

The nation's drug companies generally support health care overhaul. And while the powerful insurance industry opposed the legislation, it did so quietly, and the result was that Republicans could not count on the type of advertising campaign that might have peeled away skittish Democrats in swing districts.

Over all, the bill envisioned the most sweeping set of changes to the health care system in more than a generation, and Democrats said it marked the culmination of a campaign that Harry Truman began when he sat in the White House 60 years ago.

Debate on the House floor had already begun when Obama strode into a closed-door meeting of the Democratic rank and file across the street from the Capitol to make a final personal appeal to them to pass his top domestic priority.

Later, in an appearance at the White House, he said he had told lawmakers, "to rise to this moment. Answer the call of history, and vote yes for health insurance reform for America."

It appeared that a compromise brokered Friday night on the volatile issue of abortion had finally secured the votes needed to pass the legislation.

As drafted, the measure denied the use of federal subsidies to purchase abortion coverage in policies sold by private insurers in the new insurance exchange, except in cases of incest, rape or when the life of the mother was in danger.

But abortion foes won far stronger restrictions that would rule out abortion coverage except in those three categories in any government-sold plan. It would also ban abortion coverage in any private plan purchased by consumers receiving federal subsidies.

Disappointed Democratic abortion rights supporters grumbled about the turn of events, but pulled back quickly from any thought of opposing the health care bill in protest.

One, Rep. Jan Schakowsky, D-Ill., detailed numerous other benefits for women in the bill, including free medical preventive services and better prescription drug coverage under Medicare. "Women need health care reform," she concluded in remarks on the House floor.

A Republican alternative was rejected on a near party line vote of 258-176.

It relied heavily on loosening regulations on private insurers to reduce costs for those who currently have insurance, in some cases by as much as 10 percent. But congressional budget analysts said the plan would make no dent in the ranks of the uninsured, an assessment that highlighted the difference in priorities between the two political parties.

10:30 PM ET -- GOP health care alternative rejected. The Republicans' alternative health care bill was voted down in the House, 176-258.

Rep. Timothy Johnson (R-Ill.), an obscure member of the party, was the lone Republican to vote against the GOP plan. The purpose of doing so was unclear. Speculation had surfaced on Saturday that, if there were one Republican defection, it would have been Louisiana Republican Rep. Joe Cao. He ended up supporting Boehner.

Commenting on the Johnson vote, one Democratic health care activist emailed: "random."

-- Sam Stein

10:19 PM ET -- Blue Dog Democrats' anti-abortion amendment passes. The House has passed a provision advanced by Rep. Bart Stupak (D-Mich.) that severely restricts women's reproductive health choices under the health reform bill.

The vote was 240-194, with 64 Democrats voting in favor of the amendment (and 1 Republican, Rep. John Shadegg (R-Ariz.), voting 'present').

HuffPost's Ryan Grim detailed the Stupak amendment earlier:

Stupak's...amendment...would ban the public health insurance option from funding abortion and also ban any private plan operating within the exchange from funding abortions. Under Stupak's plan, a woman buying private insurance from within the exchange with her own money would not have a choice of a plan that covered abortion.

Here's a statement Reps. Louise M. Slaughter (D-N.Y.) and Diana DeGette (D-Col.), co-chairs of the Congressional Pro-Choice Caucus:

"Placing onerous new restrictions on a woman's right to choose sets a terrible precedent and marks a significant step backwards. This effort will effectively ban abortion coverage in all plans, both private and public - marking a significant scaling back of the options offered under existing laws. Such a terrible, last minute amendment to a critical, historic piece of legislation is a shame. This kind of outrageous interference in health care by the government marks a sad day in this struggle and will result in women across America losing the right to health care."

10:08 PM ET -- "Dean of the House" delivers final health care speech. Rep. John Dingell (D-Mich.), the longest-serving member of the House of Representatives, who has introduced a national health care bill at the beginning of every session of Congress since he came into office, received a standing ovation as he began the final Democratic health care speech of the night.

9:54 PM ET -- A Republican vote for health care? Roll Call reports that Louisiana GOP Rep. Joseph Cao may vote in favor of the final health care bill if Rep. Stupak's anti-abortion amendment passes. Rep. Cao defeated scandal-plagued Democrat William Jefferson in 2008, and faces a major up-hill climb in keeping his seat in 2010 in his overwhelmingly Democratic district.

Multiple sources tell HuffPost that the White House has been working hard to win his vote, and that with the abortion amendment in play, his vote is up in the air.

9:31 PM ET -- "Republican ideas are already in there, thanks!" Debate is still taking place on the Republican health care alternative that will be voted on later this evening, before the vote on the Democratic-favored health care bill.

Several GOP members have argued tonight that the Democratic bill doesn't contain bipartisan ideas. Not so, say Dems, who have been distributing quotes from various Republicans declaring that they agree with most of the Democratic health care bill.

Rep. Eric Cantor: "[Cantor] said Republicans and Democrats agree on 80 percent of fixing the nation's healthcare system, but could not show the crowd a detailed plan that has been endorsed by House Republicans." [The Hill, 9/10/09]

Rep. Aaron Schock: "My hope is we could start over and focus on the 80 percent we both agree on," Schock said. "My hope is we could focus on a clean bill.'" [Herald-Review, 9/15/09]

Rep. Charles Boustany, after giving his party's official response: "In fact, I would venture to say that we agree on about 80% of the issues right now. It's just a matter of hashing out those few areas where we disagree." [MSNBC, 9/10/09]

Rep. Steve LaTourette: "LaTourette estimates that Republicans and Democrats agree on 80 percent of health care reform ideas, although they have serious disagreements on how to take care of underinsured and uninsured people in a way that won't harm those who have insurance." [Cleveland Plain Dealer, 10/17/09]

Here's a sample of the debate on the GOP alternative -- video of Rep. George Miller (D-Calif.), who was interviewed earlier tonight by HuffPost's Ryan Grim (see below).

Democratic aides: We've got the votes. "Today we will pass the Affordable Health Care for America Act," Speaker Nancy Pelosi (D-Calif.) said on the House floor Saturday evening. Politico is reporting that Democrats have at least the 218 votes needed to pass the bill. Four Democratic aides tell HuffPost the same thing.

Kristie Greco, a spokeswoman for Majority Whip James Clyburn (D-S.C.), declined to confirm the number.

The news that Pelosi has the votes can have unpredictable effects on undecided members. Some members, seeing the bill passing, may want to pile on and get on the side of history. Others react by thinking that they can now oppose it, look tough at home, but not jeopardize passage. Toward that end, watch for a handful of no votes to dribble out from Dems over the next hour or so.

A note of caution: Republicans are still allowed a parliamentary procedure known as a "motion to recommit." Within that motion, they could include any sort of mischief they see fit: conventional wisdom is that the motion will include some language concerning illegal immigration, but if any decision has been made, aides are being mum about it. Depending on whether it passes and how it impacts the bill, it could sway a vote or two on final passage, but it's unlikely, because the motion can be ignored as the House and Senate work to merge their bills later in the legislative process.

A Dem aide guessed that 9:30 PM ET was looking like a rough approximation of the time for a final vote.

Here's Pelosi's speech on the floor:

-- Ryan Grim

8:20 PM ET -- Democratic Rep.: "It sounds corny but..." Rep. George Miller (D-Calif.) guesses that Democrats have 225 votes for health care reform (218 are needed for passage), he told two reporters in the Speaker's lobby, one from Politico and one from HuffPost.

Miller, as chairman of the Education and Labor Committee, played a key role in drafting the bill.

Politico asked him what would happen to freshman being forced to "walk the plank."

"Who's walking the plank?" Miller asked. "For national health care?"

Voting against the bill could, in reality, come back to hurt Democrats who broke with their party, National Journal is reporting.

Rather than danger, Miller saw a historic victory.

Asked by HuffPost how he felt about the impending passage, he said: "It's incredible, when you think you really have this possibility and you know the history. You know, obviously, over 35 years I've participated in a couple of efforts. So in that sense yes, it sounds corny, but this is the kind of thing that makes you proud to be a member of Congress. You get to do something like this. You get to participate in something like this. You get to participate in trying to figure out how to make this work in our society. So it's a real privilege. A big, big, big privilege is what it is, to be able to participate in this."

Is the vote solid?

"I think it's good. Yeah, I think it's good," he said.

Told that both HuffPost and Politico were reporting Dems had the votes, he jokingly called to Pelosi: "Madam Speaker! Take a rest."

With 218 needed, Miller's prediction of 225 would make it a fairly close vote. Politico asked if he was upset it wasn't higher.

"Look, you go through this entire history and nobody's done it? Take it," he said, punching one hand with the other. "Whatever it is."

-- Ryan Grim

7:49 PM ET -- A reporter takes a spill. After a full day of debate, House staffers and reporters are passing around this video today for comic relief.

7:30 PM ET -- Michele Bachmann wears a lei, critics go to town. Outspoken Minnesota Republican Michele Bachmann (somewhat inexplicably) was sporting a Hawaiian lei when she spoke out against health care reform tonight. She said she was doing so because people in Hawaii told her to vote against the bill.

A Democrat blasted out an email: "I feel it is my duty to point out that Hawaii has a health care mandate where EVERY employer has to provide health care benefits to ALL employees who work over 20 hours a week."

7:00 PM ET -- The newest member of Congress speaks: My district needs this. Speaking on the floor of the House of Representatives for one of, if not the, first time since being elected to office, Rep. Bill Owens (D-N.Y.) made it clear that he would vote for health care reform and viewed the legislation as a boon for small business.

"My district needs one thing: jobs," said the newly elected Democrat. "In upstate New York, small businesses are the jobs engine. Over the past 15 years, they have been responsible for nearly two-thirds of all the jobs created in [the area]. But the cost of health care is grinding the engine down. Over the last decade, small business insurance premiums are up 129 percent. That means much higher expenses, more businesses dropping coverage, and a sicker, more financially-strapped work force, and enormous pressure on small business owners...

"This bill can change that. It creates a competitive marketplace where individuals and small businesses can shop for polices at fair rates. It guarantees preventive care for a healthier, more productive work force, and it encourages Americans to start businesses of their own because the cost of health care will no longer tie them to the same job. The people of my district need jobs. They need me to vote yes. I came to congress to move America forward. This will do that."

Owens' vote, in the end, likely won't be the deciding margin if the House passes health care legislation Saturday evening. While the margin of the final vote seems likely to be small, it's mainly because Speaker Nancy Pelosi will have allowed a group of moderate Democrats to vote against the legislation for electoral purposes.

But Owens' vote is indeed a potent symbol in the eyes of Democratic leaders. Earlier in the day, President Barack Obama pointed to Owens' victory in upstate New York earlier this week as a reason that the party should rally behind the House's legislation.

"He said to look at Bill Owens," a senior Hill aide who was at the meeting recalled. "There is a House seat that's been in Republican hands for more than one hundred years. But Owens didn't run away from reform. He campaigned on it. And he still got elected."

5:46 PM ET -- How Rep. Clyburn introduced Obama. An aide to Majority Whip James Clyburn (D-S.C.) passes on the speech he made earlier today while introducing the president to the Democratic caucus:

"As I listened to the previous speakers, I thought about last year's campaign. Congressman Marion Berry and I spent a few days together traveling throughout South Carolina in a little RV that I leased for about 10 days. Accompanying us on parts of those trips was my grandson. As the father of 3 wonderful daughters, having a grandson was a real blessing to me. But he arrived three months before he was expected. He was three pounds and eight ounces at birth, and had three operations before he was 20 pounds. I can still remember the looks of excitement on the faces of my daughter and son-in-law when they made the last payment on their 15% co-payment.

"One day as we rode around in that RV, we watched on a television monitor as then candidate Senator Barack Obama was talking about the need for health care reform. I looked at that young man and thought about how fortunate he was to have had the best doctors and treatment available.

"Today that young boy is 15 years old, and while playing golf with him not long ago, using my driver, I had made one of my longest drives of the day. He pulled out his three-wood and drove his ball right past mine. He is where he is today because of what we're trying to do for every child. He was fortunate to be born to parents who had health insurance. But every child born in America should have the same chance he had. That is what we are trying to do today, and the man who has brought us to the point of being able to do just that is here with us today. Ladies and gentlemen, the President of the United State of America, Barack Obama."

4:54 PM ET -- Rep. Rangel to GOP Leader Boehner: "Shame on you." Minority Leader John Boehner (R-Ohio) and Rep. Charlie Rangel (D-N.Y.) just got into a testy exchange when Boehner asked Rangel if he would guarantee that pro-life language in the House version will remain in the bill through conference committee with the Senate.

"You've been here long enough to truly understand how this system works," Rangel responded, saying that he couldn't guarantee him anything. Even if he could, said Rangel, who is under ethics investigations, such a guarantee "might be a violation of our ethics laws."

The press gallery and the House floor erupted in laughter.

From there it heated up, with Boehner saying that allowing a vote on the amendment was a "shell game" because the party planned to remove it later.

"Shame on you," responded Rangel, with one of the more direct insults you'll see on the House floor, where speakers are supposed to direct their comments to the chair, not directly to other members.

-- Ryan Grim

4:39 PM ET -- Progressive group releases new poll timed to health care vote. In light of a tough loss in Virginia's gubernatorial election, a progressive advocacy group is trotting out some new poll numbers making the case that the Democratic Party lost by abandoning the principles of its base.

A Research 2000 Virginia Poll conducted for the Progressive Change Campaign Committee reveals that 64 percent of Virginians who supported Barack Obama but did NOT vote in 2009 said that the party's gubernatorial candidate, Creigh Deeds, was "not progressive enough." Driving the point home further, 58 percent of Virginia voters who are registered as Independent but supported Obama in 2008 election, likewise, said that Deeds was "not progressive enough."

The findings cut against the argument that emerged from the 2009 gubernatorial elections, which held that Democrats lost in Virginia and (to a lesser extent) New Jersey because they were not moderate enough.

Only eight percent of Democratic Obama voters in Virginia and 16 percent of Independent Obama voters in Virginia said they thought Deeds was "too far to the left."

In its survey, PCCC also looked at how a public option for insurance coverage played in the Virginia governor's race. It concludes that Deeds was hurt by his opposition to the public plan. Forty-one percent of respondents said that Deeds' declaration that he would consider opting out of a public plan as governor made them less excited about his candidacy. Only six percent said it made them more excited.

-- Sam Stein

4:22 PM ET -- GOP Rep. uses "granddaughter" (not his own) as political prop. Things are getting a bit weird on the House floor, as Republicans and Democrats continue their daylong debate over health care legislation.

At roughly 3:40 p.m., Rep. John Shadegg (R-Ariz) took to the microphone with a baby girl in hand. Named "Maddie," he began by proclaiming that the child was not, in fact, his granddaughter. But he didn't say whose it was.

And yet, for the next minute, there was Shadegg bopping the baby up and down and using her as a prop to rail against the government option.

"I wish this was my granddaughter," Shadegg said. "This is Maddie. Maddie believes in freedom. Maddie likes America because we have freedom here. And Maddie believes in patient choice health care. She asked to come here today to say she doesn't want the government to take over health care. She wants to keep her plan."

The chamber was either a bit freaked out or slightly humored. It was difficult to say.

"Mr. Speaker that was a remarkable child and a great ventriloquist," responded Rep. Henry Waxman (D-Calif.).

-- Sam Stein

4:18 PM ET -- Rep. Stupak on progressives: You can't be crying wolf all the time because you lose your wolfiness. For weeks, the Congressional Progressive Caucus threatened to withhold substantial support from the health care bill if it didn't include a robust public option tied to Medicare rates. For weeks, a gang of pro-life Blue Dogs threatened to withhold the support of at least 40 members -- to "take down the rule," in House speak -- if it didn't include language tightly restricting reproductive rights.

There is no robust public option, but the abortion language is in.

HuffPost asked Rep. Bart Stupak (D-Mich.), the lead Blue Dog negotiator, why he succeeded and the progressives failed.

"Because I didn't threat[en]. These are the facts," he said.

But you did threaten, a reporter pointed out.

No, Stupak said, it wasn't a threat. It was a promise. "No, they know I'll vote against the rule," he said.

Stupak said the Blue Dogs have gradually been sending a message to leadership and that much of it goes back to a previous vote involving an appropriations bill that Blue Dogs wanted to include pro-life language.

In July, the House considered a Financial Services Appropriations bill that would allow publicly-funded abortions in the District of Columbia. Stupak and allies were not allowed an amendment, so they sought to "take down the rule" -- in other words, round up enough votes to deny he bill a chance to get voted on on the floor. When time expired, the pro-lifers had prevailed. But Pelosi held the vote open for extra time and persuaded four members to switch their votes.

They didn't win in the end, Stupak said, but they accomplished their goal.

"We wanted to send a message," he said. "We went back and I said, 'See, I can take down your rule.'"

He has held his fire since then, saving his strength for the health care bill.

"Now, I have not threatened that every time that we went to Rules Committee and we didn't always get our pro-life amendments, I did not try to take down any rules. You have to pick your fights at the right time. You can't be crying wolf all the time because you lose your wolfiness. You lose your credibility," he said. "So I'm not going to lose my credibility. So you use it at certain times when it's appropriate."

-- Ryan Grim

4:12 PM ET -- Timeline of today's votes. A Hill aide sends over the general timeline for the rest of today's activities in the House.

It currently looks like the final vote on the full health care reform bill will occur around 9PM ET. Here is the order of events until then:

* General debate will continue for about three more hours
* Debate on the Stupak anti-abortion amendment
* Debate on the Republican health care substitute
* Votes on the Stupak amendment and the GOP substitute
* Debate on the "motion to recommit," a procedural move used by the minority party
* Vote on the motion to recommit
* Vote on the full bill

-- Nico Pitney

3:37 PM ET -- A photo of the health care bill sitting in Speaker Pelosi's office.

3:33 PM ET -- A Blue Dog for health care reform. Rep. Patrick Murphy, writing for HuffPost, explains "why we can't afford to fail."

3:15 PM ET -- Rep. Stupak: Health care has the votes whether anti-abortion amendment passes or fails. Rep. Bart Stupak (D-Mich.) told reporters that regardless of the outcome of the vote on his amendment, which would severely restrict coverage of reproductive health issues, the House health care bill is headed for passage. He is whipping support for the amendment and estimates he has 225 votes. If he's right, the amendment will pass, and he predicted enough pro-life Democrats will vote yes on the final bill to put it over the top. But if it fails, he said, enough pro-lifers -- ten to 15, he said -- will have been satisfied to have had their vote on the floor that they'll turn around and support the final bill anyway. Picking up ten to 15 votes would give the bill a comfortable margin for passage.

Again, If Stupak is correct -- and there's no reason to think he's wrong -- then it's a done deal, and the bill will pass the House.

"The forty members who stood strong with me through this whole deal, I think at least 15 will not vote for the bill no matter what, even if Stupak is adopted," he said. "Then there might still have been ten to 15 who would vote for it even if we didn't get our amendment."

So enough to put it over the top?

"It should be," he said.

Stupak talked to reporters about yesterday's on-again-off-again negotiations, describing how he had come to a deal with Pelosi in the evening, only to have her call him back at 9:00 p.m. to say she had to walk away from it because the pro-choice base of the caucus wouldn't support it.

Instead, Stupak was offered the amendment that will be voted on later today. Stupak's tale confirms what the Huffington Post reported last night.

His amendment, Stupak noted, is in fact more restrictive than the language he had previously agreed to include in the bill. The pro-choice crowd, demanding the right to vote their consciences, Stupak said, overplayed their hand and look to be handing him a bigger victory. Stupak's amendment is extremely restrictive -- any individual or any business that gets any subsidy or tax credit -- which will be most people in the country -- will not be able to purchase a health care plan that covers abortion, even with their own money. They can, however, buy supplemental coverage from a separate plan. Stupak's amendment would represent the most significant rollback of reproductive rights in decades.

Is it even Constitutional?

"It may not be. I don't know," Rep. Jan Schakowsky (D-Ill.) told HuffPost. "But we're certainly not looking to resolve this in the courts." They may not be, but someone, somewhere, might be.

The progressive site FireDogLake has posted an action item on Stupak's amendment -- "Call Bart Stupak's Donor PACs and tell them you're staying away because they finance anti-abortion activism."

-- Ryan Grim

3:10 PM ET -- GOP Rep. Mike Pence: Dems who help GOP block reform will be akin to World War II vets who risked lives for freedom.

3:02 PM ET -- Rep. King contemplates wrapping Capitol building with health care bill. Ten minutes after Majority Leader Steny Hoyer (D-M.D.) took to the House floor to relay the tale of a young boy who died because a tooth infection went untreated and spread to his brain, Rep. Steve King (R-Iowa) was trying to literally wrap the Capitol building with the legislation.

The House, on Saturday, began what should be a lengthy process of debating and voting on the final language of reform. But not everyone was willing to simply sit through the event. Outside, King and others were leading a mob of angry tea-party protesters in a round of bizarre and disruptive shenanigans.

About 20 feet off the House floor, at the entrance to the lawn in front of the Capitol building, King and two colleagues were wielding a massive copy of the 1,900-page bill, rolled up around a wooden poll. A man accompanying a clearly excited King, suggested that they wrap the legislation around the building.

"Let's do it," he proclaimed. "Let's wrap the building."

A security guard, looking on disapprovingly, patiently urged them not to try. "You can't do that sir," he said. "You can't do that."

In the background, the tea party protesters who had gathered for a second day of railing against health care's passage were dispersing. Sensing a lost opportunity, King turned to go back outside, asking his co-conspirator to grab the rolled up bill.

A Hill aide tells the Huffington Post that he and others have been plotting to tape pieces of the bill to the Capitol building for several days.

-- Sam Stein

2:00 PM ET -- President Obama's Rose Garden remarks on health care. Here's video:

1:58 PM ET -- Democrats pass key hurdle. Democrats passed a key parliamentary hurdle easily, 242-192, the result of the deal struck late last night. Rep. Earl Blumenauer (D-Oregon) began a standing ovation on the Dem side. Texas Republican Louie Gohmert rose to congratulate Dingell on the victory. He asked for unanimous consent "to restore his chairmanship back to him." The GOP side erupted in applause, but Democrats remained mostly silent, unhappy to be reminded of the internal battle between Dingell and Rep. Henry Waxman (D-Calif.), which cost Dingell the chairmanship of the Energy and Commerce Committee.

-- Ryan Grim

1:55 PM ET -- Male GOP congressmen try to shout down female lawmakers. During early debate over the health care bill, a group of House Republicans -- led by Rep. Tom Price (R-Georgia) -- attempted to stop the Democratic Women's Caucus from making their arguments about how the health bill would benefit women by screaming over them.

Rep. Lois Capps (D-Calif) only had time to say "Mr. Speaker, I ask unanimous consent to--," before Price shouted "I object." The presiding chair, Rep. John Dingell (D-Mich.) made gestures to maintain control, declaring "the request is not yet before the House," and Price was "out of order," to little effect. Capps attempted to go on, but Price continued shouting "I object, I object, I object, I object."

The same shouting tactics were used on Rep. Mary Jo Kilroy (D-Ohio) who asked angrily: "do I not have the right to be able to continue my sentence without objections that are trying to censor my remarks here on the floor that I have a right to make as a member of this House?"

Watch the compilation reel that Think Progress put together below.

-- Lila Shapiro

1:54 PM ET -- President Obama points to Bill Owens. President Obama referred to Congressman Bill Owens, the Democrat who won the special congressional election in New York on Tuesday, as an example of why Democrats should vote for the health care bill. Owens won the seat, held by a Republican for the last hundred years, running on a progressive health care platform.

1:43 PM ET -- Emotions running high. Emotions are running high on the House floor, as Rep. John Dingell - the longest serving member in the history of the House - is presiding over the health care debate -- the first time he has presided over the chamber since the 1965 Medicare vote.

And if that didn't tug at the hearts of soppy pols enough, a source sends over word that Dingell is actually using the same gavel today that he brandished 44 years ago.

"They took it off the wall," said the source, who noted how tightly the congressman was holding it.

There is, indeed, a lot of strategically produced nostalgia filtering its way into the final House vote on health care reform. At a meeting with members earlier in the day, President Barack Obama referenced the historic nature of the vote and Dingell's role in the Medicare debate to persuade members of the need to back the legislation.

-- Sam Stein

1:42 PM ET -- Are Democrats confident? Well, they're passing around copies of the nearly 2,000 page bill and autographing it for each other on the floor. Some members have only gotten Pelosi's autograph, others have the entire first page of the bill covered in the signatures of their colleagues.

-- Ryan Grim

1:38 PM ET -- Key vote called. John Dingell (D-Mich.) calls for a vote on rule -- a key vote that Pelosi has been whipping furiously; it's the vote anti-abortion Dems had threatened to "take down." But things are going smoothly for the Speaker so far. The vote on a "previous question," which concluded just before the rule was called, passed 247-187, a comfortable victory. The vote on the rule is timed for 15 minutes.

-- Ryan Grim

1:32 PM ET -- Details from Obama's meeting with House Democrats are HERE.

1:20 PM ET -- One more 'no' vote. One more 'no' vote: Rep. Mike McIntyre, a Democrat from North Carolina, will oppose the health care bill. Ken Spain, a spokesman for the National Republican Congressional Committee, sends out the news to reporters and includes "just a thought."

The GOP campaign-man's thought: "How are vulnerable Democrats who vote 'Yes' going to feel when we are using their fellow Democrats' statements against them in ads next year? Members of their own party are citing out-of-control spending, debt, tax increases, kills jobs, etc."

Among other reasons, McIntyre says he is opposing the House bill because it "costs way too much money" and "raises too much in new taxes."

Vulnerable Dems certainly won't be thanking Mike McIntyre.

-- Ryan Grim

1:10 PM ET -- CBO has bad news for House GOP. The Congressional Budget Office has bad news for the House GOP. It had originally estimated that the Republican health care plan would save $4.4 billion from fraud enforcement. The number raised some eyebrows for -- it turns out -- good reason. The CBO corrected its estimate on Saturday in a letter to Rep. Pete Stark (D-Calif.). Stark is chairman of the Ways and Means subcommittee with control over health care.

From the CBO letter:

The HCFAC funding at issue is $266 million a year of direct spending under current law. CBO's earlier understanding was that the intent was to increase funding by $300 million a year, for a gross direct spending cost of $3 billion over 10 years. As drafted, however, the substitute amendment has the effect of setting (and freezing) HCFAC funding at exactly $300m a year. In other words, the language as drafted would increase funding by $34 million a year, or approximately $0.3 billion over 10 years (not the $3 billion).

As noted above, our original estimate shows an increase in direct spending of $3.0 billion over 10 years. With that level of funding, we estimated nonscoreable savings of $4.4 billion over the budget window. (Those savings are "nonscoreable" because Scorekeeping Guideline #14, as adopted by the Congress several years ago, specifies that any estimated reductions in direct spending or increases in revenues that stem from direct spending for program administration purposes cannot be counted for purposes of budget enforcement.)

The corrected estimate, to reflect the language as drafted, is an increase in direct spending of $0.3 billion over 10 years. With that change in HCFAC funding, we estimate nonscoreable savings of $0.5 billion over 10 years. The net result of that correction is to increase the net pay-as-you-go savings of the Boehner substitute by about $2.7 billion (by removing $3 billion in direct spending cost and adding back in $0.3 billion). Because of Scorekeeping Guideline #14, the change in nonscoreable savings does not affect the tally of direct spending for budget enforcement purposes.

12:58 PM ET -- White House pool report on Obama's meeting with House Dems.

Motorcade departed Cannon 12:25, arr. WH 12:30, taking route down Independence Ave.

POTUS walked toward Oval w/ axelrod, Reggie Love, and Phil Schiliro of leg affairs.

Readout of caucus meeting from Bill Burton:

The President made the case that Congress has a historic opportunity today to provide stability and security for those who have insurance, affordable coverage for those who don't and bring down the cost of health care for families, small businesses and the government. He said that we have made more progress on comprehensive reform than any administration and any Congress in the past 70 years - and we should take this historic opportunity to pass health care reform so that he can sign a bill by the end of this year.

12:23 PM ET -- Democrats finish meeting with President Obama. House Democrats are speaking to reporters after concluding a meeting with President Obama about the health care vote today.

12:09 PM ET -- Dem: I'll vote for health care if anti-abortion amendment passes, predicts it will. Rep. Marcy Kaptur (D-Ohio), one of the few remaining undecided votes on health care, said she would support the legislation if it included a provision that would restrict the ability of insurers to cover abortion.

If the amendment offered by Rep. Bart Stupak (D-Mich) is not passed by the House - and a vote will come on Saturday - Kaptur said she would remain "undecided" on whether to support the broader reform effort.

"For some people this is a make or break issue," she said, when asked if other anti-abortion Democrats would be satisfied enough to vote for health care reform merely by having the Stupak amendment come to a vote.

Speaking to reporters before going into a caucus meeting with President Barack Obama, the Ohio Democrat predicted, ultimately, that the Stupak amendment would pass. The entire Republican caucus, which includes 177 members, seems likely to support the measure. And Stupak claims to have 40 Democratic lawmakers backing his effort. That would give the amendment 217 votes - one shy of passage. But Kaptur said she believed others would come on board.

"I honestly don't have a list," she said. "I think Mr. Stupak and others might be the best ones to ask about that but I believe that there are large numbers that will vote for our amendment and I think it will pass."

Asked what she was hoping to hear from the president on the issue, Kaptur replied: "I hope he says something!" The White House, she added, had yet to talk to her about her concerns with the legislation.

"Nothing in our amendment changes existing law," she said, "it maintains existing law, but it doesn't absolve the bill of existing law."

-- Sam Stein

11:39 AM ET -- Dem: Anti-abortion lawmakers will support bill without anti-abortion amendment. A high-ranking Democrat said on Saturday that he expects many of the party's anti-abortion members to support health care legislation even if a provision making abortion less accessible is defeated on the floor.

Rep. Mike Honda (D-Calif.) told the Huffington Post he felt confident that a compromise reached last night -- to allow a vote of Rep. Bart Stupak's (D-Mich.) amendment, which would make it harder for insurers to provide abortion -- would placate lawmakers on the fence, regardless of whether the amendment passed.

"Will that be sufficient?" Honda asked. "I didn't hear anybody say 'Yeah, that would be sufficient. But I think there is a sense that it would (satisfy these folks)."

Honda similarly predicted that if the Stupak amendment were to pass (likely with full Republican support), he did not suspect that pro-choice lawmakers would drop their support of the bill.

As for what he hoped to hear from President Obama, who is briefing lawmakers starting at 11:25, Honda said:

"I think he is going to come in and reassert his principles. I hope that he says that he thinks we have a good situation now."

-- Sam Stein

11:24 AM ET -- Rangel feeling confident. A stream of lawmakers have been arriving in the Cannon House Office building for today's big health care strategy session with the president. Virtually all have been ignoring the press. But as he walked by the roped off reporters, Rep. Charlie Rangel (D-N.Y.) turned and smiled.

"You feeling confident Chairman Rangel?"

"Yep," he replied, before moseying into the conference room.

Rep. Rob Andrews (D-N.J.) seemed similarly chipper, telling the Huffington Post that he felt good about the upcoming vote.

Those two, however, were far more optimistic than others. Most lawmakers seem sullen as they are entering the premise and several have simply offered don't-know-like shrugs.

-- Sam Stein

11:02 AM ET -- Obama set to brief lawmakers at 11:15. A White House aide tells the Huffington Post that the president is on schedule to come to Capitol Hill to rally support for health care legislation.

Obama's trip to the opposite side of Pennsylvania Avenue was announced on Friday. But there was nervous chatter on the Hill that he would delay or even cancel the trip if the Democratic leadership felt passage of legislation was out of reach. The president, an aide said, remains slated at this point to arrive and talk with lawmakers at 11:15 -- a small point of relief for anxious Democrats.

The aide did not elaborate as to whether Obama would field questions from his fellow Democrats or merely help whip up support for the legislation. Among the big questions left unanswered is how the President feels about the amendment offered by Rep. Bart Stupak (D- Mich.), which would drastically restrict the coverage of abortions by health care insurers.

-- Sam Stein

10:46 AM ET -- The President's pitch. What is the White House telling fence-leaning Democrats? The AP's Eric Werner talked to Rep. Jason Altmire (D-Penn.) who "said he heard from Obama, White House Chief of Staff Rahm Emanuel, Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan. Their message: 'This is a historic moment. You don't want to end up with nothing,' said Altmire, who remained undecided."

10:10 AM ET -- Rep. Dingell to preside over House for first time since 1965 Medicare vote. Democrats wavering on the health care bill will have their heart-strings tugged by the man overseeing today's planned vote: Rep. John Dingell (D-Mich.), the Dean of the House of Representatives and the longest-serving member in history.

Dingell's late father, also a congressman, introduced the first bill to provide national health insurance in 1933, and his son has continued a tradition started by his father by introducing health care legislation at the beginning of every session of Congress.

Rep. Dingell last led debate on a vote on April 8, 1965, the day the House passed legislation creating Medicare, according to his office.

10:08 AM ET -- House Hispanic Caucus balking at bill over immigration provisions. (AP) As drafted, the health care legislation permits illegal immigrants to purchase coverage with their own money inside the insurance exchange that would be created -- a provision that the 23-member Hispanic Caucus wants retained in any final compromise that reaches Obama's desk.

The controversy surrounding illegal immigrants remains "a work in progress," Rep. Nydia Velazquez, a New Yorker and chairwoman of the Hispanic Caucus, said after a meeting in Pelosi's office on Friday.

One lawmaker who attended the session, speaking on condition of anonymity to discuss the private talks, said members of the Hispanic Caucus sought and received assurances from Pelosi that she and the leadership would support them as the bill made its way through the House and ultimately to the president's desk. But this lawmaker said the speaker was not able to get a pledge in return that the Hispanics would all vote for the bill regardless of how their issue was ultimately settled.

Despite the uncertainty, Hispanic lawmakers generally have a strong incentive to support the legislation. According to the Census Bureau, nearly 31 percent of Hispanics are uninsured, roughly double the rate of 15 percent for the U.S. population as a whole.

10:02 AM ET -- What happens if Democrats don't have the votes? The answer is easy: they won't vote -- at least on Saturday. Democratic leaders insist that they can get the legislation passed today, but

9:20 AM ET -- Bishops endorse health care bill. "The United States Conference of Catholic Bishops delivered a critical endorsement to House Speaker Nancy Pelosi on Saturday by signing off on late-night agreement to grant a vote on an amendment barring insurance companies that participate in the exchange from covering abortions."

8:39 AM ET -- Compromise reached on major potential health-care hurdle. HuffPost's Ryan Grim reports: As the House of Representatives inches toward a final vote on comprehensive health care reform this weekend -- the most dramatic domestic policy debate in several generations, a reorganization of a sixth of the economy - the only thing the parties can talk about is abortion and immigration.

"It tells you something about our country," remarked one distressed member of Congress, who didn't want to be named speaking ill of this fine land.

What it tells isn't pretty: The ranks of the uninsured are steadily being filled, with the number approaching 50 million. Health care costs are rising at a rate several times that of inflation, eating into the take-home income of the majority of the American people and threatening to break the federal budget in less than a decade.

Yet the talk is of abortion and immigration.

All day on Friday, House leaders struggled to reconcile the pro-life and pro-choice wings of the Democratic Party. Over the last several weeks, the pro-choice bloc, consisting of nearly 200 Democrats, had gradually come to terms with an amendment authored by Rep. Lois Capps (D-Calif.).

The intent of the amendment was to keep the debate about health care rather than abortion and it would make clear that - as is current law - no federal funds would be used for abortion. "Our hope was that we could continue the current ban on federal funding for abortion so the issue wouldn't bog down the overall health reform legislation," wrote Capps at the time.

That wasn't enough for pro-life Democrats. On November 3, Rep. Brad Ellsworth (D-Ind.) offered a more conservative compromise, one that restricted abortion in a bunch of extra ways and would require one private plan in the exchange not to cover abortion.

The divorce from reality had been filed by this point, considering that most insurance plans -- even using pro-life numbers -- do not cover abortion.
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Still, pro-choice Democrats swallowed the compromise, but said they'd go no further. Health care reform, said Rep. Lynn Woolsey (D-Calif.), a staunch pro-choicer and co-chair of the Congressional Progressive Caucus, should not be a vehicle to drive a pro-life social agenda.

That's when Rep. Bart Stupak (D-Mich.) re-entered the debate. Stupak is a longtime pro-life advocate and had been pressing his concerns upon House leadership. On Friday, Ellsworth withdrew his compromise language from negotiations, according to several House sources, sending the debate back to the starting line, where Stupak was waiting.

Stupak, in meetings with Pelosi and other members of leadership, pressed to include, instead, his own amendment that would ban the public health insurance option from funding abortion and also ban any private plan operating within the exchange from funding abortions. Under Stupak's plan, a woman buying private insurance from within the exchange with her own money would not have a choice of a plan that covered abortion.

During the early afternoon, Pelosi was leaning toward including some more moderately blended version of Stupak and Ellsworth's amendment's as part of the health care bill that would be sent to the floor, several aides told HuffPost. Just before 5:00 PM, Stupak and Rep. Henry Waxman (D-Calif.), who battled over abortion while the bill moved through Waxman's Energy and Commerce Committee, huddled on the House floor. Leaving the floor, the generally talkative Waxman gruffly brushed off reporters, asserting his alleged right "not to be swarmed."

Tempers flared. A Democratic congressman told House Republicans, who then told the Huffington Post, that Rep. Diana DeGette (D-Colo.) was asked to leave a leadership meeting where the pro-life agreement was being considered. DeGette is firmly pro-choice, and it was thought, the source said, that she would not agree to the deal. "False," said a leadership aide, saying that "she had to leave to attend another meeting. Other pro-choice members [were] in there with leadership, as well as Waxman."

Either way, the question came down to who had the votes. Stupak's driving argument was that he had more than the forty members he needed to "take down the rule" - legislative lingo for defeating a bill on the House floor before it comes for a final vote. No one was sure whether Stupak actually had the 40 votes, but pro-choice Democrats were skeptical.

As the night and the meetings wore on, Pelosi shifted, multiple aides said, and was leaning toward allowing a floor vote on the Stupak-Ellsworth amendment rather than inserting it into the bill. The logical conclusion is that Pelosi determined she would lose too many pro-choice and progressive votes in the process of harnessing pro-life Democrats.

Shortly after midnight, Stupak addressed the Rules Committee and requested a floor vote on the amendment, ending a day of drama, but leaving open questions that will be answered tomorrow: Does his amendment have enough votes to pass? If it does, will pro-choice Democrats flee and sink the bill?

The thinking among leadership is that allowing a vote -- regardless of the outcome -- helps win votes for final passage. If it passes, then pro-lifers line up behind health care reform. If it fails, at least they had their vote. For pro-choicers, if the amendment passes they can still fight to remove it during negotiations with the Senate -- which rejected tough abortion restrictions.

Meanwhile, aides from both parties say, the GOP is planning out how it will game the language in its motion to recommit - an alternative measure aimed at stamping out the bill that the minority is entitled to introduce. The GOP could include language supporting Democrat-backed proposals, such as single-payer health care or a robust public option -- and then vote present, allowing a majority of Democrats to carry the vote to victory and complicate things for leadership. (Dems probably wouldn't have the votes, however, for single-payer, believe it or not.)

Or the GOP could toss out anti-immigration language. That effort could garner the support of a big enough bloc of Democrats to give Pelosi genuine concern that it could prevail. Here we wander further from reality: undocumented workers currently get free medical care at great expense to the American people at emergency rooms across the country. The GOP's alternative approach, as it's been described in the past, denies that reality while simultaneously turning businesses into immigration-enforcement arms. People here illegally, however, would still be able to go to the emergency room for free.

Lost in the back and forth are the tens of millions without insurance and the nation's broken health care system. More surprising than the behavior of Congress, perhaps, is the fact that it has gotten as far as it has.

7:45 AM ET -- The Democratic 'no' votes. HuffPost's Jeff Muskus reports: House leaders, with the help of the White House, frantically whipped for health care votes Friday in advance of a floor vote, but the number of Democrats planning to vote against reform continues to rise.

As of 6 p.m. Friday, 26 House Democrats have stated that they will oppose the health care bill. The confirmed "No" votes so far: John Adler (N.J.), Brian Baird (Wash.), John Boccieri (Ohio), Dan Boren (Okla.), Bobby Bright (Ala.), Travis Childers (Miss.), Artur Davis (Ala.), Lincoln Davis (Tenn.), Bart Gordon (Tenn.), Parker Griffith (Ala.), Stephanie Herseth Sandlin (S.D.), Larry Kissell (N.C.), Suzanne Kosmas (Fla.), Frank Kratovil (Md.), Jim Marshall (Ga.), Eric Massa (N.Y.), Jim Matheson (Utah), Mike McMahon (N.Y.), Charlie Melancon (Louis.), Walt Minnick (Idaho), Collin Peterson (Minn.), Ike Skelton (Mo.), Bart Stupak (Mich.), John Tanner (Tenn.), Gene Taylor (Miss.) and Harry Teague (N.M.).

This level of opposition isn't fatal to health reform -- Democrats only need 218 of their 258 votes to pass the bill -- but it makes leadership's margin for error much smaller.

Unsurprisingly, 15 of those 26 are Blue Dogs. Several from rural areas cited the familiar Blue Dog complaint of "regional disparities" -- typically a shorthand for the different state levels of reimbursement under Medicare -- although the bill headed for a vote contains a public option that is not tied to Medicare, not the so-called "robust" option Blue Dogs have opposed for months.

Some of the bill's opponents are from districts where lack of health care coverage is less of an issue. Bart Stupak's longstanding drive for stronger anti-abortion language made his opposition a virtual certainty. And Baird said that he would oppose the bill in part because a report from Medicare actuaries is still forthcoming.

The most common complaint among the confirmed "No" votes, however, is overall cost. "Congress should not pass a bill that costs more than $1 trillion or increases the financial burden on middle class families and small businesses," Adler said in a statement Friday. "First and foremost, I cannot vote for legislation with this big of a price tag in today's economic climate," Childers said Wednesday.

Several of the confirmed "No" votes said they would prefer a package more like the weaker Senate Finance Committee bill.

UPDATE: The Chicago Tribune speaks with Rebecca Polihronis, an acquaintance of Sosa, who claims that that "he is going through a rejuvenation process for his skin."

EARLIER:

Sammy Sosa's skin appears to have lightened considerably. Photographs taken at an event in Las Vegas reveal a surprisingly light pigmentation on the former slugger. While no cause has been established at this time, the web site Midwest Sports Fans speculates that steroid use could be responsible:

There appears to be at least some evidence suggesting that steroid use could be one of the lifestyle choices that increases a person's likelihood of becoming symptomatic with vitiligo.

It was reported in June that Sosa, who captured the nation's attention as a prolific home run hitter in the 1990s and earlier this decade, tested positive for steroids in 2003.

LOOK:

Green is no stranger to being naked, as she first shot to fame in the Bernardo Bertolucci movie "The Dreamers," which featured nudity and explicit sex.

First Ladies have always garnered public attention. Their activism, political prowess, and style make most of them household names. Just recently, Martha Washington made headlines because historians are now trying to revamp her once frumpy image-- she apparently wore the Manolo Blahniks of her time on her wedding day and was quite beautiful and witty, despite earlier reports to the contrary. Haters!

But how well do you know your history? See if you can name these foxy former First Ladies and scroll down for the answer key. Then vote in our poll.

(Hint: seeing as this is the Style Page, I chose women that were particularly, well, stylish.)

SLIDESHOW:

**Scroll down for answer key**
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ANSWER KEY:
1) Grace Coolidge, married to President Calvin Coolidge (1923-1929)
2) Ida McKinley, married to President William McKinley (1897-1907)
3) Abigail Adams, married to President John Adams (1797-1801)
4) Rosalynn Carter, married to President Jimmy Carter (1977-1981)
5) Dolley Madison, married to President James Madison (1809-1817)
6) Jackie Kennedy (okay, so that was easy), married to President John F. Kennedy (1961-1963)
7) Julia Tyler, married to President John Tyler (1841-1845)

POLL:

*Fun facts taken from the National First Ladies Library website.

Conservative rhetoric notwithstanding, the House bill is not a "government takeover." I wish it were. Instead, it enshrines and subsidizes the "takeover" by the investor-owned insurance industry that occurred after the failure of the Clinton reform effort in 1994. To be sure, the bill has a few good provisions (expansion of Medicaid, for example), but they are marginal. It also provides for some regulation of the industry (no denial of coverage because of pre-existing conditions, for example), but since it doesn't regulate premiums, the industry can respond to any regulation that threatens its profits by simply raising its rates. The bill also does very little to curb the perverse incentives that lead doctors to over-treat the well-insured. And quite apart from its content, the bill is so complicated and convoluted that it would take a staggering apparatus to administer it and try to enforce its regulations.

What does the insurance industry get out of it? Tens of millions of new customers, courtesy of the mandate and taxpayer subsidies. And not just any kind of customer, but the youngest, healthiest customers -- those least likely to use their insurance. The bill permits insurers to charge twice as much for older people as for younger ones. So older under-65's will be more likely to go without insurance, even if they have to pay fines. That's OK with the industry, since these would be among their sickest customers. (Shouldn't age be considered a pre-existing condition?)

Insurers also won't have to cover those younger people most likely to get sick, because they will tend to use the public option (which is not an "option" at all, but a program projected to cover only 6 million uninsured Americans). So instead of the public option providing competition for the insurance industry, as originally envisioned, it's been turned into a dumping ground for a small number of people whom private insurers would rather not have to cover anyway.

If a similar bill emerges from the Senate and the reconciliation process, and is ultimately passed, what will happen?

First, health costs will continue to skyrocket, even faster than they are now, as taxpayer dollars are pumped into the private sector. The response of payers -- government and employers -- will be to shrink benefits and increase deductibles and co-payments. Yes, more people will have insurance, but it will cover less and less, and be more expensive to use.

But, you say, the Congressional Budget Office has said the House bill will be a little better than budget-neutral over ten years. That may be, although the assumptions are arguable. Note, though, that the CBO is not concerned with total health costs, only with costs to the government. And it is particularly concerned with Medicare, the biggest contributor to federal deficits. The House bill would take money out of Medicare, and divert it to the private sector and, to some extent, to Medicaid. The remaining costs of the legislation would be paid for by taxes on the wealthy. But although the bill might pay for itself, it does nothing to solve the problem of runaway inflation in the system as a whole. It's a shell game in which money is moved from one part of our fragmented system to another.

Here is my program for real reform:

Recommendation #1: Drop the Medicare eligibility age from 65 to 55. This should be an expansion of traditional Medicare, not a new program. Gradually, over several years, drop the age decade by decade, until everyone is covered by Medicare. Costs: Obviously, this would increase Medicare costs, but it would help decrease costs to the health system as a whole, because Medicare is so much more efficient (overhead of about 3% vs. 20% for private insurance). And it's a better program, because it ensures that everyone has access to a uniform package of benefits.

Recommendation #2: Increase Medicare fees for primary care doctors and reduce them for procedure-oriented specialists. Specialists such as cardiologists and gastroenterologists are now excessively rewarded for doing tests and procedures, many of which, in the opinion of experts, are not medically indicated. Not surprisingly, we have too many specialists, and they perform too many tests and procedures. Costs: This would greatly reduce costs to Medicare, and the reform would almost certainly be adopted throughout the wider health system.

Recommendation #3: Medicare should monitor doctors' practice patterns for evidence of excess, and gradually reduce fees of doctors who habitually order significantly more tests and procedures than the average for the specialty. Costs: Again, this would greatly reduce costs, and probably be widely adopted.

Recommendation #4: Provide generous subsidies to medical students entering primary care, with higher subsidies for those who practice in underserved areas of the country for at least two years. Costs: This initial, rather modest investment in ending our shortage of primary care doctors would have long-term benefits, in terms of both costs and quality of care.

Recommendation #5: Repeal the provision of the Medicare drug benefit that prohibits Medicare from negotiating with drug companies for lower prices. (The House bill calls for this.) That prohibition has been a bonanza for the pharmaceutical industry. For negotiations to be meaningful, there must be a list (formulary) of drugs deemed cost-effective. This is how the Veterans Affairs System obtains some of the lowest drug prices of any insurer in the country. Costs: If Medicare paid the same prices as the Veterans Affairs System, its expenditures on brand-name drugs would be a small fraction of what they are now.

Is the House bill better than nothing? I don't think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.

So let's try being more blunt: if you want a better experience of life, live it!

Notice I did not say, "if you want more things out of life, go get them." I'm talking about the quality of your life experience, and not the quantify of toys you can accumulate. Contrary to the bumper sticker, the person who dies with the most toys does not necessarily win - unless, of course, you may be talking about winning the booby prize.

So many people seem to still be stuck on the measuring stick of the material--how much do you make, how much do you have in the bank, what kind of house do you have, what kinds of electronics do you own, where do you go on vacation, and all manner of physical world things.

Even more amazing to me is how many keep trying to blame some euphemistic society for their ills, and, in particular, the American society for having instilled in them the focus on things vs. quality of experience.

Measure Your Quality of Life by Quality of Experience, not by Quantity of Possessions

If you happen to have succumbed to the "Madison" avenue, TV version of success, then sure, you can blame the advertisements, the TV shows and the greedy bankers if you want. It still comes down to who drank the Kool-Aid, not who made the Kool-Aid.

So come on now: how about some modicum of reality here: Are you responsible for your choices or not? If not, you can stop reading this article and any others that follow. This work is not for you if you are looking for someone to blame. This work is for you if you are willing to acknowledge that you are the one making the choices, and that if life experience is going to improve, it will come down to choices you make today, tomorrow and the next day.

Here's an example of the societal conundrum (and please, I'm not trying to jump on anyone here, least of all the author of this email. This person had the courage to write and my experience suggests that being willing to talk about the issue is the first major step forward):

I just read your (article) and I agree with what you said. But my question to you is, how can you truly live the life you want to live when our society doesn't support it? What I mean is that if it were not for the need of money, and so much of it, in order to live decently would not their be more dreams being fulfilled without having to worry about being able to pay your bills? I am 41yrs old and every day I am constantly in my head trying to figure out what I want to do with my life, all the while knowing that what I want to do, which is to be able to experience all the things of interest to me for however long and still get paid a decent salary in which to live a modest life, all the while not feeling like some sort of failure because I didn't live up to societies brainwashing of what success is or responsibility for that matter. I just want to be free to LIVE life and not have to end up on the street in order to do that. So again tell me how can I make my dream come true? - KJ

KJ's note is great! KJ has provided a foundation upon which we can begin to make some of this clear. Let's dissect the note, line by line:

"How can you truly live the life you want to live when our society doesn't support it?" Society? Which society? Who is this society and how did it come to have the power to decide what you can choose for your own life. Assuming we aren't talking about a life of mayhem, robbery and murder, you can pretty much find hundreds, if not thousands or millions of different approaches to life, each of them chosen by the person following the lifestyle. My suggestion: start by figuring out what you would like to support in your own life. From there, you just might begin to discover choices you can make that will move you toward what you truly want.

"What I mean is that if it were not for the need of money, and so much of it, in order to live decently would not their be more dreams being fulfilled without having to worry about being able to pay your bills?" What does "decently" mean? I know of people with no bills who still worry, and those with huge bills who also worry. Vice versa as well. For some, good enough never is. Of course, the underlying premise here is the main culprit. KJ has accepted the notion that a decent life is one that can be bought. My suggestion: focus on the quality of experience, not the quantity of possessions.

"I am constantly in my head trying to figure out what I want to do with my life, all the while knowing that what I want to do, which is to be able to experience all the things of interest to me for however long and still get paid a decent salary in which to live a modest life, all the while not feeling like some sort of failure because I didn't live up to societies brainwashing of what success is or responsibility for that matter." Probably the most obvious challenge here is with the phrase, "experience all the things of interest to me." Not only does KJ want to pursue things in life, KJ seems to blame "society" for his or her brainwashing. As I have written many times before, it all starts with awareness. In this case, KJ is aware that s/he has bought into something that doesn't work, and yet persists in trying to pursue it. My suggestion: start with your own awareness and begin to redefine your idea (ideals) of what a decent life could be. Remember, you can never get enough of what you don't really want.

"I just want to be free to LIVE life and not have to end up on the street in order to do that." Again, KJ seems to have confused living with having. My suggestion: work on gaining clarity about what living means to you, how you would experience living, and what would be true if you were actually doing that. From there, you can begin to make choices that will help you make progress toward your true aspirations.

"So again tell me how can I make my dream come true?" This one depends on what your dream might be. If it is a dream focused on possessing things, then perhaps that kind of dream is, for you, a nightmare. As before, what do you want out of life, really? My suggestion: stop complaining and start choosing.

One of our readers sent me an email with perhaps the simplest summation of all:

A group of us were playing the "if only" game - you know, if only I had a job, if only I had more money, etc. And the moderator of the group asked all of us "What are you going to do about it?" It dawned on me that I had a problem and it helped me to take control of my circumstances.

As we mentioned last week, sometimes it is enough to simply recognize what is present, determine what you might like to experience differently, and then get off your "buts" and do something about it. In my work over the years, I have often said that thought is not required, only action. That's a bit too simplistic in some ways, and yet there is great truth in this little aphorism. We'll explore this one in a future post.

Please do share your thoughts, comments and suggestions, either via the comments section below, or by emailing me directly.

Russell Bishop is an Educational Psychologist, professional life coach and management consultant, based in Santa Barbara California. You can find out more about Russell at http://www.lessonsinthekeyoflife.com. Contact Russell by email at: Russell (at) lessonsinthekeyoflife.com

While Palin didn't use the phrase "death panels," she implied that rationed care would lead to elderly or disabled people being denied care to save money.

"What may they feel about an elderly person who doesn't have a whole lot of productive years left," Palin asked the audience of about 5,000. (Tickets were $30 each.) "In order to save government money, government health care has to be rationed... [so] then this elderly person that perhaps could be seen as costing taxpayers to pay for a non-productive life? Do you think our elderly will be first in line for limited health care?"

Palin made the "death panel" charge explicitly in a Facebook post the following day. "We had been told there were no "death panels" in the bill either," she wrote. "But look closely at the provision mandating bureaucratic panels that will be calling the shots regarding who will receive government health care."

In Wisconsin, Palin also expressed fear over the moving of "In God We Trust" to the edge of American coins.

"Who calls a shot like that?" she demanded. "Who makes a decision like that?"

She added: "It's a disturbing trend."

The private Bandeirante University in Sao Bernardo do Campo, outside Sao Paulo, said 20-year-old Geisy Arruda disrespected "ethical principles, academic dignity and morality."

Bandeirante University published newspaper advertisements Sunday accusing Arruda of attending class with "inadequate clothing" and having a provocative attitude that was "incompatible with the university environment."

Arruda made headlines after the Oct. 22 incident, in which she had to be escorted away by police after wearing the mini-dress to class. She put on a professor's white coat and left amid a hail of insults and curses.

In the ad, titled "Educational Responsibility," the college said it had warned Arruda to change her behavior and decided to expel her after talking to students, staff and Arruda herself. It accused her of posing for pictures and provoking other students.

The university said it was also temporarily suspending some of the students who were seen heckling Arruda in a video of the incident that made the rounds on Youtube. It did not say how many were being suspended or how long they would be kept from attending classes.

Brazil's national student union released a statement on Sunday saying it was against the university's decision to expel Arruda, and Brazil's top official for women's policy, Nilcea Freire, told the official Agencia Brasil news service that the decision showed "intolerance and discrimination."

Although Brazil is known for its skimpy attire, especially in beach cities, most college students dress more modestly on campus – commonly in jeans and T-shirts. Some students had complained that Arruda seemed out of place in her revealing clothes, Brazilian media reported.

Seth Meyers and Amy Poehler devoted their segment "Really?!? With Seth And Amy" to the subject last night,

SETH: I mean I know that to you guys swine flu is almost as terrifying as drinking tap water or sending your kids to public school but really?

AMY: Can you not read how mad people are at you? When most people saw the headline 'GOLDMAN SACHS GETS SWINE FLU VACCINE' they were super happy until they read the word 'vaccine.'

SETH: Also, Centers for Disease Control, you sent the vaccine to Wall Street before schools and hospitals? Really? Were you worried the swine flu might spread to the Hamptons and St. Barts? These are the least contagious people in the world. They don't even touch their own car-door handles.


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