Democrats broke a Republican filibuster in the wee hours of the morning and inched their sweeping $871 billion health care package toward passage before Christmas.
All 60 members of the Democratic caucus -- liberals who wanted a public option voted for a bill without one, and moderates concerned about the cost -- voted to limit debate on compromise language introduced Saturday morning. The 40 Republicans opposed and assailed Democrats for crafting back-room deals that benefit a few senators.
"It's one of the great Bernie Madoff gimmicks that I've ever seen, that anybody's ever seen," McCain, R-Ariz., charged on "Good Morning America" today, adding that this was an "unsavory practice that the American people will reject resoundingly."
One of the biggest weaknesses of the bill, McCain said, is that tax increases and cuts in Medicare and other funding would kick in as soon as the bill is passed but the benefits won't begin to accrue until four years later.
"That's nutty stuff ... it's unacceptable," he said.
The strict timeline -- a series of early morning procedural votes though one of the worst snow storms in Washington, D.C., history -- was set by Senate Majority Leader Harry Reid to pass a bill before the Christmas holiday.
An agreement on the compromise to bring Sen. Ben Nelson, the final Democratic holdout, onboard with the legislation, was announced Saturday morning. But today's vote signaled that all Democrats will support the bill.
Nelson secured a special break for his state's contributions on Medicaid funding, protected some Nebraska insurers from a new tax in the bill and got Democratic leaders to agree on slightly tougher restrictions on how abortions could be offered in insurance plans under the bill.
McCain criticized Democrats for providing concessions to a few Democrats, such as Nelson, who had been skeptical of the bill, saying it would cost people in other states.
"This was behind closed doors," McCain said. "The Republicans were never brought in to the negotiations and this is what you get -- a split country -- where the American people are opposed to what we're doing and opposed to us."
As for whether the late Sen. Ted Kennedy, who had fought for health care overhaul much of his Senate career, would approve, McCain said his friend would not like the the partisan nature of the legislation.
"I think that Senator Kennedy would appreciate the outcome," he said. "I don't think he would appreciate it on a party-line vote. There has never been a major reform accomplished in the history of this country that wasn't bipartisan. ... He never engaged in this kind of unsavory process of offering people different deals, which in the end cost people from other states lots of money and puts burdens on them."
Some liberal Democrats are also unhappy, even though they voted with their caucus. Anti-war Sen. Russ Feingold, D-Wis., who earlier helped break a Republican filibuster of a troop funding bill he opposed in order to make room on the Senate schedule for health care reform, cast blame at the White House for not pushing hard enough to include a public health insurance option.
"Unfortunately, the lack of support from the administration made keeping the public option in the bill an uphill struggle," Feingold said in a written statement.
Feingold supported the bill, however, as did every other Democrat, even though he disliked elements of it.
"While the loss of the public option is a bitter pill to swallow, on balance, the bill still delivers meaningful reform, and the cost of inaction is simply too high," Feingold said.
Democrats Unite on Senate Health Care Bill
The proposal would cost $871 billion over the next 10 years to give access for 31 million Americans who don't currently have health insurance. It counts on lower Medicare costs, taxes on the insurance industry and medical device makes as well as a special tax on high-cost insurance plans, to pay for the legislation.
Every person would be required by the government to have insurance or pay a fine. People making up to $88,000 for a family of four would get help from the government to pay for insurance. Medicaid would be greatly expanded for the poor.
Republican senators, seeking to delay the vote and turn public opinion even further against it, launched a rhetorical attack on Nelson, the conservative Democrat who withheld his support for a health reform compromise until the last moment.
Senate Minority Leader Mitch McConnell of Kentucky called provisions inserted to woo Nelson's vote a "kind of smelly proposition."
"This is supposed to be all of our health care ... not just for them," he said at a Capitol Hill press conference.
It was not just Nelson's home state of Nebraska that won concessions in closed-door negotiations, but because Nebraska's carve-out is permanent, the conservative Democrat is catching the most fire from Republicans.
Vermont and Massachusetts will also benefit from special treatment in how the federal government subsidizes state Medicaid programs, although supporters argue that those two states were being penalized because they already help provide insurance for nearly all of their citizens.
Republicans vowed to delay a final vote until Christmas Eve, even though the vote this morning effectively broke their filibuster of health reform legislation.
Why is the GOP fighting it when the passage looks clear for Democrats?
"Because they [Senate Democrats] haven't got the American public," McCain said. "They had 60 percent of the United States Senate, 60 percent of the American people are against this. They want it stopped and they certainly -- as they find out more about this unsavory process we've been through, the Cornhusker Kickback, the Louisiana Purchase, the Florida FlimFlam and all of the other kinds of dealing that went on -- they'll find it very distasteful."
Republicans Assail Concessions to Some Democrats
Other goodies were tougher to trace. The bill authorizes $100 million for hospital construction for a medical school opaquely described as "an academic health center at a public research university in the United States that contains a State's sole public academic medical and dental school."
Eleven hospitals would potentially qualify for some of the money, according to Democratic staffers. But the Secretary of Health and Human Services would be in charge of doling the funding out.
On the Senate floor, Sen. Lindsay Graham of South Carolina said the Democrats had to "cook up a deal in a back room that is sleazy in my view."
Republicans would never do that sort of back-room negotiating of a bill of this scope, Graham said.
"We're not going to put the whole nation at risk and take a broken system and make it worse just to get a vote," Graham said. "No way in hell."
"This process is not legislation. This process is corruption," said Sen. Tom Coburn, R-Okla. "It is a shame that the only way we can pass this legislation is to buy votes."
McConnell said Republicans will insist on using all their parliamentary time even after that vote, when it is clear that the bill will pass. If Republicans insist on all their time for debate, a vote on final passage of the bill is likely to occur at 7 p.m. on Christmas Eve.
"People have to show up and vote at least three more times," McConnell said, arguing that time is good for the process as lawmakers and the public read through the bill.
The Congressional Budget Office updated its cost estimate Sunday, guessing that deficit reduction under the bill could actually be half of the more than $1 trillion forecast between 2020 and 2029.
"This is not over, by any stretch," McConnell said.
If Senate Democrats pass their bill later this week as they seem sure to do, the next step will be a post-holiday conference to reconcile the House and Senate versions. Given the real differences between the two, that may not be easy.
The House version includes a public health insurance option, while the Senate version would follow the model of insurance for federal workers, allowing insurers to create national health plans overseen by a federal agency.
There are also differences in how the legislation is paid for: The House taxes wealthy Americans, while the Senate would, among other revenue measures, tax high-cost insurance plans. Unions oppose that measure.
But those fights, assuming Democrats can maintain perfect attendance this week, will wait for after the holiday.