The U.S. Senate voted along party lines, 60 to 39, to proceed with debate on health care reform.

The last two holdouts, Senator Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana decided to finally vote with the majority.

Details of the bill are sketchy at this point. The Senate version would require most everyone to purchase health care. Coverage would be extended to an additional 30 million persons. Coverage could not be denied for preexisting conditions.

U.S. Sen. Harry Reid, D-Nevada and Senate Majority Leader, is weighing increasing the Medicare payroll tax by 0.4 to 0.5 percentage point, as a way to help fund universal health care, The Wall Street Journal reported Thursday (subscription required.)

The current employee share of the Medicare tax is 1.45%. Reid's proposal would apply to only those earning more than $250,000 per year, which would conform to President Obama's campaign promise to not raise taxes on individuals earning under $250,000 per year, CNN.com reported Thursday.

Just call it a 'moderate public option.' Sort of. U.S. House Speaker Nancy Pelosi, D-California, Thursday unveiled a revised, $894 billion health care reform bill that would provide insurance to up to 36 million more Americans while cutting the budget deficit by $30 billion over 10 years.

The bill's key elements: subsidies offered to moderate-income Americans to buy insurance either from private carriers or a new, government-run program, an expansion of Medicaid to insure the poor, and an income tax increase on upper income Americans -- individuals earning more than $500,000 per year and couples earning more than $1 million.

Even though it faces an uphill battle in the Senate, look for U.S. Sen. Harry Reid's, D-Nevada, flexible public option to become part of a universal health care bill.

That's because Reid's 'flex-pub' fits the federalist system of governance
(local-state-federal) practiced by the United States in that it enables states to 'opt-out' of the public option, provided they have a state-level plan for universal care and/or are complying with other federal requirements for universal health care coverage.

And, when one thinks about it, politically and operationally, a flex-public option makes a great deal of sense.

In the past, the government has increased spending and cut taxes to spur spending during times of economic crisis.

However, Uncle Sam is now in so much debt that this is no longer a serious option. And it looks like we are going to spend another $900 billion-plus on health care reform over 10 years (a lot of money, sure, but about a third less than what Wall Street will spend on bonuses).

Sometimes, in American politics/public policy, the unexpected occurs. A year ago, if you had said health care reform in 2009 would lead to the end of the health insurance industry's anti-trust exemption, you probably would have been classified as a candidate for 24-hour observation.

It still hasn't become law yet, but on Wednesday the above took one more step toward becoming reality as the U.S. House Judiciary Committee approved a bill that would curb the health insurance industry's limited exemption from antitrust law and would allow the U.S. Justice Department to enforce laws relating to price fixing and market allocation, The New York Times reported. The committee voted 20-9 in favor of the measure, with three Republicans joining 17 Democrats.

Health care reform's long and winding road continues, as debate will begin soon on several bills in the House and Senate. Each chamber is likely to approve a bill, with the all-important conference committee set to reconcile the two after each chamber's vote.

Let's put on the old political science hat for a moment to see if history and research can tell us anything about the likely shape of the health care reform bill at this stage of the U.S. public policy process.

The House, Senate, and conference committee (CC) outcomes are labeled: Probable, Possible, Doubtful.

Although, in theory, a House/Senate conference committee could insert a rigorous public option in the reconciliation process, if the current trend in Washington prevails, the health care reform bill that emerges from the committee will not have a national public option; nor will the Obama administration require one, the AP reported.

It could, however, offer states the opportunity to "opt-in" to a public option, or contain a "trigger" -- some level at which a national, public insurance program would take effect, if, for example, a certain percentage of a state's residents remains without health insurance after a specified year, say 2012 or 2014. The former would both enable states with existing, successful universal health care programs to continue them. It would also allow states -- provided they are meeting federally-set goals for universal coverage -- to participate in the federal program on an as-desired basis.

The nation is on the cusp of historic and civilization-advancing change with the upcoming health care reform bill, and that change bodes well for Quest Diagnostics (NYSE: DGX), which is why I'm reiterating my Buy rating for the company, first recommended on June 25, 2009, at a price of $55.89.

Quest's positive story remains the same: diagnostic tests are at the core of health care services, and even though the number of tests per citizen will likely decline in the years ahead, when one adds 30-45 million more citizens regularly accessing health care services annually, within 10 years, the probability of increased business is high, to say the least.

Congressional Republican rhetoric aside, President Obama does not come close to being a socialist, so says one of the highest ranking socialists in the U.S.

Frank Llewellyn, National Director of the Democratic Socialists of America, the country's largest socialist organization, told PoliticsDaily.com that President Obama is not in their ranks. "He's not any kind of socialist at all," Llewellyn said, observing that the president is "a market guy."

The health care reform debate continues, and really, given the horse-trading and logrolling that's likely to occur in the upcoming conference committee to reconcile the House and Senate versions of each chamber's health care reform bill, assuming each chamber approves them, to cite a phrase used by political science professor Larry Sabato, the party's just begun.

A bit jaded by it all? Don't be -- it's just the political process at work, and here's one, major positive to take out of the health care reform bill's passage: a new policy that will finally end the 'tax' that U.S. citizens and businesses pay for uninsured Americans who obtain health care services.

This 'hidden health care tax' increases at the rate of $1,354 per second or $116.98 million per day. As of Friday, the American people have been charged $33.37 billion this year to pay for health care for the uninsured: that's the bill that hospitals pass on to those who have insurance.

Amid the lamentable health care reform debate, one fact is incontrovertible: despite President Barack Obama's large 2008 presidential election victory, one in which the Democrats gained 21 seats (to 257-178) in the House and eight seats in the Senate (59-40, not counting the late Senator Edward M. Kennedy's seat), the Democratic Party's majority still is not large enough to pass progressive legislation.

The solution to this is obvious enough: win more seats in the 2010 off-year congressional election, and then in the 2012 presidential/congressional election. And how does a majority party accomplish the above? By solving the nation's problems. These days, that means: 1) getting the U.S. economy growing again with robust job growth, 2) keeping the U.S. safe against international terrorism, and 3) ending the Iraq War successfully and making substantial progress toward victory in the Afghanistan War.

After discussing the status of health care with my three trusted economist friends and one equally-trusted public policy colleague, here is their employment advice for if health care reform doesn't pass and rein-in health care costs.

If health care reform doesn't pass, those citizens capable of doing so should consider becoming doctors, nurses, radiologists, surgical specialists, hospital technical support staff etc. -- i.e. consider almost any job/position in or affiliated with health care.

"Capital," Maxwell Emery (Hume Cronyn) said in the finance film Rollover (1981), "has a life of its own."

The market absolutists and conservatives who oppose health care reform are going to find out just how much havoc that capital force can generate in the years ahead, as it relates to health care costs.

My Armenian cousin, Madeline, called me from France recently. (Madeline keeps me plugged into goings-in in Europe, economically-speaking, and otherwise.)

"Whats tort avec vous, les Américains? Votre système de soins de santé est en retard, inefficace, irrationnel!" Madeline said. ("What's wrong with you Americans? Your health care system is backward, inefficient, irrational!")

I agreed. The United States spends more per person on health care than any advanced, industrialized democracy, and it still has 47 million uninsured people.