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WASHINGTON: President Barack Obama's signature drive to remake US health care barely cleared a key Senate hurdle Saturday in a narrow party-line vote the White House immediately hailed as an "historic" victory.
Senators voted 60-39 to formally start debate on sweeping legislation aimed at extending coverage to some 31 million Americans who currently lack it in what would be the most sweeping overhaul of its kind in four decades.
But Obama's Democratic allies mustered the bare minimum 60 votes needed to take up the bill, rallying two wavering colleagues and two independents to defeat 39 of the chamber's 40 Republicans, one of whom was absent.
"Tonight's historic vote brings us one step closer to ending insurance company abuses, reining in spiraling health care costs, providing stability and security to those with health insurance, and extending quality health coverage to those who lack it," said White House spokesman Robert Gibbs.
The debate was expected to begin November 30, after next week's Thanksgiving holiday break, and to last at least three weeks as senators battle over possible changes to the legislation.
The measure - which includes a government-backed insurance programme to compete with private firms and restrictions on dropping care for pre-existing ailments - is estimated to cost US$848 billion through 2019 but cut the sky-high US budget deficit by US$130 billion over the same period.
A successful final vote - expected a month away at the earliest - would force the Senate and the House of Representatives to reconcile their rival versions of the bill and vote again on whether to send it to Obama.
Democratic Senate Majority Leader Harry Reid faced three possible defectors, any one of whom could deprive the majority of the 60 votes necessary to break Republican parliamentary delaying tactics in the next procedural vote.
Those senators - Mary Landrieu of Louisiana, Blanche Lincoln of Arkansas, and Ben Nelson of Nebraska - have signalled a willingness to join Republicans if their proposed changes to core provisions of the bill are defeated.
Nelson has said he wants tougher restrictions on federal monies subsidising abortions, mirroring language the House of Representatives added to its version of the bill when it approved it in a 220-215 squeaker November 7.
"There are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done," Landrieu, who opposes the government-backed "public option," said hours before Saturday's vote.
"I'm promising my colleagues that I'm prepared to vote against moving to the next stage of consideration as long as a government-run public option is included," said Lincoln.
Democratic Senate Majority Leader Harry Reid acknowledged intra-party tensions meant "the road ahead will be the toughest stretch" and that after Saturday's vote "we can only see the finish line; we have not yet crossed it."
Republicans, one of whom has vowed a "holy war" against the bill, hope to kill the bill or delay the battle into next year with the expectation that the 2010 midterm elections may make it harder for centrist Democrats to support it.
"The health care debate is now officially underway on this 2,074 page, multi-trillion-dollar health care experiment," said Republican Senate Minority Leader Mitch McConnell.
The United States is the world's richest nation but the only industrialised democracy that does not provide health care coverage to all of its citizens, at a time when an estimated 36 million Americans have no health care whatsoever.
Several US presidents since Theodore Roosevelt in the early 1900s have sought to overcome the traditional US suspicion of a wider government role in health care.
Washington spends more than double what Britain, France, and Germany do per person on health care, but lags behind other countries in life expectancy and infant mortality, according to the Organization for Economic Cooperation and Development (OECD).
- AFP/yb
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