The Senate voted 60-39 Saturday Night to formally start debate on the healthcare measure, which will begin after Thanksgiving and consume the Senate for the remainder of the year.  The vote cleared the way for a full-scale debate beginning after Thanksgiving.

Senate Majority Leader Harry Reid (D-Nevada) won over two holdouts in his party, Sens. Mary Landrieu (D-Louisiana) and Blanche Lincoln (D-Arizona), hours before the vote.  Landrieu and Lincoln, centrists from traditionally Republican states, had been withholding their support for the procedural vote.  Both senators said they will press Reid for further changes to the bill before committing to its final passage.  The Democratic caucus remains bitterly divided over a government-run insurance option.

Democratic leaders face a tough fight ahead, and the party is still a long way from delivering on its promise to provide near-universal insurance coverage and contain medical costs.  Less than a year remains before the 2010 midterm elections, senators are eager to vote on healthcare before Christmas and complete negotiations with the House no later than the end of January.

Reid’s biggest problem is what to do about the “public option” – a government-run insurance plan most Democrats would like to create to compete with private insurers in the insurance exchanges the legislation would set up.

Thomas R. Carper (D-Delaware) has suggested a public option available only in states where private insurers fail to offer insurance plans that meet yet-to-be-defined cost standards, or in states that choose to offer a public plan in competition with private insurers.

Significant differences exist between the House and Senate healthcare plans.  Each bill differs on who counts as rich and how much they would pay.  In the House legislation, couples with more than $1 million in income would pay an additional surtax of as much as 5.4%.  The Senate bill would hit families of more modest wealth – those making more than $250,000 – with a payroll tax hike of 0.5%.

The Senate healthcare bill would create a new marriage penalty by imposing a tax on individuals who make $200,000 annually but hitting married couples making just $50,000 more.  That’s one of the 17 new taxes imposed by the bill, which also creates a levy on elective plastic surgery – some call it ‘botax’ – and places a 40% excise tax on those who have generous healthcare plans.  Under the bill, single individuals earning more than $200,000 per year and married couples earning more than $250,000 per year would see their payroll tax increase to 1.95% from 1.45%

There are likely to be fights during the floor debate over the tax increases and Medicare spending reductions that would finance the bill’s expansion of health insurance coverage.  Republicans will likely try to win amendments that would reduce medical malpractice lawsuits, which they say needlessly drive up healthcare costs.

A new AP poll finds “most Americans support curbs on medical malpractice lawsuits.”  The survey “found that 54% favor making it harder to sue doctors and hospitals for mistakes taking care of patients, while 32% are opposed.”

Reid has no reason to expect any help from the Republican minority.  Of the 40 GOP senators, 39 voted against the procedural motion to proceed with the bill.  Ohio’s George V. Voinovich did not vote.

Republicans have complained that Reid’s decision to push back implementation of some major provisions in the bill until 2014 had the effect of making the cost of the overhaul artificially low.  An analysis by the minority staff of the Senate Budget Committee projects the 10-year cost of Reid’s bill, once fully implemented from 2014 to 2023, at $2.5 trillion.  The analysis finds the measure would reduce the deficit by $126 billion over the period.