Brown doesn't have any illusions about why Coburn and Vitter decided to introduce the amendment. "It's clear they just want to score political points. They hate the public option… they want to introduce [the amendment] and have it lose," the senator said in an interview with Salon on Friday.

But Brown's a strong supporter of the public option, and he's actually been taking a stand like this one since he was first elected to the House nearly 17 years ago, keeping a campaign promise to pay for his own coverage until Congress passed health insurance for everyone. For most of that time, he paid out of pocket; now, he's on his wife's plan, which costs him a fair amount than just using the coverage he's entitled to as a senator would. So he decided he wanted to co-sponsor Coburn and Vitter's amendment.

Senators are usually eager to collect co-sponsors for their bills and amendments, especially ones from the other party, for the simple reason that this helps the bill pass. It turns out their attitude is a bit different when the amendment in question is actually a political ploy, however. Brown's office contacted Coburn's about co-sponsorship of the amendment nine times last week, to no avail.

"We did get an email back saying they would check with their boss," Brown says, but that was the extent of the response.

So on Friday, Brown took matters into his own hands, going to the Senate floor and asking to be added as a co-sponsor to the amendment by unanimous consent. Since objecting under these circumstances is pretty much unheard of, Brown was finally added as a co-sponsor, along with fellow Democrats Chris Dodd and Barbara Mikulski.

Afterwards, Coburn spokesman John Hart claimed that his boss is "happy to have [Brown] on." He did note, however, that Brown had opposed a similar amendment when a reform bill was in the Senate Health, Education Labor and Pensions (HELP) Committee.

Asked by Salon about his earlier vote, Brown said, "The one I voted against was to include all of the congressional staff. And the public option is an option. And one of the beauties of the public option is that people have a choice. I don't want to tell the people … in my office what their families should do."

Republicans said the proposed cuts to health insurance plans and medical providers mean seniors in the popular Medicare Advantage program will lose benefits. And they predicted lawmakers will ultimately back away from the cuts, once seniors start feeling the brunt.

"Medicare is already in trouble. The program needs to be fixed, not raided to create another new government program," said Republican leader Mitch McConnell of Kentucky.

Democrats said seniors will not lose any guaranteed benefits. The cuts -- amounting to a 2 percent slowdown in spending -- will help keep Medicare solvent by making it more efficient, they contended. And they pointed out that the health care overhaul bill improves preventive care and prescription coverage.

"My colleagues on the Republican side have resorted to the politics of fear to preserve a broken health care system," said Sen. Tom Harkin, D-Iowa. "What we're hearing are scare tactics designed to mislead seniors."

AARP, the seniors' lobby, threw its weight behind the Democrats.

The votes Thursday came after three days of angry debate in which Democrats accused Republicans of stalling to try to kill the bill, and Republicans protested that they were only exercising their right to give the complex legislation full scrutiny.

The first votes were held under a special agreement requiring 60 votes to prevail. That tested the coalition Democrats are counting on to move President Barack Obama's signature issue. The margin was close on the women's health amendment, which aims to safeguard coverage of mammograms and preventive screening test under a revamped system.

The 61-39 vote on a provision by Democrat Barbara Mikulski of Maryland and Republican Olympia Snowe of Maine was the first substantive ballot in an acrimonious debate that promises to go on for weeks.

After that will come an amendment to restrict abortion funding, except in cases of rape, incest or to save the life of the mother. Drafted by an abortion opponent -- Democratic Sen. Ben Nelson of Nebraska -- it looms as a major challenge for the Democrats.

Though Democrats have 60 votes in the Senate, two Democratic senators voted against the Mikulski amendment -- Russ Feingold of Wisconsin and Nelson. The measure was saved by three Republicans voting in favor -- Snowe, David Vitter of Louisiana and Susan Collins of Maine.

Thursday's vote followed the heated controversy over a government advisory panel's recent recommendation that routine mammograms aren't needed for women in their 40s. Although the advisers' recommendation was nonbinding, it prompted fears that the health care legislation would usher in an era of rationing.

The Mikulski amendment gives the health and human services secretary authority to require health plans to cover additional preventive services for women. The Congressional Budget Office said the amendment would cost $940 million over a decade

Mikulski said her amendment would guarantee that decisions are left to women and their doctors, not placed in the hands of government bureaucrats or medical statisticians. She accepted a modification to her amendment by Vitter that would specifically prevent the controversial recommendations on mammograms from restricting coverage of the test.

However, Republicans said that Mikulski's amendment still left too much discretion to the HHS secretary. A competing amendment by Sen. Lisa Murkowski, R-Alaska, would prevent the government from using the recommendations of outside advisers to deny coverage of preventive services, including mammograms and Pap tests. It was defeated by on a vote of 41-59.

The Medicare vote went to the heart of seniors' concerns that cuts from the program used to finance coverage for the uninsured will undermine the quality of their care.

Furious with opposition from AARP, McCain railed on the Senate floor and delivered a message to seniors:

"Take your AARP card, cut it in half and send it back. They've betrayed you," he said.

Underscoring the political stakes, McCain, recorded "robocalls" in states that are home to key moderate Democrats asking voters to support McCain's amendment stripping the bill's Medicare cuts. The calls, paid for by the National Republican Senatorial Committee, targeted Nelson, Bennet and Blanche Lincoln of Arkansas.

"On Monday, I introduced the first Republican amendment to the massive health care bill, which would send the bill back to the Senate Finance Committee and stop the Democrats from cutting vital Medicare coverage for our seniors. I need Sen. Blanche Lincoln to join me in this effort," McCain says in the call heard by Arkansas residents.

He asks them to go to an NRSC Web site and sign a petition to Lincoln "urging her to join my effort to fight a Washington, D.C., government takeover of your health care."

The scripts in the other states were identical. Another call by a live operator was heard by voters in North Dakota, which prohibits robocalls, and it delivered the same message, targeted at Sen. Byron Dorgan.

Two Democrats voted with McCain against the Medicare cuts, Nelson of Nebraska and Jim Webb of Virginia.

A competing amendment by Sen. Michael Bennet, D-Colo., underscoring that no benefits in traditional Medicare will be cut by the legislation, was approved 100-0.

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Associated Press writers Erica Werner and David Espo contributed to this report.

Now, he's got a new reason to oppose the Senate's bill, and he's firm in his opposition -- in fact, Nelson says, if he doesn't get the language he wants added, he'll vote to support a filibuster.

Earlier this week, Nelson said he was working on an amendment that contains restrictions on coverage for abortion almost identical to those in the controversial Stupak amendment, which is part of the House's legislation. On Thursday, the senator told reporters that if those restrictions aren't in the bill, he won't vote for cloture.

"I've said at the end of the day if it doesn't have Stupak language on abortion in it I won't vote to move it off the floor," Nelson said.

There's a catch-22 here: Nelson probably doesn't have the votes to get his amendment attached to the Senate bill. Plus,  enough House progressives have vowed to vote against the final legislation if it still contains the Stupak amendment that the bill couldn't pass. But without Nelson's vote, Senate Majority Leader Harry Reid will have to convince a Republican or two to defect in order to break a filibuster.

Never mind that Dr. Susan Love, author of what the New York Times dubbed "the bible for women with breast cancer," endorses the new guidelines along with leading women’s health groups like Breast Cancer Action, the National Breast Cancer Coalition, and the National Women’s Health Network (NWHN). For years, these groups have been warning about the excessive use of screening mammography in the U.S., which carries its own dangers and leads to no detectible lowering of breast cancer mortality relative to less mammogram-happy nations.

Nonetheless, on CNN last week, we had the unsettling spectacle of NWHN director and noted women’s health advocate Cindy Pearson speaking out for the new guidelines, while ordinary women lined up to attribute their survival from the disease to mammography. Once upon a time, grassroots women challenged the establishment by figuratively burning their bras. Now, in some masochistic perversion of feminism, they are raising their voices to yell, "Squeeze our tits!"

When the Stupak anti-choice amendment passed, and so entered the health reform bill, no congressional representative stood up on the floor of the House to recount how access to abortion had saved her life or her family’s well-being. And where were the tea-baggers when we needed them? If anything represents the true danger of "government involvement" in healthcare, it’s a health reform bill that -- if the Senate enacts something similar -- will snatch away all but the wealthiest women’s right to choose.

It’s not just that abortion is deemed a morally trickier issue than mammography. To some extent, pink-ribbon culture has replaced feminism as a focus of female identity and solidarity. When a corporation wants to signal that it’s "woman friendly," what does it do? It stamps a pink ribbon on its widget and proclaims that some miniscule portion of the profits will go to breast cancer research. I’ve even seen a bottle of Shiraz called "Hope" with a pink ribbon on its label, but no information, alas, on how much you have to drink to achieve the promised effect. When Laura Bush traveled to Saudi Arabia in 2007, what grave issue did she take up with the locals? Not women’s rights (to drive, to go outside without a man, etc.), but "breast cancer awareness." In the post-feminist United States, issues like rape, domestic violence, and unwanted pregnancy seem to be too edgy for much public discussion, but breast cancer is all apple pie.

So welcome to the Women’s Movement 2.0: Instead of the proud female symbol -- a circle on top of a cross -- we have a droopy ribbon. Instead of embracing the full spectrum of human colors -- black, brown, red, yellow, and white -- we stick to princess pink. While we used to march in protest against sexist laws and practices, now we race or walk "for the cure." And while we once sought full "consciousness" of all that oppresses us, now we’re content to achieve "awareness," which has come to mean one thing -- dutifully baring our breasts for the annual mammogram.

Look, the issue here isn’t healthcare costs. If the current levels of screening mammography demonstrably saved lives, I would say go for it, and damn the expense. But the numbers are increasingly insistent: Routine mammographic screening of women under 50 does not reduce breast cancer mortality in that group, nor do older women necessarily need an annual mammogram. In fact, the whole dogma about "early detection" is shaky, as Susan Love reminds us: the idea has been to catch cancers early, when they’re still small, but some tiny cancers are viciously aggressive, and some large ones aren’t going anywhere.

One response to the new guidelines has been that numbers don’t matter -- only individuals do -- and if just one life is saved, that’s good enough. So OK, let me cite my own individual experience. In 2000, at the age of 59, I was diagnosed with Stage II breast cancer on the basis of one dubious mammogram followed by a really bad one, followed by a biopsy. Maybe I should be grateful that the cancer was detected in time, but the truth is, I’m not sure whether these mammograms detected the tumor or, along with many earlier ones, contributed to it: One known environmental cause of breast cancer is radiation, in amounts easily accumulated through regular mammography.

And why was I bothering with this mammogram in the first place? I had long ago made the decision not to spend my golden years undergoing cancer surveillance, but I wanted to get my Hormone Replacement Therapy (HRT) prescription renewed, and the nurse practitioner wouldn’t do that without a fresh mammogram.

As for the HRT, I was taking it because I had been convinced, by the prevailing medical propaganda, that HRT helps prevent heart disease and Alzheimer’s. In 2002, we found out that HRT is itself a risk factor for breast cancer (as well as being ineffective at warding off heart disease and Alzheimer’s), but we didn’t know that in 2000. So did I get breast cancer because of the HRT -- and possibly because of the mammograms themselves -- or did HRT lead to the detection of a cancer I would have gotten anyway?

I don’t know, but I do know that that biopsy was followed by the worst six months of my life, spent bald and barfing my way through chemotherapy. This is what’s at stake here: Not only the possibility that some women may die because their cancers go undetected, but that many others will lose months or years of their lives to debilitating and possibly unnecessary treatments.

You don’t have to be suffering from "chemobrain" (chemotherapy-induced cognitive decline) to discern evil, iatrogenic, profit-driven forces at work here. In a recent column on the new guidelines, patient-advocate Naomi Freundlich raises the possibility that "entrenched interests -- in screening, surgery, chemotherapy and other treatments associated with diagnosing more and more cancers -- are impeding scientific evidence." I am particularly suspicious of the oncologists, who saw their incomes soar starting in the late 80s when they began administering and selling chemotherapy drugs themselves in their ghastly, pink-themed, "chemotherapy suites." Mammograms recruit women into chemotherapy, and of course, the pink-ribbon cult recruits women into mammography.

What we really need is a new women’s health movement, one that’s sharp and skeptical enough to ask all the hard questions: What are the environmental (or possibly life-style) causes of the breast cancer epidemic? Why are existing treatments like chemotherapy so toxic and heavy-handed? And, if the old narrative of cancer’s progression from "early" to "late" stages no longer holds, what is the course of this disease (or diseases)? What we don’t need, no matter how pretty and pink, is a ladies’ auxiliary to the cancer-industrial complex.

The clerk at the front desk looked at my Minnesota driver's license and chuckled, which I found annoying. "Pretty cold up there, huh?" he said, implying that any sensible person would leave the frozen tundra for the sunny Southwest. We Midwesterners get this a lot, especially from ex-Midwesterners who've deployed to the Sun Belt and now talk as if a light frost would break their hearts and the thought of arising on a 10-below morning and starting the car is simply unthinkable, like dying and going to hell. These poor deacclimated souls have come disconnected from their own culture.

Christmas is supposed to be white. Dashing through the snow does make your spirit bright. You put Santa in Speedos and a tank top and you've ruined the whole thing.

Christmas is one of the bulwarks of Life As We Know It, and in these parlous times we cling to its classic truth, which is: Rejoice, be not afraid, and show mercy to the poor and outcast, for it was through such people that Jesus came into the world. Dickens' ancient novella, written in a big rush because he was low on cash, is on the silver screen again, and Scrooge is moved by the Spirits to share the wealth with his downtrodden clerk. Meanwhile, the truth of Christmas is tested in Washington as we move toward some sort of semi-universal healthcare against the near-unanimous opposition of Republicans. Given the chance to be shepherds or angels, they chose instead to be Herod. Spooked by the victory of Barack Obama, they decided to fight him on all fronts, even though Americans will die as a result.

A new study, "Health Insurance and Mortality in U.S. Adults," published by the American Journal of Public Health, tells us what everyone already knows -- the uninsured are in a dangerous place. An estimated 45,000 deaths a year are associated with lack of health insurance. Uninsured Americans of working age run a 40 percent higher risk of death than those of us who are covered. If you have diabetes or heart disease, and you can't afford to see a doctor, you're in deep trouble.

The big lie that Republicans have inflicted on us, starting with St. Ronald, is that government is a morass of inefficiency, and private enterprise is the Enlightenment. (Republicans have practically disappeared from the Snow Belt. I just point this out.) My own experience is that when I go to get a new driver's license in St. Paul, or deal with the city inspector when a sewage line breaks, or walk into a post office to mail letters, or talk to the police when our house alarm goes off, I find public employees to be cheerful and competent and highly professional, and when I go for blood draws at Quest Diagnostics, a national for-profit chain of medical labs, I find myself in tiny, dingy offices run by low-wage immigrant health workers who speak incomprehensible English and are rude to customers and take forever to do a routine procedure. An hour in a Quest office will ruin your whole day.

If the government took over this miserable operation, paid the people decently and trained them to smile and speak softly to the clientele, civilization would be advanced. If we simply extended Medicare to anyone who wished to sign up for it, the vast Kafkaesque bureaucracy of for-profit insurance would come crashing down, and the public would be healthier.

Instead, Democrats fashioned a patchwork plan, trying to meet the objections of Republicans, who then opposed it anyway as socialistic. As long as any sort of reform is going to be attacked as socialistic, why not go ahead and be socialistic, just as Social Security is. It is Big Government and runs pretty well, and I don't see many Republicans calling for it to be privatized. Mr. Obama needs to learn that it is a foolish goose who attends the foxes' church. Don't worry about bipartisanship, please. Just do what's right.

(Garrison Keillor is the author of "77 Love Sonnets," published by Common Good Books.)

© 2009 by Garrison Keillor. All rights reserved. Distributed by Tribune Media Services, Inc.