WASHINGTON -- President Barack Obama cheered a crucial health care vote in the Senate on Monday that put historic legislation well on its way to pre-Christmas passage and which sharpened already edgy partisan tensions.
The middle-of-the-night vote, which knocked away Republican attempts at procedural delays, required all 58 Democrats and the Senate's two independents to hold together. The next vote is expected around 7:20 a.m. today.
Obama called the vote ''a big victory for the American people,'' and challenged critics who say it will increase, not reduce costs.
''For all those who are continually carping about how this is somehow a big spending government bill, this cuts our deficit by $132 billion the first 10 years, and by over a trillion in the second,'' Obama said. ''That argument that opponents are making against this bill does not hold water.''
Majority Leader Harry Reid, D-Nev., said: ''Never have we been so close to reforming America's broken insurance system.''
The American Medical Association announced its support for the rejuvenated bill, the product of marathon negotiations that secured the votes of Sens. Joseph Lieberman, a Connecticut Independent, and Ben Nelson, a conservative Nebraska Democrat. The AMA's support came even though the bill doesn't address a top organization goal -- a permanent fix to a flawed Medicare reimbursement formula that would cause payments to doctors to drop by 21 percent in January.
Still, Reid did make some last-minute changes to court doctors' support.
A proposed fee on physicians to enroll in Medicare, originally set at $300 annually, was dropped in a final package of amendments, and payment cuts to specialty physicians to pay for bonuses to primary care doctors in underserved areas were also eliminated, the AMA's president-elect, Dr. Cecil B. Wilson, said.
''America has the best health care in the world -- if you can get it,'' Wilson said. ''For far too many people access to care is out of reach because they lack insurance. This is not acceptable to physicians.''
With final passage on track, Republicans ramped up their criticism, denouncing the last-minute deals and concessions needed to get the 60 votes needed to overcome GOP tactics.
''I am tired of the Congress thumbing their nose and flipping a bird to the American people,'' Republican National Committee Chairman Michael Steele said in a conference call with reporters.
Reid promptly criticized Steele for saying ''something so obscene'' and ''so crass and such a terrible example for the youth.''
Sen. John McCain, R-Ariz., criticized the side deals needed to win key votes, calling them ''Bernie Madoff gimmicks.''
Still, the vote represented a major victory for Democrats and Obama, who's now clearly in reach of passing legislation extending health coverage to nearly all Americans, a goal that's eluded a succession of past presidents. The legislation would make health insurance mandatory for the first time for nearly everyone, provide subsidies to help lower-income people buy it, and induce employers to provide it with tax breaks for small businesses and penalties for larger ones.