Tuesday, March 09, 2010

Dems' splintering threatens health bill

The escalating battle among Democrats over abortion has grabbed headlines, but a few other intraparty disputes are endangering President Obama's proposed health care overhaul. From stemming rising health care costs and addressing regional disparities on Medicare rates to a general skepticism of the Senate, rank-and-file House Democrats are struggling to support Mr. Obama's plan as they close in on midterm elections. Voters have become increasingly hostile to the effort. "Any time the Senate is involved, I become nervous," said Rep. Emanuel Cleaver II, Missouri Democrat.

Polls show that certain provisions in the Democrats' plan are popular but that the American public is frustrated with the process, which has included deeply partisan attacks and accusations of legislating state-specific carve-outs in exchange for votes.

It's unclear how much can be changed from the president's plan, which is based largely on the Senate bill. Even if Democrats reach compromises on tough sticking points, some provisions can't be changed if Democrats keep to their plan to wrap up work on health care reform under complex budget reconciliation rules in the Senate.

Liberal Democrats are disappointed that the president's plan doesn't have a public option and say the tax subsidies aren't generous enough to help the poor and middle class meet the bill's insurance requirements.

Mr. Obama may have eased some of those concerns in a White House meeting last week when he pledged to try to push through a public insurance plan once he gains momentum with the health care overhaul bill, said Rep. Raul M. Grijalva, Arizona Democrat and co-chairman of the Congressional Progressive Caucus.

Another group of members, largely from the New Democrat Coalition, says the Senate bill doesn't do enough to repair the broken system that pays physicians and hospitals for treating Medicare patients. "I've always felt that the key to successful health care reform is changing the way we pay for health care, so it's outcome- and value-based, not volume-based as is fee-for-service today. And I'd like to see more in that direction," said Rep. Ron Kind, Wisconsin Democrat and one of the lawmakers who met with Mr. Obama last week. The Senate bill reforms the payment process for physicians but not hospitals or other parts of the health care system, he said. "The House did a better job of that when we passed our bill," Mr. Kind said.

Rep. John Adler, New Jersey Democrat, said on "Fox News Sunday" that "I'm not sure we've gone far enough in terms of fixing the underlying system to make it affordable for businesses and for taxpayers."

House members also have taken serious issue with the Senate's tax on high-cost insurance plans over concern that it would hurt unions, a group loyal to Democrats. The House's plan instead would increase taxes for Americans with the highest incomes. Mr. Obama's plan tried to address that concern by scaling back the tax and delaying the date it takes effect.

House Speaker Nancy Pelosi, California Democrat, promised to reform the nation's health care system soon but said it wouldn't be easy. "Every legislative vote is a heavy lift around here," she told reporters last week. "Assume nothing as to where we were before and where people may be now. We start, one, two, three, four, all the way up to a majority vote."

Rep. Chris Van Hollen, Maryland Democrat, said on Sunday's political talk shows that passage is uncertain. "Do we have a mortal lock? No," he said, though he repeated that he does "believe it will pass." "I think the trend is in the right direction because people see that the status quo is absolutely broken," he told CNN's "State of the Union," adding that his party caucus wants to see how the Congressional Budget Office analyzes a final plan's fiscal impact before committing to any votes.

The abortion issue threatens to untie support in the House as well. A dozen Democrats who voted for the House bill, led by Rep. Bart Stupak of Michigan, say the Senate bill would allow for federal funding of abortion and won't support it. The group proved its strength when it inserted strong restrictions into the House bill. These Democrats say the Senate plan would allow federal funding to cover community health care centers that provide abortions and allow tax subsidies for insurance plans that cover the procedure.

Underlying the policy differences is the House's skepticism of the Senate. The House has passed nearly 300 bills during this session of Congress that are still waiting for consideration by the Senate. Some of the bills, including a cap-and-trade proposal to curb greenhouse gas emissions, were approved with votes that were politically risky for House Democrats.

Under the president's plan, the House would pass the Senate bill and then a companion bill that repairs the Senate's plan would be introduced into both chambers. In the Senate, it would have to pass under complex budget reconciliation rules. Senate Republicans are threatening to make that process more complex in attempt to increase the wedge among skeptical House members. Republicans in the House and Senate have said they plan to make health care reform a central issue in the November elections.

The American public largely favors many of the proposed reforms but has grown frustrated with the process. Twenty-five percent of respondents in a CNN poll conducted in mid- to late February said Congress should pass a bill along the lines of what already has been proposed. That is down from 30 percent a month earlier. Proposals that have majority of public support include those requiring large and midsize businesses to provide insurance to employees (72 percent), preventing insurance companies from denying coverage for pre-existing conditions (58 percent) and the public insurance plan (51 percent) that liberals favor but Mr. Obama removed from his plans.


The same rotten Rx

If at first you don't succeed, try, try, try, try again

With Plans A, B and C having failed miserably, President Obama yesterday unveiled his latest "new and improved" version of health-care reform. He says that this incarnation "incorporates the best ideas from Democrats and Republicans — including some of the ideas that Republicans offered during the health-care summit." Unfortunately, its fundamental premise remains exactly the same — a government takeover of the health-care system.

Start with those "Republican ideas": Though mostly not bad, they're hardly game changing.

* Increase the financial incentives for states to experiment with malpractice reform by $50 million. Wow — a million dollars per state! That undoubtedly has the trial lawyers quaking in their boots.

* Undercover stings to help root out Medicare and Medicaid fraud. Fine — but when fighting fraud in government programs becomes a major concession, it shows just how out of touch Washington has become.

* Increase Medicare reimbursements. OK, higher spending for a program that's already going broke may well be a Republican idea, but it doesn't exactly make Obama's better.

* Allow health-savings accounts to be sold through the government-sponsored exchanges. This could be a positive step — but the details are key, and they remain to be seen.

HSAs have been proven to reduce the cost of health care and have added nearly 3 million people to the ranks of the insured since their inception. But they only really work in conjunction with high-deductible insurance — if your policy already pays for everything, there's not much point to saving for health expenses.

And every version of ObamaCare to date has restricted high-deductible insurance and/or mandated low-deductible policies. Unless the president is prepared to make major changes in those areas, the HSA concession is just bait-and-switch.

All in all, saying that these changes represent a "compromise" with Republicans is a bit like saying that Yankee speedster Brett Gardner is a home-run hitter. It's technically true (he hit three dingers last year), but no one's going to mistake him for Babe Ruth.

The president has also touted the new plan as "smaller" and "leaner." Smaller and leaner than what? This version may actually cost more than the last one — breaking the $1 trillion mark even under the White House's rosy assumptions.

At its heart, ObamaCare hasn't changed. It still represents a top-down, centralized, command-and-control approach to reform. The government would require everyone to have health insurance, would determine what benefits that insurance must include, would regulate insurance prices and physician reimbursement and would micromanage how medicine is practiced. All this would be accompanied by higher taxes and, most likely, higher insurance premiums.

It is a plan that says the government knows best — when it comes to a sixth of the US economy and some of the most important, personal and private decisions in people's lives. A few cosmetic concessions can't fix that basic premise.

Obama also made it clear yesterday that he wants Congress to use an obscure parliamentary gimmick known as "reconciliation" to bypass a Republican filibuster and force the bill through the Senate. Democrats will likely manage to get the 50 votes needed in the Senate to use this tactic — but the vote will be far closer in the House, where deaths, defections and resignations have erased the three-vote margin of victory Democrats had last November.

The president was right about one thing yesterday. As he said, "Every argument has been made. Everything there is to say about health care has been said, and just about everyone has said it. So now is the time to make a decision."

Reportedly, as many as nine House Democrats who once voted against ObamaCare, including Rep. Scott Murphy of upstate New York, are now open to supporting the latest version. If they do, in the face of overwhelming public opposition, this new version of health reform could turn out to be Plan L — for "loser."


Dems turn risky health vote into manhood contest

There's no way around it. Things in the House of Representatives are about to get very, very rough. With their backs to the wall, Democratic leaders are preparing a complicated plan to pass their national health care bill. Standing in the way are Democrats who oppose the bill, whether on principle or out of fear that voting for a wildly unpopular measure will spell defeat for them in November.

If you think House Speaker Nancy Pelosi is going to let them off easy, allowing them to kill the party's top policy priority in more than a generation -- well, that's not gonna happen. Democrats who are considering voting against the bill are about to experience arm-twisting, threats, and pressure like they've never experienced.

I called a Democratic strategist with a question: Say I'm a moderate Democrat. I voted for the House bill last November, but I've seen the polls, I know a majority in my district opposes the bill, and I feel certain that voting for final passage will end my time in office. Why should I vote yes?

"Look, you voted for it before," said the strategist, who asked to remain anonymous. "You should have thought about that then. You're stuck with the vote, it's around your neck, you're going to wear it like an albatross. The ad that's going to run against you is going to be the same whether you vote for it now or not. "The Republicans are going to be able to frame what you did their way, and you're going to need to be able to frame it a different way, to say that you fought to make health insurance more affordable and insurance companies more accountable. "And if you're a bedwetting crybaby, you should just go home right now." If you get the idea that, in private at least, Democrats are going to make this vote a serious test of manhood, you're right.

"You big weenie, you know what I'd like to say to you?" the strategist continued. "You sit there and you're willing to go send an 18-year-old to go fight for his country, knowing he might die, and here you are unwilling to take a tough vote on an issue that you promised your constituents and you voted for once before? You don't deserve to be here!"

What about this argument, I asked: Yes, I voted for it once, but why compound the damage by doing it again? Say you've cheated on your spouse. You can tell them you only did it once, that it was a mistake, and that you won't do it again. Or you can assume the damage has been done and carry on like Tiger Woods. Which is more likely to save the relationship?

Sorry, I was told. Real men don't turn back. "If they're bedwetters, they're bedwetters, and a lot of them are bedwetters," the strategist said of his fellow Democrats. "BUT THEY ALREADY VOTED FOR IT."

Well then, what about those Democrats who voted against the bill? To get to the 217 votes required for passage, Pelosi needs some of them to change their votes. "That's a much harder case," said the strategist. "You say to them, 'Look, we're Democrats. If we fail on this, we all fail together and everybody's going to pay the price. If you think it's important for the party -- the one that you're a member of -- to get something done, then you need to reconsider your vote. We need you. If we didn't need you, we wouldn't be asking.'"

"There are ways we can help you explain it. The Senate bill that you'd be voting for is less progressive than the House one, less costly, less tax-raising. So you can say, 'I was always for health care reform, but I wasn't going to raise taxes on families to do it.'"

But what happens when the lawmaker, however he voted the first time, raises the ultimate objection: If I vote for this, I'll lose my seat. "Let's assume you do get beat, and you have to live with it for the rest of your life," the strategist explained. "Would you rather get beat because you did something big that changed the country, or would you rather get beat because you're a weenie and sat around saying, 'I was too scared, so I got beat?'"

In the hallways and the hideaways of Capitol Hill, the Democratic message is clear: Real men don't cross the party. Understand?


One Giant Government Leap Backwards

Rather than a post-partisan olive branch to congressional Republicans and the American public, President Obama’s latest health-care speech was a declaration of war. He’s more than willing to use a 51-vote reconciliation majority to jam through a roughly $2 trillion health-care plan that amounts to a government takeover of nearly one-fifth of the economy. He’s prepared to stick Uncle Sam right in the middle of the age-old relationship between patients and doctors, and doctors and hospitals, all while subjugating the private health-care insurance system to the status of a government-run utility -- without bending the cost curve downward.

More spending. More tax hikes on investors, businesses, and individuals. New government boards to control prices, ration care, and redistribute income. The Obama administration is basically taking a giant government leap backwards that the country doesn’t want to take.

One of the most galling features of this plan is a taxpayer-subsidized government-insurance entitlement for people earning up to 400 percent above the poverty line, or nearly $100,000 for a family of four. In other words, a middle-class health-care entitlement that will add millions of people to the federal dole. It’s all too reminiscent of the political dictum of the old New Dealer Harry Hopkins: tax and tax, spend and spend, elect and elect.

The spending has been well chronicled by congressman Paul Ryan, who baffled President Obama at the so-called health-care summit with his cogent analysis of a ten-year cost of $2.3 trillion that sets a floor, rather than ceiling, for the likely expense of this entitlement package. Obama had no rebuttal.

On taxing, let’s not forget that the current health-care payroll tax of 2.9 percent will be expanded to cover all forms of investment and capital formation, on top of the repeal of the Bush tax cuts. The anti-growth consequences are incalculable. As the late Jack Kemp used to say, you can’t have capitalism without capital.

The White House says job creation is priority number one. But you can’t have new jobs without healthy businesses. And healthy businesses require investment. However, by taxing investment more we’ll get fewer jobs, reduced real wages, and slower economic growth.

And how stupid is it for the president to support a six-month payroll-tax cut for small businesses in the name of job creation while imposing a 1 percent permanent increase in that very same tax to fund the massive new health-care entitlement. Talk about self-defeating.

Oh, by the way, a government takeover of health care will cripple one of our most productive job-creating sectors. Over the deep two-year recession, while overall corporate payrolls fell by about 7.5 million, private health-care firms created almost 700,000 new jobs.

And the health-care industry is one of our fastest-growing, most technologically advanced areas. With constant breakthroughs in biotech, pharmaceuticals, medical equipment, and diagnostics, the growing demand for more health care could elevate this prosperous job-creating sector to a third of the economy in the decades ahead. What’s wrong with that? Why crush it?

Health-care reform was supposed to be about getting 10 million low-income, chronically uninsured people some health insurance. But that can be solved by playing small ball. Health-care reform also was supposed to slow down cost increases. But that will never happen until the third-party payment system, run by Big Government and Big Business, is replaced by true consumer choice and market competition.

Just give consumers the tax break, and let them shop across state lines to find the right insurance plan. And young people who are already paying taxes into Medicare should not be mandated to pay more taxes into this entitlement plan. The young will pay for health insurance when they’re ready to pay for it.

Clearly this new New Deal, or new Great Society, or whatever it is, is the government selling a product that the rest of the country doesn’t want. Ironically, polls show that roughly 80 percent of voters believe their health insurance is satisfactory, good, or excellent. Polls even show that the public knows that a simple majority vote on reconciliation is an insufficient check on runaway government.

The Byrd rule says that reconciliation is for budget control and deficit reduction. But the Obama Democrats think they can use reconciliation to install a massive new social policy that would emulate the socialist-labor entitlement state now prevalent in Western Europe. As the Greece crisis amply shows, that entitlement state is on the verge of bankruptcy.

Perhaps Obama’s throwing down the gauntlet on nationalized health care will be the political gift that keeps on giving, in terms of political regime change come November. But if Obamacare does pass, a future rollback will be very difficult, and American health care and economic prosperity will be put in grave jeopardy.


Doctor's lives already being burdened by too much bureaucracy

Leading to a REDUCTION in available medical services. Yet Obama wants to impose yet another level of bureaucracy

Some years ago, one of my favorite doctors retired. On my last visit to his office, he took some time to explain to me why he was retiring early and in good health. Being a doctor was becoming more of a hassle as the years went by, he said, and also less fulfilling. It was becoming more of a hassle because of the increasing paperwork, and it was less fulfilling because of the way patients came to him.

He was currently being asked to Xerox lots of records from his files, in order to be reimbursed for another patient he was treating. He said it just wasn't worth it. Whoever was paying-- it might have been an insurance company or the government-- would either pay him or not, he said, but he wasn't going to jump through all those hoops.

My doctor said that doctor-patient relationships were not the same as they had been when he entered the profession. Back then, people came to him because someone had recommended him to them, but now increasing numbers of people were sent to him because they had some group insurance plan that included his group. He said that the mutual confidence that was part of the doctor-patient relationship was not the same with people who came to his office only because his name was on some list of eligible physicians.

The loss of one doctor-- even a very good doctor-- may not seem very important in the grand scheme of heady medical care "reform" and glittering phrases about "universal health care." But making the medical profession more of a hassle for doctors risks losing more doctors, while increasing the demand for treatment.

A study published in the November 2009 issue of the Journal of Law & Economics showed that a rise in the cost of medical liability insurance led to more reductions of hours of medical service supplied by older doctors than among younger doctors. Younger doctors, more recently out of medical school and often with huge debts to pay off for the cost of that expensive training, may have no choice but to continue working as hard as possible to try to recoup that huge investment of money and time. Younger doctors will probably continue working, even if bureaucrats load them down with increasing amounts of paperwork and the government continues to lower reimbursements for Medicare, Medicaid and-- heaven help us-- the new proposed "universal health care" legislation that is supposed to "bring down the cost of medical care."

The confusion between lowering costs and refusing to pay the costs can have a real impact on the supply of doctors. The real costs of medical care include both the financial conditions and the working conditions that will insure a continuing supply of both the quantity and the quality of doctors required to maintain medical care standards for a growing number of patients.

Although younger doctors may be trapped in a profession that some of them might not have entered if they had known in advance what all its pluses and minuses would turn out to be, there are two other important groups who are in a position to decide whether or not it is worth it.

Those who are old enough to have paid off their medical school debts long ago, and successful enough that they can afford to retire early, or to take jobs as medical consultants, can opt out of the whole elaborate third-party payment system and its problems. What the rising costs of medical liability insurance has already done for some, other hassles that bureaucracies and politicians create can have the same effect for others.

There is another group that doesn't have to put up with these hassles. These are young people who have reached the stage in their lives when they are choosing which profession to enter, and weighing the pluses and minuses before making their decisions. Some of these young people might prefer becoming a doctor, other things being equal. But the heady schemes of government-controlled medicine, and the ever more bloated bureaucracies that these heady schemes will require, can make it very unlikely that other things will be equal in the medical profession.

Paying doctors less and hassling them more may be some people's idea of "lowering the cost of medical care," but it is instead refusing to pay the costs-- and taking the consequences.


Ten complaints a day from new mothers in NHS maternity wards

Ten new mothers a day complain about the appalling treatment they receive on overstretched and underfunded maternity wards. The catalogue of complaints ranges from patronising and rude midwives and doctors, to botched deliveries and babies being born in toilets and on reception floors. They paint a bleak picture of a hospital service that is routinely failing women and babies when they are at their most vulnerable.

Hospital spokesmen say the vast majority of new mothers are happy with the service they receive, but MPs and campaigners say the shocking figures are symptomatic of a target-driven health service dangerously short of midwives. Horror stories uncovered by a string of Freedom Of Information requests include:

● An anaesthetist who slurred his words and fell asleep twice in front of a mother-to-be.

● Women giving birth on toilets, in wheelchairs and even on the floor of the reception area.

● Midwives talking on their mobile phones while treating women and arguing with doctors in front of a patients.

● A nurse dropping a gas-and-air unit on the head of a patient.

The FOI requests to 149 hospital trusts with maternity units revealed that 2,792 complaints were lodged last year. However, just 111 trusts replied to the survey. If all had responded, the total number of complaints is likely to have reached 3,700 - or ten a day.

Almost half of the complaints related to bullying, unsympathetic, rude and apathetic staff. Seventy complaints were made about maternity care at Southampton's Princess Anne Hospital, the subject of a Channel 4 fly-on-the-wall documentary called One Born Every Minute.

The Royal College of Midwives says Britain needs another 3,000 midwives to give new mothers the one-to-one care they need. It emerged last year that the nation's midwives are more overworked than they have been for at least a decade and experts believe up to 1,000 babies a year die needlessly because doctors and midwives are too overstretched or poorly trained to detect the warning signs. Maternity units paid out almost £200million in compensation last year.

Lib Dem health spokesman Norman Lamb said the Government warned a culture of red tape and targets was putting midwives under unbearable strain. He added: 'You have good and highly dedicated people but it goes wrong if they are constantly under pressure to meet administrative requirements rather than being able to deliver the best service.'

Anna Davidson, of the Birth Trauma Association, said: 'These figures and examples are not surprising given the things we hear. 'The shortage of midwives is a real problem. We hear of women left on their own to give birth or one midwife trying to cope with eight cases at a time. 'I am sure there are examples of fantastic care and dedication, but we hear from mothers who suffer nightmares, flashbacks and panic attacks. 'They say they have suffered uncontrollable pain, haven't been listened to and were not able to follow their birth plan.'

A Department of Health spokesman said: 'The NHS delivers hundreds of thousands of babies safely every year and England is one of the safest places in the world to have a baby.'


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