Sunday, February 28, 2010

Those wicked ophthalmologists

The political Left worldwide seems to regard everyone but themselves as responsible for high medical costs. The vast load of paperwork that they impose on healthcare providers and drug companies is costless, apparently. And the high incomes of some doctors frequently come under jealous scrutiny.

A high income group in Australia is ophthalmologists. Everyone wants the very best chance of preserving their vision so people are prepared to pay for a high level of care in eye-doctoring. And Australia's Federal Health Minister, Nicola Roxon, was determined to rein those rogue eye-doctors in.

As part of its socialized medicine system, called "Medicare", the Australian government pays a large part of the cost of privately-contracted ophthalmological services, so Ms Roxon thought she had a good weapon to cut those rich eye-doctors down to size: She would halve the amount that her government pays for such services.

The conservatives in the Senate knocked back Ms Roxon's "reforms" however, so she eventually had to accept a compromise deal which cut the government payment by only 12%.

As it happens, all this affects me personally to a minor extent: I will shortly be having a cataract procedure on my right eye from a well established and formidably equipped private ophthalmological practice a short drive from where in live in Brisbane. So my ophthalmologist explained the cost structure to me.

The cost now includes a "facility fee" -- a fee for use of a private operating theatre that is common for most types of private medical procedures. I pay a similar fee when I go to my dermatologist to have skin cancers excised. The ophthalmologist remarked to me that they used not to charge such a fee. They used to absorb it into their general fees. But after Ms Roxon's "reforms", they have instituted such a fee.

So the income of the ophthalmologists remains largely the same. Ms Roxon's attack on them has been futile. What they lost on the swings, they gained on the roundabouts.

But what about the patients? Here's the catch: Facility fees do NOT attract any government refund. So the patient pays more. The government has indeed saved itself a bit of money, but at the expense of the patients, not at the expense of the doctors: A typical "unforeseen" result of Leftist intervention.

Ailing Health Care

Make no mistake: If President Barack Obama actually wanted to be the post-partisan agent of Washington change, his health-care summit would have looked a whole lot different than the meeting he recently held across the street from the White House. Every Republican, from House Minority Leader John Boehner to maverick John McCain (the latter facing primary challenger from the right, by the way) walked into the meeting imploring the White House to start over, to begin again, to hit the reset button. If the president wanted to work with them in any way, he would have done just that.

Instead the president continues to argue -- aided by media folks from near everyone on MSNBC to even Bill O'Reilly on the supposedly all-right Fox News Channel -- that the American people just don't understand what his health-care plan is all about. In one sense, I agree with him. Given the fact that even the Congressional Budget Office said it didn't have enough details to do a proper examination of the latest version of the legislation in time for the official summit, the man has a point. But it's not voters' slowness that's the problem; it's the White House with the issues.

If the president were serious about being a different kind of leader, he would have invited governors at the White House summit on health care, as Republican politicians requested.

Instead of dismissing criticisms as he has been doing for the better part of a year now in this and other debates, President Obama should have considered what Republicans had to say. One of the best lines of the summit was: "If you're waiting for Mitch McConnell to roll in here a wheelbarrow full of a 2,700-page comprehensive health-care bill, that's not going to happen," delivered by Republican Sen. Lamar Alexander. He continued, "We've watched the comprehensive, economy-wide, cap and trade. We've watched the comprehensive immigration bill ... we've watched the comprehensive health-care bill. And they fall of their own weight."

That's a message that Washington can afford to hear. That's a message that gets back to constitutional principles of federalism. And, frankly, that's a manageable message.

As Paul Ryan, a congressman from Wisconsin, whose attention to detail is such that even the president has trouble dismissing him, explained, "We don't really believe the government should be in control of all this." Pointing to what he and others have been hearing from Americans -- in town halls since the summer and perhaps most recently in the Massachusetts special election, Ryan said to the president: "I would respectfully submit: You're not listening to them."

Not listening isn't exactly the "hope and change" people signed up for. The president of the United States is a liberal ideologue who isn't comfortable telling you the straight facts. And he ridicules those who try to highlight the truth. Without a penchant for honesty -- or even a slight openness to it -- it's just about all he's left with.

On perhaps no issue is this more obvious than abortion. And it's been so with President Obama since before he was inaugurated. During the campaign, he falsified his position and called those who talked about his record in the Illinois statehouse liars. He continues to do just that. Late last year, he audaciously accused the Catholic bishops of the United States and others who criticized various versions of the health-care legislation for providing federal dollars for abortions of "bearing false witness" on the issue. And, after refusing to invite pro-life Rep. Bart Stupak, a Democrat, to the summit, when Rep. Boehner brought the issue of abortion up, the president of the United States simply ignored the minority leader. He apparently didn't believe that an issue that threatens the consciences of millions of Americans deserved a simple explanation from the White House.

A Quinnipiac poll last year found that 72 percent of voters oppose federal funding of abortion. A recent CBS poll found that half those surveyed didn't approve of the president's job on health care.

There's something to what Rep. Ryan said. And President Obama knows it or he wouldn't be trying so hard to gloss over what he's doing, and to dismiss criticisms. His options right now are to force some plan through Congress or walk away, blaming the "party of no" for killing his health-care hopes. But his own health-care summit is already on YouTube and provides ample fodder to counter his party's obstructionist Republicans. His opposition proved themselves anything but the troglodytes "Hardball" would have them portrayed as.

And if the president does manage to get enough Democrats to go along with his politically suicidal gambit, good luck explaining why the impractical plan is not the panacea it was supposed to be. And then the American people will understand things all too well.


Someone Needs to Tell the President His Health Care Plan is Dead

The day before yesterday’s White House health care summit, Sen. Kent Conrad (D-ND) told reporters: “The only way this works is for the House to pass the Senate bill and then, depending on what the package is, the reconciliation provision that moves first through the House and then comes here.” When Conrad was reminded that Speaker Nancy Pelosi (D-CA) has repeatedly insisted that the House will not pass the Senate bill until the Senate passes a second bill that fixes the first, Conrad replied: “Fine, then it’s dead.”

This was the dynamic that President Barack Obama was trying to alter with his eventually-seven-hour meeting. And judging by pretty much every major news outlet, he completely failed. Rep. Jason Altmire (D-PA), who is one of the 39 House Democrats that the White House needs to switch from a “no” the first time around to a “yes” this time, told The New York Times: “I don’t see very many at all who voted no who are going to switch their votes unless there are substantial changes in the bill.”

And that reality is already spreading throughout Capitol Hill. Politico reports that while Democrats were hoping to pass Obamacare by Easter, “there were signs Thursday night that the schedule was slipping. One Democratic lawmaker involved in the negotiations, who asked not to be identified to speak candidly of the process, said the party would not, in fact, start down the path of reconciliation next week.”

That is some rare great news for the American people. As Rep. Paul Ryan (R-WI) ably explained yesterday, Americans do not want Washington dictating their health care decisions to them, and that is exactly what Obamacare would do:
The difference is this: We don’t think all the answers lie in Washington regulating all of this. … if the National Restaurant Association or the National Federation of Independent Business, on behalf of their members, wants to set up an association health plan, we think they’ll probably do a good job on behalf of their members. Let them decide to do that instead of restricting insurance competition by federalizing the regulation of insurance, and by mandating exactly how it will work, you make it more expensive and you reduce the competition among insurers for people’s business. We want to decentralize the system, give more power to small businesses, more power to individuals, and make insurers compete more. But if you federalize it and standardize it and mandate it, you do not achieve that. And that’s the big difference we have.

President Obama bristled at this analysis, responding: “Can I just say that, at this point, any time that a question is phrased as, “Does Washington know better,” I think we’re kind of tipping the scales a little bit there since we all know that everybody is angry at Washington right now.”

The President seems to understand that the American people do not want bureaucrats in Washington controlling their health care decisions, but then he seems completely oblivious to the fact that increasing bureaucratic control at the expense of every American’s ability to make their own choices is exactly what his plan does.

The American people know this. That is why support for the President’s health care plan has been steadily declining. That is why the most recent CBS News/New York Times Poll shows 53% of Americans say the United States cannot afford to fix health care at this time. It is why 52% of Americans tell Gallup they do not want to see Obamacare pass with only 50 Senators in support (Vice President Joe Biden casting the 51st vote). That is why 59% of registered voters tell Fox News they want the President to start over.

And he should. If the President truly wants to enact historic bipartisan and lasting health care reform, he needs to admit this version of Obamacare is dead. In 2011, when there is likely to be a more centrist Congress in place, then Obama should come back and start again.


The Democrats' Problem

The Democrats did themselves no favors yesterday. The President did plenty to diminish himself. First, there was his lack of grace-- announcing,"I'm the President!," his testy reminder to John McCain about who won the election (reminiscent of his "I won" triumphalism immediately after inauguration), most notably -- and his penchant for scolding everyone was on display. Can anyone even imagine the really great presidents behaving this way? Can you imagine Ronald Reagan, or FDR (or even JFK or George HW Bush or George W Bush) hectoring, lecturing and condescending so brazenly?

Then there was the President's demonstrated inaccuracy about the fact that, contrary to his claims, his health care plan won't bring down health insurance premiums. So much for the brilliant policy wonk. Either he's dishonest, or he's wrong.

But the President's main problem -- and that of the Democrats generally -- is that it's clear it's not about America and its people anymore. It's about them. And that's political death.

When it comes to the President, it's clear that he wants his bill to pass so that he can have his way, and claim a big achievement, and vindicate his boasting about being the last president to have to tackle health care. And, of course, grow the size of government. It no longer has anything to do with actually solving a problem, or helping people, or reform. It's all about him. And it shows.

When it comes to the rest of the Democrats, they're in a similar boat. No one can claim that they're simply trying to respond to the cries for reform from the electorate. The electorate hates this bill. What seems most apparent is that they're trying to save their own skins, politically (there wouldn't be such a need for all the sob stories, otherwise -- that's called "overcompensation").

The President and the Democrats can try to claim they're doing this to "help" Americans. But voters apparently don't want this kind of "help." So it's patently obvious this is no longer about representing Americans or doing the will of the people.

It's about an out-of-control effort by the Democrats to impose their will on Americans, contrary to the people's expressed wishes. Americans know it, and they know it isn't about them -- they're seen by Dems as nothing but a stumbling block, at this point! -- and that's why there isn't any easy way for the Democrats to improve their political position.


ALG Blasts Obama for “Lying about the Increased Cost of Premiums” under Plan at Health Summit

Americans for Limited Government President Bill Wilson today condemned the Obama Administration for “lying about the increased cost of insurance premiums as reported by the Congressional Budget Office at his fraudulent ‘bipartisan’ health takeover summit.”

“Yesterday, Barack Obama flat out lied to the American people, claiming that his plan would, according to CBO, lower the cost of insurance premiums,” Wilson said.

Wilson pointed to the relevant Congressional Budget Office (CBO) report, which stated, “CBO and JCT estimate that the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law… Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.”

The CBO also reported, “About half of those enrollees would receive government subsidies that would reduce their costs well below the premiums that would be charged for such policies under current law,” which formed the basis of Obama’s claim, responding to Senator Lamar Alexander (R-TN), stating, “Lamar, when you mentioned earlier that you said premiums go up, that's just not the case, according to the Congressional Budget Office.”

Wilson said Obama was “misleading the American people. This is not a case where Obama and Alexander were ‘both right.’ Obama was wrong.”

Wilson explained, “Subsidizing premiums does not lower the cost of health care, it shifts the burden of the price of health coverage increasingly to taxpayers. At the same time, ObamaCare increases the minimum requirements for insurance coverage, which forces premiums up, as noted by the CBO.”

More here

Australia: Casualty department (emergency room) shutdowns in an already overstretched Sydney hospital system

Government logic at work

MOST seriously injured accident victims in the city and eastern suburbs will no longer be taken to St Vincent's or Prince of Wales hospitals under a new trauma plan. They will be forced to travel across town to either Royal Prince Alfred in Camperdown or St George Hospital in Kogarah. NSW Health has quietly released its trauma services plan after 10 years of wrangling among doctors. Under the plan, due to start on Monday, all major trauma patients will be diverted from Nepean to Westmead Hospital.

There are concerns about the ability of RPA, St George and Westmead to take on the hundreds of extra patients. RPA is expected to be most seriously affected as it and St George will need to absorb more than 400 extra patients a year.

The NSW chairman of the Australasian College for Emergency Medicine, Richard Paoloni, said RPA already had the highest level of ambulance arrivals in Sydney and the plan would increase pressure on emergency beds.

The Health Services Union, which represents paramedics, is concerned about increased "trolley block" - where patients are banked up waiting to get into emergency - as well as increased travel times to RPA and Westmead.

Although Nepean will still take trauma patients, the most serious will go directly to Westmead, which will increase the patient load by more than 200 this year. Westmead is already struggling to see its emergency patients on time. The latest performance figures show it is failing to meet benchmarks in three of the five triage categories and has the worst record in the state for admitting patients within eight hours - 63 per cent of patients, well below the benchmark of 80 per cent.

RPA is also failing to see all its emergency patients on time, and is not meeting benchmarks for two of the five triage categories. The Garling inquiry recommended just three adult trauma centres in Sydney.

Richard Matthews, the deputy director-general for strategic development for NSW Health, said the changes would strengthen hospital trauma systems and paramedics would still have the power to exercise their best clinical judgment. "If someone is stabbed seriously on the street outside St Vincent's the ambos will take them into the emergency department there. In the end, they've got the responsibility of making the clinical decision about what's best for the patient," Dr Matthews said. He said the hospitals affected had received extra funding but did not say how much.


Saturday, February 27, 2010

Stopping Obamacare in the House

It seems very likely that if Obamacare is going to be stopped, it will have to happen in the House. And that means turning some of supporters the deeply unpopular bill into opponents with at least enough spine to tell Nancy Pelosi and the president "No."

Thus the two lists below. The first list is of all the so-called "Blue Dogs," the alleged "moderate Democrats" in the House. Many refused to vote for Obamacare the first time around, and they need to be bucked up and made to understand that their hopes of re-election depend upon continuing to stand against the government takeover of American health care and the massive cuts to Medicare on which the takeover is premised.

The second list are the Democrats who voted for the bill in the fall but who hail from swing districts. These are the House members identified by the National Republican Congressional Committee's effort. The last thing they want are phone calls and e-mails from voters pledging to throw time and money at their opponents if Obamacare passes.

The Congressional switchboard works for them all --202-225-3121, but direct calls to their offices and especially their district offices are even more effective. E-mails work as well, but many of their number won't accept e-mails unless a district zip code is used, which means a little work for the dedicated anti-Obamacare activist. (Just use the zip code of their district office address if you want to communicate despite their filter.)

What matters is a wall of calls between now and the last-ditch effort to push the bill through. Some of the pro-life Demcrats led by Bart Stupak will stay strong and refuse to support the Senate bill with its public funding of abortion, but some will fold. Perhaps a Member or two will vote no as well because there is no "public option" by that name and they realize if they don't get it now they'll never get it.

But it will be a very close thing either way. Never have your calls and e-mails mattered more.

More here

Climbing the Health Summit

Yesterday, the long-awaited health care takeover summit at the White House took place, and it was not as was expected nor advertised. It was supposed to be a trap. Congressional Republicans were supposed to “compromise,” laying the groundwork for the government takeover of the nation’s entire health care system once and for all.

Only, they did not lie down. Indeed, they were well-prepared and their arguments were highly effective against ObamaCare on just about every point, even though Democrats spoke for 233 minutes compared to the GOP’s 110 minutes, according to the Senate Republican Conference. Barack Obama alone spoke for 119 minutes, which he studiously ignored as not counting towards the Democrats’ time. Said Obama, “I don't count my time because I'm the President.”

Leaving Obama’s arrogance aside, Republicans made the most of their time in the summit, and outside of it. Congressional Republicans’ messaging machine was firing on all cylinders throughout the day. They deployed a rapid response fact-checking barrage of press releases, which ALG News chronicled at its news aggregator, Washington News Alert. Everything from Obama lying about CBO’s report, which does state that ObamaCare would raise premiums; to Reid lying about the Democrat threat of reconciliation.

Congressional Democrats, on the other hand, apparently were not so concerned about getting rapid reponses out to the media at all. By design, it appears, they put all their stock on the summit selling itself, or perhaps the media promoting it for them. The truth is, their silence was telling.

Republicans, on the other hand, climbed the summit. And they came out on top. Within an hour of the summit’s opening remarks, it was clear that skeptics who thought Republicans should have sat it out were wrong. Republicans need not have walked away from this challenge. For, they hit the ground running.

Senator Lamar Alexander in the Republican opening statement made the point, quite effectively, that the summit was effectively pointless if Congressional Democrats refused to take the reconciliation threat off the table.

Said Alexander, “my request is this: before we go further today, that the Democratic Congressional leaders and you, Mr. President, renounce this idea of going back to the Congress and jamming your bill through on a partisan vote through a little-used process we call reconciliation.”

Continued Alexander, “You can say that this process has been used before, and that would be right, but it’s never been used for anything like this. It’s not appropriate to use to rewrite the rules for 17 percent of the economy. Senator Byrd, who is the constitutional historian of the Senate, has said that it would be an outrage to run the health care bill through the Senate like a freight train with this process. The Senate is the only place where the rights to the minority are protected, and sometimes, as Senator Byrd has said, the minority can be right.” Indeed.

Instead, Congressional Democrats left reconciliation — a process reserved for minor budget fixes — right there on the table as the summit continued unabated. Everything Republicans, and more importantly, the American people needed to know about the spirit of “bipartisanship” in Washington took place in those first minutes. And the meeting followed suit.

For Obama, the summit was a failure. And it failed precisely because Democrats refused to take the loaded gun off of the table. Instead, Republicans refused to simply bow to the will of Obama and his party. Republicans could have very easily just filed out of the room at that very moment, and just as much would have been substantively produced legislatively by the summit.

But, if they had just walked out then and there, or if they had not attended at all, a great opportunity would have been missed to set the record straight, which is exactly what they did. On point after point.

Obama and the Democrats may have thought they were laying a trap, but instead, it is they who have been hoisted by their own petards. So, Americans for Limited Government would like to say bravo to Congressional Republicans for standing up for the American people. They thank you.

On a bright note, reconciliation may have been an exaggerated threat all along, as reported by RedState’s Dan Perrin. Apparently, the votes may not be present in the House to pass a reconciliation bill. Why?

Senator Kent Conrad said, “I don’t know of any way where you can have a reconciliation bill pass before the bill that it is meant to reconcile passes.” Only, that is exactly what Democrats’ plan is in the House: pass the reconciliation bill first, then have that pass in the Senate, and only then would the House pass the Senate bill. Obama would then sign the Senate bill first, and the “reconciled” bill second, amending the Senate bill.

But, if a serious point of order can be raised, as it surely would, that the rule can only be applied to standing law and, importantly, that was enforced by Congress’ parliamentarian, House Democrats would be left with but one choice to enact their health takeover: vote on the Senate bill first. Except, they do not have the votes to do that.

Reports Politico, “When reminded that House Democrats don’t want to do health care in that order, Conrad said bluntly: ‘Fine, then it’s dead.’” One can only hope, Obama’s attempt at resurrecting his bill yesterday notwithstanding. Even if he ultimately succeeds at passing this monstrosity, at least the American people have a political party that fought for them, even when the cards were stacked against them.


After Health Debate, Obama Threatens Dem-Only Strategy

Thursday's bipartisan health care summit seemed less like an opportunity to reach across the aisle than an opening salvo in the last big battle over health care reform before the November elections. While the president and lawmakers attempted substantive policy discussions, that could not hide bitter partisan divisions.

In his opening remarks, Sen. Lamar Alexander, R-Tenn., addressed Obama on one of the issues that most irritates the GOP: "My request is before we go further today, that the Democratic Congressional leaders and you, Mr. President, renounce this idea of jamming through on a partisan vote, through a little used process known as 'reconciliation,' your version of the bill." Reconciliation is a process that takes only 51 votes to pass the Senate, instead of the 60 needed to end debate on nonbudget bills. The House would have to pass the Senate health care bill, then OK a subsequent "reconciliation" measure that altered the Senate plan.

Alexander's plea did not sit well with Senate Majority Leader Harry Reid, D-Nev. "No one has said — I read what the president has online — no one has talked about reconciliation, but that's what you folks have talked about, ever since that came out, as if it's something that has never been done before," said Reid. "Of course, reconciliation is not the only way out of this. But since 1981 reconciliation has been used 21 times, most of it by Republicans, for major things. Like the Contract for America, Medicare reform, the tax cuts for rich people."

Right-leaning blogs jumped on Reid's comments, pointing out that he said just last week Democrats were willing to use reconciliation.

Sen. Majority Whip Dick Durbin, D-Ill., said earlier in the week that Democrats were willing to move without Republicans. During the summit's break, Durbin was asked if a bipartisan deal was possible. "It's a long shot (but) it's possible," he said, "If nothing comes of this we're going to press forward. We just can't quit. This is a once in a political lifetime opportunity to deal with a health care system that is really unsustainable."

A Gallup poll released Thursday showed the public opposed to reconciliation, 52%-39%. A CNN/Opinion Research poll found just 25% support a bill similar to the one working its way through Congress; 48% say start from scratch and 25% say just stop working on health care.

Whether Congress will have the votes for reconciliation is unclear. IBD contacted the offices of two dozen moderate Democrats who voted for the House health bill in November to see if they supported reconciliation. Most declined to respond. Those who did were decidedly ambivalent. "He hopes that we can find a bipartisan way and that is his focus," said Brenden Timpe, spokesman for Rep. Earl Pomeroy, D-N.D. Asked what his boss might do if the reconciliation strategy were tried anyway, he replied: "I don't know. I haven't had a conversation with the congressman on that."

Abigail Gardner, spokeswoman for Rep. Dan Maffei, D-N.Y., couldn't pin her boss down on the issue either. She hadn't heard him say "one way or another if he is personally in favor of it or whether it would change his vote."

Rep. Kathy Dahlkemper, D-Pa., apparently isn't sure what she will do either. "Until we know it is the strategy, it is really just a hypothetical and I cannot comment on that," said spokeswoman Marie Francis.

Meanwhile, Rep. Bart Stupak, D-Mich., and a dozen or so Democrats object to the Senate health bill's abortion language. So Speaker Nancy Pelosi, D-Calif., likely will need Blue Dog moderates who voted "no" on the House bill to switch to yes. Reconciliation could give them another reason — or excuse — not to put themselves on the political chopping block.

House Majority Leader Steny Hoyer, D-Md., seemed to reflect the wobbly status of his caucus when he told reporters Tuesday that Democrats may have to break a big bill up and pass small parts instead. "We may not be able to do it all," he said.

At the halfway point of the summit, Rep. Tom Price, R-Ga., chairman of the Republican Study Committee, said, "So far the summit has illuminated what Americans have feared: Democrats fundamentally believe that medical decisions should rest in Washington, rather than with patients and doctors."

Ralph Neas, CEO of the liberal National Coalition on Health Care, not surprisingly, had a different take. "I think what we're seeing today is — and I'm sure the structure of the topics is not an accident — so much time devoted to cost containment and health insurance reform," he said. "I think you're seeing a lot of agreement on health insurance reform, whether it's the prohibition of discriminating against pre-existing conditions, or caps on benefits, or canceling of insurance."

Focusing on insurance reform could prove to be smart politics for the Democrats. The same CNN poll found that respondents favored barring insurance companies from declining coverage to those with pre-existing conditions 58%-42% and from dropping coverage of those who are sick 62%-38%. But those reforms alone could destroy the economics of the industry, experts argue, forcing premiums to surge and leaving more people without coverage.

Neas said the summit had "defied the expectations of many in terms of the relative absence of political exchanges." But policy exchanges were often characterized with heated rhetoric. Sen. Jay Rockefeller, D-W. Va., said, "The health insurance industry is the shark that swims just below the water. And you don't see that shark until you feel the teeth of that shark. ... This is a rapacious industry that does what it wants."

Rep. Paul Ryan, R-Wis., attacked the Senate bill because it's a good proxy for Obama's similar plan released Monday. "This bill does not reduce costs," he said. "The (Congressional Budget Office's) job is to score what is placed in front of them, and what has been placed in front of them is a bill that is full of gimmicks and smoke and mirrors."

At the close of the summit, Obama said the GOP needed to do some "soul searching" on health care, and that he'd proceed without them if necessary. But the GOP might not be the only ones who'll need to do some introspection. "The president and Democrat leadership have backed themselves into a politically difficult position," said Ed Haislmaier, senior research fellow at the conservative Heritage Foundation. "They want insurance reforms that necessitate an individual mandate, and that mandate is not very popular on the right, left or center."


Republicans find loophole in budget ploy to push through healthcare legislation

As it turns out, Senate Democrats may not be able to force healthcare legislation through the chamber on a simple majority vote. Republicans say they have found a loophole in the budget reconciliation process that could allow them to offer an indefinite number of amendments. Though it has never been done, Sen. Jim DeMint (R-S.C.) says he’s prepared to test the Senate’s stamina to block the Democrats from using the process to expedite changes to the healthcare bill.

Experts on Senate procedural rules, from both parties, note that such a filibuster is possible. While reconciliation rules limit debate to 20 hours, senators lack similiar constraints on amendments and could conceivably continue offering them until 60 members agree to cut the process off. Another option for Democrats would be to seek a ruling by the parliamentarian that Republicans are simply filing amendments to stall the process. But such a ruling could taint the final healthcare vote and backfire for Democrats in November. Or Senate Majority Leader Harry Reid (D-Nev.) could use a tactic similar to the so-called nuclear option to quash the GOP tactics.

If those options failed, and Reid couldn’t convince a single Republican to vote with his 59-member conference, Democrats might be forced to consider withdrawing the healthcare bill.

A Democratic leadership aide confirmed to The Hill that the options outlined in this article are correct. House Democrats have said they would not pass the Senate healthcare bill unless changes are made through reconciliation, which is necessary because Republicans control 41 Senate seats, enough to block legislation through the regular process. But Republicans may end up having that power even under reconciliation.

“You could keep offering amendments until you don’t have any more to offer,” said a congressional aide, who said he did not know how long senators would be willing to stay in the chamber to move the reconciliation package. “What the body’s tolerance would be is unknown.”

A former Senate Republican leadership aide said: “The limit is on debate, not on consideration of amendments.”

DeMint said he’s ready to try anything. “You’ll see Republicans do everything they can to delay and stop this process,” DeMint said. “They need to get the message the track they’re on is the wrong track.”

Reid spent significant time last year in close study of the Senate rules for fast-tracking healthcare legislation under special budget rules. Reid stayed away from the special process of passing healthcare reform with only 51 votes because he knew it would be messy.

But since Republicans won a Senate seat in Massachusetts, thereby stripping Democrats of a filibuster-proof majority, it appears Democrats will need to invoke those rules to make crucial changes to healthcare legislation.

DeMint said that using reconciliation rules to pass the House-requested changes to the Senate healthcare bill with only 51 votes is “tyrannical.” “I think you’ll see us offering amendments to get us into November, if we can,” said DeMint.

Sen. Judd Gregg (N.H.), the ranking Republican on the Budget Committee, said: “You could continue to offer amendments, I suspect. “You can offer an unlimited number of amendments on the budget after time is elapsed so it’s logical that you could also do it on reconciliation,” Gregg said.

Democrats could try to persuade Republican colleagues to back down and withdraw their amendments after several hours or days of voting. With a unified Democratic conference, Reid would need just one GOP senator to cut off the process. The most likely candidate would be Sen. Olympia Snowe (R-Maine), who voted with Democrats to advance the Senate Finance Committee bill but has since opposed the healthcare measure on the Senate floor.

Reid or another Democrat could make a point of order that using amendments to stall a reconciliation bill violates the spirit of the Budget Act of 1974, which sets up for expedited consideration of budget-related bills. Reid or another Democrat could argue that offering unlimited amendments violates the spirit of limiting debate.

The parliamentarian has ruled that the limit on debate does not allow senators to filibuster the motion to proceed to a reconciliation bill. The parliamentarian could rule that the same concept applies to amendments. No one really knows, because a lawmaker has never tried to use amendments to filibuster a reconciliation package. “We haven’t ever tried it before,” said a congressional aide.

Parliamentarian Alan Frumin could rule Republican amendments after a certain number out of order. But he could also allow the GOP amendments, since they are not expressly barred. If Frumin ruled with Republicans, Reid would be in a difficult position. He could either pull the bill off the floor or he could appeal the ruling of the parliamentarian.

With a simple majority of 51 votes, Reid could overturn the ruling of the chair and set a Senate precedent that amendments must be limited to within reason. This tactic would be similar to the so-called nuclear option Senate Republicans considered using in 2005 to overrule Democratic filibusters of judicial nominees.


Obama’s Health Plan – Taxes, Taxes Everywhere

The White House recently released President Obama’s health care reform proposal. The plan incorporates a mixture of the many tax increases passed by the House and Senate, hiking taxes by almost $750 billion over ten years. This is on top of $1.3 trillion in other tax increases the President recently proposed in his 2011 budget. Not that there is ever a good time to raise taxes, but doing so as the economy is still emerging from a deep recession is particularly ill-advised and will likely prolong full recovery. Moreover, the President’s proposal deviates from his stated goal to address the soaring spending and debt problem the nation faces by piling on massive new spending and taxes.

Payroll tax hikes: Obama accepted the Senate’s plan to break long-held policy by raising the Hospital Insurance (HI) portion of the payroll tax on high-income earners to pay for a new and unrelated health care entitlement. He then doubled-down on this dangerous new precedent by separately applying the HI tax to investment income for the first time. The tax code already taxes investment too much. Higher taxes still on dividends, interest and business income increases the cost of capital which will further depress investment and thus job creation. Ironic to propose this at the very time the President wants employers to create jobs.

Medicare payroll tax would hit seniors: His proposed tax hike on investment will hammer seniors particularly hard because their investment income is a major supplement to their pension and Social Security checks. Seniors also sell assets to raise income, so raising the tax on capital gains further reduces their resources. Lastly, raising the taxes on capital income and capital gains will lower asset values. Nearly 30 percent of all stocks are held in retirement savings plans. Most of the seniors that rely on the income from these plans for their livelihood are not “fat cat” investors that have been the target of other populist tax hikes. They are people that spent their working years saving money for their own retirement in mutual funds, 401(k)s, IRAs, and other savings vehicles. This would just punish them for a lifetime of careful planning and saving.

Cadillac tax: The President also adopted an excise tax on “Cadillac” health insurance plans similar to that in the Senate plan. Obama’s proposal would levy a 40% tax on plans that cost over $10,200 a year for individuals and $27,500 for families, but wouldn’t be effective until 2018. The delay will no doubt give unions and other favored groups time to negotiate their way out of the tax through collective bargaining or gain a complete legislative exemption at some point in the future before the tax kicks in. It also means delaying political pain. All the same criticisms of the excise tax apply as before. For example, insurers will embed the tax in the price of their plans. This will hide its cost from their customers. The tax will also fall heavily on middle and low-income workers whose taxes President Obama pledged not to increase. The President would have been better off capping the value of health insurance employers can provide their employees tax free. This is something that has wide support among policy experts on the right and the left and would be a real show towards openness to the bipartisan ideas he is purporting.

Still more taxes: Just like the Senate and the House, his plan incorporates a multitude of other tax hikes and fees that will go towards paying for the monstrously expensive bill. Some will raise taxes on people making less than $250,000 a year, breaking a key campaign pledge. Prime examples include:

• Excise tax on medical device manufacturers;

• Fee on brand name pharmaceuticals;

• 10 percent tax on tanning services;

• Reduce the amount families can place in Flexible Spending Accounts (FSA) and increase the penalties for non-medical deductions from Health Savings Accounts (HSA); and

• Higher taxes on health insurance companies and producers of medicine.

Each of these taxes will fall explicitly on those making less than $250,000 or will be passed down to them. And this is just a sample of the taxes that will hit those making less than $250,000 in the President’s plan. There are many more. In fact, the mandate on all individuals to purchase health insurance could also be considered another steep tax hike on those making less than $250,000.

Bottom Line: There is never a good time to raise taxes, but even the talk of doing so now continues to cause uncertainty in the economy. Sadly, the President’s plan is no better than those of the House or Senate: massive new benefits paid for by a myriad of harmful new taxes. Better to drop this plan and start over. Without crushing new taxes.


Report Concludes President Obama's Health Proposal Would Lead to Public Option

President Obama's new health care plan will all but guarantee the elimination of private insurance and lead to a single payer government-run health care system, says a new report, "White House Health Care Plan Contains Back Door to a Public Option" by policy analyst Matt Patterson of the National Center For Public Policy Research. Among the findings:

* The President's plan would create a new federal agency charged with monitoring health insurers to make sure that proposed premium increases are not "unreasonable" or "unjustified." This agency could compel private insurers to lower premiums, offer rebates or "take other actions to make premiums affordable."

* The President's plan would also dictate that health insurers cover those with pre-existing conditions and saddle them with billion in new taxes and fees.

* Health insurance is one of the least profitable industries America. In terms of profit margin, in 2009 it ranked a dismal 87th out of 215 industries; their overall profit margin was a mere 3.4 percent.

* The President's proposed combination of new taxes and price controls would cause a wave of health insurer bankruptcies, devastating the industry and reducing health insurance options for consumers.

* Eventually, the shrinking pool of private insurers would force the government to enact a single payer system to provide the insurance that Congress mandates that all Americans have.

Patterson calls Obama's ploy "breathtakingly audacious," noting, "Far from being able to keep the plan you like, the President's health care plan seems designed to make sure you end up with only one option for your health care - the government."


The recent rises in American healthcare costs are not unique

Newer drugs and procedures will cost more wherever you are

On this, we can all agree: American health care is feverishly expensive, swallowing up 17 percent of GDP. Since 2000, health-insurance premiums have more than doubled, affecting the bottom lines of businesses and hitting Middle America in the pocketbook. It’s not surprising, then, that since inauguration the administration has made the reduction of “long-term growth of health-care costs for businesses and government” its highest priority for health reform. “If we do nothing, then health-care inflation is going to keep on going up at 8 percent, 9 percent, 10 percent a year,” the president said last July, urging immediate action.

Over this past year, the administration has blamed rising costs on things that make U.S. health care different. American private insurers are too greedy. American doctors prescribe wastefully. American doctors are paid inefficiently.

The White House has pushed sweeping measures: a Medicare-style plan to compete with private insurance; new bureaucratic committees to define and oversee private coverage; expansions of public programs; and a government body tasked with bettering health care by guiding the decisions of doctors. White House budget director Peter Orszag crowed that the latest Obamacare bill “contains more cost containment and delivery-system reforms . . . than any bill that has ever been considered on the Senate floor, period.”

Of course, the very same “cost containment” systems exist in countries with socialized health care. And if the White House has confidence in a government-based solution to this problem, here’s the irony: Health-care inflation rates in the United States have been similar to those in government-managed systems that often employ the sort of regulatory policies championed by the White House.

Over the long term, the difference between the rise in costs of American health care and the OECD average from 1990 to 2006 was just 0.4 percent annually — even though bureaucrats manage most of the health spending in those other countries. Jump ahead a few years, and the trend hasn’t changed. Health care might be cheaper in socialized systems (in part, because of rationed care), but, even with their long waiting lists, costs are rising just as quickly there as here. Consider the 2009 figures:

In Britain, health costs rose 3.1 percent (and a full 5.5 percent increase in the strictly controlled hospital sector). In Ireland, the republic’s health-care system produced 2.5 percent health inflation; Irish prices declined by 5 percent across the economy, by the way. Germany’s inflation rate was at a 20-year low of 0.1 percent; health costs still rose by 1.8 percent. In Canada, health costs rose by 3.0 percent.

Canada is an interesting case study, since private insurance is banned in most of the country. Yet commentary in newspapers would be familiar to an American reader. The Toronto Star insists “something must be done” to reverse “unsustainable” spending growth. The Globe and Mail describes spiraling health costs as a “ticking time bomb.” But if costs are rising, government rationing can be felt. This month, the Province of Newfoundland’s highest elected official, Premier Danny Williams, went to the United States for urgent heart surgery, insisting the necessary treatment was unavailable in Newfoundland.

And how did the United States do with its lack of Obama-inspired Canada-Irish-German-style bureaucratic controls? Health inflation here was 3.4 percent last year, just over double the basic inflation rate. Tellingly, the worst cost increases were experienced by . . . government. Medicare costs were up 8.6 percent, and Medicaid, up 9.9 percent.

Make no mistake: That 3.4 percent may be lower than the alarmists predicted, but it’s still no cause for celebration. Whether it’s as high as other countries’ or not, health inflation is unsustainable. And international trends suggest health inflation is caused by the things that make America similar to other Western nations: worsening diet and fitness habits; higher health expectations; an aging population; costly new medical technologies; and payment systems that tend to insulate people from the economic consequences of their decisions (mainly private insurance here and public insurance abroad).


Friday, February 26, 2010


Michelle Malkin:

Oba-Kabuki: A Box-Office Bomb

The Oba-Kabuki health care show at Blair House kicked off with a big lie on Thursday morning -- and it all went downhill from there. The taxpayer-funded infomercial backfired by exposing the president's thin skin, the Democrats' naked disingenuousness and the ruling majority's allergies to political and policy realities.

Responding to Sen. Lamar Alexander's opening call for Democrats to renounce parliamentary tactics designed to limit debate, circumvent filibusters and lower the threshold for passage of health care reform to a simple 51-vote majority, Senate Majority Leader Harry Reid sputtered indignantly: "No one's talking about reconciliation!" Everybody and their mother has been invoking the "R" word on Capitol Hill, starting with Reid.

In a letter on Feb. 16, four Democratic senators pushed Reid to adopt the procedure, normally reserved for budget matters. A few days later, White House Press Secretary Robert Gibbs discussed the option. Then Reid himself talked up reconciliation on a Nevada public affairs show as an option to ram the government health care takeover through in the next 60 days.

According to The Hill, Reid said that "congressional Democrats would likely opt for a procedural tactic in the Senate allowing the upper chamber to make final changes to its health care bill with only a simple majority of senators, instead of the 60 it takes to normally end a filibuster." A few days after that, Reid snapped that Republicans "should stop crying" about the abrogation of Senate minority rights, since the GOP had used the reconciliation process in the past.

So, the cleanest, most ethical holier-than-thou Congress ever is now defending the unprecedented adoption of ram-down rules for a radical, multitrillion-dollar program to usurp one-seventh of the economy on the grounds of "two wrongs make it right"? Hope and change, baby.

For his part, President Obama responded with one part pique and two parts diffidence. After the summit lunch break, Republicans pushed the reconciliation issue again in the face of the Democrats' refusal to disavow the short-circuiting of the deliberative process. "The American people," an annoyed Obama asserted, "are not all that interested in procedures inside the Senate." Oh, really? A new USA Today/Gallup poll reports that 52 percent of Americans oppose using the procedural maneuver to pass the health care bill in the Senate.

The survey also showed that Americans oppose Demcare-style health care "reform" by 49 percent to 42 percent -- with those "strongly" opposed outnumbering those "strongly" in favor by 23 percent to 11 percent. Obama's best and brightest team of Chicago strategists, new-media gurus and communications specialists still hasn't figured it out: Voters are as fed up with the corrupt process in Washington as they are with the White House's overreaching policies. It's both, stupid.

When he wasn't cutting off Republicans who stuck to budget specifics and cited legislative page numbers and language instead of treacly, sob-story anecdotes involving dentures and gallstones, Obama was filibustering the talk-a-thon away by invoking his daughters, rambling on about auto insurance and sniping at former GOP presidential rival John McCain. "We're not campaigning anymore," lectured the perpetual campaigner-in-chief.

After ostentatiously disputing the GOP's claims that health care premiums would rise under his plan, Obama walked it back. Confronted with more GOP pushback on the failure of Demcare to control costs, Obama told GOP Rep. Paul Ryan that he'd rather not "get bogged down in numbers." Not numbers that he couldn't cook on the spot without staff consultation, anyway.

Obama and the Democrats labored mightily to create the illusion of almost-there bipartisanship by repeatedly telling disagreeing Republicans that "we don't disagree" and "there's not a lot of difference" between us. But the dogs weren't riding the ponies in this show.

This was a set-up from the start. The "we're so close" mantra is the rhetorical wedge the White House will use to blame Republicans for fatal obstructionism, while whitewashing festering opposition from both pro-life Democrats who oppose the government funding of abortion services still in the plan and left-wing progressives in the House who are clinging to a full, unadulterated public option.

While Republicans came off well, the six-hour blowhard-fest was a monumental waste of time. Obamacare Theater tied up GOP energy and resources as the White House readies its "Plan B" (expanding government health care coverage, just at a slower pace) and Democratic leaders prep their reconciliation ram-down for early next week. This Washington box-office bomb is a prelude to much bigger legislative horrors still to come. Don't you love farce?


Jonah Goldberg:

Health-Care Humdrum

The longest week I ever spent was the six hours I spent watching Thursday's health-care summit. The better angel of my nature says that this confab is a wonderful spectacle of democracy. Serious men and women airing serious disagreements in a (relatively) respectful and substantive manner. Huzzah for democracy. Wahoo for C-SPAN. Attaboys and attagals to all involved.

My more devilish side says that this is a debacle par excellence, the policy-wonk equivalent of a show trial where the result is foreordained and the speeches are for the benefit of no one but those who don't understand what's really going on while the posturing is for the handful of Kremlinologists who care passionately about minutiae.

More to the point: It was mind-bogglingly, soul-achingly, sand-poundingly, metaphysically and ontologically boring. It's like driving through Kansas on the interstate (something I've done many times): long, vast stretches of boredom punctuated by the occasional brief promise of excitement that would require detouring from the planned route.

It reminds me of that old Monty Python skit where British soldiers are equipped with the world's funniest joke, a joke so funny that even to hear it guarantees you'll die laughing. The British army translates the gag into German (different translators for each word so as to prevent their own deaths), and has its troops read the German version as they march through Ardennes forest. Suddenly, Nazi soldiers start falling dead from the trees. Substitute "boring" for "funny" and you'll get a vague sense of how dull this summit was. At one point I could swear Mitch McConnell was counting fibers in the carpet just to stay awake.

For months, Republicans have fairly tagged President Obama for breaking his promise to put health-care negotiations on C-SPAN. That talking point was rendered moot Thursday. But now there's a better talking point: The summit showed why Obama was crazy for wanting to televise this stuff in the first place. Real negotiations never happen in front of cameras because to cut a real political deal in public is the political equivalent of cutting your own throat.

Now, just because the scripts were written beforehand doesn't mean that everyone's lines worked. Obama opened by striking a pose of plausible fairness and open-mindedness but grew more and more snarky (to use a technical political-science term) and less presidential as the event wore on. Obama's condescension to John McCain -- "we're not campaigning any more, the election's over" -- pleased everyone who already loves him and nobody who doesn't.

House Speaker Nancy Pelosi relied on the Democrats' favorite rhetorical gambit: policy-by-anecdote. Invoking the sad plight of some person no one knows can be effective, but we've been hearing such stories for a very long time, even as support for Pelosi's solutions has plummeted.

But it was Senate Majority Leader Harry Reid, mugging for his doomed re-election bid at home, who put the ugliest face on the Democratic Party. Cranky, mean and short-tempered, Reid seemed like he was sitting on a carpet tack throughout the discussion. He snapped that "no one is talking about reconciliation" -- a reference to the arcane parliamentary procedure Democrats are considering as a means to ram their unpopular bill through Congress.

That's true, save for the more than 100 House Democrats and more than 20 Senate Democrats who had already signed letters calling for reconciliation. His crotchety dyspepsia combined with arrogant dishonesty made the leader of the Senate seem like the sort of oldster who would pinch little kids for fun if he could get away with it.

The Republicans were arguably more boring than the Democrats precisely because they had to seem nicer. (Iowa Sen. Tom Harkin, who bizarrely played the race card, had no such concerns.) But when Sens. Lamar Alexander, Jon Kyl and Tom Coburn weren't contemplating committing seppuku like that Japanese soldier in "Airplane!" just to end the ennui, they succeeded in undermining the central talking point of the Democrats: that the Republican Party has no ideas on health care.

It may have been excruciatingly dull enough to force Osama bin Laden from his cave, but the Republicans patiently telegraphed an inconvenient truth: They do care about health-care reform, they just loathe Democrats' version of it (and, yes, have much to gain by blocking it). At halftime and again afterwards, when delegates were no doubt mainlining Red Bull, the Democrats' spinners took to the airwaves to insist that the Republicans "don't want anything." But anyone watching knows that's not really true.

That is, if anyone was watching.


"The Times" of London:

Political theater

Thirteen months into his presidency, Barack Obama invited 40 congressional leaders to a meeting yesterday to forge consensus on an issue that threatens to bankrupt the country and derail his ambition of transforming American society.

His challenge to Republicans to abandon politics-as-usual fell largely on deaf ears, but it brought moments of drama, including a rebuke of Mr Obama’s governing style over the past year from his former opponent, Senator John McCain. Mr Obama responded: “We’re not campaigning, John. The election’s over.”

Six hours of televised debate left uncertain the fate of the most ambitious social legislation in a generation: the reform of a health insurance system that accounts for nearly a sixth of the US gross domestic product. It has become a proxy for an even broader battle between liberals who last year sensed an historic chance to reinvent the federal government in favour of the poor, and conservatives determined to bury Mr Obama’s campaign promises of change and render him a one-term president. As one commentator from his home town of Chicago put it: “Obama needs a victory. Either that, or he faces irrelevancy and insurrection.”

Long before the Secret Service shut the streets around the White House to allow Mr Obama to walk to Pennsylvania Avenue to Blair House, the venue for the meeting, his opponents and even his Vice-President, warned that the event would prove to be nothing more than political theatre. Their words were justified — but it was compelling theatre.

Mr Obama opened proceedings with an appeal for bipartisanship, and for reform of a system that he said had forced his mother to argue with insurance companies from her hospital bed as she lay dying from ovarian cancer.

The Republican reply came from Lamar Alexander, the former Governor of Tennessee, who offered his story of a constituent struggling to pay for his wife’s breast cancer treatment. He argued that the solution was to tear up Democratic health reform Bills and start again. Republicans went on to propose a six-point plan that they said would cut costs and extend insurance cover without the $950 billion (£620 billion) price tag attached to Mr Obama’s plan.

Solemn undertakings to keep the affair cordial and focused on the needs of the American people quickly gave way to partisan tit-for-tat. When Mr Alexander claimed that Democratic proposals would raise insurance premiums for many, the President interrupted him twice, saying: “No, no, no, here’s what the Congressional Budget Office actually says.”

Progress towards comprehensive health reform ground to a halt last summer when conservative activists at town hall meetings successfully branded it a government takeover, draining enthusiasm among moderate Democrats worried about re-election in November. The project appeared doomed last month when the Republicans’ gain of Ted Kennedy’s old Senate seat robbed the Democrats of a majority.

Yesterday’s meeting was predictably rancorous, but by no means all scripted. “You are entitled to your own opinion, but you are not entitled to your own set of facts,” Harry Reid, the Senate majority leader, told Republicans at one point.

After a dissection of the 2,400-page Senate health Bill by Eric Cantor, one of Mr Obama’s most effective critics in the lower House, Louise Slaughter, a New York Democrat, came to the rescue with a human interest story to eclipse them all. It concerned two elderly sisters. When one died and the other lost her dentures “she wore her dead sister’s teeth”, Ms Slaughter said. “Of course, they didn’t fit. Can you believe that in America?”

A bipartisan breakthrough was always the least likely outcome of this minutely choreographed event. Playing to a live TV audience for six-hours, both sides sought to score points without seeming to and to appear conciliatory while knowing that their battle lines were already all but fixed. “We might surprise ourselves,” Mr Alexander said. He was referring to his search for common ground. He did not find much yesterday.

Health care: Dems just don't have the votes

Now that the White House and Democrats are making a last push to pass their so-far-unpassable national health care bills, the only thing that matters is whether they can get 217 votes for victory in the House and 50 votes (plus the vice-president's tie-breaker) for reconciliation in the Senate. Good policy doesn't matter. Bad policy doesn't matter. All that matters is votes.

The White House and Democrats have lost sight of the essential insanity of the process -- desperately searching for corners to cut so they can pass an enormous re-ordering of the American economy that Americans don't want -- because all they can think about now is passing something. It could be anything, as long as it is "comprehensive."

So where are the votes? Start in the House. House Democrats have to do two things. First, they have to pass the health care bill that Senate Democrats passed on December 24 -- Cornhusker Kickback, Louisiana Purchase and all. They could stop there and send the bill to the president's desk, but that, of course, is not going to happen. So they then have to pass a set of agreed-upon "fixes" to the Senate bill that the Senate would then pass by using the reconciliation process. (The fixes will start in the House; reconciliation bills have to originate in the House because all revenue measures have to originate in the House.)

The original House health care bill passed last November by a 220 to 215 margin. But supporters have lost four votes since then. Democrat Rep. Robert Wexler has left the House, and Rep. Neil Abercrombie is expected to leave this week. Rep. John Murtha died, and Republican Rep. Joseph Cao, the only GOP lawmaker to vote for the bill, now says he will vote against the measure. That leaves Democrats with 216 votes, one short of the 217 it will take to pass. (That number is one less than the usual 218 because of the vacancies in the House.)

In addition, it's thought that some number of Democrats who voted for the original bill will likely vote against the Senate version because it lacks the House bill's language on the subject of abortion (the president's proposed compromise doesn't help on that subject, either). Republicans estimate there may be 11 such Democrats. If there are, that takes the number down to 205, which means Speaker Nancy Pelosi will need to find a dozen "yes" votes to make up the difference. It is widely thought that she had some possible yes votes in reserve last November, to be used if they were absolutely essential to passage. Are there 12? No one knows.

And that doesn't begin to consider the Democrats who voted in favor of the House bill last November but have now finally been persuaded, by continued public opposition in the polls, the Senate election in Massachusetts, and the generally worsening political climate for Democrats, that another vote in favor of the wildly unpopular health bill would be suicidal. Can Pelosi really be willing to bet that she can get everyone who originally voted yes on the bill to vote yes again? And for the Democrats who originally voted against the bill -- does anyone believe that any are going to change their minds to vote yes?

Remember, no matter what you hear, the House will have to vote yes on the original Senate bill, outrages and all. Democratic leaders will try to arrange things so that that vote will somehow be obscured, and the emphasis will be on the "fixes" reconciliation bill, but for health care to become law, the House will have to approve the Senate bill. Do you think the Democrats' Republican opponents might mention that in the coming campaign? Of course they will. Which means Democrats will be explaining and explaining and explaining that they fixed the outrageous problems in the bill at the same time they passed it. Would you want to make that case every day on the stump?

The bottom line: Pelosi is probably many votes short of being able to pass the Senate bill, along with the still-unwritten fixes. In public Democrats are trying to create a sense of inevitability about the bill -- they've tried to do that at various times during the year-long process -- but there is absolutely nothing inevitable about the passage of their national health care plan.


Obama plan may pass in pieces

Antitrust measure could win bipartisan support in House

Top House Democrats on Tuesday left open the prospect of President Obama's comprehensive health care overhaul failing and passing pieces of it, a process already being used to try to repeal health insurance industry antitrust protections. The antitrust measure, which was not in the reform framework Mr. Obama released Monday, could pass the House Wednesday with bipartisan support, which would mark the first time Republicans and Democrats have been able to agree in the health debate. It would come a day ahead of Mr. Obama's health summit.

House Majority Leader Steny H. Hoyer said Democrats support Mr. Obama's outline, but if a complete overhaul bill can't get through Congress, there are good pieces that should become law. "We may not be able to do it all," he said. "I hope we can do it all in a comprehensive piece of legislation that would provide affordable, accessible, quality health care to all Americans. But having said that, if we can't, then you know me - if you can't do a whole, doing part is also good."

House Speaker Nancy Pelosi stressed the importance of repealing the antitrust protections and that Democrats can simultaneously pass a small bill alongside work on the comprehensive bill. "We will be taking up comprehensive health insurance reform shortly but we wanted to make sure that in paving the way for that legislation we paved the way for fairness, for competition, for better care, better quality, better affordability for the American people," she said.

The antitrust bill repeals the 1945 McCarran-Ferguson Act that exempted the insurance industry from federal antitrust rules. "For too may decades the health insurance companies have enjoyed monopoly protections that are enjoyed really by no other industry, with the exception of Major League Baseball," said Rep. Tom Perriello, the Virginia Democrat who introduced the bill. "The result of this has been a lack of competition and a lack of accountability that has helped send prices up for consumers and working families across the country."

It's unclear what impact the repeal would have. Democrats say it would increase competition and stop bid rigging and price fixing. Insurance companies oppose it because they say it would lead to regulatory confusion and that state law already prevents anticompetitive practices. The Congressional Budget Office, Congress' nonpartisan budgetkeeper, found that the repeal would have "no significant effects" on the federal budget or private insurance premiums.

Insurers say McCarran-Ferguson never allowed them to engage in price-fixing or bid-rigging. "Health insurance is one of the most regulated industries in America at both the federal and state levels," said Karen Ignagni, president and chief executive officer of America's Health Insurance Plans (AHIP), an industry trade group. "The Act is extremely limited in scope and has nothing to do with competition within the health insurance industry." AHIP says that insurers are subject to federal antitrust laws in addition to other state and federal regulations.

The repeal has support in the Senate as well. Nineteen Democrats signed on to a letter to Mr. Obama, Ms. Pelosi and Mr. Reid asking them to include the repeal in their final health bill.

White House spokesman Robert Gibbs said Tuesday that the antitrust bill would be done in addition to a comprehensive bill, not instead of. "This will ultimately complement health care reform in ensuring the changes that you make in the market - that the ability to look into potential anti-competitive practices, that that's not, quite frankly, illegal to do," he said. "This is not in lieu of something to make broader changes in the insurance market. This is a complementary step along the way."

Democrats on Capitol Hill say they are cautiously supportive of Mr. Obama's health reform outline, which closely follows what the Senate passed in December but includes a number of repairs designed to please the House.

The plan was written with reconciliation in mind, White House officials said. That's the complicated procedural tool Democrats could use to pass the bill with only 51 votes, circumventing a Republican filibuster. Senate Majority Leader Harry Reid said Democrats have not decided to pursue that route but chastised Republicans, who on Tuesday labeled the proposed use of reconciliation a rare procedural "trick."

"I've been told that my Republican friends are lamenting reconciliation, but I would recommend for them to go back and look at history," Mr. Reid said. "Since 1981, reconciliation has been used 21 times. The vast majority of those reconciliation efforts have been by Republicans ... realistically, they should stop crying about reconciliation as if it's never been done before."


With reform dead, health care debate becomes pure politics

Question: When should you start suspecting President Obama isn't serious about a health care proposal? Answer: When he doesn't have the pharmaceutical industry on his side.

The biggest changes Obama has proposed to the Senate bill -- such as price controls on insurers and higher taxes on drug companies -- don't look like moves to get Republican votes or help the bill glide thought the filibuster-proof budget reconciliation process. It looks like Obama is simply trying to push his heretofore allies (drug makers) and uneasy partners (health insurers) fully onto the other side of the fence with the Republicans, thus painting a helpful political picture for 2010.

The White House spent 2009 publicly decrying the "special interests" supposedly undermining their "reform" of the health care market. But the White House also spent 2009 privately cutting deals with drug companies -- deals that fueled public skepticism about the bill and left the president's liberal base feeling jilted.

Even the insurers made out well in last year's negotiations, successfully killing the public option, inserting insurance mandates on both individuals and employers, and securing massive subsidies for the purchase of health insurance. Former Democratic National Committee Chairman Howard Dean was exaggerating, but not all that much, when he called the Senate bill "a bigger bailout for the insurance industry than AIG."

Still, Obama portrayed his "reform" effort as a struggle against "those who profit from the status quo." For the most part, the White House never named these dastardly profiteers, possibly because industry was mostly on the president's side.

So while he spent 2009 battling imaginary foes over a real bill, Obama now might be battling real foes over an imaginary bill. Without reading minds, we can't know for sure if Obama believes he can still pass a health care bill, or if he truly sees the rough outline he issued Monday as the path toward making a bill become a law.

But there's plenty of reason to believe his current proposal is simply a political wedge: An effort to actually drive the insurers and drug makers into fierce opposition, thus helping Democrats frame the 2010 elections as "reformers" vs. "fat-cat industries." In other words, it looks to me like the president has decided to engage the same game he has accused -- not always unfairly -- Republicans of playing: Drawing political battle lines rather than trying to reform anything.

Look at the Web page the White House debuted for this week's proposal and summit. As of Tuesday morning, the page dedicated more words to attacking insurers than to laying out policies, highlighting blog posts with these headlines: "Nobody is Immune from Insurance Company Abuses," "Premiums, Profits, and the Need for Health Reform," "Putting Health Care in the Hands of Consumers -- Not Insurance Companies," "The Insurers and the Ultimate Irony."

Insurers aren't the only bad guys Obama's proposal would drive into the nay camp (that is, the GOP camp). The bill would also slap a Medicare tax on "unearned income" such as investments and rent, thus drawing more blood from wealthy investors and landlords.

We saw the first glimpses of the Democrats' 2010 strategy at Obama's rally for Massachusetts Senate candidate Martha Coakley. "Whose side are you going to be on?" Obama asked, the side of the "special interests" or of working Americans.

The "whose side are you on" motif is a favorite of Democrats going back to Adlai Stevenson. But it's an awkward one to ask about Obama's first year, in which he sided with big energy companies in backing the House climate change bill, with the largest cigarette company in signing a tobacco bill, with the insurers in signing an expansion of subsidies for children's health insurance, with the Chamber of Commerce in signing the largest spending bill in history (and Big Coal in including the largest earmark in history), with Wall Street in ramping up the bailouts of the financial industry, and of course with drug companies in backing the Senate's subsidy-packed health care bill.

This renewed push for health care reform gives Obama an opportunity to set a different stage. Proposing federal price controls on insurance premiums is bad policy, but good politics. Bad policy proposals are fine and can get plenty of Democratic votes if the package is really just filibuster bait. If Obama can't pass a reform, at least he can force the Republicans to stand with insurers, drug makers, landlords, and wealthy investors in killing a bill described as "reform."


Medicare is Cheating Seniors Out of Care, Says New Study

Chronically low Medicare reimbursement rates to physicians and hospitals are forcing doctors to limit the number of Medicare patients they see - or opt out of the program altogether - with devastating results to seniors' health care options, says a new study, "Medicare Doctor Shortage Endangers Seniors' Access to Care," by Matt Patterson of the National Center for Public Policy Research.

From the Southwest to Florida, from the Midwest to New York, primary care doctors and specialists at both hospitals and private practices are turning away Medicare patients because they cannot afford to treat them, the study concludes.

The report analyzes government data, health care provider statistics, and news reports from across the country to paint a frightening picture of a government program failing the most vulnerable members of our society: our seniors. Among the findings:

* Some Mayo Clinic facilities are no longer accepting Medicare patients for primary care, turning thousands of seniors away from their trusted physicians.

* 30 percent of Medicare patients seeking a new primary care doctor reported difficulty finding one, including 17 percent who claim they had "big" problems finding a new doctor.

* Only 73 percent of Medicare participating family doctors are accepting new Medicare patients.

* Only 38 percent of Texas primary care physicians say they will accept new Medicare patients in the face of low Medicare reimbursements.

* More than half of California hospitals reported operating at a loss, due in part to low Medicare reimbursements.

* Hospitals in Iowa report trouble recruiting new doctors thanks to low Medicare reimbursements, and warn that the trend may be a threat to the quality of future care.

Says Patterson, "At a time when President Barack Obama is proposing yet another $1 trillion health care plan, Medicare - the original government health insurance program - is going bankrupt, underfunding doctors, and cheating seniors out of care. Why don't we worry about meeting our existing health care obligations before we take on additional burdens?"


Specialist British nurses ‘ too stretched to care for all who need it’

Nurses who provide specialist services for the long-term sick are overstretched and unable to deliver care to all who need it, health unions and charities say today. The Royal College of Nursing (RCN) and other bodies said that the NHS could save millions of pounds by investing in nurses to support people with conditions such as Parkinson’s disease, multiple sclerosis and epilepsy. But despite recent pledges by the Government to provide cancer patients with dedicated care, other specialist posts were vulnerable to cuts as the health service faces several years of financial restrain, the RCN said.

The union surveyed almost 300 specialist nurses working in 60 NHS organisations and charities and found that only 36 per cent believed that all those patients who needed specialist nursing received it. Of the 49 per cent who identified problems accessing specialist care, 69 per cent said it was because specialist nurse services were oversubscribed and could not take on new patients. More than a third said that they had seen cuts in services over the past 12 months, while 57 per cent are concerned that jobs will be threatened in the near future.

Specialist nurses work in areas including cancer care, diabetes and asthma, helping to keep people out of hospital by offering advice on medication and day-to-day living. The RCN estimates that £56 million a year could be saved on care for people with Parkinson’s through greater use of specialist nurses. A further £180 million could be saved by treating multiple sclerosis at home rather than in hospital, while £84 million could be shaved off the community health budgets if specialist nurses, rather than GPs, supported people with epilepsy.

Dr Peter Carter, general secretary of the RCN, told The Times that despite pledges from ministers to help to support more people in their homes and prevent unnecessary hospital visits, nursing posts were vulnerable when local health managers sought to cut costs. “Nurses realise that whoever wins the next election will be looking to make savings and to deliver more for less. The pressure on services with the economic downturn is going to go on for several years and things are likely to get worse before they get better,” he said. “Anecdotally, at the moment there is talk of local managers ‘reviewing skill mix’, which is just a euphemism for cutting staff.”

When the NHS was last in deficit in 2006, up to 23,000 nursing posts were lost, frozen or downgraded, in many cases depriving patients of specialist advice and care, Dr Carter said. “While the temptation may be to cut or downgrade specialist nursing roles, this would be a false economy which would only add to the growing cost of treating long-term conditions,” he added. About 17 million people in Britain are living with a chronic condition.

The RCN is calling for specialist posts to be supported by guaranteed funding, underwritten by the NHS, to ensure that short term cutbacks do not jeopardise posts in the long-term. Charities supporting the RCN’s policy recommendations include the Parkinson’s Disease Society, Macmillan Cancer Support, the Terrence Higgins Trust and the MS Society.

Norman Lamb, the Liberal Democrats’ health spokesman, commented yesterday: “Cuts are already taking place in marked contrast to the Prime Minister’s commitment for cancer patients to get personal support at home from specialist nurses. “Instead of chasing headlines, the Government needs to show how it intends to improve care.”

Meg Macarthur, senior policy officer at Breakthrough Breast Cancer, another of the charities supporting the call, said: “The threat to breast care and other specialist nurses is potentially devastating to patients. “We know that these nurses play a significant role in their care and recovery, offering an invaluable service throughout their treatment journey.”


Australia: Private emergency room opens as an alternative to long waits at government hospitals

Patients who pay $195 can jump the queues at hospital emergency departments when the nation's largest health fund opens its first standalone clinic today. Medibank is guaranteeing patients with minor injuries and illnesses will be treated within one hour at its first Rapid Care Clinic in Brisbane. The fund is confident it will have a Sydney facility operating in June.

The clinics, staffed by specialist emergency doctors, will deal with urgent but non-life-threatening medical conditions such as broken bones, sprain, cuts and minor burns, viruses, headaches, earaches and sore eyes.

Twenty thousand patients a month wait more than the clinically-recommended one hour to be treated in the clogged emergency departments in public hospitals.

Single mother Kylie Endycott, who spent five hours at Sydney's Royal Prince Alfred Hospital yesterday after her one-year-old son Beau had difficulty breathing, said the clinics were a great idea but thought fees could be altered for different family situations.

Almost 170,000 people using a public hospital emergency department leave in frustration every year because of their wait for treatment. Medibank hopes to fill this gap. "Anybody who experienced attending a busy hospital emergency room with a minor injury or sick child, tried to get an appointment with their GP at short notice or out-of hours, will understand the Rapid Care Clinic," Medibank managing director George Savvides said.

The clinics will be open 365 days a year from 8am to 9pm to anyone, although Medibank members pay just $150 for a consultation and face no charge for X-rays, plaster or stitches. The clinics will refer conditions such as chest pain, severe breathing difficulty, acute stomach pain, severe burns, loss of consciousness, head and neck injuries or pregnancy-related conditions to the nearest hospital.

Emergency medicine specialist Dr Peter Herron - who runs the Brisbane clinic, which has been open for a week and a half - has treated seven people including several fractures, a bee sting, a laceration and an earache.

Australian Medical Association president Dr Andrew Pesce said the clinics would help those who could afford them but was disappointed that underfunding of the public hospital system had made them necessary. He is concerned they will lead to further fragmentation of patient care. Those who use these clinics can't claim for their treatment from their health fund or Medicare and must pay the full cost out of their own pocket. The Health Services arm of the fund has run similar clinics for corporate clients for years.


Thursday, February 25, 2010

British government's Stafford Hospital caused ‘unimaginable suffering’

And the bureaucrats responsible skate, with full pockets and no move for them to face any charges. See here

Patients were routinely neglected or left “sobbing and humiliated” by staff at an NHS trust where at least 400 deaths have been linked to appalling care. An independent inquiry found that managers at Mid Staffordshire NHS Foundation Trust stopped providing safe care because they were preoccupied with government targets and cutting costs. The inquiry report, published yesterday by Robert Francis, QC, included proposals for tough new regulations that could lead to managers at failing NHS trusts being struck off.

Staff shortages at Stafford Hospital meant that patients went unwashed for weeks, were left without food or drink and were even unable to get to the lavatory. Some lay in soiled sheets that relatives had to take home to wash, others developed infections or had falls, occasionally fatal. Many staff did their best but the attitude of some nurses “left a lot to be desired”.

The report, which follows reviews by the Care Quality Commission and the Department of Health, said that “unimaginable” suffering had been caused. Regulators said last year that between 400 and 1,200 more patients than expected may have died at the hospital from 2005 to 2008.

Andy Burnham, the Health Secretary, said there could be “no excuses” for the failures and added that the board that presided over the scandal had been replaced. An undisclosed number of doctors and at least one nurse are being investigated by the General Medical Council and Nursing and Midwifery Council.

Mr Burnham said it was a “longstanding anomaly” that the NHS did not have a robust way of regulating managers or banning them from working, as it does with doctors or nurses. “We must end the situation where a senior NHS manager who has failed in one job can simply move to another elsewhere,” he added. “This is not acceptable to the public and not conducive to promoting accountability and high professional standards.” A system of professional accreditation for senior managers would be considered and the Mid Staffordshire trust might lose its foundation status.

Some NHS chief executives have received six-figure redundancy packages or moved to other trusts despite poor performance. Martin Yeates, the former chief executive at Mid Staffordshire, received pay rises that took his annual salary to £180,000, while standards at the trust deteriorated. The Liberal Democrats claimed that he had also received a payoff of more than £400,000 after stepping down last March, though Mr Burnham said he had received “no more than his contractual entitlement”.

The Care Quality Commission, the NHS regulator, said that the trust under its new management was now “safe to provide services”. But it still had concerns about staffing, patient welfare, the availability and suitability of equipment at the trust, and how it monitored and dealt with complaints. The inquiry made 18 recommendations for the trust and the wider health service, which the Government accepted in full. They include a new review of how regulators and regional health authorities monitor NHS hospitals and a report on “early-warning systems” to identify failing trusts.

But the families of those who died or suffered poor care branded the inquiry a “whitewash” and repeated calls for a full public investigation. The Conservatives accused ministers of trying to blame managers rather than taking responsibility for problems with national targets. Julie Bailey, who founded the victims’ campaign group Cure the NHS after her mother died at Stafford Hospital, said that the handling of the scandal was disgraceful and unacceptable. “It is time that the public were told the truth about the very large number of excess deaths in NHS care and the very large number of avoidable but deadly errors that occur every day.”

The NHS Confederation, which represents health trusts, said: “The responsibility for the way this hospital was run rests with its board, management and staff but, as the report says, the framework of targets, regulatory systems and policy priorities it worked within are also very important.”

Breast cancer victims face NHS ageism, campaigners claim

Age discrimination is rife in the care of breast cancer patients, campaigners claimed yesterday. Older women with the disease are up to 40 times less likely to be given surgery on the NHS than younger patients, research shows. They are also less likely to be diagnosed or receive standard treatments such as chemotherapy and radiotherapy.

The findings on surgery applies to women over the age of 80. When they do get surgery, it is 'significantly' less likely to be breast-conserving, with more women losing their entire breast during the operation. In addition, those over 70 are not routinely invited to breast screening, which can lead to an earlier diagnosis.

Daphne Cook was diagnosed with breast cancer aged 74, but her consultant said she did not need radiotherapy as being older might make it difficult for her to get to the hospital. Mrs Cook, now 87, a grandmother of seven and great-grandmother of six, eventually got the treatment after her daughter, a health worker, questioned the decision. 'I didn't understand the importance of radiotherapy treatment and I certainly wouldn't have pushed for it,' Mrs Cook said. She has since enjoyed more than ten years of good health.

Jeremy Hughes, chief executive of Breakthrough Breast Cancer, which carried out the research, said: 'Ten years ago women like Daphne were not being given a full range of treatment options and our research has found this is still the case today, despite many advances in breast cancer treatment. 'With nearly 12,000 women dying of breast cancer each year it is scandalous that all women are not receiving equal access to the treatments they need.'

The charity is calling for the Government to implement laws against ageism in the Health Service. Last year a survey of doctors caring for older patients found that almost half believed the NHS is 'institutionally ageist'.

The risk of breast cancer increases with age and a third of cases occur in women aged 70 and over. Nearly 46,000 were diagnosed with breast cancer last year, and experts predict this will rise to 57,000 a year by 2024 - an increase of 20 per cent.


"New-and-Improved ObamaCare!"

Yesterday, Barack Obama unveiled his latest, "new-and-improved" version of ObamaCare. Sadly for the American people, it's more of the same. According to the New York Times, the Obama proposal "sticks largely to the version passed by the Senate in December." This is therefore the same proposal that 58 percent of voters overwhelmingly oppose, as reported by Rasmussen Reports. A full 61 percent want Congress to simply start over.

As well they should. As Americans for Limited Government President Bill Wilson commented yesterday, "This is pretty much the same government-run health care proposal that the American people have already rejected." Indeed.

According to the Times, the White House claims the plan will cost some $950 billion atop the already swelling entitlement burden that cost $1.441 trillion in 2010 alone. It also proposes extending taxpayer-subsidized coverage to some 31 million Americans.

Unfortunately, the proposal was so vague, the Congressional Budget Office cannot even grade it properly. Writes CBO Director Douglas Elmendorf: “preparing a cost estimate requires very detailed specifications of numerous provisions, and the materials that were released this morning do not provide sufficient detail on all of the provisions.”

Rest assured, if this latest abomination is anything like the Senate version, as is reported, the true cost will be more like $2.5 trillion over ten years once fully implemented, as Senate Republicans have claimed of the bill they opposed in the Senate.

And, lest anyone doubt the veracity of that figure, such as Senator Al Franken or Talking Points Memo, just check with the Congressional Budget Office, as reported by the Weekly Standard in December: “The Democrats are irresponsibly and disingenuously claiming that the bill would cost $871 billion over 10 years. But that's not what the CBO says. Rather, the CBO says that $871 billion would be the costs from 2010 to 2019 for expansions in insurance coverage alone. But less than 2 percent of those ‘10-year costs’ would kick in before the fifth year of that span. In its real first 10 years (2014 to 2023), the CBO says that the bill would cost $1.8 trillion -- for insurance coverage expansions alone. Other parts of the bill would cost approximately $700 billion more, bringing the bill's full 10-year tab to approximately $2.5 trillion -- according to the CBO.”

Even Senator Max Baucus admitted that the bill would cost $2.5 trillion when he said, “health care reform, whether you use a ten-year number or when you start in 2010 or start in 2014, wherever you start at, so it is still either $1 trillion or it's $2.5 Trillion, depending on where you start…”

Although the White House in one breath claims the bill will be “deficit-neutral,” it is forced to admit that it will indeed be funded by taxpayers: “Millions of families will receive hundreds of billions of dollars in tax credits to help them pay for insurance in the new exchanges… The Act also provides financial assistance to reduce out-of-pocket costs for moderate and low-income eligible Americans.” Those are direct subsidies for health benefits; to call them tax credits is like calling Medicare or welfare a tax credit.

Obama’s claim to deficit-neutrality depends on the critical $483 billion in ten-year cuts to Medicare, Medicare Advantage, and Medicaid. But, a $210 billion “doc-fix” bill — kept apart from ObamaCare — that passed the House in November restores a good portion of those cuts, as reported by FOX News.

This is where the rationing comes in. As the government’s unfunded health care liabilities become increasingly unsustainable over the next several years, the growing costs of providing health benefits for everyone will assuredly eat into the benefits of providing coverage to seniors and the poor.

The greater the insurance pool, the more costly the “doc-fixes” and other subsidies will be in the future, and the less benefits there will be to go around.

This is therefore a bill that will ultimately ration care away from seniors, lower the quality of medical treatment, increase premiums, drive the American people off of their private health options and onto government-run ObamaCare, and bankrupt the Treasury with unsustainable costs. And one that Congressional Democrats intend to pass by simply eliminating the filibuster and weakening the nation’s two-party system, as ALG News has previously reported.

If one needed any more proof of the phoniness of this White House, look no further than February 25th’s health care summit, where Obama hopes to create a theater of bipartisanship, all the while hocking the same old, wretched Congressional bill that barely survived the town halls.

Of course, it’s a theater of the absurd. And the meeting is a stage for Obama to pretend that it is not. The bill is to be rammed through regardless of the summit; with or without Republican support. This “new-and-improved” proposal, its much ballyhooed summit, and the pretense of honest, faithful negotiations have more in common with a reprehensible, Orwellian, Third World banana republic than a fully mature citizen republic. This is not change, it is a fraud.


ObamaCare at Ramming Speed

The White House shows it has no interest in compromise

A mere three days before President Obama's supposedly bipartisan health-care summit, the White House yesterday released a new blueprint that Democrats say they will ram through Congress with or without Republican support. So after election defeats in Virginia, New Jersey and even Massachusetts, and amid overwhelming public opposition, Democrats have decided to give the voters what they don't want anyway.

Ah, the glory of "progressive" governance and democratic consent.

"The President's Proposal," as the 11-page White House document is headlined, is in one sense a notable achievement: It manages to take the worst of both the House and Senate bills and combine them into something more destructive. It includes more taxes, more subsidies and even less cost control than the Senate bill. And it purports to fix the special-interest favors in the Senate bill not by eliminating them—but by expanding them to everyone.

The bill's one new inspiration is a powerful federal board that would regulate premiums in the individual insurance market. In all 50 states, insurers are already required to justify premium increases to insurance commissioners, who generally have the power to give a regulatory go-ahead, or not. But their primary concern is actuarial soundness and capital standards, making sure that companies have enough cash to pay claims.

The White House wants to create another layer of review that will be able to reject any rate increase that is "unreasonable or unjustified." Any insurer deemed guilty of such an infraction by this new bureaucracy "must lower premiums, provide rebates, or take other actions to make premiums affordable." In other words, de facto price controls.

Insurance premiums are rising too fast; therefore, premium increases should be illegal. Q.E.D. The result of this rate-setting board will be less competition in the individual market, as insurers flee expensive states or regions, or even a cascade of bankruptcies if premiums are frozen and the cost of the care they are expected to cover continues to rise. For all the Dickensian outrage about profiteering by WellPoint and other companies, insurance is a low-margin business even for health care, and at least 85 cents of the average premium dollar, usually more, is devoted to actual health services.

Price controls are always the first resort of national health care—i.e., Medicare's administered prices for doctors and hospitals. This new White House gambit is merely a preview of ObamaCare's inevitable planned medical economy, which will reduce choice and quality.

The coercive flavor that animates this exercise is best captured in the section that purports to accept the Senate's "grandfather clause" allowing people who like their current health plan to keep it. Except that "The President's Proposal adds certain consumer protections to these 'grandfathered' plans. Within months of legislation being enacted, it requires plans . . . prohibits . . . mandates . . . requires . . . the President's Proposal adds new protections that prohibit . . . ban . . . and prohibit . . . The President's Proposal requires . . ." After all of these dictates, no "grandfathered" plan will exist.

Meanwhile, the new White House plan further vitiates the remnants of cost-control that remained in the House and Senate bills. Now the highly vaunted excise tax on high-cost insurance plans won't kick in until 2018, whereas it would have started in 2013 in the Senate bill, and this tax will only apply to coverage that costs more than $27,500.

Very few plans ever reach that threshold, and sure enough, this is the same $60 billion deal the White House cut in December with union leaders who have negotiated very costly benefits. Now it is extended to all to avoid the taint of political favoritism.

While the White House claims to eliminate the "Cornhusker Kickback," the Medicaid bribe that bought Nebraska Senator Ben Nelson's vote, political appearances are deceiving. As with the union payoff, what the White House really does is broaden the same to all states, with all new Medicaid spending through 2017 and 90% after 2020 transferred to the federal balance sheet. Governors will love this ruse, but national taxpayers will pay more.

And more again, because the White House has adopted the House's firehose insurance subsidies. People earning up to 400% of the poverty line—or about $96,000 for a family of four in 2016—will qualify for government help, and, naturally, this new entitlement is designed to expand over time.

The Administration also claims to have discarded the House's 5.4-percentage-point surtax on joint-filers earning more than $1 million a year, but it sneaks it back in by expanding the Senate's expansion of the 2.9% Medicare payroll tax to joint income above $250,000. The White House would now apply that tax for the first time to income from "interest, dividends, annuities, royalties and rents," details to come.

The larger political message of this new proposal is that Mr. Obama and Democrats have no intention of compromising on an incremental reform, or of listening to Republican, or any other, ideas on health care. They want what they want, and they're going to play by Chicago Rules and try to dragoon it into law on a narrow partisan vote via Congressional rules that have never been used for such a major change in national policy. If you want to know why Democratic Washington is "ungovernable," this is it.


A man with a plan

Obama seems to surmise that the American people have forgotten that he already had a plan and that it looked almost exactly like his "new" one

In his speech to a joint-session of Congress on September 9, President Obama introduced what he called "my plan" for "health care reform." The next day, the Washington Post noted that "the president for the first time Wednesday embraced a set of ideas as 'my plan.'" About the same time, Obama authored a health-care piece in which he referred to "my plan" eight separate times (nine, if you include a set-aside quote).

Now, fast-forward about six months, to just three days before the made-for-TV "health summit," and, lo and behold, the president released -- as if for the first time -- a health-care plan. Is he kidding?

Sadly, he's not. Instead, the president seems to surmise that the American people have forgotten that he already had a plan and that it looked almost exactly like...well, this one. The colossal increases in federal spending remain (last projected by the Congressional Budget Office (CBO) to total $2.5 trillion in the bill's real first decade). The cuts to Medicare Advantage (MA) remain (last projected by the CBO to tally $21,000 per MA beneficiary in the bill's real first decade). And most of the political cronyism apparently remains -- like the "Gator Aid" deal, which would exempt seniors in South Florida from those MA cuts. Also back for an encore are the tax increases that would funnel (at last count) $1.0 trillion (in the bill's real first dozen years) from American taxpayers, through the federal government, to private insurers -- alongside the mandate that Americans buy insurers' product.

To be fair, there are a couple of new wrinkles. In exchange for these generous perks, insurers would have to go through another level of review before implementing any price-increases they might have planned. State insurance regulators, such as the ones in California (hardly a conservative, free-market bastion) who didn't object to Anthem's rate increases, would now be subject to overrule by the federal government. The U.S. Department of Health and Human Services (HHS), the department that (according to the Washington Post and 60 Minutes) already manages to lose $60 billion a year in taxpayer money to Medicare fraud -- compared to $8 billion in combined annual profits for America's ten largest private insurers -- would come to the rescue. The costs to insurers from this extra bureaucratic hurdle would, of course, be passed on in higher premiums (and would probably even be factored into the rate-increase requests) -- except for when HHS refuses a rate-increase request, in which case the insurers would simply do what the government does when it wants to cut health costs: ration care.

Another new wrinkle would be to increase Medicare taxes. For the first time ever, a Medicare tax would be levied on the income of certain people (those folks who annoy Obama by making over $200,000) from investments, dividends, annuities, rentals, and royalties -- which the President lumps together and calls "unearned income." But this tax-revenue would not be used to pay for Medicare, which desperately needs to be put on more solid financial footing. Instead, this new Medicare tax would pay for -- you guessed it: the president's plan, which would cut Medicare.

When the president first mentioned what he called "my plan" for "health care reform," it was in the wake of the August voter uprisings. He spoke of it in the context of his broader message to Congress, which was that there was no need to let a little thing like voter dissatisfaction get in the way of a perfectly good plan. This week's nearly identical plan comes in the wake of Scott Brown's victory in Massachusetts. So disconnected from political currents does the President seem, one wonders whether this same plan (with a new wrinkle or two) will also be re-released -- and presented as brand-new -- in the wake of the November elections.


ALG Defends Newfoundland Premier Williams’ Right to “Best Possible Health Care”

Calls on Congress to Protect American Patients from “Government Takeover of the Nation’s Health System”

Americans for Limited Government President Bill Wilson today defended Newfoundland Premier Danny Williams’ decision earlier this month to receive heart surgery in America rather than in Canada, saying “Canada’s socialized, government-run system is of such low quality not even the Premier of one of Canada’s provinces wants to risk his own health there.” Williams yesterday said that “I did not sign away my right to get the best possible health care for myself when I entered politics,” describing the decision as “my heart, my choice and my health.”

Wilson said the episode was proof that “America’s system has generated a quality of medical treatment that is unparalleled in the entire world.” “Now, Barack Obama wants us to suffer the same type of low-quality care Premier Danny Williams was able to avoid by coming to the U.S.,” Wilson added, renewing his call for members of Congress to reject the Administration’s latest proposal.

“Premier Williams has a right to the best quality of health care in the world, and so do the American people, who are being force-fed a government-run system that will ration care, reduce quality, and increase costs,” Wilson said.

Yesterday, Wilson condemned Obama’s proposal as “more of the same: a government takeover of the nation’s entire health system,” calling it a “mishmash” of the House and Senate versions “with the same $2.5 trillion price tag.” “This is pretty much the same government-run health care proposal that the American people have already rejected. It’s just like the House and Senate versions that have already passed that will cost some $2.5 trillion over ten years once fully implemented,” Wilson said.

As reported by the New York Times, the Obama proposal “sticks largely to the version passed by the Senate in December.” According to Rasmussen Reports, 61 percent of voters say they want Congress to start over on any health care legislation. 58 percent oppose the bill in its current form, which only 39 percent support.