Durbin: Lincoln Has (Maybe) Told Reid   [NRO Staff]

From First Read:

After reading reports that Democratic Sen. Blanche Lincoln (D-AR) has already told Majority Leader Harry Reid (D-NV) how she'll vote tomorrow on issue of whether to bring the healthcare bill to the floor, Lincoln's office was quick respond.

"No other Senator speaks for Senator Lincoln," Lincoln's spokeswoman told NBC in an email. "She is still reviewing the bill."

Earlier in the day, the Senate's No. 2 Democrat Dick Durbin told several reporters that Lincoln had already made her voting intentions known to Reid.

"She's told Sen. Reid," Durbin said without revealing the substance of the conversation.

A few hours later, Durbin too joined in with clarifying remarks. In a written statement, he said, "In a conversation with reporters earlier today, some of my remarks regarding Sen. Lincoln were unclear and have been incorrectly interpreted.

11/20 04:13 PM Share

Nelson's A Yes   [NRO Staff]

From CNN:

Nebraska Sen. Ben Nelson announced Friday that he would be supporting the motion to proceed that would allow the Senate to begin debate on the Democrats' health care reform legislation.

"Throughout my Senate career I have consistently rejected efforts to obstruct," he said in a statement. "That's what the vote on the motion to proceed is all about. It is not for or against the new Senate health care bill released Wednesday. It is only to begin debate and an opportunity to make improvements. If you don't like a bill why block your own opportunity to amend it?"

11/20 12:37 PM Share

Vitter: Reid Has 60 For The MTP   [Robert Costa]

From The Hill:

Senate Majority Leader Harry Reid (D-Nev.) will get exactly the 60 votes he needs to pass healthcare reform legislation through its first test tomorrow, Sen. David Vitter (R-La.) said Friday.

Reid on Thursday scheduled a cloture vote on a motion to proceed yesterday. The vote is the first crucial test the healthcare bill will face in the Senate.

"My guess, that's all it is, is that it would be exactly 60 to exactly 40 but we'll see," Vitter said on MSNBC this morning. "I think he probably does [have enough votes] for this first pivotal vote."

11/20 12:33 PM Share

How Will We Pay for Health-Care Reform? New Taxes!   [NRO Staff]

From Heritage:

Below is a list of the tax increases Congress and the Administration have proposed to finance health care reform. This list includes taxes in the bill passed by the House of Representatives, the bill the Senate is currently debating, and other taxes mentioned as a possible way to pay for health care reform.

• An income surtax on taxpayers earning more than $500,000 a year,[1]
• An excise tax on high-cost "Cadillac" health insurance plans that cost more than $8,500 a year for individuals or $21,000 for families,[2]
• An excise tax on medical devices such as wheelchairs, breast pumps, and syringes used by diabetics for insulin injections,[3]
• A cap on the exclusion of employer-provided health insurance without offsetting tax cuts,[4]
• A limit on itemized deductions for taxpayers with a top income tax rate greater than 28 percent,[5]
• A windfall profits tax on health insurance companies,[6]
• A value-added tax, which would tax the value added to a product at each stage of production,[7]
• An increase in the Medicare portion of the payroll tax to 3.4 percent for incomes great than $200,000 a year ($250,000 for married filers),[8]
• An excise tax on sugar-sweetened beverages including non-diet soda and sports drinks,[9]
• Higher taxes on alcoholic beverages including beer, wine, and spirits,[10]
• A tax on individuals without acceptable health care coverage of up to 2.5 percent of their adjusted gross income,[11]
• A limit on contributions to health savings accounts,[12]
• An 8 percent tax on all wages paid by employers that do not provide their employees health insurance that satisfies the requirements defined by the Secretary of Health and Human Services,[13]
• A limit on contributions to flexible spending arrangements,[14]
• Elimination of the deduction for expenses associated with Medicare Part D subsidies,[15]
• An increase in taxes on international businesses,[16]
• Elimination of the tax credits paper companies take for biofuels they create in their production process—the so-called "Black Liquor credit,"[17]
• Fees on insured and self-insured health plans,[18]
• A limit or repeal of the itemized deduction for medical expenses,[19]
• A limit on the Qualified Medical Expense definition,[20]
• An increase in the payroll taxes on students,[21]
• An extension of the Medicare payroll tax to all state and local government employees,[22]
• An increase in taxes on hospitals,[23]
• An increase in the estate tax,[24]
• Increased efforts to close the mythical "tax gap,"[25]
• A 5 percent tax on cosmetic surgery and similar procedures such as Botox treatments, tummy tucks, and face lifts,[26]
• A tax on drug companies,[27]
• An increase in the corporate tax on providers of health insurance,[28] and
• A $500,000 deduction limitation for the compensation paid by health insurance companies to their officers, employees, and directors.[29]

More to Come

The full list of taxes proposed to pay for health care reform is provided because taxes currently left out of the Senate or House bills could reappear at any point.

11/20 12:20 PM Share

The Audacity of Senator Reid’s Health-Care Bill   [Sally Pipes]

During the 2008 election campaign, Barack Obama’s book The Audacity of Hope was often mentioned. A year after his election to the presidency, Obama continues to push on his number-one domestic-policy issue — affordable, accessible, high-quality health care for all Americans. Under his vision of achieving universal coverage while reducing health-care costs, he touts a plan that he says would cost about $900 billion over 10 years and be deficit-neutral. His goal — a bill on his desk by the end of this year.

With Nancy Pelosi’s House bill having passed on November 7 by a vote of 220 to 215 with only one Republican in support, we are all now waiting with bated breath to see what will happen to Sen. Harry Reid’s 2,074-page bill, which was introduced on November 18 at a cost estimated by the CBO to be about $849 billion over 10 years. It is expected that the cloture vote will take place on Saturday evening. Senator Reid needs 60 votes from senators to proceed with the debate on the bill. I am not sure if he has the votes or not.

However, it is very clear that the president, Speaker Pelosi, and Senator Reid want to pass a bill in early 2010 at the latest. Whatever the final bill looks like, it is going to cost much more than $1 trillion and will result in increased taxes for all Americans. Ultimately, we will all face rationed care and long waiting lists like those found in Canada, where the government is the virtual sole provider of health care.

What is astounding is that these liberal politicians are not listening to the American people. Polls show that about 82 percent of Americans like their health care and 56 percent do not favor the plans released from both houses.

The executive committees of the AMA and AARP both endorsed the House bill, which includes a public option, a new tax on the wealthy, controls on insurance companies, and individual and employer mandates. The members of these organizations did not have an opportunity to vote on the endorsements. We are now seeing many doctors protesting the move by quitting the AMA, and several thousand seniors have turned in their AARP membership cards.

Americans need to continue being loud and clear in articulating to their members of Congress their displeasure with the pending plans to take over the $2.3 trillion health-care industry. The president’s book may be entitled The Audacity of Hope, but his health-care plan amounts to “the audacity of politicians” who do not want to follow the wishes of their constituents.

— Sally Pipes is president and CEO of the Pacific Research Institute. Her latest book is The Top Ten Myths of American Health Care: A Citizen’s Guide.

11/20 11:05 AM Share

Republicans Can't Afford to Parrot the Democrats' False Numbers   [Jeffrey H. Anderson]

So far, Republicans are using the numbers that the Democrats want them to use for the taxes and Medicare cuts imposed by Senator Reid's new bill.

The Democrats want everyone to quote figures from 2010 to 2019, even though only 1 percent of the bill's "ten year" costs would hit in the first four years of that period, while 99 percent would hit in the last six.

The bill's real first ten years are from 2014 to 2023, during which time the Congressional Budget Office says the $1.8-trillion bill would raise Americans' taxes by $892 billion, would funnel $802 billion out of Medicare, and — if it didn't follow through on its pledge to cut doctors' payments under Medicare by 23 percent in 2011 and never raise them back up — would increase deficits by $286 billion.

These are the figures that accurately reflect the bills' costs, taxes, Medicare cuts, and deficit-spending. Yet, so far, most Republicans have seemingly been content to cite the figures for taxes and Medicare cuts that the Democrats want them to cite — figures that (whether by careful design or not) come in below the threshold figure of $500 billion.

Republicans should be talking about the bill's $800 billion increases in taxes, the $800 billion it would siphon from Medicare to spend elsewhere, and the fact that it would either cut doctors' payments by $431 billion or increase deficits by nearly $300 billion — one or the other.  They shouldn't be cutting those figures in half.

11/20 10:07 AM Share

Reid's Stacked-Deck Gamble   [Tevi Troy]

Senator Reid's health-care bill will cost $848 billion (at least) and impose a host of new and increased taxes, including one on plastic surgery. Fox Business's Brian Sullivan has a helpful entry this morning on what the bill does and does not do.

At this point, though, the specifics take a back seat to the political drama. Despite the fact that Reid has a significant Democratic majority in the Senate, he is currently working to make sure that he can keep 60 votes together in order to get the bill to the Senate floor via a motion to proceed.

The fact that this is so hard — despite the fact that there are only 40 Republicans — is because this bill, like the House bill passed a few weeks ago, has plenty in it to offend a variety of consituencies. Unions, for example, dislike the tax on cadillac, or high-value, insurance plans. The Washington Times's Stephen Dinan and David M. Dickson quote Teamster president James Hoffa, Jr on the subject as follows: "Any claims that it affects only 'Cadillac' plans and thus the wealthy is misleading. This tax will fall on one-third of Americans in ten years."

Dinan and Dickson also explain how the Reid bill will bring back the marriage penalty, which President Bush campaigned against and, with Congress, largely eliminated.

Despite the bill's problems, Senator Reid is focused on that key vote tomorrow night. My guess is that he wins, largely because he has 60 members in his caucus — the legislative equivalent of a stacked deck. I have to assume he would only proceed on such a high-stakes bet if he knew he could win.

Reid has miscalulated before, though, as we saw with the recent doc fix that failed to get a majority in the Senate, let alone the 60 it needed. Still, the safer bet is that the motion to proceed succeeds, which opens up a whole new round of politicking, amendments, and more test votes.

Even if the bill does pass at the end of the day, it is not going to solve the biggest problem faced by our health system, which is runaway costs — 2.5 trillion dollars and rising faster than inflation. If the Democrats succeed, we will likely see a reduction of the number of uninsured but no improvement on the cost side, which means we would just have to reopen the debate again as the new programs proved to be unsustainable. The only good news in that scenario is that we will probably have more Republican votes to count on at that point. In other words, the health-care debate is not near the end nor even the beginning of the end; it may only be, as Churchill once said, the end of the beginning.

11/20 09:44 AM Share

Sebelius: Digging Deeper   [Hanns Kuttner]

The breast-cancer screening guideline has put Secretary of Health and Human Services Kathleen Sebelius in the midst of the most contentious debate of her tenure thus far. It looks like she's decide to throw the U.S.  Preventive Services Task Force under the bus.

In an interview with NPR's Mara Liasson, Sebelius said the House-passed health bill gave her, not the task force, the authority to decide what health insurance will and will not cover. That isn't quite true. The statutory language says that if the task force recommends some service, health insurance has to cover it. The HHS secretary can decide to cover something that is not recommended (e.g., routine mammography for women ages 40 to 49), but she could not decide to take away coverage of something the task force recommended. (Senator Reid's plan is similar.)

The much more important point is that the HHS secretary would have plenary power to decide what health insurance must cover. Not just preventive services, but all services. That is the essence of political health insurance and what distinguishes the system of private health insurance we have now from a system of political health insurance. Some of the questions that will be politicized are predictable: Should health plans be required to cover contraceptives and assisted fertility treatments? Others will be pure interest-group politics: Should every health plan be required to cover the services provided by some medical subspecialty or some new surgical procedure or device that the FDA has just approved?

Sebelius's position on the task-force recommendation is, "Trust me, not them." The task force had science on their side, but what will the politicians have on their side?

—  Hanns Kuttner is a visiting fellow at Hudson Institute. 

11/20 09:28 AM Share

Thursday, November 19, 2009

When Harry Met Saturday   [Kathryn Jean Lopez]

WASHINGTON (Reuters) - Democrats in the U.S. Senate geared up for a fierce battle over a new healthcare reform plan on Thursday as Republicans condemned the bill's price tag and tax hikes before the first crucial test vote on Saturday.

Senate Democratic leader Harry Reid's 2,074-page blueprint for overhauling the $2.5 trillion healthcare system sparked what promises to be a long and bitter debate over President Barack Obama's top domestic priority.

The Senate will vote on Saturday night on whether to move to debate on the legislation — the first key procedural hurdle for the Senate plan and one that requires 60 votes from the 100-member body.

"The finish line is in sight," Reid said. "I'm confident we'll cross it soon."

11/19 11:17 PM Share

A $4.9 Trillion Spending Increase   [James C. Capretta]

The health-care plan unveiled yesterday by Senate Majority Leader Harry Reid has some in the mainstream media gushing because, on paper at least, the Congressional Budget Office (CBO) says it will reduce the federal budget deficit by about $130 billion over ten years, and more in the second decade.

But the supposed fiscal prudence of the Reid plan is a complete mirage, for a number of reasons.

For starters, the Reid plan assumes that Medicare physician fees will get cut by about 20 percent beginning in 2011 and then remain very restrained indefinitely. Virtually no one in Congress believes that will happen, nor do they want it to. Indeed, just a couple of weeks ago, Senator Reid himself tried to overturn the planned cuts in physician fees, at a cost of nearly $250 billion over a decade. It does not matter to taxpayers if Senate Democrats try to pass their health-care agenda in one or two bills. The total cost will be the same. With the so-called “doc fix” included in the tally, the Reid plan would increase the federal budget deficit by about $100 billion over ten years, not reduce it.

Keep reading this post . . .

11/19 07:23 PM Share

Harry Reid and the Dirty Dozen   [Grace-Marie Turner]

The 2,074-page health reform bill that Senate Majority Leader Harry Reid unveiled last night is a maze of complexity and duplicity. It spends $848 billion over ten years to provide new subsidies for health coverage, increases taxes by $486 billion, and allegedly cuts spending by $491 billion. Yet it still leaves 24 million people without insurance.

The new taxes never will be enough to pay for Reid's reform plan because Congress does not have the will to make the cuts to Medicare and Medicaid he uses to bring down the bill's advertised cost.

The American people continue to tell pollsters that they believe the health-reform bills that Congress is considering would increase the deficit, drive up health costs, reduce the quality of care, and increase government bureaucracy.

They are correct. Here are a dozen reasons why:

Keep reading this post . . .

11/19 07:17 PM Share

Only the Sick Need Apply   [Benjamin Zycher]

A friend pointed me to the following language in the CBO analysis (page 9) of the Reid bill: "CBO's assessment is that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that were somewhat higher than the average premiums for the private plans in the exchanges" (emphasis added). This presumably is because the public plan would have to be self-financing, just like any old insurance company, depending (I assume) only on some seed money from the rest of the federal government.

Can they be serious? Put aside the absurdity of the notion that a public plan would operate just like Blue Cross or one of the others. (After all, the whole purpose of the public plan is to transfer wealth among constituencies in ways that market competition precludes.) Instead, consider the implications of the assertion that premiums in the public plan would be higher than those for the average of the private plans. That means automatically that only the sickest patients would opt for the public plan, even if guaranteed-issue/community-rating regulations were applied to the private plans. And the public plan is supposed to operate like a business, covering its costs? Please.

— Benjamin Zycher is a senior fellow at the Pacific Research Institute.

11/19 05:29 PM Share

The Best Defense Is a Good Offense   [Jeffrey H. Anderson]

As my piece published this morning by the New York Post details, only 1 percent of the costs of Senator Reid's new bill would kick in until the fifth year of its alleged "first ten years." Starting in 2014, 99 percent of the bill's costs would hit, meaning that its real first ten years are from 2014 to 2023. 

In that real first decade, the CBO reports that the bill would cost $1.8 trillion, raise Americans' taxes by $892 billion, siphon $802 billion out of Medicare, and — if doctors' pay under Medicare isn't really cut by 23 percent and never raised back up — would increase our deficits by $286 billion. 

On NRO today, Tevi Troy and I suggest a Republican alternative — one that would lower premiums, bend the cost-curve down, reduce the number of uninsured by half, and still be deficit-neutral (without having to cut doctors' fees to make that deficit-neutral claim). Our proposal wouldn't raise taxes, would divert hundreds of billions of dollars from already barely-solvent Medicare, and wouldn't dramatically increase the federal government's power and control over our health-care system. 

By providing a blueprint for real reform — reform that doesn't mess with anyone's employer-provided insurance or its tax status —Republicans could more starkly portray the indefensible nature of the Democrats' already unpopular bills. Americans are thirsting for an alternative to seeing their taxes, premiums, and deficits increase, while their quality of care and liberty decrease. Senate Republicans should give it to them — and now.

11/19 03:09 PM Share

Senator Reid's Track Meet   [Hanns Kuttner]

I've decided to put off the 2,074-page Senate health plan and instead start with the Congressional Budget Office (CBO) 36-page analysis.

CBO's Table 1, "Estimate of the Effects on the Deficit . . ."  provides the backing for Senator Reid's assertion that his proposal will reduce the deficit by $130 billion over the ten fiscal years from 2010 through 2019.

The string of numbers to the left of $130 billion, the year-by-year impact, shows how Senator Reid plans to win this race. He has two runners, spending and savings. He wants savings to win by $130 billion. But looking at their speed, spending is a faster runner. Savings can still win if it starts first. Senator Reid plans to use two starter's pistols: one for savings, one for spending. Savings starts first, and only when savings hits its stride does spending start. Summing up the numbers on the CBO table, savings will be $146 billion ahead of spending through 2014, when eligibility for new health-insurance subsidies begins. Then spending hits its stride and wears down the disadvantage of a late start, ending the ten-year race only $130 billion behind. 

While Senator Reid gets his talking point for describing a ten-year race, the legislation signs us up for the marathon, and unfortunately, in that long a race, spending can win.

—  Hanns Kuttner is a visiting fellow at Hudson Institute. 

11/19 12:56 PM Share

Reid's Mandate for Federally Subsidized Abortion   [Kathryn Jean Lopez]

Senate Majority Harry Reid (D.-Nev.) late Wednesday published the final text of a Senate health care bill that would mandate federally subsidized abortion.

The mandate appears on page 120 of the 2,074-page bill under the seemingly innocuous heading: ‘Assured Availability of Varied Coverage Through Exchanges.”

Specifically, the provision requires that the secretary of Health and Human Services make certain that at least one health insurance plan offered in government-regulated insurance exchanges where people will be able to purchase health insurance using government subsidies must provide coverage of abortion. The secretary also must make certain that at least one plan available in the exchanges not cover abortions.

More here.

11/19 12:51 PM Share

Death Panel in the U.K.   [Greg Pollowitz]

From BBC News:

Liver cancer drug 'too expensive'

A drug that can prolong the lives of patients with advanced liver cancer has been rejected for use in the NHS in England, Wales and Northern Ireland.

The National Institute for Health and Clinical Excellence (NICE) said the cost of Nexavar - about £3,000 a month - was "simply too high".

But Macmillan Cancer Support said the decision was "a scandal".

More than 3,000 people are diagnosed with liver cancer every year in the UK and their prognosis is generally poor.

Only about 20% of patients are alive one year after diagnosis, dropping to just 5% after five years.

11/19 11:38 AM Share

Racial Preferences in the Reid Health-Care Bill   [Roger Clegg]

If you search the Reid health-care bill for the words “diversity,” “minority” and “minorities,” “underrepresented” and “underserved,” and “racial” and “ethnic,” you'll find all kinds of stuff, much of it disturbing, such as using the government's grantmaking authority to pressure medical schools into affirmative-action admissions policies. (The Washington Times had a front-page story on objections by a majority of U.S. Commission on Civil Rights to various racial-preference provisions like this in an earlier version of the health-care bill; Linda Chavez devoted a column to the issue early on; and I had also noted this problem on The Corner.)  If this post sounds familiar, btw, it’s because I also noted the same problems with Pelosicare last week. Doesn’t Harry Reid read The Corner?

11/19 09:59 AM Share

Wednesday, November 18, 2009

Abortion in the Senate   [Kathryn Jean Lopez]

Doug Johnson from the National Right to Life Committee on the Senate bill:

Senate Majority Leader Harry Reid (D-Nv.) has rejected the bipartisan Stupak-Pitts Amendment and has substituted completely unacceptable language that would result in coverage of abortion on demand in two big new federal government programs.

Reid seeks to cover elective abortions in two big new federal health programs, but tries to conceal that unpopular reality with layers of contrived definitions and hollow bookkeeping requirements. 

Rep. Lois Capps (D-Ca.), who has a 100% pro-abortion voting record, said in a press release following release of the Reid language:  "It appears that their approach closely mirrors my language which was originally included in the House bill."  The Capps language referred to was opposed by NRLC and other pro-life organizations and was deleted by the House by a vote of 240-194 on November 7, as 64 Democrats (one fourth of all House Democrats), along with 176 Republicans, voted to replace it with the Stupak-Pitts Amendment.

The Stupak-Pitts Amendment would prevent federal subsidies for abortion by applying the principles of longstanding federal laws such as the Hyde Amendment to the new programs created by the health care legislation.  Those principles prohibit both direct funding of abortion procedures, and subsidies for plans that cover elective abortions, in existing federal programs such as Medicaid, the Federal Employees Health Benefits Program, and the military.  Regrettably but predictably, Reid rejected the bipartisan Stupak-Pitts language.  Instead, Reid has sought to please the militant minority that demands funding of abortion through federal programs, even though substantial majorities of Americans believe that abortion should be excluded from government-funded and government-sponsored health programs.  

The Reid bill establishes a big new federal health insurance program, the public option (although now referred to in Reid's bill as the "community health insurance option").  The bill authorizes (on page 118) the federal Secretary of Health and Human Services to require coverage of any and all abortions throughout the public option program.  This would be federal government funding of abortion, no matter how hard they try to disguise it.

In addition, the bill creates new tax-supported subsidies to purchase private health plans that will cover abortion on demand.  

National Right to Life will continue to fight for the Stupak-Pitts Amendment, and to oppose the stubborn attempts of congressional Democratic leaders to establish new federal government programs that will fund coverage of elective abortions.

11/18 10:08 PM Share

Harry Reid's Bill   [Kathryn Jean Lopez]

Can be read here.

11/18 09:47 PM Share

Is Government-Driven 'Cost Containment' Our Only Option?   [James C. Capretta]

President Obama continues to argue that it is crucial for Congress to pass a health-care bill because it will help slow the pace of rising costs. Perhaps the president and his aides actually believe that to be the case. But, in recent days, it has become abundantly clear that virtually no one else does.

Today, in a column in the Wall Street Journal, the dean of the Harvard Medical School, Jeffrey Flier, says the bills under consideration in Congress are not health reform bills at all, but just access expansion proposals. As he puts it, “I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it.”

Flier is just the latest commentator to sound the alarm on costs. Robert Samuelson and David Broder made similar points in columns published in recent days in the Washington Post, as did David Leonhardt in the New York Times.

So what do Obama apologists say in response to this chorus of criticism?

Keep reading this post . . .

11/18 06:14 PM Share

Sebelius Dissembling on Breast-Cancer Screening Recommendation   [Hanns Kuttner]

The heat on the recommendation from the U.S. Preventive Services Task Force has brought Secretary of Health and Human Services Kathleen Sebelius into the fray with a statement issued today.

She makes this point about the task force: "They do not set federal policy and they don't determine what services are covered by the federal government." 

That's true, but she omits the fact that she works for a president who endorsed the House-passed health-reform bill which would make the task force's recommendations the standards that the federal government would enforce. (See Section 222 of the House-passed bill, "Essential Benefits Package Defined.")

I wonder if Secretary Sebelius would also be surprised to find out that her department pays for the task force's work.

—  Hanns Kuttner is a visiting fellow at Hudson Institute.

11/18 05:09 PM Share

Mammograms   [Kathryn Jean Lopez]

Carrie, I had an exchange with Dr. David Gratzer yesterday about the news, which to me seemed like an obvious caution against health frenzies — in this case, the previous insistence women get mammograms early and often.

He agreed and added:

there is another point, too.  The practice of medicine isn't always clear-cut.  We did many mammograms because it seemed right; now the evidence suggests otherwise.  When I was in residency the treatment for depressed Manics was Prozac (or her sister drugs) — turns out that that intervention is not only highly problematic but is actually bested by placebo (according to a landmark New England Journal of Medicine paper).

For those on the left, this sort of thing is unsettling — it undermines their claim that medicine will be better if only we appointed government officials to help guide decisions (like Obama's proposed IMAC); for those on the right, this sort of thing is unsettling because it shows how challenging it will be to have better transparency and consumer empowerment.
 
Health policy, it turns out, can be interesting.

11/18 02:05 PM Share

Newt + 50: Slow Down   [Tevi Troy]

Newt Gingrich has put together a letter signed by 50 Republican leaders (including yours truly) urging President Obama, Speaker Pelosi, and Majority Leader Reid to slow things down, open up the process, and not break the bank on the Democrats' health-care overhaul. It's worth a read.

11/18 08:53 AM Share

Tuesday, November 17, 2009

Americans Like Obamacare About as Much as Hillarycare   [Jeffrey H. Anderson]

Here are some highlights from the new Washington Post/ABC News poll released today. This poll is generally among the most liberal-leaning, and yet there would still be plenty to be concerned about if one were a swing-state Democratic senator flirting with voting for Obamacare.

According to the poll, not only do more people disapprove, rather than approve, of the way President Obama is handling health care and the federal deficit, but more than 40 percent strongly disapprove of his performance on these issues (41 and 43 percent, respectively, compared to only 28 and 19 percent who strongly approve). 

The number of respondents whose “impression” of President Obama is not only unfavorable but strongly so has tripled since January 16 (from 9 to 27 percent).

By a margin of almost two-to-one (37 percent to 19 percent), respondents think that the quality of their health care would get worse, rather than better, under Obamacare, and this gap has widened by 4 percent since August. The poll also shows responses to an essentially identical question about President Clinton’s health-care agenda shortly before its defeat in 1994. At that time, people expected the quality of their health care to get worse by 38 to 20 percent — nearly identical numbers to today.

Furthermore, by a three-to-one margin, respondents with health insurance expect it to get worse, rather than better, under Obamacare (39 to 13 percent). By a margin of 52 to 11 percent, they expect their health-care costs to increase. And by a margin of 56 to 20 percent, they expect the overall costs of health care nationwide to increase. 

With overwhelming expectations of lower-quality care, worse health insurance, and higher health costs, the news isn’t good for those who want to give the federal government dramatically more power and control over our health-care system.

11/17 05:02 PM Share

Government Dictates in Action   [Carrie Lukas]

Many have speculated about how a government commission charged with determining what should be considered necessary medical care would operate. As the Washington Post reports today, newly offered recommendations about breast exams from the U.S. Preventive Services Task Force gives us a window into what this future might look like:

Women in their 40s should stop routinely having annual mammograms and older women should cut back to one scheduled exam every other year, an influential federal task force has concluded, challenging the use of one of the most common medical tests.

In its first reevaluation of breast cancer screening since 2002, the independent government-appointed panel recommended the changes, citing evidence that the potential harm to women having annual exams beginning at age 40 outweighs the benefit.

The article quotes experts on both side of the equation: Some welcome these recommendations, while others call them “crazy” and warn that they potentially undermine the progress that has been made in reducing the number of deaths associated with this type of cancer. 

Who's right? The article details some of the factors the panel considered: They weighed the number of false positives and unnecessary procedures against the number of lives saved from early dectection and treatment. But who makes the final calculation? Who decides that it is better to increase your odds of missing a diagnosis by a little bit than running the risk of a false-positive?

It seems clear that individuals are the only people who can make that determination for themselves. Certainly, there are some who would rather avoid uncomfortable, and even painful, procedures even if that slightly increased their risks of dying from the disease. And individuals should be aware of the real problems and dangers associated with preventative measures so they can make an informed decision about what's best for them.

And of course there is the matter of cost. While the panel claims that cost wasn't a factor in their recommendation, if it wasn't this time with this particular panel, it certainly would be once government was the nation's primary insurer. And costs have to be taken into consideration: We can't all get daily body scans just to make sure that nothing unwanted is growing. But again, who should determine how much you are willing to spend on preventative care? Clearly, it should be an individual decision: We should make decisions as we shop for insurance policies that offer a variety of coverage options. 

Of course, there will be some who cannot afford health insurance on their own and, if there is going to be a federal role in providing insurance, it should be targeted at these truly needy individuals. Ideally, the government should still try to give those in need as much freedom to choose as possible (better to provide them with vouchers or payment support so they can purchase insurance on their own than forcing them into a one-size-fits-all government plan). Yes, this means that some will get more care than others. Some will be able to afford more generous insurance plans than the rest of us. But that will be the case in any system we adopt: The wealthy will always be able to use their money to escape the system and to receive better service and care.

I hope that this panel's recommendation receives a lot of media attention. This is really the central issue in this health-care debate. It's not about coverage, and it's not about costs. It's about control. Who should make these determinations, the individual or the state? I think I know which way the American people would vote. 

11/17 01:54 PM Share

Political Health Insurance   [Hanns Kuttner]

The new statement from the U.S. Preventive Services Task Force on breast-cancer screening lead the news today.

The U.S. Preventive Services Task Force gets a special role in the politicization of health insurance in the House-passed health-reform bill. Section 222, "Essential Benefits Package Defined," says all health plans in America must cover services that get a grade of "A" or "B" from the task force. The task force now gives routine screening mammography for women aged 40 to 49 a "C" grade. ("The USPFTF recommends against routinely providing the service.") 

The push for prevention in the House bill was offered as a positive example of what turning over the definition of health insurance to the federal government would produce. The conflicting response to the task force's new recommendation shows that even this best example can have a downside. Today, a recommendation from the task force is just that: a recommendation. Millions of employers and thousands of insurance plans will decide what will be done with it. It will be a broad debate, with many decisions made in many places with many possible results, results that can go one way and then another way if the parties later decide they don't like where they first land. With political health insurance, the task force will have the force of law.  

Yesterday's task force release is a foretaste of things to come should political health insurance further displace private actors in deciding what is health insurance. 

—  Hanns Kuttner is a visiting fellow at Hudson Institute.

11/17 09:47 AM Share

What a Difference a Month Makes    [Kathryn Jean Lopez]

Last month, the Washington Post announced: “Public option gains support; CLEAR MAJORITY NOW BACKS PLAN.” But this week they're having to report the results of their own new poll: Support for the public option is at its lowest since August.

11/17 07:07 AM Share

Monday, November 16, 2009

Gas on the Entitlement Fire   [James C. Capretta]

President Obama has argued all year that a primary reason to enact a version of his health-care plan is to “bend the cost-curve” that has been burdening government and household budgets for years. Of course, the president has not shown that he has a credible plan to address rising health-care costs. But that hasn’t stopped him or his aides from talking as if they did.

Robert Samuelson has been a skeptic of Obamacare’s supposed cost-control potential from the beginning, but his column in today’s Washington Post summarizes his case with particularly effective force. It doesn’t hurt that all the evidence is on Samuelson’s side in this debate.

Samuelson’s critique is particularly important because the nation’s long-term prosperity is already threatened by rising entitlement costs. For starters, we are on the cusp of an unprecedented demographic shift. Over the course of the next quarter century, the population age 65 and older will increase from 39 million to 76 million people. This flood of new enrollees in Social Security and Medicare will push the costs of these programs up very dramatically. And runaway per capita health-care costs will exacerbate the problem substantially. According to the Congressional Budget Office (CBO), between 1975 and 2007, per capita Medicare spending rose, on average, 2.3 percentage points faster than per capita GDP growth. Medicaid’s per capita spending growth rate was not far behind. CBO expects both programs to continue growing at an accelerated pace for the foreseeable future. With an aging population and rising health costs, the long-term budget outlook is already challenging, to put it mildly. CBO projects that federal spending on Social Security, Medicare and Medicaid will rise from 10.1 percent of GDP in 2009 to 15.7 percent in 2035. That jump — 5.6 percent of GDP in twenty-five years — would be equivalent to adding another Social Security program or Defense Department to the federal budget without any additional revenue to pay for it.

And so, faced with a mountain of unfunded entitlement obligations, what would Obamacare do? Pile on more. According to the Census Bureau, in 2008, there were 127 million Americans under the age of 65 living in households with incomes between 100 and 400 percent of the federal poverty line. The House and Senate health-care bills would essentially promise all of them either free insurance through Medicaid or caps on their insurance premiums based on their incomes. This would constitute the single largest entitlement spending expansion since the Great Society programs of the 1960s. CBO expects the federal spending associated with these new open-ended health entitlement commitments to reach about $200 billion annually by 2019 and escalate at about 8 percent annually thereafter.

Meanwhile, the measures being touted as potential health-care cost-control steps are, by and large, nothing more than minor adjustments to existing provider payment arrangements in Medicare, and sometimes only tests of new payment approaches. For instance, the administration has been pushing a provision that would limit payments to hospitals that have high rates of preventable readmissions. The House-passed bill includes this change, but at a savings of only $1.6 billion in 2019. And even this level of savings is highly questionable, given the tendency of Congress to water down “payment reforms” over time. Indeed, it’s easy to imagine Congress rolling this payment change back at the first word that some hospitals are keeping the sickest patients out of their beds to avoid risking readmission payment “adjustments.” But even if it and other tweaks in the bills survive, they wouldn’t amount to much and certainly wouldn’t offset the cost pressures unleashed by extending new entitlement promises to a vast portion of America’s middle class.

And that’s not just the conclusion of critics like Samuelson. That’s also what the Chief Actuary for the Centers for Medicare and Medicaid Services (CMS) found in his review of the House-passed bill, released on Friday. As he put it, the provisions aimed at slowing the pace of rising costs would, by and large, have a “relatively small savings impact.” Consequently, instead of “bending the curve,” overall national health expenditures would rise by nearly $300 billion over a decade.

The only cost-cutting items in the House bill that the Chief Actuary said would really pinch costs are the across-the-board Medicare payment rate cuts applied to hospitals, nursing homes, and others. Of course, these kinds of arbitrary payment changes have been tried many times before and have never worked to really ease cost pressures. But, on paper at least, they appear to reduce federal spending. However, the Chief Actuary made it clear in his review that even though he listed the savings on his tables, he doesn’t think things will work out that way in the real world. As he put it, the cuts would push payment rates so low over time that some institutions wouldn’t be able to survive if they continued to serve Medicare patients. The threat of reduced access to care would be reason enough for Congress to reverse course and increase the payment rates at a later date. (Of course, that’s exactly what Congress is planning to do this year with physician fees, now scheduled to get cut 21 percent in January based on a previous congressional payment-rate policy that has now run amok.)

For a while, some Democrats liked to deflect calls for entitlement reform by suggesting that what the country really needs is a health-care plan that slows the pace of rising costs. Indeed, it has become almost a mantra among some Obama apologists to say “health reform is entitlement reform.”

But the bills moving through Congress thoroughly discredit that contention. There’s no reform in these bills. They are entitlement expansions, plain and simple.

Indeed, the Obama administration likes to suggest it has a plan to painlessly root out unnecessary health spending without harming patient care. In truth, there is no such plan, and there never will be. The federal government has no capacity to drive greater efficiency in the diverse and complex health sector. When cost pressures mount, as they surely would if Obamacare passes, the federal response will be what it has always been in the past: price controls and arbitrary caps. All Americans will pay the cost with inferior quality of care and access restrictions. The proponents of the current bills are betting that, by the time this reality has sunk in, it will be too late to wean the public off of another vast and irreversible entitlement.

11/16 06:47 PM Share

The Pro-Life Movement: More Than Just the Catholic Bishops   [William Saunders]

According to the abortion lobby the Stupak-Pitts amendment was a ploy by the hierarchy of the Catholic Church to obstruct the rights of women.

A press release by the Center for Reproductive Rights went so far as to claim, “The U.S. Conference of Catholic Bishops has apparently been given veto power over legislation intended to provide affordable healthcare coverage to all Americans, including women.”

Pretending the pro-life movement is reducible to the Catholic clergy and that they are trying to take over the U.S. government is a move straight from the play-book of Planned Parenthood’s founder, Margaret Sanger.

Keep reading this post . . .

11/16 05:40 PM Share

Bending the Cost-Curve and the Truth   [Jeffrey H. Anderson]

After months of hearing President Obama talk about the need to "bend the curve" on rising health costs, the Office of the Chief Actuary at the Centers for Medicare and Medicaid Services (CMS) has issued a thorough review of the House health bill. Its verdict? The bill would in fact bend the cost-curve. It would bend it upward.

In July, the Washington Post wrote, "From the start, President Obama has been firm. . . . He told us flatly that he won't accept a bill that doesn't 'bend the curve' on rising health-care costs." Furthermore, "Any reform, he has said, must be 'deficit-neutral.'"

Just over three months later, the president pushed, implored, and cajoled House Democrats to pass a health bill that, by 2020, would increase deficits by well over $100 billion (in the absence of a fanciful 21 percent pay cut to doctors under Medicare that no one expects to materialize) and which, according to the government's own CMS analysis, would increase nationwide health-care costs by over $500 billion in relation to what those costs would be under current law — and by $289 billion even if doctors' pay is slashed.

Keep in mind that these aren't merely increases in government spending that would be offset by decreases in private spending. Rather, over the next decade, the total costs of all health care in America — private and public combined — would rise by over $500 billion (and by $289 billion even if doctors' pay is cut) under the House bill in relation to current law. Against his word, the president has championed a bill that would raise health costs and deficits — and would raise them substantially.

No wonder that in today's Washington Post, Robert Samuelson writes, "The disconnect between what President Obama says and what he's doing is so glaring that most people could not abide it. The president, his advisers and allies have no trouble. But reconciling blatantly contradictory objectives requires them to engage in willful self-deception, public dishonesty, or both."

11/16 03:58 PM Share

People Catch On   [NRO Staff]

From the AP:

AP Poll: Fine print in health care prompts worries . . .

When poll questions were framed broadly, the answers seemed to indicate ample support for Obama's goals. When required trade-offs were brought into the equation, opinions shifted — sometimes dramatically.

11/16 02:44 PM Share

Take a Lesson from Hillarycare   [NRO Staff]

From Grace-Marie Turner:

Polling data from 1994 shows that voters punished elected officials at the polls for supporting the Clinton health reform plan, not for failing to pass it. Opposition to the Clinton legislation grew as voters realized they would pay more for poorer quality health care in a system controlled by government. As a result, failure to pass the plan was greeted by voters with relief, not disappointment.

In fact, exit polls after the 1994 elections found that 58 percent of voters said that Congress' decision to put off health care reform was "good because more time is needed for discussion." Only 31 percent said the delay was "bad because the country needs reform now."

The numbers are similar today, with 61 percent saying they want President Obama and congressional Democrats to keep trying until they are able to make a deal with the Republicans on a health care bill — even if it means the debate continues into next year, according to a Nov. 11 AP-GfK Roper Public Affairs & Media poll. Only 31 percent want Democrats to go ahead and pass a health reform bill this year without bipartisan support. . . .

Rank-and-file Democrats face a big decision: Will they listen to public opposition and understand the true story of the 1993-94 health care debate? Or will they follow their leaders who are trying to rewrite history in order to pass a health reform plan that the public believes will cost more and deliver poorer quality health care?

11/16 02:19 PM Share

Deficit Disconnect   [Tevi Troy]

Bob Samuelson has a pretty devastating takedown of the president’s proposed health overhaul in today’s Washington Post.  He makes two points, in particular, that bear repeating. First is the point I made on Friday that the president’s spending policies, on health care as well as in other areas, contradict what Samuelson calls his “cautionary message” on deficits. As Samuelson puts it, “The disconnect between what President Obama says and what he's doing is so glaring that most people could not abide it.”

The second point is that while the current health proposals would reduce the number of the uninsured, they will not bring down costs and therefore do not constitute real health reform. Samuelson cites a number of studies finding “that various congressional plans would increase national health spending compared with the effect of no legislation.” I fear that if the Democratic effort passes, we will need to reopen this issue again in a very short time to address the cost issue in a serious way. And the second time will be harder, as the benefits we have to give in terms of expanded coverage will have already been doled out. In other words, there will be no spoonful of sugar to make the cost medicine go down.  

This benefits-first approach is in fact the opposite of reform. As Samuelson concludes: “If new spending commitments worsen some future budget or financial crisis, Obama's proposal certainly won't qualify as "reform," as the president and The Post (also in its news columns) call it. It's more like malpractice: a self-inflicted wound.”

11/16 11:40 AM Share

Tort-Reform Demonstration Projects -- Enough Already    [Jason Fodeman]

In Mr. Obama’s primetime speech to the Joint Sessions of Congress, he called for “demonstration projects” to “test” the benefits of malpractice reform. At the time, many contended our country is way beyond the need for demonstration projects and needs national comprehensive tort reform. Unpredictable, exorbitant jury payouts have resulted in lawyers flooding the system with baseless lawsuits. This increases medical-malpractice premiums, a cost which is ultimately passed on to the patient, and forces many doctors, especially those in high-risk fields, to retire or relocate. The threat of lawsuits also compels physicians to order expensive, often unnecessary tests, procedures, and referrals simply to thwart lawsuits. Despite substantial evidence malpractice reform could quell these problems, except of course from the trial bar and their shills in Congress, Mr. Obama demanded proof.

Mr. Obama should be careful what he wishes for. He asked for a tort-reform success story and he just got it in the form of a new report by the Missouri Department of Insurance, Financial Institutions, & Professional Registration. The report demonstrates the efficacy of tort reform. In 2005, the state of Missouri was a gold mine for the trial bar. Venue shopping, where lawyers try cases in friendly courts irrespective of place of injury, was rampant. Courts could also force defendants to pay 100 percent of judgments even if their negligence contributed only 1 percent to the injury.

Keep reading this post . . .

11/16 10:43 AM Share

How Quick Would Health Insurance Change?   [John Hood]

The Kansas City Star has a piece today on a sometimes-overlooked element of the congressional debate about health-care legislation: the timing.

Should a bill become law late this year or early next year, some of the key tax and spending provisions won’t go into effect until 2013 — which means, by the way, that highly unpopular future provisions might not survive a year or two of prospective public reaction (remember Dan Rostenkowski’s noisy little stroll down the street?) But that doesn’t mean that the legislation would have no immediate effects:

While the exact language isn’t known, experts expect the final measure to place new regulations on insurance companies almost immediately — while postponing for three years the requirement that everyone have insurance.

That’s a recipe, they say, for higher costs for you and your employer, perhaps as early as 2010.

“You aren’t going to have to throw everything out the window,” said Ed Haislmaier of the Heritage Foundation, a conservative think tank in Washington. “But there’s a lot that can be done prior to 2013 on the regulatory side that will have the effect of driving up costs.”

A lobbying group called America’s Health Insurance Plans made the same point in a letter to House members before the Nov. 7 approval of a health reform plan.

“These reforms would force the reopening of existing contracts and increase the cost of coverage for American families by promising new benefits that cannot be supported by current premium levels,” the lobbying group wrote.

11/16 10:28 AM Share

Sunday, November 15, 2009

Cost Surge   [Michael Graham]

From today's Boston Globe:
 
Finally a surge President Obama can support: "Health Care Costs Surge for Small Business."
 
Premiums up 20-40% in one year for MA small biz under ObamaCare 1.0.

11/15 05:35 PM Share