Liability Update/Health Care Focus - September 9, 2009
Administration hits the "reset" button on health care reform
by Donna Baver Rovito, Editor, "Liability Update/Health Care Focus"
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Make sure to tune in to the President's speech tonight - don't worry, you won't be ABLE to miss it. (I think they've commandeered every network other than Cartoon Network and the Tractor Channel - and it's entirely possible that they'll have Bugs Bunny shilling for the public option!)
Sit with your finger on the "talk" button, so you can call your members of Congress immediately afterward, to reiterate your position that the federal government doesn't belong in your doctor's office with you.
Yes, I think I can state pretty safely that we won't hear anything new - repackaged, possibly - but not NEW, which means that none of our objections should change AFTER the speech.
YOU ARE THE REASON for tonight's desperate Joint Session of Congress. They heard you. They didn't like what you said, but THEY HEARD YOU.
Tell them WHY you don't agree with their plans. There's a lot of ammunition in the stories that follow. And after you call them tonight, call them again tomorrow. And write. And email.
Keep it up - it's WORKING.....
Contents and Links:
Obama's Crisis: Credibility
Plan in Congress proposes fines up to $3,800 for Americans who don't buy health insurance
5. Baucus Aims For Health Agreement In Advance Of Obama Speech Tonight (multiple sources)
The Wall Street Journal
The Los Angeles Times
Kaiser Health News
The New York Times
The Wall Street Journal
The New York Times
6. Democratic Leaders Say Reform Bill Is Progressing (multiple sources)
The Associated Press/Boston Globe
Coalition to Protect Patients' Rights
Health Alert The “R” Word
A Bipartisan Plan to Wreck the System
Five Major Faults with the Health Care Bills
10 Things I Hate About Health-Care Reform
Like your health plan? Read this
Obama has it exactly backwards on health costs
Thirty-Nine Fallacies About Health Care
10 Surprising Facts about American Health Care http://www.ncpa.org/pub/ba649
Why the U.S. Ranks Low on WHO's Health-Care Study
Doctors Offer Senators Their Opinion on Health Care Reform
Free Our Health Care Now
A.M.A. Endorses a Health Care Overhaul
Conservatives for Patients' Rights
Pew Research Center
Pew Research Center
By a 46% to 39% margin, more Americans generally oppose than favor the health care proposals being considered in Congress
Obama's Crisis: Credibility
By Michael Gerson
Wednesday, September 9, 2009
President Jimmy Carter once sent a note to an adviser extolling the importance of crisis to leadership. "When a president has authority to act unilaterally (as in a crisis), his leadership can be exerted. Otherwise, compromise, delay and confusion are more likely. It's our system. I like it."
Politicians, like the rest of us, are often victims of their wishes. Carter was eventually smacked by the waves of crisis he sought to ride.
But encouraging a sense of crisis is a traditional tool of executive leadership. And using a joint session of Congress to address a single domestic issue is the most dramatic expression of this approach.
Carter did it effectively in April 1977. He spoke of the energy crisis as "the moral equivalent of war." Energy resources were "simply running out." (Carter's CIA predicted worldwide oil shortages by the mid-1980s.) America needed to "cope with a crisis that otherwise would overwhelm us."
The speech had immediate influence. The share of Americans who viewed the energy crisis as a serious problem jumped nine points, to 54 percent. One congressional staffer enthused: "It's damn near unpatriotic to oppose the president right now."
But the effect was temporary. Carter's energy-reform bill passed the House, but the Democratic Senate resisted on key issues, resulting in an impasse. Eventually, the energy crisis faded in comparison to unsought emergencies such as the Soviet invasion of Afghanistan and the taking of American hostages in Iran.
And so Barack Obama's address to Congress on health care, at a minimum, must answer the question: What is the crisis? When individuals can't get needed health care, it is certainly a crisis for them. This, Obama might argue, creates moral responsibilities for the rest of us to help. But this would argue for a more incremental approach, adding coverage for the working poor instead of remaking the American health system for everyone.
The overwhelming majority of Americans, by the definition of denied care, do not face a health-care crisis. Most polls show that about 80 percent are "very" or "somewhat" satisfied with their health plans. Those in the greatest need are often the most satisfied -- 90 percent of insured Americans who suffered serious illnesses are satisfied with their health care. According to a study published by the Cato Institute, a very small percentage -- even of the uninsured -- are "dissatisfied or highly dissatisfied" with the health care they get in other ways. On health care, the American public brims with satisfaction -- though most are concerned about rising costs.
So perhaps this is the crisis: rising costs that will eventually overwhelm state and federal budgets and consume more and more of individual paychecks. But this is precisely the area where current Democratic approaches are least credible. Obama abandoned his pledge to reduce the government's health costs long ago; now he aims only at budget neutrality. But every pending health-reform bill in Congress would increase both short- and long-term deficits, failing even on Obama's modified terms. Americans get the joke. While Obama has made cost control a centerpiece of his public message, only about 20 percent of Americans, in one poll, believe Obama will keep his promise not to increase the deficit with health reform.
The main challenge for Obama is this: Announcing a more credible, specific approach to controlling health-care costs will not solve his political problem. Aggressive cost-control options -- squeezing Medicare fees even further, abandoning fee-for-service in Medicare entirely, restricting "unnecessary" procedures through an all-powerful medical board, putting more cost burdens on individuals -- tend to be frightening or difficult. Major tax increases would lessen the need for drastic cost reductions. But the obvious source of revenue -- eliminating the health insurance deduction for employers -- would open a new front of controversy.
America has an ongoing crisis -- an economic crisis of rising unemployment and negative economic growth. Obama clearly believed the economic emergency would give him the opportunity to do anything on the progressive agenda that he wished. Actually, it gave him the burden to do one thing well: respond to the economic emergency. Insofar as health reform is seen as complicating this task -- particularly by the addition of massive, inflationary debt -- the narrative of crisis will continue to work against Obama instead of for him.
It is all very Carter-like. Obama presents a political priority as a national crisis. But the economy, Afghanistan and Iran may be crises enough for anyone.
((SPEAKING of credibility....))
Wednesday, September 2, 2009
I was surprised to learn from President (now Surgeon-in-Chief) Obama that surgeons make $30,000 for amputating a diabetic foot. Either he is giving us a raise or he again is just woefully ignorant of the facts.
The Medicare reimbursement for amputation in our area is about $650. This includes preoperative work-up, the surgery and all postoperative visits for 90 days afterward.
As an orthopedic foot and ankle specialist in Western Pennsylvania for 23 years, I can say that most of these patients for whom we care are long-term patients and even friends. Amputation is a painful but sometimes necessary last resort to save a patient's life or to restore a patient's ability to walk with a prosthesis.
Once again, our president is pointing a finger at someone else (doctors or insurance companies) to divert attention away from the government's poor track record with health care. For the record, Medicare will not pay for custom diabetic shoes with custom inserts ($400 to $500) that may prevent the foot ulcers that lead to amputation, but it will pay for a prosthetic leg costing thousands after an amputation.
Like the majority of physicians and Americans, I am concerned about the president's "health care reform," especially when he seems to have so little grasp of the reality behind health care in America.
Dr. Michael W. Bowman
The writer is the former president of the American Association of Orthopaedic Foot and Ankle Surgeons.
Plan in Congress proposes fines up to $3,800 for Americans who don't buy health insurance
THE ASSOCIATED PRESS
As Obama talked strategy with Democratic leaders at the White House, the one idea that most appeals to his party's liberal base lost ground in Congress. Prospects for a government-run plan to compete with private insurers sank as a leading moderate Democrat, Sen. Max Baucus of Montana, said he could no longer support the idea.
The fast-moving developments put Obama in a box. As a candidate, he opposed fines to force individuals to buy health insurance, and he supported setting up a public insurance plan. On Tuesday, fellow Democrats publicly begged to differ on both ideas.
Democratic congressional leaders put on a bold front as they left the White House after their meeting with the president.
"We're re-energized; we're ready to do health care reform," said Senate Majority Leader Harry Reid of Nevada.
House Speaker Nancy Pelosi, D-Calif., insisted the public plan is still politically viable. "I believe that a public option will be essential to our passing a bill in the House of Representatives," she said.
After a month of contentious forums, Americans were seeking specifics from the president in his speech to a joint session of Congress on Wednesday night. So were his fellow Democrats, divided on how best to solve the problem of the nation's nearly 50 million uninsured.
The latest proposal: a ten-year, $900-billion bipartisan compromise that Baucus, who heads the influential Finance Committee, was trying to broker. It would guarantee coverage for nearly all Americans, regardless of medical problems.
But the Baucus plan also includes the fines that Obama has rejected. In what appeared to be a sign of tension, White House spokesman Robert Gibbs pointedly noted that the administration had not received a copy of the plan before it leaked to lobbyists and news media Tuesday.
The Baucus plan would require insurers to take all applicants, regardless of age or health. But smokers could be charged higher premiums. And 60-year-olds could be charged five times as much for a policy as 20-year-olds.
Baucus said Tuesday he's trying to get agreement from a small group of bipartisan negotiators in advance of Obama's speech. "Time is running out very quickly," he said. "I made that very clear to the group." ((WHY is time running out? What he should have said is that Obama's political window of opportunity is running out....))
Some experts consider the $900-billion price tag a relative bargain because the country now spends about $2.5 trillion a year on health care. But it would require hefty fees on insurers, drug companies and others in the health care industry to help pay for it.
Just as auto coverage is now mandatory in nearly all states, Baucus would require that all Americans get health insurance once the system is overhauled to make premiums more stable and affordable. Penalties for failing to do so would start at $750 a year for individuals and $1,500 for families. Households making more than three times the federal poverty level — about $66,000 for a family of four — would face the maximum fines. For families, it would be $3,800, and for individuals, $950.
Baucus would offer tax credits to help pay premiums for households making up to three times the poverty level, and for small employers. Upper middle-class households making between three and four times the poverty level would not have to pay more than 13 percent of their income for health insurance. People working for companies that offer coverage could avoid the fines by signing up.
Nonetheless, the fines pose a dilemma for Obama. As a candidate, the president campaigned hard against making health insurance a requirement, and fining people for not getting it.
"Punishing families who can't afford health care to begin with just doesn't make sense," he said during his party's primaries. At the time, he proposed mandatory insurance only for children.
White House officials have since backed away somewhat from Obama's opposition to mandated coverage for all, but there's no indication that Obama would support fines.
One idea that Obama championed during and since the campaign — a government insurance option — appeared to be sinking fast.
House Majority Leader Steny Hoyer, D-Md., told reporters a Medicare-like plan for middle-class Americans and their families isn't an essential part of legislation for him. Hoyer's comments came shortly after a key Democratic moderate said he could no longer back a bill that includes a new government plan.
That left liberals in a quandary. They've drawn a line, saying they won't vote for legislation if it doesn't include a public plan to compete with private insurance companies and force them to lower costs.
Rep. Mike Ross, D-Ark., who once supported a public option, said Tuesday that after hearing from constituents during the August recess, he's changed his mind.
"If House leadership presents a final bill that contains a government-run public option, I will oppose it," Ross said.
Democrats are considering a fallback: using the public plan as a last resort if after a few years the insurance industry has failed to curb costs. That approach is also being pushed by Sen. Olympia Snowe, R-Maine, a moderate whose support could be critical to any health legislation.Snowe said Tuesday that Obama's been open to her fallback idea.
"He's been receptive, recognizing that there's difficulties with the public option," Snowe said. Republicans have cast it as a government take-over.
Baucus is calling for nonprofit co-ops to compete in the marketplace instead of a public plan.An 18-page summary of the Baucus proposal was obtained by The Associated Press. The complex plan would make dozens of changes in the health care system, many of them contentious. For example, it includes new fees on insurers, drug companies, medical device manufacturers and clinical labs.
People working for major employers would probably not see big changes. The plan is geared to helping those who now have the hardest time getting and keeping coverage: the self-employed and small business owners
Wednesday, September 9, 2009
Kaiser Daily Health Policy Report:
Check back on Kaiser Health News for the latest headlines
5. Baucus Aims For Health Agreement In Advance Of Obama Speech Tonight
[Sep 09, 2009]
Democrats are promising to send President Obama a health reform plan this year as Senate Finance Committee Chairman Max Baucus continues to try to get key Republicans on board with a new proposal.
The Wall Street Journal on what is likely to be included in the plan: "The broad aim of the overhaul is to expand insurance coverage to most of the 46 million Americans who currently lack it, and to reorient the health system so medical costs increase at a slower rate." The goals may seem at odds. "Covering most of the nation's uninsured is estimated to cost hundreds of billions of dollars over the next decade. But advocates of an overhaul say getting these people insured puts the system on a path to lower costs by reducing their expensive use of emergency rooms and helping them stay healthy in the first place. Any plan would increase the government's involvement in the health system, one of the most contentious elements of the debates" (Adamy, 9/9). Politico quotes Baucus: "Time is running out very quickly, and I suspect I will be making some decisions very quickly," Baucus said. 'On the one hand, I want to work to get a solution, but I want to make clear that we aren't going to dally." Politico adds that Baucus' plan "does not include the public insurance option ... but does include health care cooperatives. He also supports a new tax on health insurers who provide high-cost plans and a new fee on insurance companies to pay for reform, designed to raise $6 billion per year starting in 2010" (Brown and Frates, 9/8).
The Los Angeles Times: "Like the other major Democratic proposals, Baucus' plan would prohibit insurers from denying coverage to people with preexisting medical conditions, a cornerstone of the changes being pushed by the president and his congressional allies. It would also require nearly all Americans to get insurance" (Levey and Hook, 9/9). CQ Politics on the cooperatives in Baucus' plan: "The Baucus proposal would cost less than $900 billion over 10 years, at least $100 billion less than the overhaul bills approved by other congressional committees. It would be fully paid for over that period through a variety of fees on stakeholders -- such as $6 billion a year from health insurers, and $2.3 billion a year from pharmaceutical companies -- as well as a tax on insurance companies that offer the most expensive health insurance plans and cuts to Medicare" (9/8).
Kaiser Health News has the particulars on Baucus' plan -- which he calls a "framework" (9/8).
The New York Times: "Mr. Baucus said he asked the lawmakers -- two Democrats and three Republicans -- for their reaction to his proposal by Wednesday morning, saying he hoped to reach an agreement before Mr. Obama's scheduled speech to a joint session of Congress on Wednesday night. Senator Olympia J. Snowe of Maine, the Republican seen as most likely to join in a Baucus plan, sounded generally positive in her initial reaction to his proposal. But Ms. Snowe said she did not want to be rushed into making a decision about it and had a few concerns outstanding" (Hulse and Pear, 9/8).
Roll Call: "Other negotiators (Sens. Chuck) Grassley and (Mike) Enzi declined to endorse or reject the proposed policy framework Baucus floated over the weekend," but one "Senate Democratic source" said the two told Baucus "they would have a hard time signing on to it" (Pierce and Drucker, 9/9).
The Wall Street Journal: "If the group cannot come to a bipartisan agreement within a week or so, many expect Mr. Baucus to push ahead with his plan even if it has little or no Republican support. ... (Snowe) called the Baucus plan 'a work in progress,' but she added, 'It has many promising elements.' Among the changes Ms. Snowe said she would like to see were a provision addressing medical malpractice lawsuits, action to relieve the Medicaid burden on the states, and an assurance that national insurance plans, not just state-based ones, be available through a proposed insurance 'exchange'" (Bendavid, 9/8).
The New York Times in an analysis piece: "Getting a bill through the Senate remains a big challenge, but even there, the Obama administration has a reasonable chance of corralling the 60 votes it would need to pass legislation more or less on its terms" (Stolberg, 9/8).
6. Democratic Leaders Say Reform Bill Is Progressing
[Sep 09, 2009]Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi are calling for Democratic unity on health care overhaul after a meeting with President Obama yesterday that they say "re-energized" them. CQ Politics: Reid said, "'Even before the August recess, 80 percent of health care is already done. It's ... the 20 percent where we still had to work on,' Reid said. 'In our conversations today, we think we're up to 90 percent. ... We have 10 percent that we need to work on, and we can do that'" (Bettelheim and Epstein, 9/8). Differences remain, however, Roll Call reports: "Divisions started at the top, with Speaker Nancy Pelosi (D-Calif.) once again declaring a public insurance option 'essential' to the success of a broader package hours after her No. 2, House Majority Leader Steny Hoyer (D-Md.), suggested it might need to be cut loose to garner enough votes to pass the chamber. Pelosi also appeared to open the door a crack to a 'trigger' that would use the public insurance option only as a fallback if private insurance companies fail to hold down costs and improve quality. ... Despite the apparent fissures, House Democratic leaders made a show of unity after an early evening huddle Tuesday, claiming broad consensus on the need for reform and 85 percent on the substance. 'There's no division,' Pelosi said. 'We all support a public option.'" Many Democrats and all Republicans have called the public option a non-starter (Newmyer and Dennis, 9/9). But The Hill reports that the tide is turning against the public option in advance of Obama's speech. "Reid, who plans to play a bigger role in the healthcare debate this fall, took a noncommittal stance on the issue Tuesday. He delivered a speech on the Senate floor that left the need for a government-run program unmentioned. At a press conference at the White House following his and Pelosi's meeting with Obama, Reid said the Senate would try to pass a public option 'or something like a public option' but stopped far short of the impassioned plea Pelosi delivered at his side" (Soraghan, Bolton and Youngman, 9/8). Pelosi, though, may be turning the public option into her trump card, Politico reports: "Pelosi's leverage in her perpetual push-pull with Reid has been boosted by a rebellion among pro-public-option progressives ... who say they are tired of being shortchanged by the White House. ... Democratic insiders say Pelosi is intent on harnessing that liberal power play as the only way to keep the public option alive, even if it's in a watered-down form" (Thrush and O'Connor, 9/9). The Associated Press/Boston Globe on the public option: "Many Democrats want to do away with private insurance and replace it with something resembling Medicare coverage for all, but that's not politically feasible. Offering the choice of a government insurance plan was a compromise within the Democratic Party. But Republicans are adamantly opposed, saying it's the first step to a government takeover of health care. Defeating the government plan also is the top priority for the insurance industry, and hospitals, doctors and drugmakers have their own concerns about it. Unions strongly support the public option, and so does a majority of the public in opinion polls" (Alonso-Zaldivar, 9/9). CongressDaily: "Reid said outside the White House that Congress was 're-energized' by a summer recess during which many members were pummeled for their support of Obama's ambitious effort. Pelosi said the break was 'pretty exciting,' stating that 'in the month of August, our members heard from their constituents' and 'they bring back the benefit of that thinking'" (House and Condon, 9/9). Reid also talked in restrained terms about using budget reconciliation to pass a reform bill, Roll Call reports in a second story: " 'We can get it through that way, but it's not as robust a bill,' Reid said of the reconciliation option in comments to Roll Call" (Koffler, 9/8).
COALITION STATEMENT: Former Head of AMA Voices Doctors’ Concerns before Obama Speech Tonight
September 09, 2009
WASHINGTON - In response to the American Medical Association (AMA) reiterating its support of President Obama's healthcare plan, the former president of the AMA and current spokesman for the Coalition to Protect Patients' Rights, Dr. Donald Palmisano, today issued a statement outlining what the Coalition hopes to hear from the President tonight.
"Just hours before President Obama's historic speech on healthcare reform, we recognize areas that could use improvement in our health system, but remain concerned that the federal government will try to over-treat the symptoms," Dr. Palmisano said.
"In the end, this debate on heath system reform will come down to the willingness of policymakers - including the President - to do what can be done to improve our healthcare system. Either they will come together and work on those issues that are supported by the majority of Americans, like expanding access to healthcare and slowing the cost curve; or policymakers will allow partisanship and acrimony to stymie progress and continue the unsustainable status quo," Dr. Palmisano said.
In his statement, Dr. Palmisano outlined five specific points that will lead to beneficial health system reform:
A government-controlled public option should be taken off the table because it will lead to long waiting lines to see a doctor, substandard care, and an end to medical discovery. Additionally, the public-option has been divisive to the health reform debate and could "paralyze the possibility of reform."
Access to healthcare must be expanded all uninsured Americans. There are a variety of ways to do this using the marketplace.
Patients deserve access to the best medical expertise in the world, so we must make sure our healthcare system continues to have the best doctors, specialists, and other medical professionals possible.
The U.S. needs to remain the leader in medical research and discovery. The government should continue its investment in the NIH and encourage private innovation.
Policymakers must enact comprehensive medical malpractice reform.
Following is the full text of Dr. Palmisano's statement:
Together we can strengthen our nation's healthcare system
The United States has the best medical system in the world. We have world class medical facilities in every major city and research centers that are second to none. We respect the value of life by caring for a child even before conception and tend to an elder's need until her last breath. And no one - regardless of ability to pay - is refused emergency care.
Currently, more than 250 million Americans have health insurance and the vast majority are happy with their coverage and their doctors. Americans enjoy having the flexibility to go to the doctor when they’re sick and know they'll get the care and medicines they need to get well. Over time, patients have built personal relationships with their local physicians and their staffs and it's not uncommon for a local doctor to tend to the needs of three generations from a single family. These relationships build trust and intimacy to support life's most challenging moments.
Today, citizens across the country are engaged in an important discussion over health system reform. This discussion provides us with a tremendous opportunity to improve the healthcare system if our focus is on patients - not politics.
Now, just hours before President Obama's historic speech on healthcare reform, we recognize areas that could use improvement in our health system, but remain concerned that the federal government will try to over-treat the symptoms.
Anyone watching the healthcare reform debate knows that discussion over the government-controlled "public option" has polarized the citizenry. Based on government-controlled health systems in other countries, doctors and patients alike are concerned that it would weaken our health system here. Specifically, it would lead to long waiting lines to see a doctor, substandard care, and an end to medical discovery. Because of its ineffectiveness and its potential for continued contention, the public option must be taken off the table, otherwise it will paralyze the possibility for reform.
Instead, legislators should focus on the areas where there is wide agreement: Policy changes must ensure patients can see the doctor of their choice, get the treatments they need when they need them, and spur new medical discovery, all while slowing the cost curve.
The good news is this can all be done.
First, we need to expand access to healthcare by making health insurance more affordable. Individuals should have personal ownership of their health coverage and have the ability to comparison shop. Many uninsured Americans could have the coverage they need with a little help from tax credits, health savings accounts, or vouchers. Also individuals could save money by being able to purchase health insurance across state lines. Arbitrary state boundaries have become impenetrable walls prohibiting patients to have access to a variety of coverage options.
Additionally, health insurance should be portable and coverage options must be available for patients with pre-existing conditions. And patients should always have the right to privately contract with their doctors, so they can get the care they want, even if their insurance plan won't cover it.
Second, every patient wants to be taken care of by the best medical professional possible, so we need to keep our medical expertise and specialty doctors here in the U.S. When a patient has cancer, she wants to see a doctor who has had years of training in oncology and is knowledgeable about the latest ways to beat the cancer - not someone who may not even be a physician. Americans are fortunate to have the best medical expertise in the world, we cannot allow our health system to falter by diluting the medical profession.
Third, the government should continue its investment in research through agencies like the National Institutes of Health (NIH) and also reward innovative discovery in the private sector with tax incentives and patent protection. Americans are living longer, healthier lives thanks to the trillions of dollars in public and private investment in medical devices, pharmaceuticals, and advanced surgical techniques. We've all benefited from this investment and in order for our health system to remain the envy of the world, our nation must continue to foster an environment where ingenuity can flourish.
And finally, policymakers must enact comprehensive medical malpractice reform.
Statistics indicate that 80% of cases are closed without payment and when there is a trial, the physician wins 89% of the time. Those lawsuits - even when dismissed or closed without payment - cost doctors time, money, and encourage defensive medicine adding billions to the cost of medical care. All of this increases malpractice insurance rates and gets passed on to the overall price of care. In addition, it forces doctors to leave communities, and costs patients their trusted medical advisor or the lack of a critical specialist in an accident or other crisis.
In the end, this debate on heath system reform will come down to the willingness of policymakers - including the President - to do what can be done to improve our healthcare system. Either they will come together and work on those issues that are supported by the majority of Americans, like expanding access to healthcare and slowing the cost curve; or policymakers will allow partisanship and acrimony to stymie progress and continue the unsustainable status quo.
About the Coalition to Protect Patients' RightsThe Coalition to Protect Patients Rights is a non-partisan, grassroots coalition made up of over 10,000 doctors, healthcare providers, advocacy groups, and concerned citizens who are dedicated to the implementation of patient-centered healthcare reform that will improve patient care.
For more information, visit the Coalition to Protect Patients' Rights website at www.protectpatientsrights.org.
Health Alert The “R” Word
Sep 9, 2009
by John Goodman
“Lies and distortions,” says David Axelrod. “The 26 lies about H.R. 3200,” headlines an Annenberg report. “The Five Biggest Lies About Health Reform,” is the lead in a Newsweek article.
You would think we were living in some foreign country.
There are many contentious issues, of course. But towering above all others, THE ISSUE is denying people care. Or, if you like, health care rationing.
At the National Center for Policy Analysis we have brought this issue up frequently — but, I believe, in a responsible way. For that matter, Barack Obama has brought the issue up frequently — also in a responsible way.
Yet what is driving the defenders of Obama Care crazy is that this issue is being discussed at all. For one thing, the President is saying things most Democrats never say when they talk about health care. For another, the opponents have passed up not a single opportunity to distort and exaggerate to the hilt. To get one absurd statement out of the way, let’s admit that none of the bills before Congress contain the words “death panel.”
Still, is there something here we should be worried about? Answer: Yes. You should be very worried.
President Obama’s view of how to control health care costs. His own grandmother probably didn’t need the hip replacement she received, the President opined on one occasion. “Maybe you’re better off not having the surgery, but taking the painkiller,” he told another audience. We’re only talking about eliminating care that is unnecessary, he told a national television audience at the ABC infomercial in June.
President Obama was more explicit in his speech to the American Medical Association. Patients are getting too many tests, too many exams and too many services of all types, he said. Office of Management and Budget Director Peter Orszag says we could lower health care spending by one-third nationwide if doctors everywhere practiced medicine as efficiently as the lowest spending regions.
Here’s the bottom line. Barack Obama really does want to come between you and your doctor. More precisely, he wants to change the way your doctor practices medicine. In the Administration’s ideal world, you would get all the health care you need. Only unnecessary or futile care would be eliminated. But that’s what the Canadian government, the British government and just about every other government in the world says. To state the obvious, the public clearly does not trust the Administration to get it right.
How rationing will be done under Obama Care. As I explained in a recent National Review editorial, rationing Obama-style will be done indirectly. It will be the result of administrative decisions — all ostensibly made for the best of reasons: to eliminate futile and unnecessary care. Here’s how it will work:
Under Medicare, the Administration is seeking the authority to make decisions on reimbursing providers through an independent commission. The federal government will use the power of the purse to force doctors to change the way they practice medicine. There will be fewer CAT scans, fewer MRI scans, fewer blood tests and fewer operations for the simple reason that Medicare will quit paying for procedures it considers questionable.
But how do we know that the scan or the test not ordered isn’t in reality life-saving? We don’t. In the very act of trying to change how doctors practice medicine from the payer side of the market, we run the real risk that quality of care will be sacrificed. And remember: the rule makers in Washington — far away from practicing doctors and real patients — will be under constant pressure to keep spending down.
Medicaid (for the poor) could be pressured in the same way as Medicare (for the elderly and disabled). But what about private health plans?
Under Obama Care, everyone who does not get health care from an employer will be required to obtain it in a health insurance exchange. The plans will be free to set their own premiums, but they will have to charge all enrollees the same price — regardless of health status. Because some plans will attract a greater percentage of sick enrollees than others, a government administrator will have the power to “tax” plans with healthier enrollees in order to subsidize plans with sicker enrollees in a process called “risk adjustment.” And it is precisely through such adjustments that the government will have enormous power to influence what is done for the sick.
For example, suppose a plan attracts an above-average number of people whose doctors say they need hip replacements and ask the government risk adjustor for an extra payment to cover the cost. The risk adjustor may decide these hip replacements constitute “unnecessary care” or “futile care” and deny the request. In this way, the risk adjustor will have the power to indirectly force health plans to deny people care.
The government risk adjustor will be aided in this effort by a national health board which will be doing “comparative effectiveness” analyses. If the health board decides that a certain type of hip replacement in certain circumstances is “unnecessary” or “futile,” this will be prima facie cover for the risk adjustor to deny payments and for the health plan to deny care.
What is the difference between rationing and eliminating unnecessary care? As a practical matter, there isn’t much. Rarely does a doctor intentionally give a patient unnecessary care. That’s malpractice. But there is a lot of care that is of marginal value. A great many MRI scans, blood tests, other diagnostic procedures and even a lot of surgeries cost a lot more than any value they create for patients. However, getting rid of them through rules established by payers would almost certainly constitute a form of rationing.
For example, “comparative effectiveness” in Britain means comparing the number of extra years of life that are produced by a procedure/test/drug/etc. to the cost. The rule of thumb currently used is: approve the procedure so long as it costs less than about $45,000 per (quality-adjusted) year of life saved.
Is it fair to bring up the writings of Zeke Emanuel and Tom Daschle? I think it is. As noted at this blog, Daschle’s book makes comparative effectiveness, as practiced by the National Institute for Health and Clinical Excellence (NICE) in Britain, the model for controlling health care costs. Obama initially chose Daschle to be his health care czar and Daschle’s co-author is the Director of the Health and Human Services Office of Health Reform. Also as noted here, Emanuel’s writings on the need to ration and how to do it reflect a state of mind. None of this is Administration policy, of course. But an enormous amount of health reform policy will be enacted administratively. So the attitudes of people in the Administration who design and carry out the reform are important and fair game.
Is there a better way? As I have argued in Congressional testimony, in an NCPA study and at this blog, waste cannot be effectively eliminated by demand-side measures. Efficiencies have to come from the supply side of the market. If providers are freed to repackage and reprice their services, they will produce higher-quality, lower-cost care without any direction from on high. Of all the examples we can point to of excellence in medical care, not a one was created by Medicare, Blue Cross, an employer, or any other third-party payer.
Burden of proof. No one knows exactly how Obama-type health reform will work. But there is one point on which everyone should agree. The burden of proof is on the Obama Administration to demonstrate how they plan to reduce health care spending without denying people high quality health care.
((The following may be offensive to some people....to whom I say: "Get a sense of humor."))
OPINION: BUSINESS WORLD
SEPTEMBER 8, 2009, 7:28 P.M. ET
A Bipartisan Plan to Wreck the System
The health-care address President Obama should really give to Congress
By HOLMAN W. JENKINS, JR
What follows is a leaked first draft of President Obama's speech on health care tonight, complete with instructions for Democrats in the audience.
Members of Congress, Ladies and Gentlemen, Children of the Obama Youth Corps—I come to you tonight to speak frankly about our nation's health-care crisis and how we in Washington can make it worse.
Salami tactics on health care have long involved slicing the salami from both ends.
On one hand, we enlarge the government's role in providing health care, making more and more voters dependent on Washington.
On the other, we enact regulations and restrictions to keep driving the private insurance system off a cliff.
To the American people I promise tonight, whatever compromises lay ahead, whatever the arduous negotiations, Democrats and Republicans will work together to continue to drive the current system off a cliff. (Applause from Democrats in the audience; Nancy Pelosi beams.)
Even if we cannot enact my administration's "public option," we will extend the great work of previous generations, making sure private health care continues to be unaffordable to more and more Americans, and piling up fresh mandates on employers so fewer and fewer of our citizens will have either jobs or health insurance.
At the same time, with tax dollars, we will continue to subsidize ever more consumption of that which everyone agrees we already consume too much.
We may not get there right away. But by taking these steps, we will bring closer the day when the only form of health care for most Americans will be government-provided health care, and the dream will never die. (Pandemonium among Democrats. Nancy Pelosi daubs her eye.)
I want to give a shout-out to our Republican friends, who have been with us every step of the way, who have been an important part of our salami progress so far—by pushing various "patient's bills of rights," defending the tax giveaways that encourage spending regardless of cost or benefit; by expanding Medicare, Medicaid, Veterans benefits and subsidized health care for middle-class children.
I say tonight, without Republican help, we could never have brought the system to its current dysfunction and I thank you.
Now, much has been said about our "public option" that's been confusing and misinformed. It's in that spirit that I speak to you tonight.
Critics wonder: How can a new "public option" bring meaningful competition to the health-insurance marketplace and drive down costs?
They miss the point. The great work done so far has tended to squash competition, and we would continue this work—by restricting the ability of insurance companies to design and market their policies; by regulating what coverage they can offer; by using tax distortions to keep consumers in the dark about what their health care really costs, so they will continue to treat it as a "free lunch" when it actually gobbles up more and more of their disposable incomes.
People, this is why insurance rates keep going up and up, and why a competitive marketplace, in which consumers reward those who provide high-quality care at low cost, hardly exists. And I say again, with all humility, this is a great bipartisan achievement.
So the purpose of our public option is not to change any of this, but merely to scoop up the growing number of Americans who won't be able to get private coverage because we've made private coverage so expensive and uneconomic.
Some say the public plan would be unfairly subsidized with tax dollars. No, no, no—the public option would be self-sustaining, just like the Post Office, just like Medicare, just like the federal government, which carefully lives within the tax revenues it receives each year.*
Now, my administration is not wedded to the "public option." I know my Republican friends say families should not have health care. They believe we can save money by lying down before rapacious insurance CEOs. They say the indigent should be encouraged to practice self-surgery (I'm sure some Republican somewhere thinks this is a good idea).
But let's put aside our differences and recognize how much we have already accomplished together. I say to Republicans and Democrats alike, if we can just keep working together to inflate the burden of public and private health-care spending as we have the past 30 years, we will push the system to the breaking point. Yes, we can. Yes, we can. (Democrats chant, "Yes we can." Nancy Pelosi levitates above the audience, flies around the chamber three times and bursts into flame. . . .)
. . . Together we can push our current health-care system over a cliff, and then—well, then [STRONG ENDING HERE]____
*Certain factual statements subject to OMB review.
August 28, 2009
Five Major Faults with the Health Care Bills
by Nina Owcharenko
Current efforts by Congress to "reform" the health care system are centered on several flawed policy initiatives that will transfer more power and decisions to Washington and away from patients and families.
Rather than create a massive government-based health care system and dislocate people from their existing private coverage, policymakers should focus on putting the health care system on a path where individuals and families are in control of their health care dollars and decisions.
Shortfalls of the Health Care Bills
The following five provisions are the cornerstone of the House and Senate bills and unavoidably result in legislation taking health care reform in the wrong direction.
1. New Public Plan and Federal Exchange. Both the House and Senate bills would create a new government-run health care plan through the establishment of a federally run national health insurance exchange. The result: widespread erosion of private insurance and substantial consolidation of federal control over health care through the exchange. As is evident in the details of the House bill (H.R. 3200), there is no level playing field for competition between the government plans and private health plans. Plus, the incentives in the legislation guarantee that millions of Americans will lose their existing employer-based coverage.
2. Federal Regulation of Health Insurance. Both the House and Senate bills would result in sweeping and complex federal regulation of health insurance. Moreover, it would take oversight away from states and concentrate it in Washington.
3. Massive New Taxpayer-Funded Subsidies. Both the House and Senate would expand eligibility for Medicaid, but they would also extend new taxpayer-funded subsidies to the middle class. Such commitments would result in scores of Americans dependent on the government to finance their health care. This is unfortunate because Congress could have reformed the tax treatment of health insurance to enable people to keep their existing private coverage and buy better private coverage if they wished to do so.
4. Employer Mandate. Both the House and Senate bills would impose an employer mandate for employers who do not offer coverage and for those whose benefits do not meet a new federal standard. An employer mandate would hurt low-income workers the most and would also stifle much-needed economic growth. Employer mandates are passed on to workers in the form of reduced wages and compensation. This is exactly the wrong prescription for businesses, especially during a recession.
5. Individual Mandate. Both the House and Senate bills would require all people to buy health insurance. There is no doubt that such a mandate would result in a tax increase on individuals and families whose health insurance does not meet the new federally determined standards. This means that Congress will, for the first time, force Americans to buy federally designed packages of health benefits, even if they do not want or need those benefits.
It also means that health benefits will tend to become increasingly costly as powerful special interest groups and representatives of the health industry lobby intensively to expand the legally mandated health benefits, medical treatments and procedures, and drugs that all Americans must buy under penalty of law.
A Better Direction for Health Care Reform
Congress should stop and take a step back from these divisive House and Senate measures. Instead of trying to overhaul one-sixth of the American economy and seize an unprecedented amount of political control over health care decisions and dollars, policymakers should consider proceeding with smaller, incremental improvements. Policymakers need to proceed slowly and deliberately, making sure that the initial steps they take are not disruptive of what Americans have and want to keep, actually work, and do not result in costly and damaging and unintended consequences. There are three broad areas where Members can and should find consensus:
1. Promote State Innovation. Congress should preserve the states' autonomy over their health care systems and give them greater legal freedom to devise solutions that meet the unique characteristics of their citizens. In addition, individuals should also have the freedom to purchase coverage from trusted sources and not be restricted by where they happen to live. This means that Americans should be able to buy better coverage across state lines. Congress should respect and encourage personal freedom and diversity.
2. Establish Fairness in the Tax Treatment of Health Insurance. There is little disagreement that today's health care tax policy--which favors coverage obtained through the workplace--distorts the market and is inequitable. Instead of expanding government-run programs like Medicaid, policymakers should offer tax relief to those individuals who purchase private health insurance on their own, regardless of where they work.
At the same time, Congress should make sure that tax relief goes only to taxpayers. Congress should also devise a voucher program, giving low-income citizens the opportunity to get private coverage if they wish to do so. There is a broad bipartisan consensus that Congress should help low-income working families with direct assistance to enable them to get health insurance.
3. Get Serious About Entitlement Reform. Medicare and Medicaid, the giant health care entitlement programs, are not only increasingly costly, but they are also not delivering value to the taxpayers. The best way to secure value to patients (not government officials) is to compel health providers to compete directly for consumer dollars by allowing seniors and the poor to choose the coverage that is right for them using the money that is already available to them in these programs. This will "bend the cost curve" while at the same time allowing private-sector innovation to flourish.
Americans want to fix the problems in the health care system--but not at the expense of their own coverage. It is time policymakers recognize the lack of support for a major overhaul. But instead of continuing to protect the status quo, Congress should advance improvements that put the health care system on a path to reform.
Such improvements should be focused on increasing choice and competition not by turning control over to Washington but by empowering individuals and families to control their health care dollars and decisions.
Nina Owcharenko is Deputy Director of the Center for Health Policy Studies at The Heritage Foundation.
Robert E. Moffit, "A Federal Health Insurance Exchange Combined with a Public Plan: The House and Senate Bills," Heritage Foundation Backgrounder No. 2304, July 30, 2009, at http://www.heritage.org/Research/HealthCare/bg2304.cfm.
Edmund F. Haislmaier, "Micromanaging Americans' Health Insurance: The Impact of House and Senate Bills," Heritage Foundation WebMemo No. 2558, July 23, 2009, at http://www.heritage.org/Research/HealthCare/wm2558.cfm; Dennis G. Smith, "Undercutting State Authority: The Impact of the House and Senate Health Bills," Heritage Foundation WebMemo No. 2559, July 23, 2009, at http://www.heritage.org/Research/HealthCare/wm2559.cfm.
Dennis G. Smith, "New Taxpayer Subsidies: The Impact of the House and Senate Health Bills," Heritage Foundation WebMemo No. 2564, July 23, 2009, at http://www.heritage.org/Research/HealthCare/wm2564.cfm.
James Sherk and Robert A. Book, "Employer Health Care Mandates: Taxing Low-Income Workers to Pay for Health Care," Heritage Foundation WebMemo No. 2552, July 21, 2009, at http://www.heritage.org/Research/HealthCare/wm2552.cfm.
10 Things I Hate About Health-Care Reform
One Doctor's Orders for How To Really Fix Our System
By Arthur M. Feldman
Sunday, September 6, 2009
As a cardiologist and the administrator of a large practice that includes general internists and specialists, I spend much of my time trying to figure out how to provide care for a growing number of uninsured or underinsured patients. I also have to battle billion-dollar private insurance companies that don't adequately cover patients with preexisting illnesses and often deny coverage for necessary treatments.
On a basic level, I'm with the president: Our health-care system needs to be changed so that all of my patients, and all citizens, have access to the care they need. But I don't agree with how he wants to fix things. Most of my colleagues and I strongly oppose the health-care reform bills that Congress will take up again this week. The proposals leave enormous gaps unfilled.
Before President Obama addresses a joint session of Congress on Wednesday, I hope he will consider these 10 major reasons why I -- and doctors like me -- worry that the legislation on the table will leave us worse off.
1. Private insurance companies escape real regulation.
This is what makes my colleagues and me so cynical about the reform proposals. Every physician has insurance company horror stories: patients who went untreated because their carriers wouldn't pay, endless hours on the phone to get administrators' approval for necessary tests and mountains of paperwork to collect reimbursements. It will be hard for doctors to buy into health-care reform if insurance companies get a free pass.
2. We urgently need tort reform, but it's nowhere to be seen.
Malpractice costs rise each year, as do the number of frivolous lawsuits. Our practice has seen a 10 percent increase in malpractice expenses this year. Sure, doctors make mistakes, and patients deserve fair compensation for their injuries and lost wages, but in this area of the law, physicians and hospitals are too often at the mercy of capricious juries.
When the president brought up the "fear of lawsuits" in his address to the American Medical Association in June, he got a huge response from the crowd. That's because practically every doctor has a story about a jury that awarded huge damages to a plaintiff despite the absence of wrongdoing by the physician. The best from our practice group is the physician who was sued -- even though he was out of town during the patient's entire hospitalization. Without fixing these spiraling insurance costs and the legal environment that allows large payments in unjust suits, physicians will continue to practice expensive "defensive" medicine or simply leave states that do not enact tort reform.
3. "Prevention" won't magically make costs go down.
Obama has called for disease prevention on a national scale, but that won't be a cure-all. Louise Russell,, a researcher at Rutgers University, analyzed hundreds of studies on prevention and medical costs and found that, in general, prevention adds to costs instead of reducing them. That's because it often means medication for hypertension and elevated cholesterol, and screening and early treatment for cancer. Unless Congress outlaws McDonald's, cigarettes, alcohol and idleness and cleans up the environment, no amount of "prevention" will put a dent in the cost of keeping Americans healthy.
4. Reform efforts don't address our critical shortage of health-care workers.
Many people believe that the fix for our physician deficit is simple: expand class sizes at existing medical schools and create new ones. Sorry, it's not that easy. There is a cap on the number of federally funded training positions for newly minted M.D.s. It hasn't changed since 1996. If the number of graduates of U.S. medical schools increases but the number of post-graduate training positions remains the same, we won't have fixed the problem -- we'll have created a different one. Training programs will simply take more U.S. graduates and fewer foreign ones, and the total number of physicians trained each year will remain the same -- too low. And foreign medical school graduates tend to practice in rural and underserved urban areas, the very places that need the most help.
5. We need more primary-care physicians -- but we also need specialists.
Everyone is worried about the dwindling ranks of primary-care physicians. But we need more specialists, too. There are impending shortages in fields such as oncology, cardiology, general surgery and gastroenterology. An article in the American Heart Association's journal Circulation noted that by 2020 there won't be enough cardiothoracic surgeons to treat the growing number of American seniors. Surgery, the journal of the Society of University Surgeons, reported an expected shortage of 1,300 general surgeons in the United States by 2010. Few Americans will tolerate not having access to a specialist in an emergency or having care rationed because of a limited number of skilled physicians.
6. We have to streamline drug development and shake up the Food and Drug Administration.
Creating and producing new drug therapies in the United States is a nightmare. Regulatory hurdles, disorganization and a lack of leadership at the FDA, as well as burdensome conflict-of-interest policies, have made the drug-approval process grindingly slow. At the same time, development costs are close to $1 billion per drug. Federal regulations are so convoluted that most clinical trials are now performed outside the country -- taking billions of dollars out of the U.S. economy and making it harder for American patients to be first in line for new treatments.
7. We can't fund health-care reform by cutting payments to doctors.
This isn't about one doctor looking out for his bottom line. It's about physicians being able to provide the accessibility and quality of care that their patients want. The Centers for Medicare and Medicaid Services has proposed increasing payments to primary-care physicians by approximately 6 percent while lowering payments for many specialists, including cardiologists and oncologists, by as much as 20 to 40 percent. These drastic recommendations were based on a questionable American Medical Association physician survey showing that expenses for cardiology and oncology practices dropped precipitously over the past five years -- a finding that defies logic. If these cuts are approved, the American College of Cardiology estimates that 40 percent of the cardiology practices in Florida will go bankrupt. We need to pay for performance, not automatically reduce fees for procedures that patients have come to expect.
8. We can't forget about research.
Every modern treatment for human disease is related in some way to research at U.S. academic medical centers -- much of it supported by the National Institutes of Health. These include new treatments for cancer, devices to prevent sudden cardiac death and medications that save the lives of patients having heart attacks.
However, decreased federal funding for research over the past six years has threatened to decimate a generation of young scientists and the cures they could discover. While the stimulus package provided $10 billion for NIH-supported research, the allocation was for only two years. The health-care reform legislation provides no information about the level of research funding after 2011.
9. Cutting reimbursements could shut some hospitals down.
Proponents of the current reform legislation know that no one wants their local hospital to close. So the White House's initial call to pay for health-care reform through cuts of more than $200 billion in hospital reimbursements over the next decade was scary. Obama sought to reassure people in June, explaining that "if more Americans are insured, we can cut payments that help hospitals treat patients without health insurance." But there is no data to support this promise. It is unlikely that the homeless, the mentally ill, the substance abusers or the illegal immigrants who now receive their care in "safety net" hospitals will carry any form of health insurance. Grady Memorial Hospital, one of the premier public hospitals in the United States, which has cared for the underserved residents of Atlanta for more than a century, would probably have closed its doors had it not been for a $200 million gift from a local benefactor.
10. We need to improve the quality of care.
Obama has said that "if doctors have incentives to provide the best care instead of more care, we can help Americans avoid the unnecessary hospital stays, treatments and tests that drive up costs." This is an overly simplistic view of what is needed. Poor care clearly costs more money. However, as the Institute of Medicine has pointed out, poor quality of care can be divided into three types: underuse of care, misuse of care and overuse of care. While eliminating misuse and overuse will decrease the cost of care, correcting problems from underuse will actually increase costs.
I have a close view of the limitations of our current health-care system. Not just with my patients, who are often unable to afford the care they need, but also in the plight of a young colleague. He was diagnosed with an aggressive form of lung cancer and sought treatment at a nationally renowned Boston cancer center. Most people with lung cancer undergo expensive chemotherapy and radiation therapy, but even those aggressive measures have a limited effect on long-term survival. His physicians discovered that he had a type of cancer that might respond to a new drug in clinical testing, provided free by the pharmaceutical company sponsoring the research. Although the cost of his care is far less than that of traditional chemotherapy, his insurance company refused to pay for it because it is "experimental."
But he has been lucky. His friends and colleagues have helped support his treatment, and wherever possible his doctors have provided free care. His cancer has responded dramatically to the drug, he has suffered no side effects, and he is back at work full-time.
However, I don't want my patients to rely on luck. I want them to have insurance that will pay for their care, and I want to be able to offer new medications and the most sophisticated treatment. I want to be able to give preventive care as well as to monitor patients effectively if they develop diseases. I want to be able care for my patients in their homes, and I want to offer palliative care if it becomes necessary. I want them to be able to afford all this. In short, I want to see major reforms in health care -- I just don't want what is on the table.
Arthur M. Feldman is a cardiologist and chair of the department of medicine at Jefferson Medical College. He is the author of "Pursuing Excellence in Healthcare: Preserving America's Academic Medical Centers." He will be online to chat with readers Tuesday at 2 p.m. Submit your questions and comments before or during the discussion.
Like your health plan? Read this
September 2, 2009 by Michael D. Tanner
In his most recent weekly radio address, President Barack Obama denounced “willful misrepresentations and outright distortions” in the debate over health care reform. He then went on to repeat one of the most outright distortions in the entire debate: “If you like your private health insurance plan, you can keep your plan. Period.”
No, Mr. President. No you can’t.
To go straight to the chapter and verse: under Section 59(B)(a) of HR3200, the bill making its way through the House, and Section 151 of the bill that passed out of a Senate committee, every American would be required to buy health insurance.
And not just any insurance: to qualify, a plan would have to meet certain government-defined standards. For example, under Section 122(b) of the House bill, all plans must cover hospitalization; outpatient hospital and clinic services; services by physicians and other health professionals, as well as supplies and equipment incidental to their services; prescription drugs, rehabilitation services, mental health and substance-abuse treatment; preventive services (to be determined by the Centers for Disease Control and Prevention and the United States Preventive Services Task Force); and maternity, well-baby, and well-child care, as well as dental, vision, and hearing services for children under age 21.
But that’s not all. Section 1239(b) of the bill also establishes a federal Health Benefits Advisory Committee, headed by the U.S. surgeon general, which will have the power to develop additional minimum benefit requirements. There is no limit to how extensive those future required benefits may be.
If your current health insurance doesn’t meet all those requirements, you won’t be immediately forced to drop your current insurance for a government-specified plan. But you would be required to switch if you lose your current insurance or “if significant changes are made to the existing health insurance plan.”
More critically, for the 70 percent of us who get our insurance through work, those plans would all have to satisfy the government’s benefit requirements within five years.
More likely, your employer will simply find that the increased cost and administrative burden is not worth it, and will dump you into the government-run “public option.”
The Lewin Group, an independent actuarial firm, estimates that under the House version of the bill, as many as 89.5 million workers will simply lose their current employer-provided plan and be forced into government-run insurance.
Seniors, too, could lose their current coverage, at least the 10.2 million seniors currently participating in the Medicare advantage program. That program offers many seniors benefits not included in traditional Medicare, including preventive-care services, coordinated care for chronic conditions, routine physical examinations, additional hospitalization, skilled nursing facility stays, routine eye and hearing examinations, and glasses and hearing aids But the House bill cuts payments to the Medicare Advantage program by roughly $156.3 billion over 10 years.
In response, many insurers are expected to stop participating in the program, while others increase the premiums they charge seniors. Millions of seniors will likely be forced off their current plan and back into traditional Medicare.
Finally, the bills would all but eliminate Health Savings Accounts (HSAs), currently used by nearly 10 million Americans. Section 122 of the House bill and 311 of the Senate bill set minimum payout levels for any insurance policy. Insurance payouts must cover 70 percent of claims under the House bill and 76 percent under the Senate bill. And the bills also prohibit any deductibles or co-payments for preventive care.
But virtually none of the high-deductible insurance plans in existence today, and required to accompany an HSA, can meet such a standard. They are simply not designed to work that way. The result will be that a plan designed to those specifications would offer few if any advantages over traditional insurance and would not be competitive in today’s markets.
As a result, insurers warn they would stop offering high-deductible policies.
Any way you look at it, under the bills currently before Congress, millions of Americans will be forced out of their current health insurance plan, even if they are happy with it. Period.
It is time for the president to stop spreading this particular “willful misrepresentation and outright distortion.”
Obama has it exactly backwards on health costs
By: David FreddosoCommentary Staff Writer09/03/09 10:40 AM EDT
Last night's (extremely civil) debate between the two Pennsylvania Senate challengers, former Republican Rep. Pat Toomey and Democratic Rep. Joe Sestak, also featured the e-mail fact checks and press releases that have become typical of political debates.
The Toomey camp sent out one detailed release on the issue of whether the public option insurance plan will pay Medicare rates to providers. Sestak said erroneously that the rates would be negotiated. According to HR 3200, the bill that Sestak voted for, the rates are Medicare rates for the first three years of the public option's operation.
It seems like an obscure, insider's issue, but the release raises a much broader point:
Medicare payment rates are far below private plan payment rates. According to the well-respected Lewin Group, Medicare payments to Pennsylvania physicians are 76% of private payments and Medicare payment to Pennsylvania hospitals are 71% of private payments.
When doctors and hospitals lose money, they leave the profession and close down. According to a 2006 report by the Pennsylvania Medical Society, the number of permanent full-time equivalent physicians declined sharply in recent years.
While factual, detailed and relevant, this rebuttal misses a much more important issue that goes to the heart of President Obama's push to reform health insurance.
In order to stay in business despite Medicare underpayments, doctors and hospitals make up for them by gouging private insurers, who in turn pass the increased costs along to patients in the form of higher premiums and co-pays, and/or reduced benefits. If Medicare is underpaying doctors by 25 to 30 percent, then your insurer is paying (read: you are paying) more for health care to make up the difference.
President Obama's approach to health care reform begins with the premise that the broader health care market is driving up costs for Medicare, which has in turn become an unsustainable fiscal liability for the federal government. He has it exactly backwards. Medicare, already an usustainable liability, is driving up costs for the broader health care market.
By confusing cause with effect, the president risks exacerbating the problem with his solution.
((Is anyone other than me sick of hearing the people who've benefited from our outstanding health care system badmouth it with psuedo-"facts?"))
Thirty-Nine Fallacies About Health Care
By Richard E. Ralston
Following are some of the most common arguments, with suggested responses that apply the principles discussed in American Health Care: Essential Principles and Common Fallacies.
1. "The quality of health care in America is ranked lower than 36 other countries."
When you hear this, always ask, "Ranked by whom and how?" In 2000 United Nations bureaucrats at the World Health Organization sent a survey to "officials and experts" selected by the U.N. Why should we be surprised to learn that government "officials and experts" in France thought that their government-run health care system was the best in the world? The scoring of these surveys also made them meaningless. For example, 25 percent of the scoring was weighted based on the assessment of how "fair" the financing was in each country. For "fair," read socialist—the list was largely a ranking of how socialist each country's system is.
2. "Medicare and Medicaid are far more efficient and less wasteful than private insurance, spending only three percent on administrative overhead."
When you hear this, always ask, "Why is the administrative cost always given as a percentage?"
One reason is that, due to the age of covered patients, the average Medicare and Medicaid reimbursements are higher than those of private insurance—and administrative costs are therefore a lower percentage of the larger amount paid. Another reason is that the huge cost of contending with 130,000 pages of Medicare regulations is pushed onto the providers. The cost of the more than 100,000 employees of the Internal Revenue Service who collect Medicare taxes are also omitted from Medicare's "administrative overhead." But the biggest reason is that the government programs make no effort to minimize expense or fraud. Fraud counts for about $50 billion in Medicaid expenses every year—as high as $18 billion in New York alone. Total spending has been going through the roof for more than 40 years, but the government's administrative cost of burning money is quite low. That does not prove that the government is efficient or prudent. Private insurance companies, on the other hand, need to keep fraud and expenses down or go out of business.
3. "Government or universities develop most new medications and then just hand them over to pharmaceutical companies to manufacture and make all the profits."
When you hear this, mention that the National Institutes of Health (a government agency) reports that the pharmaceutical companies—who spend about $60 billion each year on research—develop more than 90 percent of new drugs.
4. "Advertising of drugs is bad because it increases the price of medications."
When you hear this, ask, "Why does any business advertise any product? Because they just want to add to their costs and increase the price?" Manufacturers of computers and other technological products who spend a lot on research need to find their market. A pharmaceutical company, spending an average of $800 million to develop a major new drug, has a few years of patent protection to bring the drug to the attention of physicians and patients who need it. This allows them to spread research costs over a much larger customer base and reduce unit cost—which lowers the price.
5. "Private corporations are wasteful and bloated bureaucracies. Government-provided health care is lean and efficient."
When you hear this, you might want to laugh. Then ask, "So you think that the 20th Century proved that communism and fascism work?" Is the Department of Motor Vehicles or the purchasing practices of the Defense Department our best models of administrative efficiency?
6. "People live longer in some countries because of their socialist health care systems."
When you hear this, ask if the people in those countries didn't live longer before they nationalized their health care systems. Ask how many people in those countries died on their highways, were killed in combat, shot by criminals, addicted to drugs, were severely overweight or in poor health when they arrived as illegal immigrants.
7. "The free market is callous and greedy, while government health care is compassionate and pays close and solicitous attention to the needs of every individual."
When you hear this, recite the following litany: Katrina, King-Harbor Hospital in Los Angeles, the annex at Walter Reed Army Hospital, the Veterans Administration, the government of New York State, members of Congress, every political spoils system since the Roman Republic.
8. "We can lower health care spending by eliminating all profits."
When you hear this, ask why we pay FedEx, UPS and DHL to deliver packages at a profit instead of using the U.S. Postal Service. Ask why we pay Microsoft and Apple for computer products at a profit instead of having all computers and software produced by the government. Ask why we don't have the government produce all of our food and build all of our housing if it can do it so much better without needing a profit. Ask where the money would come from, without profits, for drug research and development. Ask how expensive government drug research would be if it never had to get results. Ask what the cost of assuaging public employee unions and the politicians they fund will be when profits are eliminated.
9. "Government controls will lower the cost of insurance premiums to what we can afford."
When you hear this, ask why the government requires those who struggle to afford insurance to pay taxes on the money they use to pay for it. Ask why the government mandates that insurance cover treatments advocated by special-interest lobbies even when people do not want the coverage. Ask why state governments refuse to allow competition—and lower premiums—from insurers in other states. Government controls are now making insurance more expensive. Affordable insurance is hard to find because it is forbidden by law.
10. "Americans spend a higher percentage of their GDP on health care than any other country."
There are both good and bad reasons for the present level of spending on health care. Bad reasons include the waste and fraud in government-financed health care, regulations that drive up the cost of insurance, and what following the lead of complex Medicare reimbursement procedures and regulations has done to private insurance. Good reasons include the fact that one reason Americans spend more on health care is because they can. America is a rich country, and what is more important than health care? How much is too much? Americans not only have the most advanced drugs, diagnostic and other medical equipment but also make them more available than any other country. If we had a free-market medical system, those who could afford to try and live forever in perfect health would spend money that would stimulate medical research that would benefit all of us.
11. "Public opinion polls show that most Americans want more government health care."
A lot of people may respond favorably when asked if they think someone else—anyone else—should pay for their health insurance. Government, their employer, anyone else will do. They might not reply in the same way if asked if they should be responsible for providing everyone else with health care. They might not reply in the same way if they understood the consequences of government health care, such as rationing and long waits for surgery, treatments, or referral to specialists—or the government causes of problems with the status quo. They might not reply in the same way if asked if they really trust politicians and the loving arms of the federal bureaucracy for all of their health care. They might not respond in the same way if asked if they want government control of all aspects of health with nowhere else left to go.
12. "Huge jury awards in medical malpractice suits do not increase health care or insurance costs."
When you hear this, ask where the money comes from to pay the hundreds of millions of dollars in contingency fees that go to some trial lawyers every year. Ask whether these lawyers really care only about the "little guy." Ask why so many physicians and surgeons now have to pay liability insurance premiums of far more than $100,000 a year. (No, the insurance companies do not keep it all or lose it in the stock market.) Ask how the government legal framework and court management for our tort system is set up to encourage lawyers to convince so many juries that all patients live forever in perfect health unless a physician or hospital makes a mistake. Ask how much is paid in political contributions every year by trial lawyers to buy protection for this legalized extortion. Ask how some law firms were able to hire one radiologist to review more than 600,000 x-rays and diagnose most of them with the same disease. Ask how many billions of dollars are wasted on unnecessary tests and procedures that physicians have to order to protect themselves from frivolous lawsuits.
13. "Insurance companies can afford huge malpractice settlements, and doctors can afford large liability insurance premiums."
Ask who we really think ends up paying those premiums. Ask how much the fear of second-guessing and litigation has increased the use of unnecessary and expensive testing and treatments, and how much other "defensive medicine" has driven up the cost of health care and health insurance for everyone.
14. "Governments provide their citizens with free health care."
Point out that government cannot create anything, but rather it can only take things. Health care, like everything else, is ultimately made possible by business activity. What a government means when it says it is giving you something for "free" is that it is forcing you to pay for something whether you use it or not, or taking something from you to give to someone else.
15. "Countries with nationalized health care systems provide their citizens with all the health care that they need."
When you hear this, ask why Canadians travel to the United States every year and spend $1 billion on American health care. Ask why Americans have more access to MRI and CT scan equipment and more of the new breakthrough drugs. Ask why Americans have better survival rates for cancer and heart attacks. Ask why more than one third of physicians employed by the National Health Service in Britain buy private insurance, and why six million of their potential patients in Britain also buy private insurance, when government health care is free. Ask why so many British citizens waiting for free surgery and cancer treatment fly to India to pay for it, and ask why no one, other than Michael Moore, is jumping on a boat to get free health care in Cuba.
16. "Physicians must provide any services that the government requires because they are indebted to society for their medical education."
The first answer to this is that "society" did not spend many years of intense, dedicated effort to complete a medical education. Individual physicians did that, most of them accumulating a lot of personal debt in the process. But the most important answer is that, while many of us experienced public education (of inconsistent quality), we do not owe anyone anything. You might be grateful to some but not all of your teachers. You might be grateful to your parents for their taxes that paid for your education. But that does not mean that you must accept an undefined, unlimited and eternal moral obligation to everyone that ever has been or will be alive because you received a public education. Of course, this argument indicates that, for some people, imposing such an obligation might be the purpose of public education: if the government provides a part of your education, it owns you for life.
17. "Health care is very important, so the government should control all medical practices and health providers, to give everyone all the health care they lay claim to."
When you hear this, say, "Not in America. Our own health must never be handed over to government because it is so important.
18. "The government must take over health care to control increasing costs."
Ask when the government has been able to control the cost of anything, let alone something as technological, complex, personal and dynamic as health care. Ask why the cost of health care managed by the government has been increasing so rapidly. Ask, "What is the cost of cost control? How much do current cost-control efforts add to the amount of paperwork and expense of billing? How much would ever more controls add to the cost of health care?"
19. "The Food and Drug Administration must be given more powers and funding to control the development of drugs."
When you hear this, ask, "How many terminally ill patients have died while waiting for drugs later approved by the FDA? What does the FDA approval process add to the cost of new drugs? Why does the FDA spend years trying to determine how drugs might work in every possible instance, while losing track of safety issues? Why do clinical trials using terminally ill patients require that half of the dying patients be given a placebo instead of the new drug? How has the enormous power of the FDA become a magnet drawing those with a political agenda to manipulate and manufacture clinical research to serve their objectives?
20. "The Food and Drug Administration must create a new agency to evaluate new drugs for comparative effectiveness with other drugs, after they have spent years being evaluated and tested before being approved for safety and effectiveness."
Ask how much longer that will add to the time needed for new drugs. Ask what that will add to the cost of each new drug. Ask how new clinical trials will be able to compare the effectiveness of drugs that meet the unique needs of each gender and of different ethnic and age groups. Will your gender or ethnic group be denied medications that work better for them but not for all groups? Ask how all drugs can be compared in this way when some individuals respond differently to many drugs, and what will happen when a drug that is the only thing that helps some people is prohibited because something else works for others. (Ask whether the government should decide that, if ibuprofen works better than aspirin for most people, aspirin should be prohibited even if it works better for you.) Ask what will happen to the development of new "personalized medicine" that targets only a few individuals if the government requires that everything work the same way for everybody.
21. "The government should spend billions more on medical research to cure more diseases."
When you hear this, point out the most distinguishing factor of government medical research: it never has to actually get results. Private research is always more efficient and gets results because it has to in order to pay for itself. Also point out that government research funds are often allocated to "politically correct" diseases based on the political pull of the constituents for those diseases, rather than to areas that are more auspicious for research. Invested funds are always more productive than dollars taken from taxpayers.
22. "Will not the commitment of President Obama in his 2009 address to Congress to eliminate cancer save many lives?"
Ask if the increased funding of $2.9 billion to the National Cancer Institute, with President Clinton's commitment to eliminate cancer, eliminated cancer. Ask if President Nixon's commitment to eliminate cancer, with the major new research in the National Cancer Act of 1971, eliminated cancer. Ask why, if government spending can be depended on to eliminate a disease, the President did not pledge new spending to eliminate death.
23. "The government can rapidly cut the cost of health care by mandating electronic medical records."
Ask how that will reduce the cost of treatment, medical equipment, drugs, physician services or any other health costs. Ask if the increase of electronic records that has been happening for many years has had any substantial impact on rising costs. Ask how, if all medical records are included into a single, government database, with access available to hundreds of thousands of workers in medicine and related fields, there will be any medical privacy possible. Ask why creating electronic records require that all of your medical records must be turned over to the government without your permission. Ask why the new "national coordinator" will be able to review your records to evaluate and require changes in the treatment recommended by your physician. Ask why this national coordinator will be able to turn your records over to any organization for "research," without your permission, or sell your records to outside businesses for marketing purposes, without your permission, or why the Secretary of Health and Human Services will be able to turn your records over to anyone for any purpose, without your permission. Ask anyone if they think their physician will be able to recommend a treatment for them if inspection of medical records resulted in a rebuke by the national coordinator for providing the same treatment to other patients.
24. "Health care is broken."
First ask yourself if you think your own health care is broken. If it is, ask who broke it. If the answer is the regulatory and legislative activity of politicians, ask how they can be trusted to fix it. Ask if the reform they advocate will be in their own political interest or in the interest of the best health care.
25. "Government programs such as Medicare and Medicaid cut medical costs by controlling and reducing reimbursements paid to physicians and hospitals and other providers."
Ask what happens when providers are forced to provide services at a rate that does not cover their costs. We have decades of experience with that. They must shift those costs to other patients and private insurers, which increases the cost of health care and insurance for everyone.
26. "Mandatory insurance is the best course of health care policy because it supports individual responsibility."
When you hear this, ask if it should also be mandatory to buy a nice house and take out a big mortgage to solve housing problems. Ask if making the lack of insurance into a crime has anything to do with individual responsibility. Ask how destroying individual rights supports responsibility. Ask if the purchase of something is made mandatory, will that make it cheaper, or more expensive. Ask if politicians who use the force of law to require you to buy health insurance will be able to resist micro-managing exactly what such insurance must cover. Ask how special interests will use the mandate to make contributions to politicians and lobby to add more coverage requirements for their benefit. Ask why politicians, like former Senator John Edwards, also want to require, through such mandates, that everyone get specific examinations. Ask how such requirements will be enforced and what it will do to the privacy of medical records. How does being forced by the government to do things increase individual responsibility? Why not encourage freedom?
27. "The government should require the computerization of all medical records, which should then be made available to the government to ensure their privacy."
Ask why the same people that are terrified (perhaps with justification) of the government intercepting some international phone calls have no problem with giving the government every personal detail of your medical history.
28. "We need Universal Health Care."
The best response to whatever that means is that "Universal Freedom" is the best and only effective means to maintain our health, our lives and anything else that we value.
29. "We need to trust the government to provide us with the best medical care."
Ask if we really trust the loving arms of government to provide us with the best medical care. Ask if government health care does not often turn into political health care, to serve the spoils system of politicians and provide service primarily to those special interests with political pull.
30. "Only government can reduce the cost of health care."
Ask why every government health care system in the world reduces cost only by reducing the availability of health care and increasing rationing and the time spent on waiting lists for referral to specialists, diagnosis and treatment, and by denying access to some medications, testing and treatment completely.
31. "People need health care, so health care is a right that must be provided to them by others."
The response must be that everyone has a right to seek health care, to make their own decisions about it, and even to ask others for it if they can't get it. But no one has a right to anyone else's life.
32. "Health care spending can be reduced by providing insurance to everyone, because costs now incurred by the uninsured will no longer be passed along to the rest of us."
Ask how those savings can be achieved without spending as much or probably more to pay for the insurance.
33. "Health care spending can be reduced by mandating that everyone buy insurance."
Ask, if this is true, why mandatory insurance in Massachusetts resulted in rapidly increasing spending beyond all projections. Ask why Medicare, which is mandatory for all Americans, has seen rapidly increased spending beyond all expectations, has $36 trillion in unfunded liabilities and is rapidly running out of money.
34. "The State Children's Health Program is necessary to provide children with health care."
Ask why it is necessary to move millions of children who have private insurance into a government program, if not to make them dependent on politicians handing out benefits. Ask why the program slips in restrictions on opening more efficient specialty hospitals, if not to protect the special interest of large hospital empires. Ask how the program will be funded once income from the tax on a rapidly diminishing pool of smokers runs out.
35. "A Federal Health Board is required to control expense and require better health care."
Nearly one hundred years ago the Federal Reserve System with a Federal Reserve Board was established to insure a stable money supply and eliminate recessions, depressions, inflation, and unemployment. Ask how the Federal Reserve Board has done with that. Ask why we should expect more of a Federal Health Board. Based on experience, what could possibly go wrong?
36. "Medicare should be expanded to cover all Americans."
Ask how Medicare can do that when it already has tens of trillions of unfunded liability for current Medicare patients and has not been able to control spending for them.
37. "Only government can control health care spending and hold costs down."
Ask why, based on more than two hundred years of experience, we should think that the government can hold down the cost of anything. Ask why the government cannot do as good a job at providing affordable primary care as new walk-in clinics in retail stores. Ask why Wal-Mart and its competitors have done more to reduce the cost of generic drugs than any government program.
38. "Only the government can guarantee quality health care."
Ask if the U.S. Postal Service provides better and more affordable delivery than FedEx or UPS. Ask if public schools and teacher unions guarantee better or even more affordable education for children than private and parochial schools. Ask if government-run hospitals provide better care than private commercial and non-profit hospitals.
39. "The government can require American medicine to concentrate on wellness."
Ask if most government systems don't concentrate instead on rationing. Ask if a wellness approach will help those on waiting lists for months or years for medical diagnostic equipment, access to specialists or surgery.
((Not that you'd KNOW any of this if you listen to the main stream media....))
10 Surprising Facts about American Health Care
http://www.ncpa.org/pub/ba649 No. 649
Tuesday, March 24, 2009 by Scott Atlas
Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers and academics alike are beating the drum for a far larger government rôle in health care. Much of the public assumes their arguments are sound because the calls for change are so ubiquitous and the topic so complex. However, before turning to government as the solution, some unheralded facts about America's health care system should be considered.
Fact No. 1: Americans have better survival rates than Europeans for common cancers.
Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.
Fact No. 2: Americans have lower cancer mortality rates than Canadians.
Breast cancer mortality is 9 percent higher, prostate cancer is 184 percent higher and colon cancer mortality among men is about 10 percent higher than in the United States.
Fact No. 3: Americans have better access to treatment for chronic diseases than patients in other developed countries.
Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them.
Fact No. 4: Americans have better access to preventive cancer screening than Canadians.
Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate and colon cancer: Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent). Nearly all American women (96 percent) have had a pap smear, compared to less than 90 percent of Canadians. More than half of American men (54 percent) have had a PSA test, compared to less than 1 in 6 Canadians (16 percent). Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent).
Fact No. 5: Lower income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report "excellent" health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as "fair or poor."
Fact No. 6: Americans spend less time waiting for care than patients in Canada and the U.K. Canadian and British patients wait about twice as long - sometimes more than a year - to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.
Fact No. 7: People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either "fundamental change" or "complete rebuilding."
Fact No. 8: Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the "health care system," more than half of Americans (51.3 percent) are very satisfied with their health care services, compared to only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).
Fact No. 9: Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K. Maligned as a waste by economists and policymakers naïve to actual medical practice, an overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade. [See the table.] The United States has 34 CT scanners per million Americans, compared to 12 in Canada and eight in Britain. The United States has nearly 27 MRI machines per million compared to about 6 per million in Canada and Britain.
Fact No. 10: Americans are responsible for the vast majority of all health care innovations.
The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country. Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined. In only five of the past 34 years did a scientist living in America not win or share in the prize. Most important recent medical innovations were developed in the United States. [See the table.]
Conclusion. Despite serious challenges, such as escalating costs and the uninsured, the U.S. health care system compares favorably to those in other developed countries.
Scott W. Atlas, M.D., is a senior fellow at the Hoover Institution and a professor at the Stanford University Medical Center. A version of this article appeared previously in the February 18, 2009, Washington Times.
((Wow, an article with CITATIONS! What a novel thought - to actually present factual backup for what you say....do they TEACH that in journalism school anymore?))
1 - Concord Working Group, "Cancer survival in five continents: a worldwide population-based study,.S. abe at responsible for theountries, in s chnologies, " Lancet Oncology, Vol. 9, No. 8, August 2008, pages 730 - 756; Arduino Verdecchia et al., "Recent Cancer Survival in Europe: A 2000-02 Period Analysis of EUROCARE-4 Data," Lancet Oncology, Vol. 8, No. 9, September 2007, pages 784 - 796.  U.S. Cancer Statistics, National Program of Cancer Registries, U.S. Centers for Disease Control; Canadian Cancer Society/National Cancer Institute of Canada; also see June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S.," National Bureau of Economic Research, Working Paper No. 13429, September 2007. Available at http://www.nber.org/papers/w13429.  Oliver Schoffski (University of Erlangen-Nuremberg), "Diffusion of Medicines in Europe," European Federation of Pharmaceutical Industries and Associations, 2002. Available at http://www.amchampc.org/showFile.asp?FID=126. See also Michael Tanner, "The Grass is Not Always Greener: A Look at National Health Care Systems around the World," Cato Institute, Policy Analysis No. 613, March 18, 2008. Available at http://www.cato.org/pub_display.php?pub_id=9272.  June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."  Ibid.  Nadeem Esmail, Michael A. Walker with Margaret Bank, "Waiting Your Turn, (17th edition) Hospital Waiting Lists In Canada," Fraser Institute, Critical Issues Bulletin 2007, Studies in Health Care Policy, August 2008; Nadeem Esmail and Dominika Wrona "Medical Technology in Canada," Fraser Institute, August 21, 2008 ; Sharon Willcox et al., "Measuring and Reducing Waiting Times: A Cross-National Comparison Of Strategies," Health Affairs, Vol. 26, No. 4, July/August 2007, pages 1,078-87; June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."; M.V. Williams et al., "Radiotherapy Dose Fractionation, Access and Waiting Times in the Countries of the U.K.. in 2005," Royal College of Radiologists, Clinical Oncology, Vol. 19, No. 5, June 2007, pages 273-286.  Nadeem Esmail and Michael A. Walker with Margaret Bank, "Waiting Your Turn 17th Edition: Hospital Waiting Lists In Canada 2007."  "Hospital Waiting Times and List Statistics," Department of Health, England. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/HospitalWaitingTimesandListStatistics/index.htm?IdcService=GET_FILE&dID=186979&Rendition=Web.  Cathy Schoen et al., "Toward Higher-Performance Health Systems: Adults' Health Care Experiences In Seven Countries, 2007," Health Affairs, Web Exclusive, Vol. 26, No. 6, October 31, 2007, pages w717-w734. Available at http://content.healthaffairs.org/cgi/reprint/26/6/w717.  June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."  Victor R. Fuchs and Harold C. Sox Jr., "Physicians' Views of the Relative Importance of 30 Medical Innovations," Health Affairs, Vol. 20, No. 5, September /October 2001, pages 30-42. Available at http://content.healthaffairs.org/cgi/reprint/20/5/30.pdf.  OECD Health Data 2008, Organization for Economic Cooperation and Development. Available at http://www.oecd.org/document/30/0,3343,en_2649_34631_12968734_1_1_1_37407,00.html.  "The U.S. Health Care System as an Engine of Innovation," Economic Report of the President (Washington, D.C.: Government Printing Office, 2004), 108th Congress, 2nd Session H. Doc. 108-145, February 2004, Chapter 10, pages 190-193, available at http://www.gpoaccess.gov/usbudget/fy05/pdf/2004_erp.pdf; Tyler Cowen, New York Times, Oct. 5, 2006; Tom Coburn, Joseph Antos and Grace-Marie Turner, "Competition: A Prescription for Health Care Transformation," Heritage Foundation, Lecture No. 1030, April 2007; Thomas Boehm, "How can we explain the American dominance in biomedical research and development?" Journal of Medical Marketing, Vol. 5, No. 2, 2005, pages 158-66, U.S. Department of Health and Human Services, July 2002. Available at http://fraser.stlouisfed.org/publications/erp/page/8649/download/47455/8649_ERP.pdf .  Nicholas D. Kristof, "Franklin Delano Obama," New York Times, February 28, 2009. Available at http://www.nytimes.com/2009/03/01/opinion/01Kristof.html.  The Nobel Prize Internet Archive. Available at http://almaz.com/nobel/medicine/medicine.html.  "The U.S. Health Care System as an Engine of Innovation," 2004 Economic Report of the President.
August 22, 2007
Why the U.S. Ranks Low on WHO's Health-Care Study
By John Stossel
The New York Times recently declared "the disturbing truth ... that ... the United States is a laggard not a leader in providing good medical care."
As usual, the Times editors get it wrong.
They find evidence in a 2000 World Health Organization (WHO) rating of 191 nations and a Commonwealth Fund study of wealthy nations published last May.
In the WHO rankings, the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. Michael Moore makes much of this in his movie "Sicko."
The Commonwealth Fund looked at Australia, Canada, Germany, New Zealand, the United Kingdom and the United States -- and ranked the U.S. last or next to last on all but one criterion.
So the verdict is in. The vaunted U.S. medical system is one of the worst.
But there's less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading.
First let's acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles. The system is riddled with tax manipulation, costly insurance mandates and bureaucratic interference. Most important, six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness. As Milton Friedman always pointed out, no one spends other people's money as carefully as he spends his own.
Even with all that, it strains credulity to hear that the U.S. ranks far from the top. Sick people come to the United States for treatment. When was the last time you heard of someone leaving this country to get medical care? The last famous case I can remember is Rock Hudson, who went to France in the 1980s to seek treatment for AIDS.
So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways.
The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.
Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.
When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.
Diet and lack of exercise also bring down average life expectancy.
Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.
It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.
The U.S. ranking is influenced heavily by the number of people -- 45 million -- without medical insurance. As I reported in previous columns, our government aggravates that problem by making insurance artificially expensive with, for example, mandates for coverage that many people would not choose and forbidding us to buy policies from companies in another state.
Even with these interventions, the 45 million figure is misleading. Thirty-seven percent of that group live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled.
For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine.
Next week: the truth about the Commonwealth Fund study.
Copyright 2007 Creators Syndicate Inc.
Doctors Offer Senators Their Opinion on Health Care Reform
More than 11,000 doctors from around the country who connected on a medical Web site called Sermo signed a petition outlining several issues they think are critical parts of health reform. The petition was delivered to the 100 Senate offices Tuesday.
By Jim Angle
Tuesday, September 08, 2009
Doctors made the rounds of Senate offices Tuesday -- not to treat lawmakers but to implore them to listen to physicians on health care reform.
"A number of us don't feel like we've had much input in this debate," one doctor said.
More than 11,000 doctors from around the country who connected on a medical Web site called Sermo signed a petition outlining several issues they think are critical parts of health reform, including tort reform, transparent billing, insurance reform and changing the payment systems to encourage preventive medicine.
The petition was delivered to the 100 Senate offices Tuesday, including that of Sen. Tom Coburn, who is also a doctor.
"I agree with you we hadn't heard from the medical community," the Republican said. "We've heard from a lobbying arm that's interested in money, not patients and not physicians."
The petition comes a day before President Obama addresses a joint session of the Congress in an attempt to rally a fractious Democratic Party and persuade Republicans to drop their opposition.
To win the support of doctors, tort reform is key. Some, such as orthopedic surgeons, can pay up to $80,000 a year in malpractice insurance. Obstetricians have it even worse. They can pay astronomical sums of more than $200,000 a year. But insurance is only half the cost.
"There's been a number of surveys which have shown that up to a third of all tests and procedures that are done aren’t necessarily in the best interest of the physician or the patient," said Dr. Daniel Palestrant. "They are done to protect both parties from liability."
Nevertheless, tort reform isn't part of any of the congressional proposals so far, including the massive one in the House.
"If we are putting everything on the table as the president says to try and improve health care, it would seem suspicious that in a 1,200-page bill, the word tort reform or malpractice isn't mentioned once," Palestrant said.
In fact, some Democrats, including former Democratic National Committee Chairman Howard Dean acknowledges the party was reluctant to cross trial lawyers because they contribute so heavily to Democratic candidates.
But some say that has to change.
"I think the time has come for the Democrats to say alright, we're going to have to take on one of our own here," said Democratic strategist Bob Beckel. "They are going to have to contribute because it is true that runaway lawsuits have caused insurance premiums to go up."
Beckel says that would be a smart political move that would give Democrats more credibility and quiet down Republicans, as he put it. He also says a lot of Democrats are thinking about such a move as a way to breathe new life in the health reform debate.
Dear Friends and Members: Seven days and counting until "White Coats To Congress", where the nation's "practicing" doctors will meet in Washington, DC, to voice our opposition to the government takeover of healthcare. HR 3200 and the corresponding Senate Bill is the most serious threat to the physician-patient relationship and patients' freedom of choice in our lifetime and will impact the life of every American citizen. This event will be a game changer in the debate as we go to Congress and remind them that the AMA's tepid response and endorsement of this flawed bill does NOT represent the best interests of patients nor the opinion of the majority of "practicing" doctors. This is a watershed moment in our professional career and we urge all physicians to make every effort to stand in unity with their peers. We also recommend that "friends" of D4PC reach out to all doctors they know to make them aware of this historical event. We are pleased to announce many positive developments since the August D4PC NEWSLETTER. In order to ease navigation and make efficient use of your time, we have redesigned the website with discreet ACTION steps and links to your elected officials. This endeavor is a work in progress and we are committed to making changes as necessary to serve our members/friends needs.Since the August Congressional recess, we have witnessed tremendous energy and heated discussion from the public/patients as details of the proposed legislation emerge. To effectively promote our message and proposals for responsible healthcare reform, we have retained the professional service of a media consultant and public relations group. As a result of these relationships, we have had the opportunity to serve on panel discussions at numerous Town Hall meetings and have given dozens of radio interviews across the nation, including many syndicated shows. This media exposure has brought new members from dozens of states. Last weekend, we filmed a three minute video which you can view on the D4PC website, FACEBOOK and YOUTUBE. To facilitate this video going viral on the web, please email this video link to your entire address book and encourage your contacts to do the same. View video here:
Many receiving this current NEWSLETTER are new subscribers, so I will mention a few things that were included in last month's edition. We want to remind you that D4PC advocates responsible, meaningful and sustainable healthcare reform that will help lower costs, increase access for all Americans, enable technological/pharmaceutical innovation and preserve patients' ability to make independent healthcare decisions with their doctors and allied health professionals. Although the "rush" to pass this disastrous bill has been derailed, the debate is far from over. While it may appear Congress has been on vacation, there are myriad Congressional aides, lobbyists and power brokers working frantically on details of both bills in order to bring legislation to the floor for a vote as soon as both chambers reconvene next week. Furthermore, the Administration clearly recognizes public opinion and support has fallen dramatically and is preparing to "reinvent" their message for President Obama's Speech to Congress and the nation next Wednesday. THIS IS NOT THE TIME TO BE COMPLACENT!!!! We believe the next few weeks are critical as the Congressional leadership has stated they will pass this bill "by any legislative means necessary". These are the ACTIONS we need you to take:-Continue the barrage of emails/faxes/phone calls to your respective US Rep.and two US Senators. It is vital that you do the same communication blitz to as many Reps./Senators from other states as well, especially the "Blue Dogs", who will most likely determine the fate of both bills. All contact information and talking points are provided on the ACTION LINK on the D4PC website. DO NOT SEND VIA US MAIL. It will not be delivered for 8 weeks. -
Visit the website: www.docs4patientcare.org several times per week as we add new items and ACTIONS frequently. Read the articles under RESOURCES to learn more about this issue and review our proposals for common-sense solutions to address the problems in our healthcare system. Please share these recommendations with others so they are informed of existing solutions other than a "government" takeover. -
Join our “new” FACEBOOK Group Page listed as: Docs 4 Patient Care. Please insert spaces in our name in order to hit the correct page.. -
Sign the PETITION on our website. We have received 1.2 million signatures and would like to deliver 2 million to Congress.-Please continue to inform and motivate family, friends and colleagues to ACTION and ask them to visit www.docs4patientcare.org.
As this issue progresses, we will provide updates of important developments and calls to ACTION. We are a grassroots group with limited resources. In order to continue this effort and play an influential role in protecting your healthcare system, go to our website today and please make an online donation of $50. We certainly appreciate any financial contribution you are able to make. Thank you for your interest and support on this important issue.
Respectfully,Dr. Tod Rubin
We need your help! Your "Free Our Health Care NOW!" petition, www.freeourhealthcarenow.com, needs only 70,000 more supporters to become the largest policy petition in American history delivered to Congress! With your help, more than 1.3 million Americans will make their voice heard!
YOUR MISSION: To inspire 70,000 Americans to sign the "Free Our Health Care NOW!" petition and make it the largest policy petition ever delivered to Congress. If each of you recruits just one more signer together we will make history!
TIMETABLE: On your behalf, we will deliver the "Free Our Health Care NOW!" petition to Congress on Wednesday, September 9. The final tally of petition supporters will occur the day before, at 5pm on Tuesday, September 8. We have 96 hours to accomplish our mission!
THE REASON: As taxpayers and as patients, the American people simply can't afford government-run health care. Quality and access will decrease; costs will skyrocket; rationing will be in place! This is your petition, your voice and your opportunity to fight for your country!
WHAT HAPPENS NEXT? Many of the members of your community are thinking about health care. They're worried, angry and uncertain. They're tired of the rhetoric and they want change that they can trust.
Tell them about the "Free Our Health Care NOW!" petition. Tell them why you signed www.freeourhealthcarenow.com and why you continue to believe that a better health care system is possible.
This is a mission we can accomplish together. We have a purpose which cannot be denied: to protect the health of our family, our friends, and our country!
Thank you for your continued support. If you can plan to join us on 9/9/09 in Washington, DC. (http://www.mediakit.ncpa.org/files/media_advisory.pdf)
Jeanette Nordstrom National Center for Policy Analysis www.ncpa.org
((Is it my imagination, or does the AMA seem to be backing down a little from their unconditional support of the existing plans? Perhaps this is in response to the outrage of many AMA members - who, I hope, have NOT cancelled their memberships, but rather pledged themselves to a higher level of involvement in order to help SHAPE AMA policy, rather than simply complain about it...))
September 9, 2009, 2:01 pm
A.M.A. Endorses a Health Care Overhaul
By David D. Kirkpatrick
The American Medical Association — the group that polls show is most trusted by the public to recommend the right changes to the health care system — on Wednesday issued a public letter to Congress and President Obama broadly endorsing his proposed overhaul on the morning before he makes his biggest push for the plan in a televised speech.
In the group’s letter (PDF), its president, Dr. J. James Rohack, urges the elected officials “to reach agreement this year on health system reforms” and lists measures it hopes to see in the bill. Many are already key elements of the president’s proposals, like universal health coverage, the elimination of private insurers’ denials for pre-existing conditions and new incentives for preventive medical care.
The association makes no mention of the president’s proposed government-run insurer, which the A.M.A. has quietly opposed. The group has evidently concluded that no powerful public plan will end up in the final bill.
The list does include an item that would protect doctors’ incomes by revising Medicare payment formulas that at present would result in reimbursement cuts. That item — currently in all the major overhaul bills in Congress — is a big incentive for doctors to get behind the administration’s plan.
More controversially, the medical association also calls for rules to protect doctors from malpractice suits — “medical liability reforms that would reduce the cost of defensive medicine.” Such protections are highly popular with Republicans and a longstanding goal of the doctors. But the idea is highly unpopular with many Democrats and their allies in the powerful trial-lawyers’ lobby.
The White House has recently hinted that the president is likely to endorse some limits on malpractice suits — probably a “safe harbor” for doctors who follow certain rules rather than any cap on damages — which may help explain the timing of the medical association’s endorsement.
Polls show that voters trust the doctors on the subject of health care reform more than any other interest group, either party in Congress or the president himself.
AMA Letter - September 8, 2009
Open Letter to President Obama and Members of Congress
As our nation's elected leaders, you have an historic opportunity to improve the health and well-being of the American public.
On behalf of America's physicians and their patients, we strongly urge you to reach agreement this year on health system reforms that include the following seven critical elements:
Provide health insurance coverage for all Americans
Enact insurance market reforms that expand choice of affordable coverage and eliminate denials for pre-existing conditions
Assure that health care decisions are made by patients and their physicians, not by insurance companies or government officials
Provide investments and incentives for quality improvement, prevention and wellness initiatives
Repeal the Medicare physician payment formula that will trigger steep cuts and threaten seniors' access to care
Implement medical liability reforms to reduce the cost of defensive medicine
Streamline and standardize insurance claims processing requirements to eliminate unnecessary costs and administrative burdens
The challenges in our health care system are many and complex.
Enactment of the above policies will create the foundation for a stronger, better performing health care system, improve access to affordable, high-quality care and reduce unnecessary costs. Further, those who are currently insured, including Medicare patients, and those who are uninsured will all benefit from greater security and stability.
The American Medical Association and our individual members are working hard to improve health care delivery and quality through a broad range of initiatives to promote best practices and reduce unnecessary costs.
We reaffirm our commitment to work with each of you to adopt and implement health system reforms that will benefit all Americans.
J. James Rohack MD
Conservatives for Patients' Rights
Today's Daily Dose
The Wall Street Journal reports this morning that the President will press for a government-run insurance option in his speech tonight to Congress. With support for a government-run health care option waning, Rick Scott is encouraging President Obama to truly lead by dropping the public plan. "The President has an excellent opportunity to show some leadership and move the debate forward by dumping the government-run public option that has been resoundingly rejected by the American people." The 100 best Twitter feeds for Women's Health Issues have been compiled by Online Nurse Practitioner Schools. In a tragic story from Great Britain, a baby born prematurely after 21 weeks and a few days, was denied life saving care because of national health care guidelines. This can only leave us wondering: Is trying to save a premature baby in opposition to government regulations in the United Kingdom?
Lives Shattered By Government-Run Health Care Brian Faughnan - Red State
As the debate on health care continues, liberals in Washington continue to try to convince Americans that we need government-run health care. Rather than tell the truth about long waits, denied treatments, lack of trained professionals, and bureaucratic mistakes, they try to convince listeners that the problems of the current system can only be solved by more government. With that in mind, I will present one case study of government-run care per day - either for 100 days, or until the debate in Washington is over. These stories are drawn from the book Shattered Lives, by the National Center for Public Policy Research: According to Britain’s state-managed health service, cataract surgery is a “common” and “straightforward” operation that usually should last between 15 and 20 minutes. But such a quick turnaround would have been news to Richard Adams of London, who went blind in both eyes while waiting three years for cataract surgery.Pelosi's Trump Card: The Public Option Glenn Thrush and Patrick O'Connor - PoliticoNancy Pelosi finally has a trump card. Tired of watching helplessly as House bills are carved up to win support from conservative Democrats and moderate Republicans in the Senate, the speaker has a message for President Barack Obama and Senate Majority Leader Harry Reid: Take the public option out of health care reform, and you may not have a bill at all. “Every time we have had a negotiation, Reid and [White House chief of staff] Rahm [Emanuel] say you have to accept this or that because we need the 60 votes [for cloture],” says a senior Democratic aide in the House. “That’s true this time. The difference now is that Pelosi can turn right back at them and say, ‘I can’t pass this in the House without the progressives.’ And that will be true, too.” Pelosi’s leverage in her perpetual push-pull with Reid has been boosted by a rebellion among pro-public-option progressives, African-American and Hispanic House members, who say they are tired of being shortchanged by the White House and will vote no rather than OK a bill without the public option. Democratic insiders say Pelosi is intent on harnessing that liberal power play as the only way to keep the public optionMax Baucus To Gang Of Six: Time Is Running OutCarrie Budoff Brown and Chris Frates - PoliticoAs Congress waits on the president’s health care speech Wednesday, Barack Obama is in the unusual position of waiting on six senators most of the public couldn't pick out in a crowd. They’ll decide whether Obama has any hope of getting significant Republican votes for health reform — or whether he will have to go it alone with only Democrats, a politically risky path. Senate Finance Committee Chairman Max Baucus (D-Mont.) gave the bipartisan Gang of Six until 10 a.m. Wednesday to submit ideas on his compromise health reform bill. At that point, he will decide whether to continue the talks or possibly abandon hopes of a broadly bipartisan bill. The goal is to have a decision ahead of Obama’s speech to a joint session of Congress — and whatever Baucus decides could chart the course of health care reform in the Congress. Baucus’s compromise bill is, in effect, the last hope to achieve Obama’s goal of getting significant Republican support for an overhaul of the U.S. health care system. But two of the last Republican negotiators, Sens. Chuck Grassley of Iowa and Mike Enzi of Wyoming, have signaled in recent weeks that they might not be able to sign on to a compromise. If not, Baucus said Tuesday he would go ahead with his bill anyway.How Republicans Will Respond Andy Barr - PoliticoLooking to score points in the immediate aftermath of President Barack Obama’s speech Wednesday, Republicans have readied a response strategy that they hope will steal some of the president’s thunder. Republicans are prepared to take on the president following the speech no matter what he unveils Wednesday night and will attack Obama for supporting a public option even if he backs off from such a program in his speech. “Even if Obama says that he doesn’t support a public option, Republicans still expect him to work towards one, whether in the form of [an insurance] co-op or through another way, and we will continue to hit him on it,” a Republican National Committee official told POLITICO. The Republicans also are pushing hard to frame the Obama’s speech in the hours leading up to its delivery. Tuesday night, RNC Chairman Michael Steele kicked off a series of national and regional television and radio interviews with an appearance on Fox News host Sean Hannity’s show, criticizing the president’s anticipated remarks. Obama's Actions Are Louder Than WordsMichael Steele - PoliticoHere’s what we know for sure – the president will give a good speech Wednesday night. He always does. We also know that he will say a lot of things that the American public likes and agrees with when it comes to health care reform. He always does. But there is one small problem. Speaker Pelosi’s bill, a bill that the president haendorsed, doesn’t have anything in common with the president’s eloquent, poll-tested rhetoric. In fact, no Democrat proposal exists from the president or any of his congressmen that has anything in common with the president’s rhetoric. The president will tell us Wednesday night that if you like your current health care plan you can keep it, that no one will interfere with the doctor patient relationship, there will be no threat of rationing care for seniors, there will be no cuts to Medicare, the Cubs will win the World Series, and gravity is no longer a factor. The truth is that the Democrats’ government-run health care experiment could force over 80 million Americans from their current health coverage. Hospitals and doctors could drop many of their patients. Speaker Pelosi’s bill could also give government bureaucrats the power to limit or deny treatments, especially for seniors. Democrats plan over $500 billion in cuts to Medicare that could threaten access to treatments, especially for low-income seniors.Multiple Hurdles Await Democrats Jeanne Cummings and Patrick O'Connor - PoliticoThe final lap for Congress that begins this week is shaping up less as a deliberative, legislative session than as an oncoming train wreck. A rattler loaded with the Democrats’ top priorities — championed for more than a decade from the minority side of the aisle — is now headed for action in a House and Senate controlled by the party. And that leaves few scapegoats if they fail to deliver. But the hurdles facing the Obama administration and its allies, fresh from a tempestuous August, go beyond the typical deep-pocketed industries and conservative interest groups. The legislative calendar itself becomes a new adversary, squeezing the floor time available for debate before the December recess. It’s an issue that could become particularly acute in the Senate, where the minority can use friendlier rules to stall any steamrolling. Plain old exhaustion and frustration also could become management issues for House and Senate leaders, suggests John Feehery, a former top aide to House Speaker Dennis Hastert (R-Ill.). Senate Leaders: Stick To The Basics Trent Lott - PoliticoThe toughest job in our nation’s capital is Senate majority leader, exceeded only on occasion by Senate minority leader. By design, the Senate is a very difficult place to manage, with its unusual rules and the competing philosophical interests in both party caucuses. In the House of Representatives, the speaker rules because he or she has the Rules Committee, which determines when, how long and what amendments, if any, are in order during floor debate. The president has the entire administration to carry out his orders. So what is a leader in the Senate to do? First, do what must be done, and then do what is broadly supported by both parties. That alone would produce a pretty good agenda. Begin with the appropriations bills, and give them priority floor time. After all, the government has to be funded by individual appropriations bills or by some form of an omnibus bill at the end of the fiscal year. Seldom have all the appropriations bills been passed by Oct. 1. This was accomplished in 1996 but only because the leadership of both parties decided to get it done. Completing those bills would consume most of September and then some. Democrats Promise to Send Health Plan to ObamaCarl Hulse and Robert Pear - The New York TimesDemocratic Congressional leaders assured President Obama on Tuesday that they would deliver a health care overhaul to his desk this year as the author of a new compromise Senate plan said he was ready to push ahead with his legislation. “We are not going to dally. We are not going to dawdle,” Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said after a meeting with five fellow architects of his compromise legislation. “Time is running out very quickly,” Mr. Baucus added. Mr. Baucus said he asked the lawmakers — two Democrats and three Republicans — for their reaction to his proposal by Wednesday morning, saying he hoped to reach an agreement before Mr. Obama’s scheduled speech to a joint session of Congress on Wednesday night. Senator Olympia J. Snowe of Maine, the Republican seen as most likely to join in a Baucus plan, sounded generally positive in her initial reaction to his proposal. But Ms. Snowe said she did not want to be rushed into making a decision about it and had a few concerns outstanding.Obama To Endorse Public Plan In SpeechJonathan Weisman and Janet Adamy - The Wall Street JournalPresident Barack Obama, in a high-stakes speech Wednesday to Congress and the nation, will press for a government-run insurance option in a proposed overhaul of the U.S. health-care system that has divided lawmakers and voters for months. White House officials say the president will detail what he wants in the health-care overhaul, as well as say he is open to better ideas on a government plan if lawmakers have them. Democratic plans call for requiring most Americans to carry health insurance. Failure to comply could cost families as much as $3,800 a year, according to a new Senate proposal. The president is likely to say that a government-run insurance plan, known as the "public option," will not provide a level of subsidies that give it an unfair advantage over private insurers, according to aides familiar with the speech preparations.Obama And The Bureaucratization Of Health Care Sarah Palin - The Wall Street JournalWriting in the New York Times last month, President Barack Obama asked that Americans "talk with one another, and not over one another" as our health-care debate moves forward. I couldn't agree more. Let's engage the other side's arguments, and let's allow Americans to decide for themselves whether the Democrats' health-care proposals should become governing law. Some 45 years ago Ronald Reagan said that "no one in this country should be denied medical care because of a lack of funds." Each of us knows that we have an obligation to care for the old, the young and the sick. We stand strongest when we stand with the weakest among us. We also know that our current health-care system too often burdens individuals and businesses—particularly small businesses—with crippling expenses. And we know that allowing government health-care spending to continue at current rates will only add to our ever-expanding deficit. How can we ensure that those who need medical care receive it while also reducing health-care costs? The answers offered by Democrats in Washington all rest on one principle: that increased government involvement can solve the problem. I fundamentally disagree.Obama Speech Aims To Reenergize Effort Shailagh Murray and Lori Montgomery - The Washington PostPresident Obama will seek to rally Congress to pass health-care reform in a prime-time address Wednesday, even as lawmakers continue struggling to reach broad consensus on some of the toughest issues in the debate. Senate Finance Committee Chairman Max Baucus (D-Mont.) offered the president a glimmer of hope for compromise, circulating a detailed draft of the only Democratic reform proposal that has been assembled with significant Republican input. But in a meeting Tuesday, Baucus was unable to persuade his "Gang of Six" bipartisan negotiators to endorse the nearly $900 billion plan, which does not include many provisions that liberal lawmakers are clamoring to see in a final measure. He gave his two Democratic and three Republican colleagues until 10 a.m. Wednesday to offer suggestions for improving the bill, which would require all U.S. citizens and legal residents to buy health insurance or carry coverage either through an employer, a public program or new insurance "exchanges" as of 2013. Opposition to Health Care Reform Revives Christian RightJacqueline L. Salmon - The Washington PostThe Christian right, facing questions before the presidential election about its continuing potency as a force for cultural and political change, has found new life with Barack Obama in office, particularly around health care. As the president prepares to address a joint session of Congress on Wednesday night to press for health-care reform, conservative Christian leaders are rallying their troops to oppose him, with online town hall meetings, church gatherings, fundraising appeals, and e-mail and social networking campaigns. FRC Action, the lobbying arm of the Family Research Council, has scheduled a webcast Thursday night for tens of thousands of supporters in which House Minority Leader John A. Boehner (R-Ohio) and other speakers will respond to the president's health-care address. "Movements do better when they have something to oppose," said D. Michael Lindsay, a sociology professor at Rice University who studies evangelicals. "It's easier to fundraise in those kinds of situations. It's easier to mobilize volunteers because you have an us versus them mentality, and that plays very well right now for the Christian right." Ex Clinton Aides: Obama's Health Plan Needs Direction Christina Bellatoni - The Washington TimesPresident Obama went out of his way to avoid the mistakes President Clinton made during his own health care reform battle 16 years ago - springing his own, hyper-detailed 1,342-page reform plan on Congress - but veterans of that White House say the new president has gone too far in the opposite direction. With Congress put in charge of writing the legislation, the debate spiraled out of Mr. Obama's hands this summer, and Republicans are already gloating that they have bloodied the new president on one of his administration's top priorities. Lanny Davis, a Washington lawyer and a former Clinton special counsel, said Mr. Obama seems to have used Mr. Clinton's lesson as his primer on what not to do. "They all thought they made a mistake in not letting Congress write the bill," Mr. Davis said in an interview. "While [Mr. Obama] had the right idea about not dropping a 1,000-page bill, he went too far in the other direction about not telling the American people what he stands for," added Mr. Davis, a regular contributor of opinion pieces to The Washington Times.
Pew Research Center
By a 46% to 39% margin, more Americans generally oppose than favor the health care proposals being considered in Congress