Thursday, October 29, 2009

10/28/09 - SGR Fix Fails, public option by any other name (would cost just as much....)

10/28/09 - Liability and Health News Update
SGR fix fails, public option by any other name....(would cost just as much)

by Donna Baver Rovito, Editor, "Liability and Health News Update"
Author, "Pennsylvania's Disappearing Doctors"

****If you would like to receive Liability and Health News Update in your email box, please email and put "subscribe" in the subject line.****

This LIABILITY UPDATE/Health Care Focus "newsletter" is a free service which I provide, as a volunteer, to help supply medical liability reform and other health care news and information, legislative updates, and political insight to physicians, patients, liability reform and quality health care advocates. NO ONE pays me to do this.

I am not employed by any physician or health care reform advocacy or liability reform organization, political party or candidate, although I volunteer for several. I am a quality health care, physician and patient advocate, breast cancer survivor, physician's spouse, journalist, political noisemaker, mom, and freelance writer. I am not nor will I ever claim to be unbiased, unlike many in the mainstream media.

Most information in this newsletter is copied and pasted from other sources, and will always be identified with links. Opinions and clarifications are my own, and do not reflect the official position of any physician or patient advocacy organization, tort reform, or health care reform group unless stated as such. My opinions are placed in double parentheses (("my opinion")), italicized and appear in blue. This Update is emailed to health professionals, physician and patient advocates, and others interested in ensuring access to quality medical care. It also appears on the following BLOG:

If you'd prefer not to receive these periodic updates about health care issues in America, please hit "Reply" and put "Unsub health group" in the subject line and I'll remove your email address immediately.





From Take Back Medicine
Doctors on the Hill will hold their own hearings!

Nationwide Doctors' Demonstration at Noon, Nov. 21

From Docs4PatientCare
Lobbying on Capitol Hill

From the San Francisco Chronicle

Democrats struggle to find unity on health plan

From the Heritage Foundation's Morning Bell
The Senate’s Public Plan “Opt Out” – More Optics than Option for the States

From the Washington Post
Public plan mirage

From the Heritage Foundation
Morning Bell: No Matter What You Call It, It’s Still Just Government-Run Health Care

From Fox news

Too Much of a Good Thing? Public Health Plan Could Have Huge Advantage in Market

From The Hill

Hoyer: House Dems on the verge of bringing healthcare bill to the floor

New York Times
Democrats Lose Big Test Vote on Health Legislation

From the AMA Website
AMA deeply disappointed Senate has failed seniors, baby boomers and military families by blocking S. 1776

From The Hill

'Doc fix' collapses, Reid tells colleagues AMA led him astray

From the Heritage Foundation
Morning Bell: A Whole New Health Care Ball Game

From Patients First - Get involved NOW

From Talking Points Memo
Six Dems -- And One Independent -- Ask Reid For Two 72-Hour Waits On Health Reform

From the Heritage Foundation
Harry Reid and the Chamber of Secrets
House Panel Paves Way for 'Nuclear Option' in Health Care Reform Bill

From National Review
Paul Ryan on Reconciliation [Robert Costa]

From Heritage Foundation

Congress’ Secret Plan to Pass Obamacare by Thanksgiving – Update

From National Review
Obamacare DissectedTen things that probably will be in the health-care bill (but shouldn’t).

Obama Economics Advisor Robert Reich Blasted for Promoting Death Panel

From Heritage Foundation
If it's so urgent, why would two elections pass before health reform takes effect?

From the Washington Post
New report boosts backers of lawsuit reform

From the Wall Street Journal
What Singapore Can Teach the White House
Its health care is first class, cheap and market-driven.



The first three items are about doctors speaking out about health care reform, including a nationwide physician demonstration scheduled for Nov. 21. NO ONE has more authority to speak on this issue - and while doctors are all over the board politically, I think there are important fundamentals on which almost everyone can agree. If you fear that the health care plans being debated at the national level will impact those fundamentals, then you MUST speak out now. A future Update will feature more stories about doctors' ideas about the health care debate.

You're probably aware by now that the SGR fix failed to garner even a majority in the Senate, much less the 60 votes which would have been required to move the legislation to the Senate Floor (cloture.) I've included a couple of stories about that - I find it quite annoying that Sen. Reid has opted to blame the AMA and the Republicans for the lack of support of many members of his own party. MANY THANKS to everyone who made calls and send emails about this important issue - I still don't quite comprehend why it's suddenly such a big deal for Congress to FIX ITS MISTAKE and repeal the flawed formula that will reduce physician reimbursements from Medicare by 21% in January 2010 - especially since Congress never has and never WILL actually let those reductions go into effect, so the "savings" they're making all the noise about replacing never really existed in the first place. Sigh.

The public option is back - with a shiny new name: the "consumer" option. Same old, same old, though. A lot of stuff about that follows, including whether or not "opting out" really is, and what's being written into the compromise bills behind those big closed doors in Washington.

Several pieces, as well, on transparency - if the public (or the legislators, for that matter) will get to SEE the bills that are currently being crafted, or if the Senate will try to sneak the bill through using reconciliation or the "nuclear option."

There are also some pieces which pose some interesting questions - like, if it's so URGENT to "fix" health care that we do it without proper consideration, why won't the provisions of the bills currently being written go into effect until 2013? Or why Sarah Palin got blasted for talking about "death panels" when one of the President's own advisors has advocated the same thing under another name?

You ARE all planning to vote on Tuesday, right? Yes, it's only an off-year election, and there aren't any major state legislators up for election - but there ARE judicial seats, and I strongly urge EVERYONE to get to the polls to support Joan Orie Melvin for PA Supreme Court.

Why Joan Orie Melvin over her opponent? Well, Joan is from a medical family and has always been open to medical issues, but even MORE so, her opponent seems to be the darling of the PA trial lawyers - and we all know what THAT means.

I'll send out a special election Update this week, with more of the information you'll need about this pivotal Supreme Court election. THIS DIRECTLY IMPACTS health care in Pennsylvania, so PLEASE find time to vote, ask your family and friends to get out and vote for Joan Orie Melvin for PA Supreme Court, and make sure your office staff has time during the day to cast their ballots on Tuesday.



((Not much notice, but I think this sounds fascinating...if you miss it, you can watch it online afterward....))

From Take Back Medicine
Doctors on the Hill will hold their own hearings!
Tuesday, October 27, 2009 at 07:09PM
Watch online WED. Oct 28, 2009

If the Democratic Congressional committee chairs won’t hold hearings about health care reform bills, then the Congressional GOP doctors will!

On Wednesday, October 28th, 2009, the GOP Doctors Caucus will host a hearing to examine what physicians and economic experts think about the impact of healthcare legislation put forth by Congressional Leadership in the House of Representatives and Senate.

Former Congressional Budget Office (CBO) Director Douglas Holtz-Eakin, Spokesman for the Coalition of State and Specialty Societies Dr. Todd Williamson, and practicing physicians are scheduled to testify.



Physicians to Review Symptoms and Offer Diagnosis of Health Plans
When: Wednesday, October 28th, 20093:30 p.m. – 5:30 p.m.
Where: The U.S. CapitolHVC 201

To view the live webcast of this event, please visit:
The GOP Doctors Caucus is Co-Chaired by Congressmen Tim Murphy and Phil Gingrey.
The membership is composed of 13 Republican members of Congress with backgrounds in the healthcare profession.

Witnesses include:
Panel One:
Dr. M. Todd Williamson, Immediate Past President, Medical Association of Georgia
Dr. Jerry L. Miller, Family Practice/Internal Medicine, Holston Medical Group (TN)
Panel Two:
Mr. Douglas Holtz-Eakin, Former Director, CBO
Dr. Robert DeJesus, Gastroenterologist from Westmoreland Gastroenterology Associates (PA)


Nationwide Doctors' Demonstration at Noon, Nov. 21 on Capital Steps in Harrisburg

((A courageous Reading area physician, Dr. Ed Chastka, has volunteered to help make this nationwide physician demonstration happen in PA - and I've agreed to help as well, but we're going to need physician coordinators to drum up both local and statewide support!

If you'd like to get involved, or even if you would just consider attending a demonstration - PLEASE - contact me at and I'll pass your information along to Dr. Chastka.

The White House had a doctor meeting to try to convince people that doctors in general supported various health care proposals - but WE KNOW that there are a lot of doctors out there who OPPOSE the public option, government mandates, etc.

THIS is an opportunity to let YOUR VOICES be heard.....please sign on to get involved....))


The MillionMedMarch is Marching State by State.

When: 12:00 PM Local Time, November 21, 2009

Where: All Major Cities

For location and contact information please see our map

Interactive Map

We Need
Leaders in each state to organize at state capitals and other cities and recruit attendees
leaders to contact local media pre and post event for tv/radio/print interviews
leaders to get to local politicians who have to deal with increased medicaid enrollment and each state's US Sen./Rep. to inform them of disastrous features of the bill
doctors in each state to get the message out to patients and doctors on the sidelines


A physician grassroots movement to re-establish honor, dignity and worth to the medical profession. That its sole mission is to protect the relationship between the doctor and the patient.
Resources and Links
Support MMM
Contact Us

From Docs4PatientCare
Physician Lobbying on Capitol Hill

Colleagues –

The next 90 days are crucial. Docs4patientcare is organizing lobbying trips to Capitol Hill on the following days:

The trips will be in smaller groups (10-12) than our previous trips, and each trip will be targeted to 2-3 key Senators/Congressmen as necessary. Each trip will require an early AM flight and a return flight same day.

I need docs to go! Please look over the dates and let me know which dates you can go. This is not the time to assume someone else will do it.

Alan Zuckerman
((Please contact Dr. Zuckerman directly if you can participate...))


From the San Francisco Chronicle

Democrats struggle to find unity on health plan
By RICARDO ALONSO-ZALDIVAR, Associated Press Writer
Wednesday, October 28, 2009
(10-28) 03:54 PDT WASHINGTON (AP) --

Democrats are still struggling to find a strategy that will let them push a health care overhaul through the Senate and fulfill President Barack Obama's goal of signing a bill this year.

A day after Majority Leader Harry Reid announced that the Democratic bill would include the option of a government insurance plan, moderates in his own party lost no time Tuesday in voicing their displeasure. Reid, D-Nev., needs every Democrat to break the filibusters Republicans are vowing to mount. But some of the moderates refuse to say whether they'll stick with their leader on procedural votes, let alone those on the merits of the bill.

"We are a long way from reaching conclusion," said Budget Committee Chairman Kent Conrad, D-N.D.

Speaker Nancy Pelosi is in a similar position in the House. Efforts to draft a consensus health care bill for a vote have been stalled for more than two weeks because of disagreements among Democrats.

There are nine weeks left in the year to deliver a bill to Obama's desk.

Intense days and nights lie ahead, said Sen. Bill Nelson, D-Fla. Senators who don't like the bill will find themselves the focus of a "prayer session," said Nelson. "They will pray that the retribution of God doesn't come down on them," he joked.

Nonetheless, moderate Democratic senators who control the balance of power on health care were holding their ground. Republican opposition stiffened, and party leaders announced they would attempt to strangle the bill before formal debate begins.

Despite the obstacles, senior Democrats cast Reid's draft legislation as a turning point. Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, said there is now a "sense of inevitability ... that, yes, we're going to pass health care reform."

The government insurance option long ago emerged as the biggest flashpoint in both the House and Senate as Democrats try to pass legislation that extends coverage, bans insurance practices such as denial of coverage because of pre-existing medical conditions and slows the growth of health care spending nationally.

But before any substantive issue can be joined on the Senate floor, Reid's first challenge is to gain 60 votes — the number needed to overcome a filibuster by Republicans — just to bring the bill up, a parliamentary maneuver so routine that a vote is rarely required.

But Sen. Mitch McConnell of Kentucky, the Republican leader, announced that in this case, even procedural votes will count. That's because, in his view, the underlying bill would "cut Medicare, raise taxes and increase health insurance premiums." He suggested Democrats could expect campaign commercials next year on the basis of the vote and recalled that Sen. John Kerry, D-Mass., was ridiculed in his 2004 presidential campaign for having once said he voted for a bill before he voted against it.

Sen. Tom Carper, D-Del., said he may seek changes on the Senate floor, a move likely to be welcomed by moderates. He backs a government role in states where one or two insurers control the market and premiums are high, along the same lines as a plan supported by Sen. Olympia Snowe, R-Maine. ((Like....purchasing insurance across state lines.....?))

That general approach, in which a lack of competition in an individual's state would trigger a government insurance option, "is still alive," said Sen. Kent Conrad, D-N.D.

While Reid is expected to eventually secure all 60 Democratic votes on the critical first test to bring the bill to the Senate floor, Sens. Ben Nelson of Nebraska, Mary Landrieu of Louisiana, Evan Bayh of Indiana and Blanche Lincoln of Arkansas all declined to say on Tuesday how they would vote.
In an indication of the pressure Reid faces, Bayh said the majority leader had agreed to cut an earlier proposal for a $40 billion tax on medical device makers.

"He significantly modified that proposal in a way that I understand will not impact thousands of good-paying jobs," said Bayh, whose state is home to Guidant Corp., a maker of cardiovascular devices, among other major industry players. Numerous officials said Reid had agreed to reduce the new tax to $20 billion over a decade. The officials spoke on condition of anonymity because no announcement had been made.

In the House, the principal stumbling block is disagreement among Democrats over how to set fees for doctors, hospitals and other health care providers participating in the public insurance plan.
Liberals want the government to set the rate unilaterally, pegged to the charges the government pays Medicare beneficiaries. Moderates want the government to negotiate with the providers in setting fees.

Pelosi favors the approach liberals want, but officials say she has all but concluded she cannot gain the necessary majority of 218 votes for it.

House Democrats also must resolve internal disagreements relating to abortion services and health care for immigrants before they can send the bill to the House floor for a vote.

Associated Press writers David Espo, Julie Hirschfeld Davis, Ben Evans, Andrew Miga, Ken Thomas and Erica Werner contributed to this report.


From the Heritage Foundation's Morning Bell
The Senate’s Public Plan “Opt Out” – More Optics than Option for the States
Posted October 26th, 2009 at 3.37pm in Health Care.

In the Senate, there is growing interest in the idea of a state “opt-out” of the federal public plan, a government –run health plan that would “compete” against private health plans. This latest Senate ploy creates the illusion of an “option” rather than making any fundamental changes
to the controversial proposal. While it is difficult to understand its true impact until legislative language is available, taxpayers who will bear the cost burdens of a new government health care entitlement should keep a few points in mind:

1. States could only op-out of the public plan, not of the entire bill.This is only an “opt-out” of one section of the massive health care proposal. There are literally hundreds of provisions that the states may find unacceptable, like the costly Medicaid expansion. That, for example, would add millions of new people onto the Medicaid rolls, and aggravate the “crowd out” of private health coverage and guarantee higher taxpayer burdens for one of the nation’s most poorly performing welfare programs.

2. A state opt-out does not eliminate the public plan.The federal government would likely require any state wishing to opt-out to still meet federal conditions. It could come, for example, as an explicit requirement that a state set up a public plan “option” that mirrors the federal public plan or as a public plan masquerading as a “co-op” that is in effect controlled, funded and accountable to the government. For those who wish to see a genuinely competitive insurance market, with all plans competing on a truly level playing field, a public plan requirement is a dangerous proposition whether administered at the federal level or the state level.

3. Experience shows that a federal public plan would likely be the easiest option for state officials.With the typical bureaucratic red tape and administrative complexity accompanying a state opt-out, states would likely discourage states from opting-out. Moreover, the federal strings that follow would likely strangle states ability to administer an option that does not closely follow the federal public plan model.

Crushing State Innovation. The massive bills in the House and Senate- with individual and employer mandates, federal control over health insurance benefits, new boards and commissions micromanaging what taxpayers get or don’t get, new fees, taxes and insurance costs- is a challenge to the citizens of the states. Bright and innovative state officials would prefer to embark on their own reforms, but these bills would crush creativity, innovation and experimentation under the weight of federal control and conformity.

A true state “opt out” would allow states to opt-out of the entire health care proposal in exchange for making measurable progress in improving cost,
quality and access to care for its citizens. Any other opt-out is just another shell game that is intended to appear as a concession but in reality provides a pretext for greater federal control and blocks much needed structural changes.

Nina Owcharenko


From the Washington Post
Public plan mirage
By Robert J. Samuelson
Monday, October 26, 2009

In the health-care debate, the "public plan" is all things to all people. For supporters, it would discipline greedy private insurers and make health-care coverage affordable. For detractors, it's a way station on the path to a single-payer insurance system of government-run health care. In reality, the public plan, also known as the public option, is mostly an exercise in political avoidance: It pretends to control costs and improve access to quality care when it doesn't.

As originally conceived by Yale political scientist Jacob Hacker, the public plan would be a government-created, nonprofit insurance company providing Medicare-like coverage to the under-65 population. But unlike Medicare, benefits would be paid for mainly by premiums -- not taxes. Americans could buy coverage from the public plan or a private insurer.

Competition and choice would increase, say liberals. Facing the low-cost public plan, private insurers would hold down their own premiums, the argument goes. Health-care costs for everyone would moderate. Government subsidies to provide universal coverage would be cheaper. By some estimates, Medicare's administrative costs are only 3 percent of spending, compared with 13 percent or more for private insurers. A new public plan is widely presumed to enjoy an advantage in overhead.

Nonsense, retort critics. The public plan's low costs would be artificial. Its main advantage would be the congressionally mandated requirement that hospitals and doctors be reimbursed at rates at or near Medicare's. These are as much as 30 percent lower than rates paid by private insurers, says the health-care consulting firm Lewin Group. With such savings, the public plan could charge much lower premiums and attract lots of customers. But health costs wouldn't subside; hospitals and doctors would offset the public plan's artificially low reimbursements by raising fees to private insurers, as already occurs with Medicare. Premiums would increase because private insurers must cover costs to survive.

As for administrative expenses, any advantage for the public plan is exaggerated, say critics. Part of the gap between private insurers and Medicare is statistical illusion: Because Medicare recipients have higher average health expenses ($10,003 in 2007) than the under-65 population ($3,946), its administrative costs are a smaller share of total spending. The public plan, with younger members, wouldn't enjoy this advantage.

Likewise, Medicare has low marketing costs because it's a monopoly. But a non-monopoly public plan would have to sell itself and would incur higher marketing costs. Private insurers' profits (included in administrative costs) also explain some of Medicare's cost advantage. But profits represent only 3 percent of the insurance industry's revenue. Moreover, accounting comparisons are misleading when they don't include the cost of Medicare's government-supplied investment capital. A public plan would also need investment capital. And suppose the public plan suffers losses. Congress would assuredly bail it out.

The promise of the public plan is a mirage. Its political brilliance is to use free-market rhetoric (more "choice" and "competition") to expand government power. But why would a plan tied to Medicare control health spending, when Medicare hasn't? From 1970 to 2007, Medicare spending per beneficiary rose 9.2 percent annually compared to the 10.4 percent of private insurers -- and the small difference partly reflects cost shifting. Congress periodically improves Medicare benefits, and there's a limit to how much squeezing reimbursement rates can check costs. Doctors and hospitals already complain that low payments limit services or discourage physicians from taking Medicare patients.

Even Hacker concedes that without reimbursement rates close to Medicare's, the public plan would founder. If it had to "negotiate rates directly with providers" -- do what private insurers do -- the public plan could have "a very hard time" making inroads, he writes. Hacker opposes such weakened versions of the public plan.

By contrast, a favored public plan would probably doom today's private insurance. Although some congressional proposals limit enrollment eligibility in the public plan, pressures to liberalize would be overwhelming. Why should only some under-65 Americans enjoy lower premiums? In one study that assumed widespread eligibility, the Lewin Group estimated that 103 million people -- half the number with private insurance -- would switch to the public plan. Private insurance might become a specialty product.

Many would say: Whoopee! Get rid of the sinister insurers. Bring on a single-payer system. But if that's the agenda, why not debate it directly? It's not insurers that cause high health costs; they're simply the middlemen. It's the fragmented delivery system and open-ended reimbursement. Would strict regulation of doctors, hospitals and patients under a single-payer system provide control? Or would genuine competition among health plans over price and quality work better?

That's the debate we need, but in truth, doctors, hospitals and patients don't want to be limited, whether by government or markets. Congress reflects public opinion. Fearing a real debate, we fake it.


From the Heritage Foundation
Morning Bell: No Matter What You Call It, It’s Still Just Government-Run Health Care
Posted October 27th, 2009 at 9.24am in Health Care.

Yesterday, Senate Majority Leader Harry Reid (D-NV)
announced that the health care legislation he is drafting will include a government-run health insurance plan, or as many on the left like to call it “the public option.” The new wrinkle that Reid has thrown into the proposal is an “opt out” clause which would require states to pass legislation by 2014 rejecting participation in the federal government run plan. None of the committees in the House or Senate ever even voted on this new opt out scheme. But that does not really matter. Whether it is first implemented through a co-op, or a trigger, or an opt out, the end goal is the same: government-run health care for all Americans.

Hotel Harry Reid: Reid provided
very few details for his “opt out” proposal, but here is what we do know: the government run plan would be available on the first day that major provisions of Obamacare would take effect in 2013, and states would have until 2014 to pass legislation declining participation in the program. This means that a one-vote majority of obstructionists in one chamber of a state legislature, by refusing to act, can consign a state’s residents to an eternity of government-run health care. In 17 states Democrats control both houses of the legislature and the state house. In another 24, Democrats control at least one legislative chamber or the governor’s mansion. That leaves a total of only 9 states where Republicans run the entire show — Texas, Utah, South Carolina, South Dakota, North Dakota, Missouri, Idaho, Florida, and Georgia. That means Americans in 41 states are all but guaranteed to have no choice but to endure the government run health plan. What opt out really means is: You’re already checked in, and if you don’t do so by 2014, you can never leave.

The Co-op Co-opt: Sens. Chuck Schumer (D-NY) and Kent Conrad (D-ND) have both pushed slightly different plans they both call co-ops. However, they both share the same fundamental flaws: advantageous federal funding and regulation designed to tilt the playing field in their direction. Heritage fellows Edmund Haislmaier, Dennis Smith, and Nina Owcharenko
have explained why this model is guaranteed to fail: “Simply calling some form of a government-sponsored enterprise (GSE) a “cooperative,” for instance, would be only another type of public plan in disguise. … One need look no further than Fannie Mae and Freddie Mac to see how GSEs can distort the market and leave taxpayers with huge liabilities. Decades of market distortions generated by their implicit government backing, compounded by the effects of repeated political meddling by Congress, put those GSEs at the very epicenter of the mortgage market collapse that triggered the current financial crisis and recession.”

The Trigger Trap: A trigger is a legislative tool that would put in place automatic benchmarks that if not met, would immediately unleash the government-run system into the market. For example, if 95% of Americans as defined by the bill, don’t have adequate health coverage by a certain date, the public option would be “triggered.”
What a trigger does is hold off the tough decision until future, uncertain circumstances. The public option would essentially become law today, but not go into effect until an undetermined time when economic conditions could be even worse. Had Congress enacted a trigger to save Clintoncare, the trigger would have forced states to implement HMOs at exactly the time everyone was moving away from that overly rigid version of managed care. We don’t want to repeat that mistake. It is a travesty of democracy because it allows legislators to vote for a plan now, but passes the blame for the catastrophic consequences onto their successors.
Throughout the legislative process the White House has coyly denied that the establishment of a government run health plan was essential to their health care plan. But in 2003, President Barack Obama
told the AFL-CIO: “I happen to be a proponent of a single-payer universal health care program. … And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately.”
Opt out, the trigger, and co ops will not get to government run health care immediately. They will all take time to develop. But no matter what road they try and bring Americans down, the destination is always the same: everybody in out, nobody out; that is, was, and always will be Obama’s ultimate goal.


From Fox news

Too Much of a Good Thing? Public Health Plan Could Have Huge Advantage in Market
Under the plan being pushed by House Speaker Nancy Pelosi, a government-run health insurance plan would provide nearly the same benefits as the other private plans in a new insurance exchange, at a fraction of the cost.
By Judson Berger
Friday, October 23, 2009

With 350 employees covered under his auto dealership's health care plan, Burt Brenner said a government-run insurance plan might be too good to resist.

Brenner, the chief financial officer at Lindsay Automotive in Alexandria, Va., said that private premiums have been increasing for 10 years, even when claims don't warrant it, and a "very attractive" element of the public plan is that it could stop that "rollercoaster."

"We would consider a public plan to reduce premiums if the benefits of the plan were comparable to that of our private plan," he said.

So would millions of others -- according to estimates of the sweeping impact a government-run health plan could have.

Under the plan being pushed by House Speaker Nancy Pelosi, a government-run plan would provide nearly the same benefits as the other private plans in a new insurance exchange, but at a fraction of the cost.

This would make the public plan an attractive deal. But it could also lead to an exodus of customers from private insurance -- a scenario conservatives fear will be the first step toward a single-payer system where the government is the sole insurance provider. And that, they say, would inflict further damage on the expanding deficit.

There are concerns that such a robust public plan could increase the cost of the overall reform package and follow in the footsteps of other entitlement programs, like Medicare, deep in the deficit hole.

For better or worse, analysts who gauge these plans say the version Pelosi is pushing could draw millions away from private coverage.

"We'd be moving largely to a government-run program," said John Sheils, senior vice president for The Lewin Group, a health care consultant.

The Lewin Group has long predicted that a government-run plan would have a sweeping effect on where Americans get their coverage. But it found a stark difference between the plan offered in the House Energy and Commerce Committee version, which requires a public option to use "negotiated" payment rates just like private plans, and the kind of plan pushed by Pelosi, which would pay providers using Medicare rates.

Though it claims to be editorially independent, The Lewin Group is owned by UnitedHealth Group, leading some critics to question the reliability of its studies.

The new insurance exchange would be a standardized and regulated marketplace for public and private insurance plans.

Sheils estimates that, in the new exchange, the public plan premiums would remain about level with private plan premiums if the rates are "negotiated." Because of this, a Lewin study released in September said most of its "price advantage" would be eliminated. It estimated that fewer than 1 million people would leave private coverage and that total public plan enrollment would hit about 21 million.

However, Sheils said, a plan based on Medicare rates would be about 23 percent cheaper than private plans and would attract a surge of clients.

The Lewin Group estimated that 35 million people would leave private coverage and about as many would join the government-run plan if it is open only to individuals and small firms. If it's open to all firms, the projected number of people leaving private coverage leaps to 83 million, with 103 million joining the public program.

Any public plan is likely to be limited to small firms, though according to an Aug. 31 Congressional Research Service report, a commissioner could allow larger employers to participate years down the road.

But even the scaled-back version of a Medicare-based plan could be enormously popular.

The health care legislation requires that a number of benefits be provided in all plans, public and private, in the exchange. This includes hospitalization, maternity care, prescription drugs, preventive care, and other benefits. The exchange would offer a few different tiers of coverage, but all those tiers would provide for the same benefits -- the main difference would be in the out-of-pocket expenses assumed by the patient for different services.

Lewin estimated that starting in 2011 the basic plan would cost $297 per member per month under private coverage. Sheils put that at about $229 for the Medicare-based public plan. Conservatives see this disparity as a warning sign.

"Medicare rates are artificially cheap. ... The public plan will underbid private plans with regard to enrollment," said Robert Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation.

"No matter what you call it, such a provision will lead to a government takeover of health care, which the American people strongly oppose," Michael Steel, spokesman for House Minority Leader John Boehner, wrote in an e-mail to

President Obama and congressional Democrats have long rejected this claim and say customers will just have more affordable choices under the overhaul.

"If you like what you have, you can keep it," Pelosi said Thursday.

Pelosi reportedly does not yet have the votes to pass the "robust" version of the public option she wants. Other versions of a government-run plan are also being tossed about, including one that would "trigger" the plan down the road if certain conditions are not met.

Gauging the impact of the competing plans is difficult. The Congressional Budget Office came up with more modest figures over the summer when it examined a plan to pay Medicare rates, plus 5 percent for physicians, under a public option - the exact idea being pushed by Pelosi and congressional allies.

The CBO found that premiums would probably be 10 percent cheaper than private plan premiums. And it estimated that enrollment would hit about 9 or 10 million.

Jennifer Tolbert, principal policy analyst at the Kaiser Family Foundation, said more people would certainly leave private coverage if a public plan based on Medicare rates is passed. But she questioned the suggestion that the plan would have an absolute advantage over private coverage.
"I think people base their coverage decisions not simply on cost," she said.

For one, people choose health insurance plans in part based on the network of providers they supply. And the CBO reported that, because health care providers would have the right to opt out of the public plan, "some" would choose not to participate because of the lower rates attached to the program.

But the CBO said a "substantial number" would join because of the prospect for "substantial enrollment."


From The Hill

Hoyer: House Dems on the verge of bringing healthcare bill to the floor
By Jared Allen - 10/27/09 11:30 AM ET

House Democrats are days, if not hours, away from introducing the healthcare bill that will make it to the floor, House Majority Leader Steny Hoyer (D-Md.) said Tuesday.The No. 2 Democrat in the House said it was the objective of Democrats to introduce their final bill this week so that it can be voted on next week.

“That would be our objective, because it’s our objective because we want to consider this bill next week, and we pledged to give 72 hours notice, so we need to roll out the bill this week,” Hoyer said.What the bill looks like remains unclear. Unlike Senate Majority Leader Harry Reid (D-Nev.), who on Monday announced that the final Senate bill would include a public option with an opt-out provision for the states — an announcement Reid made before pocketing the 60 votes he would need to pass such a bill — the House’s strategy has been to search for a formula that will generate 218 Democratic votes ahead of time.A whip operation that began in earnest last week to pin members down on their support for a public option tied to current Medicare rates versus one that allows doctors and hospitals to independently negotiate their reimbursement rates continued over the weekend and spilled over into this week.

On Friday Speaker Nancy Pelosi (D-Calif.) indicated an openness to a public option with negotiated rates, especially if the Senate includes some kind of public option in its legislation.
Hoyer said that the “overwhelming majority of Democrats” support a public option, but he again gave no hints as to which version is generating a critical mass of support.Asked how many additional healthcare votes Democrats are likely to win with a negotiated-rates public option, Hoyer replied: "We don’t have that number yet.”Pelosi has stood by her personal preference for a public option tied to “Medicare plus five percent,” saying that the Congressional Budget Office has preliminarily scored it as the biggest cost-saver.But she asked the CBO to produce more complete scores on both versions. House leaders, as well as important blocs of Democrats in the House, continue to wait for those scores.A Hoyer aide said Tuesday that CBO scores would be due before leaders could introduce their final bill.

With the debate on healthcare reform heating up, Democratic leaders are ramping up their floor schedule. House Democratic leaders have conveyed to their caucus that they will keep the House in session as long as necessary to pass healthcare reform legislation.

House members have been advised that the lower chamber is expected to be in session Monday through Friday next week, and there could be weekend votes. On Monday, there will be no votes until 6:30 p.m.

On Tuesday, the House is scheduled to convene with the Senate for an address from German Chancellor Angela Merkel.

The House will also be in session from Monday through Friday during the week of Nov. 16 and there could be votes on Nov. 23 and 24.
Mike Soraghan contributed to this article, which was updated at 2:35 p.m.


New York Times
Democrats Lose Big Test Vote on Health Legislation
Published: October 21, 2009

WASHINGTON — Democrats lost a big test vote on health care legislation on Wednesday as the Senate blocked action on a bill to increase
Medicare payments to doctors at a cost of $247 billion over 10 years.

The Senate majority leader,
Harry Reid, Democrat of Nevada, needed 60 votes to proceed. He won only 47. And he could not blame Republicans. ((Surprise - he did anyway....)) A dozen Democrats and one independent crossed party lines and voted with Republicans on the 53 to 47 roll call.

The Medicare bill has become a proxy for larger issues in the debate over legislation to overhaul the health care system.

Mr. Reid said the bill, by averting big cuts in physician fees, guaranteed that doctors would continue accepting Medicare patients. But since none of the costs were offset or paid for, Republicans said it was fiscally irresponsible, and some Democrats said they shared that concern.

By addressing doctors’ fees in a separate bill, Senate Democrats could hold down the cost of the broader health legislation, keeping it within the limits set by
President Obama. House Democrats are considering a similar tactic. Republicans said it was a transparent ploy to hide the cost of a health care overhaul.

Democrats had hoped that by passing the Medicare bill they could appease doctors and secure their support for the broader legislation.

Senate Democratic leaders said the bill to protect doctors’ fees had strong support from the White House, the American Medical Association and AARP.

Among the Democrats who voted against the party leadership were Senators Evan Bayh of Indiana, Kent Conrad of North Dakota, Russ Feingold of Wisconsin, Claire McCaskill of Missouri, Bill Nelson of Florida and
Ron Wyden of Oregon.

“I will vote for the doctor fix — when it is funded,” Mr. Nelson said.

Mr. Wyden said, “On the eve of a historic debate on health care, it’s essential to show a commitment to real reform,” which includes fiscal responsibility.

Mr. Reid said the Republicans had suddenly “gotten religion” and were being very frugal. In the past, he said, they did not worry about paying for tax cuts or for the drug benefit added to Medicare in 2003.

Under current law, doctors face a 21.5 percent cut in Medicare fees in 2010 and then annual 5 percent cuts for several years. Since 2003, Congress has stepped in to postpone such cuts, but it has usually found ways to offset the cost to the government.

The bill this year, by Senator
Debbie Stabenow, Democrat of Michigan, had no offset and would have repealed the current cost-cutting formula, known as the sustainable growth rate.

The Senate Republican leader,
Mitch McConnell, said he felt vindicated by the vote.

“In the Senate’s first vote on health care spending this year,” Mr. McConnell said, “a bipartisan majority rejected the Democrat leadership’s attempt to add another quarter-trillion dollars to the national credit card without any plan to pay for it. With a record deficit and a ballooning national debt, the American people are saying enough is enough.”

Despite the Senate vote, proponents of sweeping health care legislation moved ahead on other fronts.

At a meeting of the House Democratic Caucus, Speaker
Nancy Pelosi indicated that she would push for a “robust” liberal version of a government-run health insurance plan, to compete with private insurers, if she could get the 218 votes needed to win approval in the full House.

An aide to the House Democratic leadership said Ms. Pelosi had told the caucus that she had 200 votes, “or a little over 200,” for this option, which would use Medicare rates as a basis for paying
hospitals and doctors. Under another option, the government plan would negotiate rates with providers, as private insurers do.

Ms. Pelosi said the first alternative saved more money and would give the House leverage in negotiations with the Senate. But Representative Earl Pomeroy, Democrat of North Dakota, said he could not vote for this proposal because it would be damaging to his district and was likely to be dropped in negotiations with the Senate.

In North Dakota, as in many other rural areas, Mr. Pomeroy said, Medicare rates are far below those paid by private insurers.

Democrats in both chambers agreed Wednesday on one point: they want to revoke the exemption from federal antitrust law that health insurance companies have long enjoyed.

By a vote of 20 to 9, the House Judiciary Committee approved the antitrust change, which is likely to be included in the broader health care legislation. It would outlaw price-fixing, bid rigging and “market allocations” by companies that sell health insurance or medical malpractice insurance.

Mr. Reid and the chairman of the Judiciary Committee, Senator Patrick J. Leahy, Democrat of Vermont, said they would offer a similar plan as an amendment to health legislation in the Senate.
“Criminal conduct that would land people in jail in other industries is legal when insurers do it,” Mr. Leahy said.

The insurance business has been largely exempt from federal antitrust law since 1945. The
Supreme Court ruled in 1944 that insurance was interstate commerce subject to federal antitrust law. But the insurance industry won a reprieve nine months later, when Congress passed the McCarran-Ferguson Act.

States regulate health insurance and have sued insurers for anticompetitive conduct. But state officials said they had received little help from the federal government.

Richard Blumenthal, the attorney general of Connecticut, said: “I feel strongly that the exemption should be repealed. It is a legal and historical anomaly that there is such a sweeping and all-encompassing exemption for an entire industry. It makes no sense as a matter of logic or law.”


From the AMA Website
AMA deeply disappointed Senate has failed seniors, baby boomers and military families by blocking S. 1776
Permanent repeal of the Medicare physician payment formula is essential to comprehensive health system reform

Statement attributable to:J. James Rohack, MD
President, American Medical Association

“The AMA is deeply disappointed that the Senate today blocked consideration of S. 1776, legislation to preserve access to health care for America’s seniors, baby boomers and military families. Senator Stabenow is a long-time champion for patients and physicians, and the AMA, AARP and MOAA strongly supported her bill that would have laid the foundation to permanently fix the Medicare physician payment formula and keep Medicare strong as millions of baby boomers enter the program in just two years.

“As we work to improve the health system, permanent repeal of the payment formula is essential to ensuring the security and stability of Medicare. On January first, Medicare physician payments are scheduled to be cut by 21 percent, with more cuts in years to come. Nearly 90 percent of people age 50 and older are concerned that the current Medicare physician payment formula threatens their access to care.

“While short-term fixes have temporarily averted widespread access problems, they have also grown the size of the problem – and the cost of reform. The AMA is committed to fixing the Medicare payment problem once and for all for seniors, baby boomers and the physicians who care for them.

“There is widespread agreement among Republicans and Democrats that the formula is broken and needs to be repealed. Congress created the Medicare physician payment system, and Congress needs to fix this problem once and for all to fulfill its obligation to seniors, baby boomers and military families. Permanent repeal of the Medicare physician payment formula is essential to comprehensive health system reform.”


From The Hill

'Doc fix' collapses, Reid tells colleagues AMA led him astray
By Alexander Bolton - 10/21/09 01:36 PM ET

A group of Democrats joined all Republicans in blocking a 10-year freeze of scheduled cuts to doctors' Medicare payments, legislation that was considered important to getting a broader healthcare bill through later this year.

Prior to the 47-53 procedural vote, Senate Majority Leader Harry Reid (D-Nev.) blamed the American Medical Association (AMA) for giving him bad information on the number of Republicans expected to support the measure.

Reid had offered the doctors group a deal to pass the "doctors' fix" in return for support from the doctors on President Barack Obama's broader healthcare initiative, which is slated for the Senate floor later this year.

Reid told colleagues that the AMA said it could deliver 27 Republican votes for the legislation, according to two Senate Democratic lawmakers, who spoke on condition of anonymity. ((AMA leadership denies this.)) Reid needs the GOP votes because at least five members of his party have vowed to vote against the doctors' fix.

Reid said at a news conference Wednesday that he would bring up the 10-year freeze after the healthcare reform legislation is passed and will settle for a one-year fix in the meantime.
"We'll take this up again when we finish healthcare," Reid said Wednesday, "and we'll have a multiple-year fix for this. Right now, we'll only have a one-year fix."

The doctor payment cuts are mandated by a 1997 law.

“The reference to 27 votes was made well before S. 1776 was introduced and in the context of bipartisan health reform legislation," said J. James Rohack, AMA president. "The majority of Democrats and Republicans support SGR repeal for seniors and baby boomers, but today’s vote appears to be becoming the victim of Senate politics. Congress needs to fulfill its obligation to seniors, baby boomers and military families, and repeal of the SGR is an essential element for health reform to succeed.”

Though many Republicans say they want to save doctors from Medicare cuts, they have balked at the quarter-trillion-dollar bill, citing a lack of spending cuts or tax increases to pay for its cost.
Twelve Democrats and one independent joined all 40 Senate Republicans in defeating a motion by Reid to begin debate on the doctors fix bill on Wednesday. Reid brought the $247 billion bill to the Senate floor this week as part of a deal to secure the support of doctors groups such as the AMA for passage of a separate, broader healthcare reform bill later this year. But the strategy has backfired. Reid knew that he needed Republican votes because several centrist Democrats made it clear to him before this week that they would not vote for the measure if its cost was not offset. Reid though he could count on a few Republican crossover votes.

Senate Republican leader Mitch McConnell (Ky.) said in a brief hallway interview that he didn’t think the motion to proceed to the bill would pass.

Reid told reporters on Wednesday that he was led to believe that more than two dozen Republicans would vote for the bill, though he did not mention the AMA by name. “I was told by various people that we would have 27 Republican votes, which was pretty reasonable to assume since one of the co-sponsors of this legislation was [Sen.] Jon Kyl [Ariz.], the assistant Republican leader.

“I was stunned when I was told by his cosponsor Sen. Stabenow after we introduced this legislation that [Kyl] couldn’t support it. Even though he is a cosponsor he couldn’t support the legislation,” Reid said, making reference to Sen. Debbie Stabenow (D-Mich.), the lead sponsor of the 10-year doctor payment fix.

Kyl did not cosponsor the 10-year fix. Last year and in 2005 he cosponsored a measure that would have implemented a two-year freeze on the cuts to Medicare payments to doctors. An aide to Kyl said that those measures would have indexed future payments to inflation and rising healthcare costs. The aide said that Stabenow’s bill would freeze payment levels and make no provision for rising costs. Another factor is that the nation’s fiscal picture is much different than it was last year. The Obama administration recently estimated the federal deficit at $1.4 trillion.
Democratic senators are not certain whether the AMA told Reid directly that it could deliver 27 Republicans or made its estimate known through intermediaries. Reid, Senate Finance Committee Chairman Max Baucus (D-Mont.) and Sen. Chris Dodd (D-Conn.) met with doctors’ groups last week to discuss strategy. Two participants in the meeting said Reid and the groups did not talk about a specific number of Republicans that could be persuaded to support the doctors-fix bill. “No numbers were thrown around,” said the representative of one group. “Twenty-seven is a little ambitious.”


From the Heritage Foundation
Morning Bell: A Whole New Health Care Ball Game
Posted October 22nd, 2009 at 9.20am in Health Care.

You have to read all the way to
page A-25 in today’s New York Times to learn about it, but the Senate took its first floor vote on Obamacare yesterday and the White House lost. Big. The NYT reports: “Democrats lost a big test vote on health care legislation on Wednesday as the Senate blocked action on a bill to increase Medicare payments to doctors at a cost of $247 billion over 10 years. The Senate majority leader, Harry Reid, Democrat of Nevada, needed 60 votes to proceed. He won only 47. And he could not blame Republicans. A dozen Democrats and one independent crossed party lines and voted with Republicans on the 53 to 47 roll call.”

As we reported on
Monday and Tuesday, yesterday’s “doc fix” vote was part of a White House Chief of Staff Rahm Emanuel strategy to smooth passage of President Barack Obama’s $1 trillion-plus health care overhaul by transferring a quarter of its cost into a separate, and completely unpaid for, bill. This transparently dishonest shell game was too much for honest Democratic Senators like Evan Bayh (D-IN), Kent Conrad (D-ND), Russ Feingold (D-WI), Claire McCaskill (D-MO), Bill Nelson (D-FL), and Ron Wyden (D-OR). Wyden told the NYT: “On the eve of a historic debate on health care, it’s essential to show a commitment to real reform,” which includes fiscal responsibility.
Yesterday’s vote marks a significant failure of the Left’s special interest approach to passing Obamacare. From the beginning, the White House thought that if it bought off all of the business interests involved (the American Medical Association, the drug industry, health insurers, hospitals, etc.) opposition to the plan would whither. In one sense, the plan worked. USA Today reports PhRMA, Pfizer, America’s Health Insurance Plans, and the Federation of American Hospitals have all ponied up millions of dollars for lobbying and television ads in support of Obamacare.

But all these special interest television ads failed to rid Americans of their
common sense objections to Obamacare’s government takeover of health care. Gallup reports today that Americans now more than ever believe the costs their family pays for health care will get worse if Obamacare passes. And more Americans now believe that Obamacare will lower the quality of care they receive, reduce their health care coverage, and complicate the insurance company requirements they have to meet to get certain treatments covered.

Instead of the massive overhaul being pursued by the White House, a solid majority of Americans tell Gallup they want to see Congress move in the opposite direction.
By 58% to 38%, Americans would generally prefer to see Congress deal with health care reform “on a gradual basis over several years” rather than “try to pass a comprehensive health care reform plan this year.” Bipartisan, fiscally responsible, reform such as equalizing the tax treatment of health insurance purchases, freeing customers to purchase health insurance across state lines, and allowing states more flexibility on Medicaid spending are readily doable. And that is what the people want.


From Patients First - Get involved NOW

Dear Patients First supporters,

Nancy Pelosi, Harry Reid, and the White House are behaving like the American people are meaningless obstacles in their push for government-run and government-forced health care programs. It is clearer than ever that they are more interested in putting politics first instead of patients. That is why your energy and intensity has never been more needed than right now.

The Washington politicians need to know that you are paying attention, and that Leader Reid's idea of health care reform is bad for your family and bad for our country. Yesterday, Leader Reid emerged from his back-room dealing to announce that he has written a government-run insurance plan, or so-called 'public option,' back into the bill.

A government-run plan was rejected by the American people and the Senate Finance Committee earlier this month. But this is about politics not patients. Leader Reid needs to appease the extremist far left wing of his party. In a deft political move Leader Reid and his advisors have found what they think will make government-run health care more acceptable - an "opt-out."

Under Reid's opt-out states will be given the choice to opt-out of the federal government-run program. It's a false choice and a cynical political maneuver. Every state will continue to pay taxes into the federal system regardless of their choice to participate in the program. States that opt-out will end up funding the health care of the more populous states, like New York, who stay in the government program.

Health care reform needs to be done right, not fast. The quality and cost of our health care is on the line. In the coming days and weeks you're going to see a flurry of activity in Washington as Leader Reid and Speaker Pelosi finally unveil and ram their health care legislation through Congress. You're going to hear all kinds of neat new terms like, public option, competitive option, trigger-option and many more.

No matter how it's packaged it amounts to the Federal government inserting itself into your health care decisions. This will increase your taxes, create unfunded entitlements and add new layers of regulations and bureaucracy limiting your health care choices. You must act today.

Contact your Senator and Congressman and tell them no government-run health plan of any kind!

Sincerely, Patients First Team


((Please consider making a "House Call" on November 5!))

From Patients First

President Obama, Speaker Nancy Pelosi, Majority Leader Harry Reid - think you and I are tired and losing interest. The New York Times and other media outlets are writing that the grassroots fire burned out in August and September.

Talking to so many of you in recent weeks, I know that's not true. But with the health care battle at a decisive juncture, I'm asking you to take a crucial step.

We're asking you to make a "Congressional House Call" at noon on November 5 to tell your Senator or Congressman to vote NO on the Obama/Pelosi/Reid health care takeover.

As I travel the country on our Patients First bus tour and other events, folks ask me, "Tim, I've emailed and called my representatives, but what more can I do to get their attention?" This is a big way for you to get their attention. Join fellow freedom fighters in standing up one more time by going to their in-state offices on November 5 with a simple message -- "Keep your hands off my health care. Vote NO."

Please take 3 steps:
CLICK here to let us know you're willing to stand up for your freedom by walking in to the district office of your Senator or Congressman on November 5. You can also CLICK HERE to go directly to a page that lists all of the local offices within your state.

2. Please forward this information to at least 5 of your family and friends by
CLICKING here. We need as many Americans as possible to take a stand, and you are the best recruiter because they know and trust you.

We see the hypocrisy and deal-cutting coming out of Washington. You know there's $345 billion in brand new welfare spending via Medicaid expansion in the Senate health care takeover bill. And the fact that Majority Leader Harry Reid is exempting his own state from having to pay the state share of the new welfare program.

Just yesterday, Speaker Pelosi and her friends in the House came up with a new way to try and sell the so-called "public option," which in reality is the government destroying private health insurance. They called it just another form of Medicare!

We've got to show Team Obama/Pelosi/Reid that Americans like you are still in the fight, still focused, still willing to stand up and be counted.

Our goal is simple: on November 5 have activists like you show up at key Senate and Congressional offices in your state with your own message telling them to keep their "hands off your health care." Patients First, our health care project, will provide a great resource for you to take on your "House Call."

November 5 is two weeks from today. I need to know if you're willing to be a part of the Congressional House Call so please
CLICK here if you are willing to consider being a part of this crucial project.

To answer your questions about our Congressional House Call project, I will be hosting a live video chat on this Friday at 12 Noon ET. Please email questions you have about the Congressional House Call project or about our other efforts to You can also message me on Facebook with your questions by going here and clicking the "Send me a Message" tab.

You've sacrificed a lot already -- emailing and calling your members of Congress, attending tea parties and bus tour rallies, contacting your friends and family to get involved.

Now, I'm asking you to take another crucial step on November 5 to protect your freedoms.

Tim Phillips


From the Heritage Foundation
Harry Reid and the Chamber of Secrets
Posted October 14th, 2009 at 5.30pm in Health Care.

“My Administration is committed to creating an
unprecedented level of openness in Government…Openness will strengthen our democracy and promote efficiency and effectiveness in Government.”

Or so President Obama says on the White House website. But does he mean it? Of course not.

President Obama is leading the most secretive and least transparent administration in legislative history. And today, we have more proof. The video above was taken as Senate and White House leadership met behind closed doors to cobble together a bill that will make yesterday’s Finance Committee vote irrelevant. There around the cozy table are White House Chief of Staff Rahm Emanuel, HHS Secretary Kathleen Sebelius, OMB Director Peter Orzag, Senators Harry Reid (D-NV), Max Baucus (D-MT), Chris Dodd (D-CT) and a few other liberal Senators. They will negotiate the final bill that the Senate will vote on. And they’re doing it all behind closed doors, so you can’t see it. Is this an “unprecedented level of openness?”

Would you like to know what they are saying? Of course, and Presidential Candidate Barack Obama agreed with you
when he said in August 2008: “I’m going to have all the negotiations around a big table. We’ll have doctors and nurses and hospital administrators. Insurance companies, drug companies — they’ll get a seat at the table, they just won’t be able to buy every chair. But what we will do is, we’ll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies. And so, that approach, I think is what is going to allow people to stay involved in this process.” Too bad, President Obama is getting so good at breaking Candidate Obama’s promises.

Watch as Fox’s Trace Gallagher narrates the action saying: “…they’ll shuffle everyone outside, close the door…” and photographers, journalists and cameras are pushed from the room. They are persona non grata in these chambers of the Senate. Barack Obama promised America these negotiations would be on C-SPAN, and he promised we would see who is making what arguments on behalf of whom. But President Obama, Harry Reid and Rahm Emanuel know that the more you learn about their plans for your health care, the less you’ll like it.

On Friday the 13th this past February, President Obama and Democrats in Congress rammed through a trillion dollar stimulus bill without any Members of Congress reading it. It was supposed to create jobs. It didn’t. It was supposed to be online for days before a final vote. It wasn’t.

On June 26th of this year, the House of Representatives passed a massive Energy Tax called Cap and Trade, by adding 300 pages of amendments to the already unread bill only hours before the vote, which was delayed an hour by House Minority Leader John Boehner attempting
to read the bill aloud before he was forced to stop. It was supposed to help the environment. It won’t. They said it wouldn’t raise your taxes or kill the economy. It will.

And now, we have another chamber of secrets. A few liberals will get together to craft a hyper partisan bill, led by Senate Majority Leader Harry Reid and White House Chief of Staff Rahm Emanuel. Remember, what was voted on yesterday in the Finance Committee wasn’t a bill, it was the framework of a bill. What they are writing behind closed doors this week will be the ultimate legislation that still leaves millions uninsured while lowering the quality of care and raising the costs for those already covered. This legislation will get quickly shuffled to the floor and voted on through their
secret plan which has been exposed by Heritage’s own Brian Darling.

It’s time for President Obama to keep a promise. Open up the doors. Debate the bill in public. Let seniors, families, students and state governors know the consequences of this legislation. Let them see the sausage get made. Harry Potter couldn’t pull off a magic trick this good. Only Harry Reid can make transparency…disappear.

House Panel Paves Way for 'Nuclear Option' in Health Care Reform Bill
Thursday, October 15, 2009

A key House committee on Thursday quietly altered its health care legislation in a way that could allow the Senate to mow over Republican opposition to Democratic reforms by exploiting a budgetary loophole.

The Ways and Means Committee adjusted its health care overhaul package so that the Senate, down the road, could avoid a filibuster and pass health care reform with a smaller number of votes than normally required.

The long-discussed process, nicknamed the "nuclear option," is known as reconciliation. It's coming into potential play after the Senate Finance Committee on Tuesday became the last of five committees to approve health care reform legislation, sending the overhaul proposals a big step closer to the president's desk. Before it gets there, though, the bill has to pass from the committees to the floors of the House and Senate.

Under the normal process, senators can filibuster almost anything and the debate would only be cut off if at least 60 lawmakers vote to do so. For that reason, 60 is considered the magic number in the quest to pass health care reform out of the Senate.

But under reconciliation, typically used in the budget process, no filibusters are permitted and a bill can pass with just a simple majority.

Structuring the health care bill in this way allows it to be scooped up in the reconciliation process, which could torpedo the Republicans' trump card.

"The secret of the week is that Democrats pulled the trigger on the nuclear option," warned Rep. Paul Ryan, R-Wis., top Republican on the House budget committee and a senior member of the Ways and Means Committee. "They built their vehicle today."

But Ways and Means Chairman Charlie Rangel, D-N.Y., said the committee's maneuver "is strictly procedural."

He noted, however, that the "action was necessary because there is a possibility that a handful of Senate Republicans could choose to engage in partisan tactics to stall this important health reform bill."

Rangel added that this move was to "simply preserve the option of advancing health reform legislation." ((And ignore the way the Senate does business.....think how much Rangel would have screamed if the Republicans had tried to pass medical liability reform using reconciliation....))

There are questions of how much of the health reform bill supporters could pass under reconciliation rules, since they are generally reserved for budgetary measures.

But Ryan believes the change in posture means that using reconciliation to pass health care reform could be a fait accompli.

"Why create the option if you don't intend to use it," he said. "And the fact that you created it enhances the chances that you will use it."

Many Senate Democrats, including Senate President Pro Tempore Robert Byrd, D-W.Va., remain skeptical of using the budget reconciliation process to approve health care reform.

Earlier this year, Senate Budget Committee Chairman Kent Conrad, D-N.D., dismissed the idea but conceded that "it is more than theoretically possible."

House and Senate leaders hope to start debate on their respective health care reform bills later this month or in early November.

Fox News' Chad Pergram contributed to this report


From National Review
Paul Ryan on Reconciliation [Robert Costa]
Friday, October 16, 2009

As we head into the weekend, congressional Democrats are hoping that playoff baseball or college football is on your mind — anything to keep your eyes off the House Ways and Means Committee, where on Thursday Chairman Charlie Rangel (D., N.Y.) held a hearing to approve a “procedural measure” to send H.R. 3200, the Democrats’ prime health-care package, to the Budget Committee with “reconciliation instructions.”

In other words, the Democrats quietly tinkered with Obamacare legislation in the House in order to give Senate Democrats the ability to pass a health-care bill with just a simple majority of 51 votes. By marking up H.R. 3200 as legislation open to the “reconciliation” process, Rangel and company mischievously used a budgetary loophole to make their final legislative amalgam filibuster-proof.
Sound complicated? It is. To explain it all, NRO caught up with Rep. Paul Ryan (R., Wis.), the ranking member of the House Budget Committee. Rangel’s legislative maneuvers “initiated the process to jam their bill through via reconciliation,” says Ryan.

“Procedurally, you have to start in the House,” he continues. “The Ways and Means Committee is the Democrats’ first step in attempting to enable their bill to pass in the Senate without 60 votes. What’s important for the American people to understand is that Chairman Rangel used his prerogative to shut down debate.”

“Here’s how the system works. In the House, we have a complete majority-rule system,” says Ryan. “The chairmen control their committees. For reconciliation to be possible in the Senate, the House committee chairmen have to create a vehicle. The bill now moves from the Ways and Means Committee to the Budget Committee. Then from Budget, it will head to the Rules Committee. Rangel opened up another alley for the Democrats that they may use if they can’t get 60 votes in the Senate. Majority Leader Harry Reid now has this ‘nuclear option’ in his back pocket.”

“This is a massive abuse of power,” says Ryan. “The reconciliation process was designed for the budget and to help reduce deficits and debt. Now it’s being used to create new entitlement programs. The Democrats hijacked the rules in order to exploit a procedure.”

“Senator Reid, if he can’t reach 60 votes, will probably use this,” predicts Ryan. “Then both sides will have an argument with the Senate parliamentarian about the Byrd rule, which says that parts of a bill can be eliminated if they do not directly reduce the deficit. It also says that you can’t bring incidental things into the bill. It’s like going to court.”

“Then the Democratic-appointed parliamentarian comes down with a ruling, saying whether this provision is in or out of the bill. It will look at subsidies, too,” says Ryan. “The question will be whether community rating — where health-insurance companies are mandated to provide coverage — is a direct-spending policy. The argument will revolve around these policies, and their need to go into effect, or not, and their fiscal outcomes.”

“A few years ago, we tried to pass medical-liability reform, which is always filibustered in the Senate,” recalls Ryan. “We said that if we stick it in reconciliation, we can pass it, since tort reform, according to the CBO, will reduce the federal government’s health-care costs. The parliamentarian said no, saying it was not a money-saving policy. We lost that one. We’ve also tried to stick ANWR [drilling in the Arctic National Wildlife Refuge] in reconciliation before, arguing that it was a revenue-raising provision. We got it in there, but it didn’t work.”

“Using reconciliation is an art form, not a science,” says Ryan. Republicans “will have a lot of room to fight.”

“Using the tort-reform precedent from our own experience a few years ago, Republicans will be able to argue that a lot of the junk the Democrats want can’t go in the bill,” says Ryan. “That’s where Republican leaders like Senator Jon Kyl will be able to make some major arguments against the use of reconciliation.”

10/16 05:49 PMShare


From Heritage Foundation

Congress’ Secret Plan to Pass Obamacare by Thanksgiving – Update
Posted October 10th, 2009 at 1.34pm in Health Care.

Last night, Chris Frates of the
Politico posted on Live Pulse a post “Unconventional Wisdom” where a “former House and Senate leadership aid” communicate to Frates that it is possible that Reid’s plan could be to “insert the merged health care reform language into a revenue raising House bill already languishing in conference committee.

The Senate would pass it and send it to the House whereupon passage, it would go straight to the president’s desk – completely bypassing conference. Do not pass go, do not collect $200.” This would allow them to pass Obamacare by Thanksgiving.

The are a few House tax bills on the Senate calendar so all Majority Leader Harry Reid (D-NV) would have to do is to gut a House passed tax bill, insert the Senate version of Obamacare and send the tax shell bill containing the health care language back to the House.

For this plan to work, the House would have to take up and pass the Senate bill intact, with no Amendments. Reid’s language, therefore, would heave to be pre-conferenced to address all of Speaker Nancy Pelosi’s (D-CA) concerns.

Think this is a crazy scenario? Frates reports that the Thanksgiving deadline has been part of leadership talking points all week long. More Frates: “but deadline or signpost, Democrats sound serious about trying to get it done by then. Vice President Biden, chief of staff Rahm Emanuel, budget director Peter Orszag and, just this week, Speaker Pelosi have all said so.”

What will this bill look like? Will it have the public option? Will it have the necessary safeguards to make sure illegal immigrants don’t get free or subsidized health care? Will it force taxpayers to pay for abortions? How much will it cost? Nobody knows because this
Vapor Bill does not even exist yet.

This should lead all Americans who want to participate in this process to ask –
Where’s the Healthcare Bill?


From National Review
Obamacare DissectedTen things that probably will be in the health-care bill (but shouldn’t). 13, 2009, 0:00 a.m
By Stephen Spruiell

Rummaging through the stacks here at National Review world headquarters, I discovered in our Dec. 13, 1993, special supplement on Hillarycare a curious little ad that read “Just say NO to socialized health care.” The ad implored me to call 1-800-5RESIST, so just for fun, I dialed the number, hoping that maybe, just maybe, the brave soul who set up this hotline back in the ’90s was still manning the post, dispensing advice on the best way to oppose Obamacare. Wrong. A male voice offered me an invitation to “talk to ladies all over the country,” and I don’t think he meant Blanche Lincoln and Olympia Snowe.

I hung up and returned to the health-care debate, 2009. The Republicans are in disarray. The Democrats are cutting deals. The Congressional Budget Office is acting like Burger King,
telling Max Baucus, “Have it your way.” Of course 1-800-5RESIST is now a phone-sex line: We’re screwed. Or are we?

After all, back in 1993, conservatives were able to stop a health-care-reform plan that looked just as ominous and unstoppable. The Democrats had the White House, 56 senators, and an 80-vote margin in the House. They had James Carville, Hillary Clinton, and a secretive task force (though these might have turned out to be liabilities). They faced a Republican party coming off a historic defeat. R. Emmett Tyrrell had just published The Conservative Crack-Up about infighting among conservatives following the end of the Cold War. Then as now, the Right lacked an identifiable leader, save for Rush Limbaugh.

But we did have one thing going for us: Hillarycare was awful. It was loaded with mandates, government control, empty promises, and taxes. Obamacare differs in the particulars, but it is built on the same rotten foundation: a belief that dumb consumers and greedy insurance companies are to blame for the health-care mess, and therefore bureaucrats need to step in and tell them what to do while the rich pay for it.

Has this diagnosis ever been right? Has this prescription ever cured a single patient? Of course not. In fact, government interference initially created and has since greatly exacerbated the third-party-payer problem that has saddled the system with runaway costs.

Wage and price controls during World War II prompted companies to compete for workers by offering generous medical benefits, and changes in the tax code entrenched this practice to the point where we now use insurance to pay for routine health care.

For the poor and the elderly, the government created a system of entitlements whose bad design led to cost-shifting in the private sector and looming budgetary shortfalls in the public sector that the political class has no idea how to finance. Instead of reintroducing concepts like competition and personal responsibility as a way to bring down costs and make coverage more affordable, Obamacare relies on coercion and taxation to pursue these same goals less efficiently.

Here are ten reasons why no proposal built on this foundation deserves to pass:

1) Removal of the Ability of Insurers to Deny Coverage. The first thing Obama and his backers want to do — the main thing they all agree on — is take away insurers’ ability to deny people coverage or charge them different rates based on pre-existing conditions. The question of what to do for people whose health status has rendered them uninsurable is a thorny one, but the heavy hand of regulation is not the answer. States have conducted successful experiments with “high-risk pools,” and “health-status insurance” offers another promising idea. The problem with what the Democrats want — mandatory coverage at low rates for sick people (also known as “guaranteed issue” and “community rating”) — is that it gives people an incentive to postpone buying insurance until they need expensive care. Theoretically, guaranteed issue and community rating work only if the government requires everyone to have insurance. The Democrats know this; insurance mandates are integral to Obamacare.

2) Coverage Mandates on Individuals and Employers. Once upon a time, Obama was against insurance mandates. In the run-up to the Iowa caucuses, his campaign ran an ad attacking Hillary Clinton on the grounds that the mandates in her plan “would force people to buy insurance even if they can’t afford it.” Realizing that his health-care plan would be unworkable without a mandate, Obama has flip-flopped and rebranded required coverage as “shared responsibility.” Clinton fired back at the time, and Obamacare supporters argue now, that the mandate would come with subsidies to help lower-income people afford the coverage they would be forced to buy. A look at the fine print on that offer reveals that many Americans would be forced to buy pricey policies without any help from the government. Workers offered coverage by their employers (who would be required to offer it) would not be eligible for subsidies and would have to take what they’re given — which, under Obamacare, would be some minimum package of benefits designed by bureaucrats in Washington. That sounds like something that could quickly exceed what a lot of people consider affordable.

3) Government-Designed Insurance Plans. We don’t have to guess about whether government-designed insurance plans cause costs to spiral upward. We can look to Massachusetts, where in 2006 the Brahmins of Beacon Hill enacted a health-care-reform bill similar to what the Solons of Capitol Hill are pushing today. Commonwealth Care, as the Bay State’s version is called, also requires individuals to purchase a government-designed “minimum” level of coverage. As Michael Cannon of the Cato Institute has pointed out, lobbyists in Massachusetts have successfully pushed for that “minimum” to include prescription drugs, preventive care, drug-abuse treatment, hospice services, fertility treatments, prosthetics, telemedicine, and numerous other mandates. No wonder the average premium in Massachusetts has gone up significantly faster than has the national average. Even if you have insurance you’re happy with, Obamacare would eventually force you to upgrade to one of these more “comprehensive” plans. So much for his promise that you can keep the simple, affordable plan that you like.

4) Threats to Medicare Advantage. Obama’s promise to let you keep your current insurance plan must look even emptier to the approximately 9 million seniors currently enrolled in Medicare Advantage (MA) plans. MA gives seniors the option of getting their coverage from a private insurer rather than from the traditional, government-run Medicare. The government then reimburses the private insurer for the cost of that coverage. The program has proven popular: Enrollment has nearly doubled in the last five years, because the private insurers offer better benefits than Medicare. But these benefits come at a cost: Instead of requiring the private insurers to compete to provide better coverage for less, the government reimburses insurers using a Byzantine rate formula. On average, it costs the government 12 to 14 percent more to cover the average MA enrollee than the average Medicare recipient. To fix this problem — which is an artifact of Medicare’s own artificially low price-setting — the Baucus bill proposes to reimburse private insurers only for what it would have cost Medicare to cover the same enrollee. But remember, Medicare has unfair advantages in the marketplace — it can dictate prices to doctors and hospitals. Because private insurers can’t use the same strong-arm tactics to get their prices down, many would instead cut benefits, raise premiums, or drop out of MA altogether. In other words: No, not everyone can keep the plan she likes.

5) New Taxes. According to the CBO, the Senate Finance Committee’s version of Obamacare would achieve “deficit neutrality” by increasing taxes by more than $300 billion over the next ten years. Who pays? Starting in 2013, the tax would be assessed on all insurance plans that cost more than $8,000 per year for single coverage or $21,000 for family coverage. That sounds like a lot, until you consider that those thresholds are pegged to inflation as measured by the Consumer Price Index. The cost of health care generally increases much faster than that. As James C. Capretta has noted, “by 2019 and beyond, this tax would hit pretty much the entire middle class of America very hard.” Obamacare would also use tax penalties to punish those who fail to comply with its insurance mandates. The 25-year-old men who calculate that paying the penalty is a better deal than buying the pricey government-designed plan with fertility treatments are expected to be good for $1 billion or so in tax revenue over the next ten years. Taxing the young at the beginning of their careers and using the money to pay for middle-aged men at the peak of their earning power: That’s Obamacare!

6) A Stronger IRS. Over 30 new federal programs, agencies, and commissions would be required to administer the massive new health-care entitlement. Obamacare would establish a “Health Choices Administration” to dictate what your insurance plan can and cannot cover and a “Health Benefits Advisory Committee” to guide these “choices.” And if the government decides your choices are not acceptable, Obamacare gives the Internal Revenue Service the power to levy substantial fines against you. An overlooked ramification is that the IRS would have to coordinate with the Health Choices Commissioner and whatever other officials are deemed necessary to decide whether your coverage meets the government’s minimum standard. That means the IRS will be sharing your tax records with Obama’s health czars, who could use them in new and intrusive ways. As Byron York has reported, one version of Obamacare (there are five or six floating around Capitol Hill) envisions the use of tax records to “find qualifying seniors who can then be encouraged to enroll in the [Medicare] prescription drug program.” By filing your tax return, you could be signing up for government junk mail — or worse.

7) “Managed Competition” (a.k.a. “Government Control”). In the early 1990s, the buzzword was “managed competition,” which in the context of Hillarycare meant “government control.” Today, the buzzword is back, and guess what? It means the same thing. “One of the best ways to bring down costs, provide more choices, and assure quality,” Obama says, “is a public option that will force the insurance companies to compete and keep them honest.” But whether this public option takes the form of a federal-government-run insurance plan or state-sponsored, public-private co-ops, its true purpose would be to serve as a stalking horse for a fully nationalized single-payer system. We are watching this happen right now with student loans and to a lesser extent with Medicare Advantage: The government cooks the books to make it look as if cutting out the private sector would yield tremendous savings. In fact, real savings would come only from cutting out the government.

8) Reckless Expansion of Medicaid. Obamacare would make federal Medicaid dollars available to childless adults for the first time in the program’s history. Not only would this change the nature of the program from one that is primarily designed to protect children living in poverty, it would also impose new burdens on already-strapped state governments, which would be forced to come up with matching dollars to pay for the newly eligible. Not that this matters as much as it should: Many states, especially those where Democrats dominate, have expanded Medicaid eligibility even further than Obamacare envisions; whenever they run out of money, they simply ask Washington for a bailout, and responsible states end up subsidizing the reckless ones. Obamacare does nothing to change this perverse incentive structure. To the contrary: It adds to the perversity.

9) Welfare for the Middle Class. Mark Steyn has called government-run health care the “game changer” that forever alters the relationship between the citizen and the state. Nowhere is this more clear than in the way the bill means-tests for subsidy eligibility. Households with incomes between 100 and 400 percent of the federal poverty level — that’s north of $80,000 for a family of four — can have their premiums fixed as a percentage of their income, making mandatory employer-provided care even more of a raw deal (see No. 2 above).

10) Government Rationing. This is where Obamacare ends. We know this because we’ve seen what happened to health-care systems in Canada and Britain. Wherever government fiat replaces private contracting as a method for setting prices, basic problems of supply and demand crop up, and with health care, the problem is almost always too little supply. When third parties pay the bill, consumers lose the incentive to consume rationally and providers lose the incentive to provide efficiently. Supporters of Obamacare have identified the problem as one of greed and stupidity, but their solution would entrench the third-party-payer system that rewards greed and stupidity. To swim against this tide of incentives will require coercion on a massive scale and — yes — rationing.

— Stephen Spruiell is an NRO staff reporter.


Obama Economics Advisor Robert Reich Blasted for Promoting Death Panel
by Steven EditorOctober 15, 2009

Washington, DC ( -- Former vice-presidential candidate Sarah Palin got pilloried for suggesting that the government-run health care system set up under the bills in Congress would lead to "
death panels." But, now, a video has surfaced showing Obama economics advisor Robert Reich essentially admitting Palin was right.

Reich, the former Clinton administration Labor Secretary has been caught on tape making a death panel confession.In a 2007 speech at the University of California at Berkeley, Reich began his address by saying he was going to deliver a refreshingly honest talk about health care from the vantage point of an insider who would never run for president.“In other words, this is what the truth is," he said.

Reich admitted: "If you're very old, we're not going to give you all that technology and all those drugs for the last couple of years of your life. It’s too we're going to let you die."

“Also, I'm going to use the bargaining leverage of the federal government … to force drug companies and insurance companies and medical suppliers to reduce their costs," he admitted. "What that means, less innovation and that means less new products and less new drugs on the market which means you are probably not going to live much longer than your parents.”

Gary Bauer, a pro-life former presidential candidate who is the head of American Values, calls Reich's words "pretty shocking stuff.""

"The media just couldn't believe it when Sarah Palin suggested that government-run, socialized healthcare would lead to 'we're going to let you die' death panels," he said in response. "But that’s exactly what Reich said."

""To the bean counting bureaucrats, your life is a burden, not a blessing," Bauer continued. "So Big Government is going to dictate what healthcare you can and cannot receive.""

"Need critical surgery? Maybe not. Suffering from serious pain? Sorry. Need cancer treatment? Too bad," he said in an email to

"How could anyone possibly call that reform? Sadly, many politicians do," he concluded. "Reich essentially admitted that Palin was right."

Related web sites:

See the video of Reich's comments -


From Heritage Foundation
If it's so urgent, why would two elections pass before health reform takes effect?
by Robert A. Book, Ph.D.October 19, 2009

The debate over health-care reform has sparked all sorts of controversy over costs, regulations and choices. But one 'feature' seems to have escaped notice: the built-in lack of accountability of our elected leaders for what health care will be like after the plan is implemented.

Proponents claim we need reform now to solve an immediate health care "crisis." "If we don't act, 14,000 Americans will continue to lose their health insurance every single day," President Obama claimed on July 22.

Yet the bills he urges us to support will not actually provide any health care until 2013 -- by which time, if the president's claim is correct, an additional 17 million Americans will have lost their insurance.

Why the delay? The best way the people have to hold their elected leaders accountable for results is by threatening to withhold their votes. But this bill seems expressly designed to eliminate that source of accountability. By the time Americans experience the effects of this health care bill (except for the tax increases), not only will President Obama have run for re-election, but so will two-thirds of the senators -- and every House member will have been up for re-election twice. Their votes on health care reform will be old news. If it goes very badly, it will be too late to vote those responsible out of office.

Furthermore, the House bill leaves all the knotty details and controversial issues to the newly created "Health Choices Commissioner."That's the person whose job it will be to make a lot of our health care choices for us. The Senate Finance Committee (Baucus) proposal gives that authority to the secretary of Health and Human Services. Issues such as whether to:

Permit people with Health Savings Accounts (HSAs) to retain the high-deductible health plans required by the HSA law.
Allow low-cost catastrophic plans.
Permit insurance companies to cover treatment of otherwise terminally ill patients.
Require (or prohibit) coverage of abortion.
Cover new cancer drugs or controversial procedures like (as the Center for American Progress has called for) transgender operations.

These and other issues will be left to an appointed official. Elected leaders will never have to face the voters and defend these crucial decisions that affect the life and health of every American, since the decisions will be made by an unelected bureaucrat.

Any representative or senator confronted by an angry constituent could respond, in effect, "I didn't say grandma couldn't have a pacemaker. I didn't deny you that expensive cancer drug. It was the independent, nonpartisan Health Choices Commissioner. Congress -- let alone any individual member -- can't micromanage every decision the commissioner makes."

By pushing the tough decisions onto a bureaucrat -- so they don't have to go on the record by voting -- they effectively enact a system that allows them to dodge accountability.

The same official would also have the authority -- even the duty -- to audit the private plans that compete with the public option (or "co-op"), both employer-sponsored plans and plans sold by insurance companies. The official could audit plans randomly or "in response to complaints" -- and according to the House bill, demand "reimbursement" for the cost of the audits. In effect, a competitor or disgruntled former employee could run any employer or insurance company out of business by filing repeated complaints to force the targeted company to pay the cost of repeated audits to verify their manifest innocence.

And if the commissioner determines that any violations have occurred? Then according to the House bill, he or she is authorized to impose civil money penalties, suspend further enrollment in the plan, withhold premium payments made through the federal "exchange" and "work with State insurance regulators to terminate plans" (p. 45).

These penalties are entirely up to the commissioner. No particular evidentiary standard is required, and no appeals process is specified or mentioned, let alone any decision by a judge or jury. The commissioner, who will administer the "public option" or "co-op" plan, is totally unaccountable to anyone for penalties imposed on competing private health plans. And does anyone expect him or her to impose penalties on the "public option" or "co-op"? Is this the promised "level playing field"? The one designed to "keep insurance companies honest"?

The real question is, with such broad and unaccountable authority, who will keep the Health Choices Commissioner and the secretary of Health and Human Services honest? And more important, with none of this taking effect until after the next two elections, who will keep the politicians honest?

Robert A. Book, Ph.D., is Senior Research Fellow in Health Economics in the Center for Data Analysis at The Heritage Foundation.
First appeared in St. Paul Pioneer Press


From the Washington Post
New report boosts backers of lawsuit reform
By Donna Smith
Reuters Friday, October 9, 2009; 3:54 PM

WASHINGTON (Reuters) - Limiting medical malpractice lawsuits could save the U.S. government $54 billion over a decade, congressional budget analysts said on Friday in a report that could boost a Republican push to include lawsuit reform in President Barack Obama's healthcare overhaul.

Capping awards for non-economic and punitive damages along with other reforms would reduce doctors' malpractice insurance premiums and defensive medicine practices for government health programs, the non-partisan Congressional Budget Office said in a letter to Republican Senator
Orrin Hatch.

"I think that this is an important step in the right direction and these numbers show that this problem deserves more than lip service from policy-makers," Hatch said in a statement.

Hatch and other Republicans are likely to seek to add medical malpractice lawsuit reform to the healthcare overhaul legislation when it is taken up by the Senate later this month. Democrats are likely to resist any sweeping proposal.

Trial lawyers, who traditionally are generous donors to Democrats, oppose many malpractice reforms. ((Actually, they oppose ALL malpractice reforms...except the smoke and mirrors nonsense that won't make any difference at all and won't affect trial lawyers' bottom lines one bit...))

Obama's drive to overhaul the $2.5 trillion U.S. healthcare system -- the top domestic priority of the Democratic president -- is aimed at cutting costs, regulating insurers and expanding insurance coverage to millions of Americans without it.

Obama last month called for a more limited effort that would provide federal grants to states to develop pilot programs aimed at limiting malpractice lawsuits without hurting health outcomes for patients. ((Yeah, smoke and mirrors like this...))

The CBO report shows that lawsuit reform could provide a nice pot of money to help finance the plan to expand health coverage to millions of uninsured Americans.

"That's not chump change," Republican Senator
Charles Grassley said of the $54 billion savings cited by CBO. "It's a no-brainer to include tort reform in any healthcare reform legislation."

The American Association for Justice, which represents trial lawyers, played down the analysis, saying in a statement "the vast majority of empirical evidence suggests that there are only minuscule savings to be found in reforming our nation's civil justice system."

The CBO said that malpractice reform would reduce total healthcare spending by 0.5 percent. The CBO analysis also raised questions about whether limiting patients' rights to sue for damages due to negligent care would have a negative impact on health outcomes.

(Editing by Mohammad Zargham)


From the Wall Street Journal
What Singapore Can Teach the White House
Its health care is first class, cheap and market-driven.
OCTOBER 19, 2009, 7:17 P.M. ET

Critics of this island-nation often have fun referring to it as the "nanny state" for its laws against spitting, littering, or leaving behind an unflushed loo.

When it comes to health care, however, Uncle Sam has better claim to the nanny title. From our federal price "negotiations" and state regulations to discrimination in the tax code, government distortions prop up a system that puts key health-care decisions in the hands of everyone but the patient. Each new government intrusion, moreover, begets only higher costs—and a call for more intervention to fix the problem.

In Singapore, by contrast, they already have universal coverage. They also have world-class quality care at world-competitive prices. And in a week when White House chief of staff Rahm Emanuel is meeting behind closed doors with Senate Majority Leader Harry Reid, Singapore's example might have something to teach them about the kind of reform Americans really need.

"When I'm asked to describe the differences between the U.S. and Singapore systems, my one-word answer is 'complexity,'" says Dr. Jason Yap, director of marketing for Raffles Hospital, a leading private care facility in downtown Singapore. "There are so many parties in the American system that do not really contribute to care."

Dr. Yap is referring to the higher costs that come from an American system that depends on regulation and oversight to accomplish what Singapore tries to do with competition and choice. At the Raffles lounge for international patients, he shows me an example of the latter. It's a one-page, easy-to-read list of fees.

At the high end of accommodation, a patient can choose the Raffles/Victory suite for about $1,438 per night. That price includes a 24-hour private nurse, a refrigerator stocked with drinks, and an adjoining living room to entertain. At the other end of the scale, a bed in a six-person room goes for just $99.

As Dr. Yap points out, the actual care is the same whether a patient decides to stay in a deluxe suite or a dormitory-style room. But the choice is the patient's; the financial incentives encourage the patient to think about those choices; and the low-priced options help keep the overall costs down.

This is no accident. Like ours, Singapore's system is a mix of public and private care and financing. Unlike ours, Singapore's system is anchored, as the Ministry of Health puts it, "on the twin philosophies of individual responsibility and affordable health care for all."

"Individual responsibility" is not just a buzzword. All but the abjectly poor have to pay for some of their care, another downward pressure on prices. Perhaps most important, almost all working Singaporeans are required to put money in a medical savings account that they use for out of pocket expenses. It's their money, and they control it. As a result, they are careful about spending it.
"In Singapore almost everyone has to pay something for their care," says Dr. Yap. "When it's your money, you really ask yourself: Do I really need this?"

It seems to be working. According to a Raffles Hospital official, a knee replacement surgery runs between U.S. $12,000 and $14,000. Spinal fusion runs between $10,500 and $14,000, and a heart bypass (coronary artery bypass graft) from $23,000 to $26,500. Conservatively speaking, these prices are less than a third of what the same procedure would cost in the U.S.—that is, when you can even get the price.

As any American who has ever tried to make sense of a hospital bill or haggled with his insurance company over a payment can tell you, even for those who have decent coverage our system can be a bureaucratic nightmare. Singapore's system isn't perfect. It does suggest, however, that the Average Joe stands more to gain from a system where hospitals and doctors compete for patients, where patients have different price options for their hospital stays and appointments, and where they pay for some of it out of pocket.

Yes, a city-state with three million citizens has some advantages over a nation of more than 300 million people in 50 states. Yes, health care in Singapore is hardly the laissez-faire ideal. Still, there's intervention and there's intervention: What makes Singapore's health care work is that it is designed to swim with the market and not against it.

In macro terms, that means Singaporeans spend only about 4% of GDP on health care—against 17% for the United States. At the same time, Singapore scores better than the U.S. on life expectancy, infant mortality, and other key international measures.

In his address to Congress last month, President Obama complained that "we spend one and a half times more per person on health care than any other country, but we aren't any healthier for it." That's a good point. ((But not an entirely VALID one, considering how those international measures of health care effectiveness are skewed...)) And the lessons Singapore has to offer suggests that what Americans need most in Washington today are fewer closed-door meetings and more open minds.
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