Saturday, November 7, 2009

11/5/09 Liability and Health News Update - House Call, House & Senate Bills, more

11/5/09 - Liability and Health News Update
House Call Today, House & Senate Bills, More

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

***To receive Liability and Health News Update directly in your email box, please email and put "subcribe" in the subject line**

This LIABILITY and Health News Update"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.




The Election:

Health Care Congressional House Call TODAY:
Consumers for Health Care Choices at the Heartland Institute

Glenn Beck: Bachmann on ObamaCare

The Timeline:
House expected to vote on health bill Saturday

Democrats See Health-Care Timetable Slipping
Prospect of Missing Year-End Target Prompts Lawmakers to Prepare for Debate Into 2010; White House Minimizes Impact of Delay

Major Congressional Reforms Demand Bipartisan Support
ObamaCare would be an exception to the historical rule of large social legislation.

The House Bill:
House could vote Saturday on health bill

The Worst Bill Ever
Epic new spending and taxes, pricier insurance, rationed care, dishonest accounting: The Pelosi health bill has it all.

The True Cost of the House Health Bill: $1.5 Trillion

Health Alert

12 New Features in the Latest House Health Reform Bill

Tort-Bar treat - PelosiCare's perks for lawyers

House healthcare bill cuts incentives to states that cap attorney fees, damages

ObamaCare: Insurance Premiums Soaring Up, Up, and Away

Pelosi’s Health Insurance Reform Bill Establishes Waiting Lists

The Senate Bill:
House Leaders Unveil Health Bill

House health bill clocks in at 1,990 pages

House takes another step on healthcare reform

Washington 'Shall' Control Your Healthcare

Baucus Bill Does Not Bend the Cost Curve

Prescriptions for disaster - The true costs of the health-care bills

The Republican's House Bill:
CBO: Republican health plan would reduce premiums, cut deficit

Republicans Release Their Own Health Care System Reform Bill

The Government Takeover of Health Care in Pictures

Twenty Surgical Groups Say Senate Health Legislation Will Threaten Patient Access and Harm Quality

Email newsletter from the American College of Surgeons (ACS)

DJP Update 11-5-2009
AMA and another rush to judgment - Failure to wait for debate at AMA House of Delegates this weekend!

AMA supports House bills to make health reform a reality



MANY THANKS to everyone who got out and voted for Joan Orie Melvin - isn't it nice to have a "win?"

PLEASE get on the phone today and call your Representatives about the looming House Health Care vote!

Lots of stories follow about the House bill and the Senate Bill (which probably won't "move" for months - but call your Senators anyway.)

Hopefully, there will be THOUSANDS of people in Washington today to help demonstrate against this massive changeover in health care - of course, the mainstream media won't cover it, but that doesn't mean the legislators won't SEE their constituents and HEAR them as you call.

Arlen Specter
Washington DC
711 Hart Building Washington , DC 20510 Main: 202-224-4254 Fax: 202-228-1229

Bob Casey Jr.
393 Russell Senate Office BuildingWashington, D.C. 20510Phone: (202) 224-6324Toll Free: (866) 802-2833Fax: (202) 228-0604

Find your Representative using Capwiz:

We'll be demonstrating right here in Pennsylvania against what the Wall Street Journal calls "the worst bill ever" at Pennsylvania's Capitol on Saturday, Nov. 21, in conjunction with the Million Med March. Simultaneous physician and patient demonstrations will take place across the country at noon on Nov. 21.

Pennsylvania's Million Med March will begin at noon Nov. 21 in Harrisburg's City Island Parking Lots. Doctors, nurses, health care professionals, patients and other patriots will walk across the bridge to the Capitol Steps, where a rally will be held.

We'd like to see THOUSANDS of you there. For more details, you can go to or you can email me at

Thanks to everyone for your continuing and passionate advocacy efforts on behalf of health care - now isn't the time to run out of steam, though, so please KEEP IT UP!

BREAKING NEWS - The AMA just, foolishly, in my personal judgement, endorsed the paired House Bills. The American College of Surgeons, representing 20 surgical specialty societies, sent a letter to the Senate opposing the Senate Finance Committee bill, but endorsed the House bills. Sigh. Stories follow at the end.



The Election

(('Nuff said.....))

Justice of the Supreme Court
Go to Top
Judge of the Superior CourtElecting 4
Go to Top
Judge of the Commonwealth CourtElecting 2
Go to Top


Health Care Congressional House Call TODAY

((PLEASE call your members of Congress TODAY!))

Arlen Specter
Washington DC
711 Hart Building Washington , DC 20510 Main: 202-224-4254 Fax: 202-228-1229

Bob Casey Jr.
393 Russell Senate Office BuildingWashington, D.C. 20510Phone: (202) 224-6324Toll Free: (866) 802-2833Fax: (202) 228-0604

Find your Representative using Capwiz:


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House Call on Congress - Pelosi Plan Exposed - Thursday UpdateAAPS Director of Policy and Public Affairs, Kathryn Serkes, is on the ground at the Capitol this morning and reports thousands of people turning out.Keep your eye out for video and interviews of this morning's events in DC! DOCTORS: If you are going to a district congressional office today, be sure to wear white coats.ALSO, STILL TIME TO JOIN OUR VIRTUAL READING ROOMWe had physicians in our reading room on Capitol Hill, but we still need your comments. Tell us what parts of H.R. 3962 are the worst! Simply go to to submit your comments. Please use the form at this link rather than email to get us your thoughts. “PELOSI PLAN EXPOSED” Nov 5, 1 pm - 1 am! House Republicans will hold an online video town hall meeting. “Pelosi Plan Exposed” will run for 12 hours and expose the 12 truths of Nancy Pelosi’s health care bill. You can ask questions and interact with Members of Congress through Facebook, Twitter, and e-mail starting Thursday at 1:00 PM EST, and ending Friday at 1:00 AM EST. Bureaucrats Dictating the Practice of Medicine
One last item -- We thought you'd like to see this brief note from a former Congressional staffer about Section 252 of the House Bill."Bureaucrats Dictating the Practice of Medicine" .
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Kill It Dead!With every iteration the health care "reform" proposals in Congress get worse.
The Wall Street Journal calls the current Pelosi proposal the "worst bill ever." That's pretty accurate. There has never been a piece of legislation introduced in the United States Congress that is more intrusive on the lives of each and every American. The taxes, mandates, regulations, and prohibitions will put the federal government in charge of one-sixth of the American economy and will directly effect everything about our lives and the lives of our children and grandchildren for generations to come - IF it is passed and implemented. That is a very big IF. Citizens from around the country will be coming to Washington on Thursday to express their outrage at the arrogance of Congressional nitwits who want to shove this monstrosity down our throats. See Rep. Michelle Bachman's invitation to join her on the steps of the Capitol at noon on Thursday. November 5. The Tea Party Patriots will be there in force. If you can't make it to Washington, visit the district office of your own Congressman. A map is available at Americans for Prosperity Or write, call, or e-mail your own Member of Congress at the FreedomWorks War Room.There is no going back on this one. There is no compromise possible. There is nothing left in this bill worth negotiating over. It has come down to Yes or No. And you don't get a vote.-- Greg Scandlen
Consumers for Health Care Choices at the Heartland Institute
19 South LaSalle St. #903Chicago, IL 60603Reach Greg Scandlen


Glenn Beck: Bachmann on ObamaCare
November 2, 2009 - 12:55 ET

GLENN: First I want to get an update on healthcare. Michele Bachmann is with us now from Washington, D.C. Hi, Michele, how are you? CONGRESSWOMAN BACHMANN: Hi, Glenn, I'm doing great. It's good to talk to you today. GLENN: Good to talk to you. Now, you say that this healthcare package is going to pass and arrive at the president's desk? You believe that? CONGRESSWOMAN BACHMANN: Well, this is the week. This is the Super Bowl of socialized medicine. Tonight Speaker Pelosi will actually reveal the final bill that we're to vote on and we're expected to have to vote on it Friday. But I firmly believe it's not inevitable that this passes this week if we do something about it because a lot of these Blue Dog Democrats are scared to death. I don't think you are going to see any Republican votes, I doubt it. But there are people who are on the but this is the moment when I think we can actually do something about killing it because people woke up in August. We saw it with the town halls, we saw the 9/12 where all the people came to D.C. That was phenomenal. And it scared them to death, but now Speaker Pelosi's put the hammer down and she believes that she's going to be able to convince all of her people to vote for this. And I really believe, Glenn, if we can get good normal patriot, freedom loving Americans to D.C., converge at noon on Thursday on the capitol steps, and what we need to do is literally go into these members of congress' offices, look in the whites of their eyes and tell them don't take away my healthcare, don't take away my freedom. Because once government gets this power, Glenn, they can use healthcare as cradle to grave, they can use that as a pretext for controlling every other aspect of our life. GLENN: I know, I know. It's I mean, when I found vending machines in the healthcare bill, I mean, and tonight I'm going to highlight the gift to attorneys. I mean, it's the gift that just keeps on coming. Now, she's going to release the final version of the bill. Is it going to be better or worse? And I know there's I don't think anything should pass quite frankly but is it going to be bigger or smaller? Are they making cuts or additions to this bill? Do you have any idea? CONGRESSWOMAN BACHMANN: Well, if this last bill is any indication, it went from about 1,000 pages to 2,000 pages and it collapses the private health insurance industry. It says after 2013 you can never buy private health insurance again. It has taxpayer funding of abortion in it. It has every terrible provision now we all said was in it. It was in this last bill. So why would you release just before your final bill a bill that's so bad that includes every tax increase in there. $500 billion cuts in senior citizens. They have more to lose than anyone on this, senior citizens. Huge tax increases on the middle class and huge increases on premiums. Probably we're looking at $4,000 a year increase in premiums over the next few years' time. This is just, this really has never been about healthcare. It's been all about the government amassing more control and also huge tax increases, redistribution of wealth. Because one thing we know is that in the last year the government has taken over about 30% of the private economy. That's according to an economist from Arizona State University. Whether it's banks, insurance companies, mortgage companies, the whole student loan industry. Now they want to take over healthcare. If they take over healthcare, that's an additional 18% of the private economy, or within just over a year's time the federal government will have taken over 48% of the private economy. That's nothing short of stunning. That's a revolution. GLENN: Michele, how many people do you think would make an impact on those members of congress? I mean, you know, you are asking on a Monday morning for people to leave their job at a time of CONGRESSWOMAN BACHMANN: I know. It's a big ask. I know, Glenn, it's a big ask, but you love this country, I love this country and so do your listeners. They understand what's at stake and I know this is a big ask. People are afraid to lose their jobs because they don't want to lose them to travel to Washington, D.C. What? Well, this isn't just another rally that I'm calling people to. I'm asking people to actually come to Washington where we'll meet on the capitol steps. The actor Jon Voight is going to come and he's going to speak about why it's important that we hold onto our freedom and from there I am encouraging everyone to go find their member of congress. These are public places. Go into their office buildings, Cannon, Longworth, Rayburn. GLENN: How many people BACHMANN: Find them, look at their eyes. GLENN: How many people do you need for them to say holy cow? CONGRESSWOMAN BACHMANN: As many as we can get. I mean, I'm not putting a number down because I don't know. This is such an extraordinary thing. I've never done anything like this to make this kind of an ask, but everything's on the table now. Everything's at stake. Next week may not matter. It's this week when the vote will occur. That's why it's so important that people occur on Thursday so that we can make an effort. GLENN: So you are saying that CONGRESSWOMAN BACHMANN: I can't tell you how many it will take, Glenn. GLENN: So you are saying CONGRESSWOMAN BACHMANN: We just need as many as we can get. GLENN: You are saying that the reason why it's this week is because it's going to pass the House I mean, if it passes the House, it goes right to Harry Reid and Harry Reid will use the nuclear option which means that he only needs 51 votes, which they clearly have, 51 votes in the Senate to get it to the president's pen which he would then sign. You know, I was talking, you know, earlier with one of my guys and we were talking about it and I said, he said, Glenn, he is not going to pull the nuclear option. And I said, he has nothing to lose. He is losing CONGRESSWOMAN BACHMANN: He may very well lose his seat in Nevada anyway. The polls aren't good for Harry Reid. So why wouldn't he pull the alarm and do it? GLENN: Right. CONGRESSWOMAN BACHMANN: This is what they want from the beginning. This is what they want. It is about government control and government takeover. It's not about healthcare. GLENN: Interesting that it comes down to one guy who is just going to pull the lever, perhaps, pull the lever just to protect his own butt because he will say, if I pull the lever, I'll at least have ACORN and the unions in Nevada? Are you kidding me? There's no corruption in Nevada or Las Vegas. Pull the lever. They are the ones that got Barack Obama elected because they threw the election, the primary election away from Hillary Clinton in Nevada to Barack Obama, and you know that every special interest would say, Harry, if you pull this lever, we will do everything we can to win the election for you in Nevada. And if he doesn't win, he's I mean, he's out anyway. CONGRESSWOMAN BACHMANN: And Glenn, nothing is more powerful than the American people, nothing. When we come together as the American people coming together in the most beautiful place there is, the steps of the American capitol at Washington D.C., and we talk to each other and we fan out and go find their members of congress and those three office buildings and it's the capitol, it belongs to you. It doesn't belong to the individual members of congress. It belongs to the American people. And people have been saying what can I do? How can I get involved? This is the number one most effective, most efficient way to get involved. Come Thursday, noon, meet at the capitol steps. We'll have a great we'll get awe inspired by Jon Voight and then send people out. Go find your member of congress and look at them and tell them what you believe and what you think and what you want them to do. Bring the town hall to them. They have amnesia. They have forgotten already what happened in August and we need to bring the town hall to them. People should make signs. Come. We just, this is it. I don't know what else to do. I don't have anything to offer. I don't have anything for sale. All I know is that this is our country, and we don't want to lose what we've been given. We've held onto it for 233 years, but I'm worried that this is the crown jewel of socialism and if this passes, I don't know how we ever unwind it. So this is it. GLENN: Michele, God bless you. We'll get the word out and let's have you on a little bit later on this week and we'll continue to have you make the pitch for people going to Washington D.C. noon this Thursday and look them in the whites of their eyes. All right, Michele, thank you very much. CONGRESSWOMAN BACHMANN: Hey, thank you. If people want more information they can go to or a link found on your website.


The Timeline

House expected to vote on health bill Saturday
CBO: GOP measure would cover few uninsured
Lori Montgomery
Washington Post Staff Writer Thursday, November 5, 2009

House leaders put in motion the machinery to hold a rare Saturday vote on the most far-reaching expansion of the health-care system in more than 40 years.
Even so, they were still locking down support Wednesday among a handful of holdouts, with the biggest bloc dissatisfied with the measure's handling of abortion.
Many Democrats said passing the measure has become even more crucial politically after Republicans won governor's races in Virginia and New Jersey this week. So Democratic whips worked their rank and file, while House leaders tried to secure a momentum-building endorsement from the AARP, the nation's largest association of people over 50. President Obama, meanwhile, laid plans to visit Capitol Hill on Thursday or Friday to address House Democrats in a final push for his signature domestic initiative.
Late Wednesday, a bill that Republicans expect to offer as an alternative to the Democratic package received its assessment from congressional budget analysts, who concluded that the proposal would barely dent the ranks of the uninsured.
The measure would cover 3 million additional people at a cost of $60 billion through 2019, according to an analysis by the nonpartisan Congressional Budget Office. The Democrats' bill, by comparison, would cover far more -- 36 million additional Americans -- at a much higher cost -- $1.055 trillion through 2019, the CBO has said.
House Republicans are united in opposition to the majority's health bill, so to pass the measure, Democrats will need at least 218 votes from their 258-member caucus. That group grew by two in Tuesday's elections: While some Democrats bemoaned the loss of the governor's mansions,
House Speaker Nancy Pelosi (Calif.) cheerfully prepared to swear in newly elected Democrats from New York and California, both of whom have pledged to support the health bill.
"From our standpoint, we picked up votes," Pelosi said.
House leaders said that they were confident of reaching their goal in time for a Saturday debate on the most significant changes to the nation's health-care system since the creation of Medicare in 1965. They released 42 pages of amendments to the 1,990-page health package unveiled last week, a move that started the clock ticking on their pledge to make the legislation publicly available for 72 hours before lawmakers are asked to pass judgment.
"We are now in the final stage of moving this critical bill through the House,"
Majority Leader Steny H. Hoyer (D-Md.) said in a statement. "Our members have worked very hard on this legislation, and I believe that as a result, we have a strong product that will lower costs and provide greater health care stability for all Americans."
Further amendments are likely Friday, when the House Rules Committee will meet to determine the parameters of the floor debate. Lawmakers from both parties are expected to offer a series of adjustments, and Rules Committee Chairman
Louise M. Slaughter (D-N.Y.) said she would accept at least one of them: a compromise crafted to soothe the bitter divide over abortion that holds as many as 40 votes in the balance.
The dispute centers on whether the package would, for the first time in more than 30 years, broadly permit federal funds to be spent on abortion. Under the House measure, insurance plans offered through federally subsidized exchanges could cover abortion services, but the insurance companies would be asked to segregate the subsidies from private premiums and co-pays, using only the latter to cover the cost of abortion. The package also would create a government-run insurance plan, which would operate under similar rules.
Antiabortion Democrats, led by
Rep. Bart Stupak of Michigan, have criticized that approach as an accounting distinction, arguing that even private premiums paid to a public insurance program amount to federal funds. The compromise offered by Rep. Brad Ellsworth (D-Ind.) would require federal health officials to hire a private contractor to handle payments to abortion providers, an idea that appeared to leave some antiabortion lawmakers cold.
Stupak, who was back home for a funeral Wednesday, said in a statement that he would keep trying to block the health bill "until there is satisfactory language to prevent public funding for abortion," ideally by banning abortion services from both the public plan and subsidized private plans.

Democrats See Health-Care Timetable Slipping
Prospect of Missing Year-End Target Prompts Lawmakers to Prepare for Debate Into 2010; White House Minimizes Impact of Delay
NOVEMBER 4, 2009

WASHINGTON -- Time is running short for Congress to deliver a health bill to President Barack Obama before the end of the year, prompting lawmakers to prepare for the debate to carry into 2010.

Senate Majority Leader Harry Reid indicated Tuesday that the chamber may not meet its goal of passing a bill in the next several weeks. "We're not going to be bound by any timelines," the Nevada Democrat said.

President Obama wanted a health-overhaul plan in place by the August recess. Now it is looking more like it will happen by the end of the year. But WSJ's Janet Adamy says the merging of the separate House and Senate bills may take longer than that.

Democrats have worked to get the measure done before next year, when midterm elections could make some senators uneasy about voting for a sweeping bill.
In the House, Democrats are still pressing to vote on their health bill before they leave for the Veterans Day break that starts Nov. 11. Republicans are fine-tuning a 230-page health bill of their own that's more limited.
In the Senate, where debate is expected to take longer, Democrats are still waiting for cost estimates by the Congressional Budget Office and trying to bring moderates onboard. They don't expect to get the cost figures from the CBO before the end of this week, which will delay unveiling the bill and bringing it to the Senate floor for debate.
Senate aides say it's possible to pass their bill, combine it with the House legislation and deliver it to Mr. Obama before the end of the year. But the Veterans Day and Thanksgiving holidays present major roadblocks for Senate Democrats, because lawmakers return home for each holiday.
The delay would be a setback for the White House, which has made enacting a health overhaul its top domestic priority this year. But officials minimized the prospect. Dan Pfeiffer, deputy communications director at the White House, said, "Senator Reid has committed to the president that as soon as the Senate has the information back from the CBO they will move expeditiously to pass health reform."
A coalition of employer groups on Tuesday introduced an advertising campaign attacking the House health bill for raising taxes during a bad economy. The groups include the U.S. Chamber of Commerce, the National Retail Federation and the National Association of Manufacturers.
The Democrats' health proposals in the House and Senate are designed to extend insurance coverage to tens of millions of Americans by expanding the Medicaid federal-state insurance program for the poor and providing new subsidies for low- and middle-income Americans that offset the cost of health insurance. They would require most citizens to carry health insurance and prevent insurers from denying coverage to people because of their medical history.
The plan from House Republicans aims for a far smaller expansion of health-insurance coverage. It wouldn't require Americans to carry insurance or stop insurers from denying coverage to those who have been sick. Instead, the bill would allow insurance firms to sell policies across state lines, permit small businesses to pool their risks to bring down costs and rein in medical malpractice lawsuits by capping noneconomic damages at $250,000.
The Republican bill also would prohibit taxpayer-funded abortions. House Democrats have proposed that abortion services be covered through the new public health insurance plan that's part of their bill, though their bill would place restrictions on the funding so only private money could be used to pay for the procedure in most instances.
Republicans don't have the votes to pass their bill through the House, but they are using it to highlight what they see as the flaws in House Democrats' legislation. "We don't think [the House] ought to be passing a 2,000-page provision," Senate Minority Leader Mitch McConnell of Kentucky said Tuesday.
Members of the House's fiscally conservative Blue Dog coalition met with CBO Director Douglas Elmendorf Tuesday to assuage their concerns about the Democratic bill's long-term costs. Rep. Earl Pomeroy (D., N.D.), a Blue Dog, said he expects a "split decision" on how to vote for the bill within the 52-member group.—Martin Vaughan contributed to this article.
Write to Janet Adamy at and Patrick Yoest at Printed in The Wall Street Journal, page A5


Health bill could slip into next year
By: Chris Frates and Carrie Budoff Brown November 3, 2009 04:53 AM EST
Democrats have blown so many deadlines for getting health reform done this year that insiders are increasingly skeptical they can finish by year’s end — and some even suggest the effort might slip to a new deadline, before the State of the Union address. The discussions are an acknowledgment that with only two months left in the year, Democrats are still a long way from sending a bill to the president’s desk. The House could take up reform on the floor as early as this week, with a good shot at passing something by Veterans Day. But in the Senate, Majority Leader Harry Reid is still wrangling with his moderate members to corral 60 votes just to get the debate started. And on Monday, Reid sent a letter to Republicans acknowledging that he is waiting on the Congressional Budget Office’s cost estimates and analysis to finish drafting a bill. Democrats signaled that those estimates would not be ready this week, casting further doubt on their ability to finish reform this year. Democratic Sen. Kent Conrad said he spoke with CBO Director Doug Elmendorf last week and that it sounded like “it would be quite a while” before the estimates were ready. The news makes a Christmas completion “a challenge,” Conrad said. Senate Finance Committee Chairman Max Baucus (D-Mont.) also asked Elmendorf when the estimates would be ready. So how long is a while? “I asked Mr. Elmendorf that question, and I get the same answer: We just don’t know,” Baucus said. That perception is shared on K Street.“It doesn’t sound to me that they’re ready to go. They still have moderates hanging out there,” said a former Republican Senate leadership aide turned lobbyist. In order to have a shot at a year-end bill signing, Reid would have to introduce a bill this week and wrap it up by Thanksgiving, giving House and Senate leaders the month of December to reconcile the differences between the two bills and pass the conference report through both chambers. That scenario is looking more unlikely by the day. In fact, some health care insiders who had once assumed that Reid would introduce a bill by the Veterans Day recess are now bracing for the possibility that its introduction could be delayed until after Thanksgiving. And that speculation has insiders moving the goal posts once again.
Where conventional wisdom once said that any hangover into 2010 would be a momentum-killing death knell for reform, now some insiders believe that reform could survive a bleed over into the New Year as long as both chambers pass reform this year. “If both bodies have cleared the bill by Jan. 1, then momentum is clearly on the side of the bill,” opening the way for Democratic leaders to come back after Christmas recess with a bill that can pass both chambers and be sent to President Barack Obama’s desk before his State of the Union speech, said a former Democratic leadership aide turned health care lobbyist. And there are several different ways that Democrats could negotiate a final bill. They could form a conference committee that would reconcile the differences between the two bills into one final piece of legislation. But there is a way for Democrats to skip the time-consuming conference committee by using the single-bullet maneuver. In this scenario, Reid would insert reform into a House bill that has already passed both chambers, vote it out of the Senate and into the House, where, once approved, it would go straight to Obama’s desk. The maneuver is also called a ping-pong because if changes are made, the bill bounces back and forth between the chambers until both sides pass a final bill. The procedure has become a common one when passing major legislation through Congress. The housing and bank bailout bills were passed using the single bullet. “There are already discussions in leadership circles planning out hypotheticals,” said a former senior Democratic congressional aide. But Democrats dismiss the talk of shifting timelines and procedural maneuvers as gossip. They are sticking, at least publicly, to their year-end timetables. For instance, Democrat Chuck Schumer, a key Senate negotiator, said recently that the whole bill will have to be finished by Christmas.
“We’re going to have to get it done by Christmas,” he said. “We may have to work long weeks.” Democratic Sen. Ron Wyden said he thinks reform can be completed in 2009, echoing the conventional wisdom on why 2010 would be tougher. “Certainly, when you are in an election year, everybody knows events are seen through a different prism. Everybody is looking at the calendar. There are very different sets of political factors,” he said. Nadeam Elshami, spokesman for Speaker Nancy Pelosi, left no ambiguity in the Democrats’ timeline. “For years, Americans have been denied coverage, faced skyrocketing premiums or declared bankruptcy because insurance companies put profits first. These practices by the insurance companies will soon come to an end when we send a bill to President Obama this year to sign,” he said. “The American people deserve nothing less. Republicans have decided to side with the insurance companies and against the millions of Americans who are in need of health care.”
The White House still expects Congress to pass a bill before year's end. “Congress is making extraordinary progress and is on track to enact health insurance reform legislation built on the president’s principles this year,” said Linda Douglass, spokeswoman for the White House health reform office.
Still, not everyone was so sure. Stephanie Lundberg, a spokeswoman for Majority Leader Steny Hoyer, said the House is on track to meet “the goal, not the deadline,” of finishing this year. “The American people would rather we take the time to get this right than rush to meet arbitrary deadlines. The measure of success is not in dates or deadlines; it will be the delivery of quality, affordable health care for all Americans,” Lundberg said. Reid spokesman Jim Manley left even more wiggle room when he said, “We want to go the extra mile to make sure we get it right while at the same time we move as quickly as possible.” Still, the fact remains that Democrats are starting to run out of days in the year. With big chunks of time off planned for Veterans Day, Thanksgiving and Christmas, they will have to seriously pick up the pace to finish by this year.
© 2009 Capitol News Company, LLC


Major Congressional Reforms Demand Bipartisan Support
ObamaCare would be an exception to the historical rule of large social legislation.

For decades, a rule of thumb in Washington has said that there should be popular support and a bipartisan majority before approving an initiative that significantly affects tens of millions of Americans. Health-care reform—ObamaCare—has neither, yet Democrats want to impose it anyway. If they succeed, the consequences could be devastating for the country and probably for the president and his party.
The reasoning behind the rule is simple. Forcing drastic change on an unwilling public is likely to cause national disunity, stir angry protests, increase political polarization, and deepen distrust of Washington. But if popular opinion and both political parties support the change, discord will be minimal.
Discord is all but certain if ObamaCare in anything like its present form is enacted. A majority, or at least a large plurality, of Americans oppose it. Their opposition is raw and intense, as we've learned from the spate of contentious town-hall meetings held by Democratic members of Congress last summer. A Washington Post/ABC News poll of Oct. 19 confirmed the obvious: Far more Americans "strongly" oppose ObamaCare (36%) than "strongly" support it (26%).
In survey after survey, a majority of Americans or close to it say they believe ObamaCare will drive up the cost of insurance premiums while worsening health care. They expect it to necessitate a tax hike and boost the budget deficit. Most Americans (nearly 90%) consistently express satisfaction with the current health-care system, despite its imperfections.

Opposition to ObamaCare is not limited to conservatives and Republicans. Independents have increasingly turned against liberal-style health reform. On Oct. 8, Gallup reported "one of the largest declines in support" for ObamaCare was among independents, falling in one month from 37% to 26%. On Oct. 21, Gallup said that by nearly 2 to 1 (36% to 19%) independents predicted they'd oppose the final health-care reform bill to come out of Congress. Even the undecided are skeptical. "In general, Americans who are undecided on health care legislation predict it is more likely to make their own situations worse rather than better, especially in terms of cost," Gallup said on Oct. 22.
President Obama, however, continues to proclaim "the time is now" for America to adopt universal health care, directed from Washington by the federal government. This is what President Truman in the 1940s and President Clinton in the 1990s said when they proposed national health care. The public was unsupportive then, too, and bipartisan backing in Congress was absent.
A glance at some sweeping measures enacted in Washington over the past half-century underscores how essential popular approval and bipartisanship approval are. Without them the controversy and wrangling never stops.
The creation of the interstate highway system in 1956, the passage of civil rights legislation, the war on poverty and federal aid to education in the 1960s, and No Child Left Behind in 2001 all were reasonably popular measures. True, the antipoverty bill, the Economic Opportunity Act, drew only 10 Republican votes in the Senate and 22 in the House. But that dwarfs Republican support for ObamaCare. At the moment, only one Republican in the Senate and one in the House are seen as possible votes.
Even the original Social Security Act of 1935 drew majority support by Republicans in the House (81 yes, 15 no) and in the Senate (16 yes, five no).
Medicare and Medicaid were established in 1965 with doctors opposed, but the public on board. The two programs attracted a bipartisan majority in Congress of nearly all Democrats and half the Republicans. In 2003, President Bush's Medicare prescription drug benefit got only nine Democratic votes in the House, but 35 of 48 Senate Democrats voted for it.
On the other hand, consider how Congress and the White House have dealt with the volatile issue of immigration. In 1965, immigration laws were liberalized. In 1986, the laws were tightened. Both actions had public support and strong congressional backing. Then, in 2007, legislation to liberalize immigration rules was drafted by Republicans, Democrats and the White House. But the public was fervently opposed, and the legislation was abandoned. A powerful backlash, bound to fuel ethnic turmoil, was averted.
Social Security reform is the classic example of an issue in search of public and political support. Neither party would consider passing it without at least some support from the other. In 1983, when Social Security revenues were falling short of promised benefits, reform was temporarily popular. Congress raised taxes and the normal retirement age to 67. When President George W. Bush sought another round of reform in 2005, national opinion had shifted. He failed to generate support even among Republicans.
Only once in recent decades has Congress inadvertently prompted a protest so formidable that it had to reverse itself almost overnight. In 1988, it passed the Medicare Catastrophic Coverage Act to protect seniors against ruinous medical costs. Fees paid by middle- and upper-income seniors were to finance the program.
Seniors rebelled because they were required to pay too much, on a means-tested basis, for coverage that would disproportionately help others and because it didn't have what they actually wanted, long-term health-care benefits. The following year the law was repealed.
The furious reaction to unwanted Medicare coverage, which included seniors climbing on the car of then-House Ways and Means Committee Chairman Dan Rostenkowski, is a preview of the eruption of public outrage that would greet the signing of ObamaCare into law. Only the protests would be larger, more frequent and angrier. Since everyone's health care would be affected, a sizeable chunk of the country would be in a constant uproar.
There would be more tea parties, angry demonstrations and marches on Washington. Town-hall meetings of Democrats would be raucous. Sit-ins would occur at congressional offices. Conservative talk radio would turn opposition to ObamaCare into a national crusade.
Many Republicans believe the passage of liberal health-care legislation would be a windfall for them. Indeed it might be. They've already discussed taking up the crusade to kill ObamaCare as their own. They would make it the centerpiece, along with the economy, of the 2010 midterm election.
In Washington, there's an atmosphere of denial. Obama senior adviser Valerie Jarrett said Sunday that the White House believes a majority supports the president's health-care program. "It depends on what poll you're looking at," she told George Stephanopoulos of ABC News. Ms. Jarrett must have polled congressional Democrats. They're the only majority—and a lopsided one—in favor of ObamaCare.
At best, Americans are roughly divided on ObamaCare. The half opposed are far from ready to accept its enactment as permanent. This is a situation where the longstanding rule of waiting for popular support and bipartisan backing should apply.
Mr. Barnes is executive editor of the Weekly Standard and a commentator on Fox News Channel.

The House Bill

House could vote Saturday on health bill
By Michael O'Brien - 11/04/09 03:10 PM ET
The House could hold a rare Saturday vote this weekend to pass its healthcare reform legislation. An aide to House Speaker Nancy Pelosi (D-Calif.) said Wednesday that a vote could happen at 6 p.m. on Saturday, a schedule House Rules Committee Chairwoman Louise Slaughter (D-N.Y.) suggested in reports Wednesday afternoon."It could happen at 6 p.m. on Saturday, but no final decisions have been made," said Nadeam Elshami, a spokesman for Pelosi.
House Rules Chairwoman Louise Slaughter (D-N.Y.) said the goal is to finish Saturday evening. It's not clear at this point, she said, whether the goal is to finish by 6 p.m. or start voting at 6 p.m.
A Saturday vote would fit within a timeline established after the Manager's Amendment on the House bill was filed late Tuesday evening. House Democratic leaders had agreed to Republican demands that they post their final bill online for at least 72 hours before a final vote, meaning the earliest that a vote could be held is late Friday.Slaughter and the Rules Committee will meet at 2 p.m. on Friday to determine the rules for the final health debate. The vote would bump up against the Nov. 11 Veterans Day holiday, on and after which lawmakers had been expected to recess until delays in passing the health bill had led Democratic leaders to threaten to cancel the break.
Mike Soraghan and Jared Allen contributed to this story.

The Worst Bill Ever
Epic new spending and taxes, pricier insurance, rationed care, dishonest accounting: The Pelosi health bill has it all.
NOVEMBER 1, 2009, 11:23 P.M. ET

Speaker Nancy Pelosi has reportedly told fellow Democrats that she's prepared to lose seats in 2010 if that's what it takes to pass ObamaCare, and little wonder. The health bill she unwrapped last Thursday, which President Obama hailed as a "critical milestone," may well be the worst piece of post-New Deal legislation ever introduced.
In a rational political world, this 1,990-page runaway train would have been derailed months ago. With spending and debt already at record peacetime levels, the bill creates a new and probably unrepealable middle-class entitlement that is designed to expand over time. Taxes will need to rise precipitously, even as ObamaCare so dramatically expands government control of health care that eventually all medicine will be rationed via politics.
Yet at this point, Democrats have dumped any pretense of genuine bipartisan "reform" and moved into the realm of pure power politics as they race against the unpopularity of their own agenda. The goal is to ram through whatever income-redistribution scheme they can claim to be "universal coverage." The result will be destructive on every level—for the health-care system, for the country's fiscal condition, and ultimately for American freedom and prosperity.
The spending surge. The Congressional Budget Office figures the House program will cost $1.055 trillion over a decade, which while far above the $829 billion net cost that Mrs. Pelosi fed to credulous reporters is still a low-ball estimate. Most of the money goes into government-run "exchanges" where people earning between 150% and 400% of the poverty level—that is, up to about $96,000 for a family of four in 2016—could buy coverage at heavily subsidized rates, tied to income. The government would pay for 93% of insurance costs for a family making $42,000, 72% for another making $78,000, and so forth.
At least at first, these benefits would be offered only to those whose employers don't provide insurance or work for small businesses with 100 or fewer workers. The taxpayer costs would be far higher if not for this "firewall"—which is sure to cave in when people see the deal their neighbors are getting on "free" health care. Mrs. Pelosi knows this, like everyone else in Washington.
Even so, the House disguises hundreds of billions of dollars in additional costs with budget gimmicks. It "pays for" about six years of program with a decade of revenue, with the heaviest costs concentrated in the second five years. The House also pretends Medicare payments to doctors will be cut by 21.5% next year and deeper after that, "saving" about $250 billion. ObamaCare will be lucky to cost under $2 trillion over 10 years; it will grow more after that.
• Expanding Medicaid, gutting private Medicare. All this is particularly reckless given the unfunded liabilities of Medicare—now north of $37 trillion over 75 years. Mrs. Pelosi wants to steal $426 billion from future Medicare spending to "pay for" universal coverage. While Medicare's price controls on doctors and hospitals are certain to be tightened, the only cut that is a sure thing in practice is gutting Medicare Advantage to the tune of $170 billion. Democrats loathe this program because it gives one of out five seniors private insurance options.
As for Medicaid, the House will expand eligibility to everyone below 150% of the poverty level, meaning that some 15 million new people will be added to the rolls as private insurance gets crowded out at a cost of $425 billion. A decade from now more than a quarter of the population will be on a program originally intended for poor women, children and the disabled.
Even though the House will assume 91% of the "matching rate" for this joint state-federal program—up from today's 57%—governors would still be forced to take on $34 billion in new burdens when budgets from Albany to Sacramento are in fiscal collapse. Washington's budget will collapse too, if anything like the House bill passes.

• European levels of taxation. All told, the House favors $572 billion in new taxes, mostly by imposing a 5.4-percentage-point "surcharge" on joint filers earning over $1 million, $500,000 for singles. This tax will raise the top marginal rate to 45% in 2011 from 39.6% when the Bush tax cuts expire—not counting state income taxes and the phase-out of certain deductions and exemptions. The burden will mostly fall on the small businesses that have organized as Subchapter S or limited liability corporations, since the truly wealthy won't have any difficulty sheltering their incomes.
This surtax could hit ever more earners because, like the alternative minimum tax, it isn't indexed for inflation. Yet it still won't be nearly enough. Even if Congress had confiscated 100% of the taxable income of people earning over $500,000 in the boom year of 2006, it would have only raised $1.3 trillion. When Democrats end up soaking the middle class, perhaps via the European-style value-added tax that Mrs. Pelosi has endorsed, they'll claim the deficits that they created made them do it.
Under another new tax, businesses would have to surrender 8% of their payroll to government if they don't offer insurance or pay at least 72.5% of their workers' premiums, which eat into wages. Such "play or pay" taxes always become "pay or pay" and will rise over time, with severe consequences for hiring, job creation and ultimately growth. While the U.S. already has one of the highest corporate income tax rates in the world, Democrats are on the way to creating a high structural unemployment rate, much as Europe has done by expanding its welfare states.
Meanwhile, a tax equal to 2.5% of adjusted gross income will also be imposed on some 18 million people who CBO expects still won't buy insurance in 2019. Democrats could make this penalty even higher, but that is politically unacceptable, or they could make the subsidies even higher, but that would expose the (already ludicrous) illusion that ObamaCare will reduce the deficit.
• The insurance takeover. A new "health choices commissioner" will decide what counts as "essential benefits," which all insurers will have to offer as first-dollar coverage. Private insurers will also be told how much they are allowed to charge even as they will have to offer coverage at virtually the same price to anyone who applies, regardless of health status or medical history.
The cost of insurance, naturally, will skyrocket. The insurer WellPoint estimates based on its own market data that some premiums in the individual market will triple under these new burdens. The same is likely to prove true for the employer-sponsored plans that provide private coverage to about 177 million people today. Over time, the new mandates will apply to all contracts, including for the large businesses currently given a safe harbor from bureaucratic tampering under a 1974 law called Erisa.
The political incentive will always be for government to expand benefits and reduce cost-sharing, trampling any chance of giving individuals financial incentives to economize on care. Essentially, all insurers will become government contractors, in the business of fulfilling political demands: There will be no such thing as "private" health insurance.
All of this is intentional, even if it isn't explicitly acknowledged. The overriding liberal ambition is to finish the work began decades ago as the Great Society of converting health care into a government responsibility. Mr. Obama's own Medicare actuaries estimate that the federal share of U.S. health dollars will quickly climb beyond 60% from 46% today. One reason Mrs. Pelosi has fought so ferociously against her own Blue Dog colleagues to include at least a scaled-back "public option" entitlement program is so that the architecture is in place for future Congresses to expand this share even further.
As Congress's balance sheet drowns in trillions of dollars in new obligations, the political system will have no choice but to start making cost-minded decisions about which treatments patients are allowed to receive. Democrats can't regulate their way out of the reality that we live in a world of finite resources and infinite wants. Once health care is nationalized, or mostly nationalized, medical rationing is inevitable—especially for the innovative high-cost technologies and drugs that are the future of medicine.
Mr. Obama rode into office on a wave of "change," but we doubt most voters realized that the change Democrats had in mind was making health care even more expensive and rigid than the status quo. Critics will say we are exaggerating, but we believe it is no stretch to say that Mrs. Pelosi's handiwork ranks with the Smoot-Hawley tariff and FDR's National Industrial Recovery Act as among the worst bills Congress has ever seriously contemplated.
The True Cost of the House Health Bill: $1.5 Trillion
Posted November 3rd, 2009 at 11.09am in Health Care.

Nancy Pelosi has unveiled the new health care bill in the House after merging together three different versions of legislation. To appease moderate Blue Dog Democrats and to meet President Obama’s oft-stated promise that reform wouldn’t cost more than $900 billion in the first ten years, Speaker Pelosi sought to reduce the $1.5 trillion total cost of the bill. Newsflash: she failed.
The Congressional Budget Office released its preliminary score of the bill and while some in the media have been reporting its net cost of $894 billion, the total cost of health reform legislation is more like $1.5 trillion. So, Speaker Pelosi is essentially right back where she started—with a huge 2,000 page plan that carries a hefty price tag.
Donald Marron, former acting director of the Congressional Budget Office,
calculates that through a variety of provisions there is about $217 billion in additional spending in the House bill. The additional spending in the House bill brings the total cost of the House bill to $1.273 trillion, or almost $1.3 trillion in a ten year budget window.
And let’s not forget the infamous “doc fix” which prevent cuts in Medicare payments to physicians that would otherwise automatically take effect under the “sustainable growth rate formula” (SGR). Despite the Senate’s unsuccessful attempt to pass a permanent fix without paying for it, the House legislation also attempts to pull out the same $245 billion dollar plus provision from the legislative package to create the illusion that the price tag of the legislation is lower than it really is. The American people saw this budget gimmick before when it was tried in the Senate, who do the House leaders think they are fooling?
The House bill costs more than the President’s $900 billion dollar promise and its costs are in excess of $1 trillion. All told, the cost of “reform” legislation is still more than $1.5 trillion.
Greg D'Angelo


Health Alert The Pelosi Bill Explained
Nov 4, 2009
by John Goodman
The Wall Street Journal called it “
the worst bill ever.” It’s easy to see why.
For individuals: Get insurance or else. The government will tell you what minimum insurance coverage you have to buy, where you must get it and what premium you will have to pay. Refusing to buy this insurance will result in a fine (tax) equal to 2½% of your income. If you don’t pay the fine, you could go to jail.
For employers: Provide insurance or else. For most people of working age, the government will tell your employer what type of insurance coverage the company must provide; and companies failing to provide it will face a tax equal to 8% of your wage income. Nominally, employers will be required to pay 72.5% of the premium for workers and 65% for families. However, economic theory teaches — and empirical evidence confirms — that employee benefits and labor taxes are completely borne by workers themselves in the form of less take home pay. Thus, the combined penalty workers face for failure to insure is 10.5% of income.
During last year’s presidential primary, Senator Obama criticized Senator Clinton’s proposal to mandate coverage by asserting she would try to force people to buy something they cannot afford and then tax them when they don’t buy it — leaving them worse off than they were. Exactly the same criticism applies to Pelosi’s play-or-pay mandates.
Encouraging employers to drop health insurance coverage. Many of those who do not get health insurance from an employer will be forced to buy it in a government-regulated health insurance exchange — where they will receive subsidies, depending on their income. For below-average-income employees, for example, these subsidies are far more lavish than the tax subsidy available for employer-provided insurance. At 150% of the federal poverty level ($33,100 for a family of four), for example, a worker would pay no more than 3% of income in premiums. At 300% of the poverty level ($66,200), a worker would pay no more than 10.7%. These numbers and all subsequent numbers are for year 2016 and are based on the
Congressional Budget Office (CBO) analysis.
The best way to think about the options here is to consider the employer and employee combined. Is it in their collective interest to buy insurance at the place of work, or to drop coverage, pay the fine and send the employee to the exchange? Let’s assume (a) minimum family coverage costs $15,000, (b) the employee as well as the employer is able to pay premiums with pretax dollars, (c) the employee’s income is $54,000 and (d) the marginal tax rate is 30%.
Now let the employer drop coverage and pay taxable wages instead. After taxes, the employee’s take home pay will increase by $10,500. The 8% penalty for failure to insure is equal to $4,320 and let’s assume that the fine is not deductible. At this point the employee is ahead by $6,180. Now, if the employee is able to buy health insurance in the exchange for no more than 7.2% of income ($3,900) as outlined in the bill, there is a net profit of $2,280. And the lower the employee’s income, the more profitable this decision becomes. Note: You will not be able to make this decision as an individual. If your employer decides that dropping coverage is good for the group as a whole, you will be swept up in the change.
This is why millions of people will lose their current employer coverage, despite President Obama’s promise that you can keep your current plan if you like it. (Lewin estimates
19 million would lose coverage under the Senate bill.) These people will be forced into Medicaid where there is already rationing by waiting or into a health insurance exchange where health plans will have an economic incentive to underprovide to the sick (see below), if they obtain new insurance at all.
Encouraging healthy people to be uninsured. The previous example showed why millions of workers and their employers will find it advantageous to drop employer coverage. There is nothing special about the Pelosi bill in this regard. All the bills before Congress create lavish subsidies in the exchange that are not available to people who get insurance at work. So there will be a strong incentive to reorganize or adjust in order to qualify for the greatest subsidies.
Yet, having decided to end employer coverage, does it really make sense to rush to buy insurance in the exchange? Why pay expensive premiums for health insurance right now if you do not have any health problems? Under the Pelosi bill, there would be no reason to do so. People would be able to wait until after they get sick to insure and they would be able to do so without any additional financial penalty.
In our example, the penalty for not entering the exchange and buying insurance is 2.5% of $54,000, or $1,350. That’s definitely less than the $3,900 premium that purchased insurance would require.
Encouraging others to overinsure. For those who do insure and have health problems, there is a different perverse incentive: They can buy more generous coverage. Although they will have to pay the full extra cost of such coverage, the extra premium will be community-rated. This means they pay average cost for a plan under which they expect above-average utilization.
Making health insurance more costly. Whenever guaranteed issue (plans have to sell to all comers) and community rating (same premium for all — or almost the same) have been imposed, insurance becomes more expensive. We previously reported that in
New York’s individual market, premiums are $9,036 for singles and $26,460 for families. Also as previously reported, studies by BlueCross, WellPoint, the insurance industry trade association (AHIP) and every other public and private study are all predicting soaring premiums — a 50% average increase by one estimate, with premiums tripling for the young and the healthy by another.
Creating perverse incentives for health plans. In the exchange, health plans would be free to set their own premiums, but they would be required to charge the same premium to all enrollees. This means the plans would make a profit on healthy enrollees and suffer a loss on less healthy enrollees. Consequently, the plans would have strong financial incentives to attract the healthy and avoid the sick. After enrollment, their incentives would be to over-provide to the healthy (to retain their membership and attract more of them) and under-provide to the sick (to discourage their continued membership and repel others like them). Already, in the federal employee system, health plan advertisements during open enrollment period picture young, healthy families — never people with costly illnesses. And some plans
discriminate against sicker enrollees to keep costs down for healthier ones.
Taxing capital. The bill contains $572 billion in new taxes, including a 5.4 percent surtax on people who earn more than $500,000 ($1 million per couple). Since this tax will mainly fall on investment income, it is basically a tax on capital. The response will be a lower capital stock and a smaller national income in the future. It is always bad economic policy to tax capital to pay for current consumption. To tax capital to pay for wasteful health care spending that promises miniscule health benefits at the margin is especially bad policy.
Taxing labor. In Texas, about 30% of the population of working age is uninsured. The Pelosi bill would impose a 10.5% tax on the wage income of all these people — unless they buy health insurance that in most cases will cost more than 10.5% of income. The only people who will be able to escape this dilemma will be those that qualify for Medicaid — imposing a new, hefty burden on taxpayers. The economic damage this will cause to the Texas economy will be devastating.
Higher marginal tax rates. A family of four with an income just over three times the poverty line, or $78,000 in 2016, would get a (premium plus out-of-pocket expenses) subsidy of $1,200. But that’s $7,600 less than the family would get if they earned $54,000. The plan thus imposes an implicit marginal tax rate of about 32 percent ($7,600/$24,000) on wages earned by families in this income range. Throw in the individual income tax rate of 15 percent, a payroll tax rate of 15 percent and a 4 percent state and local income tax, and the effective tax rate on a middle-income family reaches 66%!
Penalties for seniors. Like the other health reform bills on Capitol Hill, the Pelosi bill makes seniors pay for a very large portion of the cost of reform. For example, there will be $426 billion of reduced spending on Medicare and Medicaid — almost all of it directed at seniors. As many as 8.5 million seniors will lose their Medicare Advantage insurance. In contrast to the Baucus bill in the Senate, the Pelosi bill gives the government more authority to push Medicare enrollees into managed care plans that have economic incentives to deny patients care.
Exacerbating the problems of cost, quality and access. Like the Baucus bill in the Senate, the Pelosi bill will increase demand, but it will do nothing to increase supply. This almost certainly will lead to higher prices and more health care spending. As previously explained, there are no
realistic offsetting provisions for controlling health care costs. Also as previously explained, the perverse incentives of managed competition will encourage health plans within the exchange to underprovide care to the sickest enrollees.
Even if the number of people who are nominally insured rises, access to care may actually decrease. As demand increases and supply does not, the waiting costs of care will rise for almost everyone and the money cost of care will rise for most people. (Remember: The vast majority of people are getting no new government subsidy.) Massachusetts cut the number of uninsured in half. But
waiting times to see a new doctor in Boston are twice as long as in any other U.S. city and the number of people seeking nonemergency care at hospital emergency rooms is as high today as ever.

12 New Features in the Latest House Health Reform Bill
Janice Simmons, for HealthLeaders Media, October 30, 2009
Much has happened in the discussion of healthcare reform since three House committees voted to approve their versions of the initial bill (HR 3200) before adjourning for summer recess.
In the intervening three months, discussions played out in a variety of venues—from town hall meetings to Capitol Hill hearing rooms—that have created a bill with many changes. Here's a look at 12 of the new features in the Affordable Health Care for America Act (HR 3962) that was released on Thursday:

Public insurance option. While HR 3200 did have a public insurance option, the way it proposed to pay for services was different. With the lower-cost earlier version, hospitals and physicians would have been paid using Medicare rates, plus 5%—a formula that most hospitals and physicians opposed. The new public option proposal requires the Health and Human Services (HHS) secretary to negotiate rates with healthcare providers--as private insurers currently do. The House bill does not have a state opt-out measure that is likely to be proposed in the Senate bill when it comes to the floor of that chamber.
"Millionaire" healthcare surcharge. In the earlier version approved by the House Ways and Ways Committee, those individuals making $280,000 or families making more than $350,000 would have been required to pay a surcharge. In the new bill, this has been raised to encompass only the wealthiest 0.3% of the population: individuals making above $500,000 and families above $1 million would pay the surcharge.
Doughnut hole timeline. The revised bill moves up the effective date to begin reducing the Medicare drug payment doughnut hole from Jan. 1, 2011, to Jan. 1, 2010. The hole initially will be reduced by $500, with a 50% discount instituted for brand name drugs paid for in the hole. Elimination of the doughnut hole will be achieved by 2019, instead of 2024 under the earlier bill.
Value-based Medicare payment formula. A new provision was included that changes the way Medicare pays hospitals and physicians—by moving from a formula that pays for the volume of tests and procedures performed to a value based formula that emphasizes quality care and cost effectiveness. The Institute of Medicine (IOM), through two studies, will make recommendations on how to fix the current Medicare reimbursement system, including addressing current geographic variations.
Insurance cooperatives. Under the revised House bill, grants and loans would be made available for the establishment and initial operation of not for profit, member-run health insurance cooperatives. They could provide coverage through the health insurance exchanges.
Intermediate assistance for uninsured. To fill the gap before the health insurance exchange is ready, an insurance program with financial assistance will be made available for those who have been uninsured for several months or denied a policy because of pre existing conditions.
Negotiation of Medicare drug prices. With the revised bill, the HHS secretary will be required to negotiate drug prices on behalf of Medicare beneficiaries.
Employer mandate exemption. The revised bill calls for exempting firms with payrolls up to $500,000 (instead of $250,000) from the mandate and indicates only a graduated penalty for not offering coverage for firms with payrolls between $500,000 and $750,000 (instead of firms with payrolls between $250,000 and $400,000.) This change exempts more small businesses (now up to 86%) from the employer mandate.
Insurer antitrust exemption. The revised bill incorporates language that would overturn the 60-year-old McCarran-Ferguson Act that gives health and medical companies an antitrust exemption and had permitted them to share data.
Age extension. Coverage under the revised bill would permit young people up to age 27 to remain on their parents' health insurance if requested.
Long-term care insurance. The revised bill creates a long-term care insurance program that would be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled. This measure would provide cash benefits to assist individuals with community based services.
Medicaid expansion. Individuals and families with incomes now at or below 150% percent of the federal poverty level will be eligible for an expanded Medicaid program. This expansion will initially be fully federally financed, then transitioned to include a 9% contribution from states starting in 2015. To improve provider participation, reimbursement rates for primary care services will be increased to Medicare rates with new federal funding.Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at


Tort-Bar treat
PelosiCare's perks for lawyers
Last Updated: 3:58 AM, November 3, 2009

In his Sept. 9 address before Congress, President Obama noted that litigation "may be contributing" to increasing health-care costs and promised to fund "demonstration projects" in the states to improve the liability system and to test "ideas about how to put patient safety first."
Alas, as House Speaker Nancy Pelosi's health-care bill emerged last week, it became clear that Congress' leaders are less interested in funding demonstration projects that work than in keeping cash flowing from trial lawyers to the Democratic Party.
Section 2351 of the Pelosi bill outlines incentive grants to the states to fund "medical liability alternative" demonstrations along the lines Obama suggested. But the grants would come with strings: The projects could not in any way "limit attorneys' fees or impose caps on damages."
The bill would not (as some have mis-reported) require states to repeal existing tort-reform laws to get incentive grants. Rather, it would use taxpayer dollars to discourage states from adopting damage caps or fee limits.
That is, the bill only pays for "demonstration projects" that don't use the most common ways to limit the abuse of medical-malpractice lawsuits -- reforms that have worked elsewhere.
Serious analysts today agree that such reforms have lowered costs. Empirical studies have also shown that they've increased access to doctors and saved lives.
After a review of emerging evidence, the nonpartisan Congressional Budget Office last month dropped its old claim that tort reforms generate "very little" cost savings. Instead, the CBO found that nationwide adoption of tort reforms would save $54 billion in government health-care outlays over the next decade.
If anything, that understates the savings. The CBO implausibly found that more savings would come from lowered liability premiums for doctors and less from reducing wasteful "defensive" medical practices -- even though most statistical studies find the latter savings to be far more significant.
Still, there's reason to go beyond the "traditional" tort reforms: Even where damage caps exist, doctors are still subjected to abusive lawsuits that cost too much and take too long; juries in complex medical cases are still likely to get the answer wrong as often as they get it right.
Thus, medical researchers at Harvard and lawyers like Covington and Burling's Philip Howard (who heads the legal-reform group Common Good) have called for even more radical reform. Howard calls for a system of specialized health courts -- akin to existing special courts that handle tax, bankruptcy and divorce cases -- to dramatically improve the way the legal system handles medical-error claims.
Unfortunately, Pelosi ignores such innovative ideas. The only medical-liability reforms her bill funds are "certificate of merit" and "early offer."
Certificate-of-merit rules require lawyers, before suing, to get a medical expert's affidavit attesting to the plausibility of the claim. Strong forms of such laws can weed out ill-founded suits, but many laws do little -- since lawyers must ultimately get an expert witness to make their case plausible at trial, anyway. Thus, this reform is typically the preferred solution of trial lawyers.
Early-offer rules are designed to promote early and fair settlement of valid claims. The Manhattan Institute, as have many noted legal academics, has been promoting them for at least 15 years. To be effective, however, early-offer rules must be paired with other reforms that Pelosi's bill won't permit -- limits on contingency fees or damages.
(For example, the rules must prevent lawyers from collecting added fees if the plaintiff goes to trial but fails to win as much as was in the early offer, or eliminate pain-and-suffering awards if the plaintiff was given an expiditious offer of full economic damages).
So it's hard not to conclude that Pelosi's liability-reform provisions are little more than window dressing -- more designed to protect trial-lawyer profits than to reduce lawsuit abuse.
The trial lawyers' political-action committee was the second-largest donor to Democratic congressional candidates in the last election cycle, and lawyers gave more money to congressional campaigns than did doctors, pharmaceutical companies, HMOs and nursing homes -- combined. That largesse would appear to be money well spent.
James R. Copland directs the Manhattan Institute's Center for Legal Policy.

House healthcare bill cuts incentives to states that cap attorney fees, damages
By Tony Romm - 10/30/09 01:07 PM ET
A provision in House Democrats' recently unveiled healthcare bill would offer incentive payments to states that reform their medical lawsuit rules -- but only if local governments do not pass laws that limit awards or cap attorneys' fees.The proposed rule is likely to anger congressional Republicans, who have made tort reform a signature issue throughout this year's healthcare debate.At issue is a small section toward the very end of the more than 1,900-page Affordable Health Care for America Act, which House Speaker Nancy Pelosi (D-Calif.) revealed on Thursday. The section promises free money for use on healthcare to states that create alternative medical liability guidelines "after the date of enactment" of Democrats' proposed insurance reform.

Although the bill specifies the amount is entirely up to the appropriations process, it does set one key condition: States are ineligible for those federal dollars if they "limit attorneys' fees or impose caps on damages."Instead, local governments' new liability rules must focus on such general topics as increasing healthcare access, accurately disclosing errors and quickly resolving disputes if they want any of the proposed incentive money, according to the billUltimately, some Democrats are likely to argue that states do not need the incentive payments if they are currently taking the initiative to revise their medical liability laws -- regardless of how they opt to do it.Republicans, however, are already raising questions about the incentive rules. At least one top GOP lawmaker on Friday reminded Speaker Pelosi that previous cost estimates predicted the country could save about $54 billion through tough tort reform.“Republicans agree with President Obama that defensive medicine drives up health care costs, but unfortunately Speaker Pelosi’s bill suggests that House Democrats are more focused on political interests than substantially reducing the costs of care by getting trial lawyers out of the examining room,” said Brad Dayspring, press secretary for House Republican Whip Eric Cantor (Va.).


ObamaCare: Insurance Premiums Soaring Up, Up, and Away
by Capitol Confidential
CBO DIRECTOR DOUGLAS ELMENDORF: “Our Judgment Is That That Piece Of The Legislation Would Raise Insurance Premiums.” (Finance Committee, U.S. Senate, Hearing, 9/22/09)
3 Reasons Premiums Will Increase
New Government Regulations: “[P]remiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market…”
(CBO Director Douglas Elmendorf, Letter To Sen. Baucus, P. 6, 9/22/09)
New Taxes On Medical Devices, Prescription Drugs And Clinical Labs: “Those projected premium amounts include the effect of the fees that would be imposed under the proposal on manufacturers and importers of brand name drugs and medical devices, on health insurance providers, and on clinical laboratories. Those fees would increase costs for the affected firms, which would be passed on to purchasers and ultimately would raise insurance fees by a corresponding amount.” (Doug Elmendorf, “CBO’s Analysis Of Premiums Under The Chairman’s Mark Of The America’s Healthy Future Act,” CBO Blog, 9/23/09)
New Taxes On High Cost Insurance Plans: “The imposition of the excise tax on insurers can be expected to lead health insurance providers and consumers to take measures to minimize their burden from the tax. As insurers pass along the cost to the consumer by increasing price, the cost of employer provided insurance will increase.” (“Memorandum: Revenue Estimate,” Joint Committee on Taxation, 9/29/09)
HHS’s Center for Medicare and Medicaid Systems Actuary: “Total National Health Expenditures Under This Bill Would Increase…”
(”Estimated Financial Effects Of The ‘America’s Affordable Health Choices Act Of 2009’ (H.R. 3200), As Reported By The Ways And Means Committee,” Centers For Medicare & Medicaid Services, P.3, 10/21/09)
AP: “The nation’s medical costs will keep spiraling upward even faster than they are now under Democratic legislation pending in the House, a report from government economic experts concluded…” (“US Health Care Tab Would Grow Under Overhaul,” AP, 10/21/09)
CBO ON SENATE FINANCE PROPOSAL: Costs Will Grow. “The gross cost of the coverage expansions, consisting of exchange subsidies, the net costs of expanded eligibility for Medicaid, and tax credits for employers: Those provisions have an estimated cost of $180 billion in 2019, and that cost is growing at about 8 percent per year toward the end of the 10-year budget window.” (CBO Director Douglas Elmendorf, Letter to Sen. Baucus, P. 10, 10/7/09)
OLIVER WYMAN STUDY: “Average premiums for small employers will increase: Under reform, small employers will experience premium increases as a result of rating rule changes and minimum benefit requirements.”
(Oliver Wyman, “Insurance Reforms Must Include A Strong Individual Mandate And Other Key Provisions To Ensure Affordability,” P.3, 10/14/09)
PRICEWATERHOUSE COOPERS STUDY: “There are four provisions included in the Senate Finance Committee proposal that could increase private health insurance premiums above the levels projected under current law.” (PricewaterhouseCoopers, “Potential Impact Of Health Reform On The Cost Of Private Health Insurance Coverage,” P.3, 10/11/09)
HAY GROUP STUDY: “Our model results show significantly higher premiums and lower coverage levels than for the most recent version of the Senate Finance Committee bill than our original assumptions would have produced.” (Hay Group, “Impact Of Proposed Senate Finance Committee Health Care Reform Bill On The Nongroup Market,” P.1, 10/5/09)
MILLIMAN STUDY: “The combined effect of immediate implementation of the reform initiatives described above would be expected to increase average premiums over and above normal trend levels in both the small group and individual insurance markets.” (Milliman, “Analysis Of Impact Of Certain Healthcare Reform Initiatives on Health Insurance,” P. 4, 7/13/09)
WELLPOINT STUDY: “Health care reform legislation introduces several new broad taxes and fees that will further drive up health insurance premiums…”
(Wellpoint, “Health Care Reform Premium Impact In Ohio,” p.17, 2009)
GALLUP POLL: “Americans Have Become More Likely To Say The Costs Their Family Pays For Healthcare Will Get Worse If A Healthcare Bill Passes…”
(“In U.S., Half See Own Costs Worsening Under Health Care Bill,” Gallup, 10/22/09)
· 76% Say Their Costs Would Get Worse or Not Change
· 22% Say Their Costs Would Get Better

Pelosi’s Health Insurance Reform Bill Establishes Waiting Lists
Even Canada Said These Were IllegalTuesday, November 3, 2009
By Michael P. TremoglieTremoglie's Tea Time BlogH.R. 3962, the Democrats’ health insurance reform bill, to be voted on this week by Congress, contains a provision to establish waiting lists as a mechanism to control costs. Such waiting lists have long been a characteristic – and a bane - of socialized medicine.Indeed, the Canadian Supreme Court ruled them illegal in June 2005. "Access to a waiting list is not access to health care," wrote Canada’s Supreme Court Chief Justice Beverly McLachlin at the time.Yet, this is exactly what the Democrats’ plan has in mind for Americans if their proposed bill becomes law. Called the “Affordable Health Care for America Act,” House Speaker Nancy Pelosi, D.- Ca., unveiled it with great fanfare last week. The bill is sponsored by Rep. John Dingel, D. Mich., and is co-sponsored by Democrat Representatives Charles Rangel of New York, Henry Waxman, Fortney “Pete” Stark and George Miller of California, as well as, Representatives Pallone and Andrews of New Jersey. It is more than 1900 pages long.But one need only turn to page 26 to find the provision for waiting lists.There, listed in Title I ‘Immediate Reforms,’ Sec. 101 ‘National High Risk Pool Program,’ paragraph (3)(g) ‘Covered Benefits Cost Sharing Premiums and Consumer Protection’ is paragraph (7) (h)(2) with the heading ‘Insufficient Funds.’This states, “If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists. (Emphasis added)The High Risk Pool Program is designed exactly for those uninsured individuals who health insurance reform proponents say are the neediest. Estimates are such people comprise one to two percent of the population.Jane Orient, M.D., Executive Director of the Association of American Physicians and Surgeons (AAPS), believes that if the government is willing to deny benefits to those who they purportedly consider the most deserving, then eventually waiting lists will be applied to everyone enrolled in the government’s plan. The Democrats’ promise to increase the amount insured, decrease costs and increase benefits is a chimera according to her.“It’s just inevitable if you make everyone dependent on the system and you make promises you can’t keep. This will be the fate of everyone dependent on the public option - and they (Democrats) want everyone in the country dependent on this program,” she said.The AAPS, ironically, was established to be the “voice of private doctors” in 1943. That year the Wagner-Murray-Dingel bill was introduced to establish a government run health insurance system. The Dingel of that bill was the father of Rep. John Dingel the author of H.R. 3962.A similar sentiment was expressed by Robert Kaufman, Professor of Public Policy at Pepperdine University in California. He too believed that although this policy is limited to only this one specific group it will eventually apply to everyone.“Rationing is the inevitable consequence of this monstrosity. There is no way that anyone can administer anything like this without waiting lists - de facto or otherwise,” he said. “Given the trajectory and logic of the Obama administration, it is a reasonable surmise to expect that this establishes waiting lists as a policy and that the burden proof is with the Obama administration to show it is not."

Posted by M. Tremoglie at
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The Senate Bill

House Leaders Unveil Health Bill
OCTOBER 30, 2009
WASHINGTON -- House leaders unveiled their sweeping health bill Thursday, ending months of negotiations to bring together fractious Democrats and setting the stage for the full House to take up the bill next week.
What Happens Next
Next week: House leaders' target date to take up a bill introduced Thursday.
Early November: Senate Majority Leader Harry Reid aims to unveil bill to bring to Senate floor. Must get 60 votes to open debate.
November and perhaps beyond: Senate debates health bill. Must get 60 votes again to end debate.
Date uncertain: If full Senate and House both pass bills, they hold conference committee to work out differences.
End of year: President Barack Obama's target date to sign a bill.
The Congressional Budget Office estimated that the legislation will spend $1.055 trillion, largely to expand health insurance, which would be more than offset by tax increases and spending cuts. The revised legislation would extend insurance coverage to 36 million Americans and create a new government health-insurance program to compete with private insurance companies.
House Democrats said the 1,990-page bill was a historic step toward universal health insurance. "We come before you to follow in the footsteps of those who gave our country Social Security and then Medicare," House Speaker Nancy Pelosi said.
Republicans, meanwhile, said the bill would create new bureaucracies without fixing the health system. "It's going to raise the cost of American health insurance," said House Minority Leader John Boehner of Ohio.No Republicans are expected to vote for the bill. While liberals praised the measure, key blocs of House Democrats haven't offered their endorsement. The fiscally conservative Blue Dog coalition said Thursday that it wants more proof that the bill lowers federal health spending in the long term.
Doctors complained that lawmakers removed a provision that staved off deep cuts to physicians' Medicare payments. Hospitals fretted the new public plan would underpay them, despite increases in reimbursement rates.
The sharpest criticism came from employers, who say it will saddle them with higher taxes, and insurance companies, which say a new public insurance plan will drive them out of business.
"We are not supportive of this bill in its current form," said Karen Ignagni, president of America's Health Insurance Plans, the main industry trade group. "We think there is a missed opportunity on comprehensive cost containment."
This version of the overhaul came after three House committees passed separate drafts over the summer. Lawmakers have for weeks been wrestling over a compromise measure.
The CBO said Thursday that it estimates the net cost of the bill at $894 billion over a decade. By that measure, it is just under the $900 billion ceiling set by President Barack Obama. He called the bill a "critical milestone" and said he was pleased it carried a public option.
The CBO raised questions about whether the public plan will save consumers money. In a letter to House leaders, CBO Director Douglas Elmendorf wrote that the plan "would typically have premiums that are somewhat higher" than those of private insurance plans offered alongside it.
The CBO estimated that new taxes and spending cuts in the bill would lower the federal deficit by $104 billion as of 2019. Expected savings diminished in the final years of the budget projection, prompting opponents to say the bill doesn't lower health costs over the long term. The CBO said it expected savings to outpace new spending but couldn't be sure.
Comparing the Plans
How the House and Senate bills line up:
Public Option
House: Creates government-run health-insurance plan that would negotiate rates with doctors and hospitals.
Senate: Same except states would have right to opt out.
Winners/Losers: Doctors likely to get higher payments than they would if public plan rates were tied to Medicare. Insurers could lose because they'll face a new competitor

Employer Mandate
House: Employers must provide health-insurance coverage or pay fine of 8% of payroll (for those with payroll greater than $750,000).
Senate: Penalty for employers who don't provide coverage is up to $750 per employee, if employees get government subsidies.
Winners/Losers: Employers generally fare better under Senate plan.

House: Surtax of 5.4% on married couples earning more than $1 million a year or individuals making more than $500,000 a year.
Senate: No surtax on the wealthy. Tax on certain high-value health-insurance plans.
Winners/Losers: Unions prefer the House bill because some union members have high-value or "Cadillac" health plans.

Individual Mandate
House: Those who go without insurance would pay fine of up to 2.5% of adjusted gross income.
Senate: Finance Committee bill would levy fines of up to $1,500 per family if people refuse to purchase health insurance.
Winners/Losers: Lower-income people get subsidies to buy coverage. Those who feel they still can't afford health insurance would lose, because they have to pay a fine.
Note: Senate consensus bill not yet released; some details may change.
The bill spends $425 billion over a decade to expand Medicaid and the Children's Health Insurance Program, and $605 billion for subsidies to low- and middle-income Americans to buy health insurance on government-run insurance exchanges. It cuts spending for Medicare and other federal health programs by $426 billion over a decade.
The bill requires most Americans to have health insurance by 2013, with fines as much as 2.5% of income if they don't. It would leave 96% of legal U.S. residents with health insurance by 2019, up from 83% today.
Lawmakers changed the bill to provide Medicaid to a greater swath of the poor, while slightly narrowing the scope of new subsidies for health insurance to middle-income Americans. A family of four earning up to $33,000 a year will be eligible for the federal-state Medicaid program. A family of four earning up to $88,000 a year would pay no more than 12% of their income for health insurance, with the government subsidizing premiums if they exceed that level.
The bill imposes a 5.4% surtax on people earning more than $500,000 a year and families earning more than $1 million a year.
Employers that don't offer health insurance face fines equal to 2% of their payroll in companies with minimum annual payrolls of $500,000 a year. The fines increase to 8% of payroll for employers whose annual payroll exceeds $750,000. Firms with a payroll of less than $500,000 would be exempt.
House Democrats added a provision that revokes a decades-old antitrust exemption for insurance companies.
As expected, the bill prevents insurers from denying coverage to people with a pre-existing health condition or dropping coverage when customers get sick. It places caps on patients' out-of-pocket medical costs and waives co-pays for preventive health services.
The bill also addresses medical liability, calling for new incentive payments to states that have alternative medical liability laws aimed at cracking down on frivolous malpractice lawsuits.
Lawmakers pulled out a provision to reverse a 21% cut to physicians' Medicare payments that's scheduled to take effect next year and introduced it in a separate piece of legislation.
Write to Janet Adamy at Printed in The Wall Street Journal, page A4


House health bill clocks in at 1,990 pages
By JONATHAN ALLEN 10/29/09 4:22 PM EST
It runs more pages than War and Peace, has nearly five times as many words as the Torah, and its tables of contents alone run far longer than this story.
House health care bill unveiled Thursday clocks in at 1,990 pages and about 400,000 words. With an estimated 10-year cost of $894 billion, that comes out to about $2.24 million per word. .
And for some members, that
may not be enough.
A “robust”
public option can’t be found in the bill. Neither can the word “doctor” – save for a few references to degrees. No “cost curve” is bent. No “blue pill” is dispensed.
“Death” and “taxes” are both in there, but “death panel” is not.
The text defines dozens of words and phrases, including “family” (“an individual and . . . the individual’s dependents”), “health insurance coverage,” “exchange-eligible individual” and “Indian.”
And for those who cry “read the bill,” beware. There are plenty of paragraphs like this one:
“(a) Outpatient Hospitals – (1) In General – Section 1833(t)(3)(C)(iv) of the Social Security Act (42 U.S.C. 1395(t)(3)(C)(iv)) is amended – (A) in the first sentence – (i) by inserting “(which is subject to the productivity adjustment described in subclause (II) of such section)” after “1886(b)(3)(B)(iii); and (ii) by inserting “(but not below 0)” after “reduced”; and (B) in the second sentence, by inserting “and which is subject, beginning with 2010 to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)”.
The section deals with “incorporating productivity improvements into market basket updates that do not already incorporate such improvements,” if that helps.
Optimistic lawmakers say it could take a week just to
get through the bill’s text.
“I’ll have to call an emergency meeting of my staff and drop the customary procedure of me reading and my staff not reading,” joked House Judiciary Committee Chairman John Conyers (D-Mich.), who famously told filmmaker Michael Moore that lawmakers “don’t read most of the bills.”
“It’s one thing to read it,” said Rep. Lee Terry (R-Neb.), a lawyer who voted against the first version of the bill on its way through the Energy and Commerce Committee. “It’s another thing to understand it when it’s written in legalese.”
When given the bill’s dimensions, Rep. Anthony Weiner (D-N.Y.) noted that some members are faster readers than others.
“That’s one afternoon for Barney Frank,” he said.
Republicans aide said a print-out of the bill weighs more than 19 pounds and stands nearly nine inches tall.
North Carolina Republican Rep. Patrick McHenry, 34 years old and a few inches taller than 5 feet, said the bill could act as a ”booster seat.”
Democrats say the
essence of the bill isn’t much different from the three sister bills they moved through committees this summer, which came in around 1,000 pages.
If you read those, they say, you pretty much know what’s in this one.
“It’s almost a complete certainty that we have already discussed and debated almost every element that’s in this bill,” said Rep. Steve Rothman (D-N.J.)
McHenry took issue with the notion that the 2,000-page bill hasn’t changed much from the earlier, 1,000-page versions. To prove the point, he pulled out a Democratic-written summary of the changes.
All eight pages of them.
Asked why the House will vote on the roughly 400,000-word bill in a week when it takes a congregation a year to read the 80,000-word Torah at a synagogue, Rothman, who is Jewish, exhibited the wisdom of a Talmudic scholar.
“It only takes a year because you read one section a week,” he said.
But Republican Rep. Joe Barton, who is Texan, said the bill is “about four reams of paper” that add up to the American public “getting reamed.”


House takes another step on healthcare reform
Thu Oct 29, 2009 7:01pm EDT
John Whitesides and Donna Smith
WASHINGTON (Reuters) - Democrats in the U.S. House of Representatives unveiled a sweeping healthcare overhaul on Thursday that would transform the insurance market, create a government-run insurance plan and levy new taxes on the rich.
Weeks of closed-door negotiations to merge three House healthcare plans produced a 1,990-page bill that would cost a net $894 billion over 10 years -- just below President
Barack Obama's target of $900 billion -- and reduce the deficit by $104 billion over the same period, budget analysts estimated.
"Today we are about to deliver on the promise of making affordable, quality health care available for all Americans," House Speaker Nancy Pelosi said in a ceremony on the steps of the U.S. Capitol.
The bill's release was another step forward in Obama's drive for healthcare reform that would rein in costs, reform the insurance industry and expand coverage to many of the 46 million uninsured living in the United States.
Obama has made an overhaul of the $2.5 trillion industry, which constitutes one-sixth of the economy, his top domestic priority.
The bill was met with unanimous opposition from Republicans and grumbling from some Democrats. Party liberals had sought a stronger public insurance option and party moderates want assurances that federal funds will not be used to pay for abortions under the measure.
The legislation could be debated in the House as soon as next week. The Senate is putting together its own version, and the House and Senate bills eventually must be combined before being sent to Obama for his signature.
Obama praised House Democratic leaders for the insurance industry reforms and said he was pleased the bill featured a public insurance option and was fiscally responsible.
"The House bill clearly meets two of the fundamental criteria I have set out: it is fully paid for and will reduce the deficit in the long term," he said in a statement.
Republicans have battled Obama and Democrats at every juncture in the healthcare debate, and they criticized the size, cost and scope of the House legislation.
"Americans' health care is too important and too complex to risk on one gigantic bill that has been written behind closed doors," said Representative Dave Camp, the senior Republican on the House Ways and Means Committee.
House Republican leader John Boehner urged Democrats to slow down the process and allow a full floor debate. "This huge bill is designed to be so complex that nobody would ever know for sure what's in it," he said.
The House bill would expand coverage to 36 million uninsured people living in the United States, the Congressional Budget Office said. It would offer subsidies to help the uninsured purchase insurance through newly created exchanges.
It would require individuals to buy insurance and all but the smallest employers to offer health coverage to workers. It also would bar insurers from refusing to cover people with pre-existing medical conditions and eliminate the industry's exemption from federal antitrust laws.
The House proposal includes a 5.4 percent surtax on individuals making more than $500,000 and couples earning more than $1 million, which would bring in an estimated $460 billion over 10 years to help pay for covering the uninsured.
It also would save money by expanding eligibility for the government's Medicaid health insurance program for the poor to people with incomes up to 150 percent of the official poverty level. Covering people through Medicaid is cheaper for the government than providing subsidies to purchase insurance.
The nonpartisan Congressional Budget Office said the subsidies for health insurance coverage would cost $1.055 trillion over 10 years, to be offset in part by $167 billion in penalties paid by individuals and employers who fail to obtain insurance.
The proposed new government-run insurance program has been a flashpoint in the debate. Obama and liberals see it as a way to increase competition with private insurers, but critics say it would lead to a government takeover.
In the House bill, the public option would use reimbursement rates negotiated with doctors and hospitals. House liberals led by Pelosi could not muster the votes for a stronger version pegged to rates for Medicare, the government's health insurance program.
The healthcare measure being prepared for debate in the Senate also includes a public option based on negotiated reimbursement rates but, unlike the House bill, it would allow states to decline to participate.
The House bill does not include the Senate's proposal to tax high-cost "Cadillac" insurance plans, which has been opposed by House Democrats and labor unions who fear it will hurt too many middle-income workers.
The lobbying group for the insurance industry, America's Health Insurance Plans, criticized the proposed government-run insurance program, arguing it would cause people to lose their existing coverage.
"A new government-run plan would bankrupt hospitals, dismantle employer coverage ... and ultimately increase the federal deficit," Karen Ignagni, the group's president, said in a statement.
(Editing by Chris Wilson)

Washington 'Shall' Control Your Healthcare
October 30, 2009
David Harsanyi
The King James version of the Bible runs more than 600 pages and is crammed with celestial regulations. Newton's Principia Mathematica distilled many of the rules of physics in a mere 974 pages.
Neither have anything on Nancy Pelosi's new fiendishly entertaining health-care opus, which tops 1,900 pages.

#toolbox #alert .title { text-transform: uppercase; font-weight: bold; font-size: 11px; }

So curl up by a fire with a fifth of whiskey and just dive in.
But drink quickly. In the new world, your insurance choices will be tethered to decisions made by people with Orwellian titles ("1984" was only 268 pages!) like the "Health Choices Commissioner" or "Inspector General for the Health Choices Administration."
You will, of course, need to be plastered to buy Pelosi's fantastical proposition that 450,000 words of new regulations, rules, mandates, penalties, price controls, taxes and bureaucracy will have the transformative power to "provide affordable, quality health care for all Americans and reduce the growth in health care spending . . . ."
It's going to take some time to deconstruct this lengthy masterpiece, but as you flip through the pages of the House bill, you will notice the word "regulation" appears 181 times. "Tax" is there 214 times. "Fees," 103 times. As we all know, nothing says "affordability" like higher taxes and fees.
The word "shall" - as in "must" or "required to" - appears over 3,000 times. The word, alas, is never preceded by the patriotic phrase "mind our own freaking business." Not once.
To vote for the bill, a legislator must believe a $1 trillion price tag is "revenue neutral," or that it alleviates any of the pain higher costs bring to the average American. This would require alcohol.
Real competition, as far as anyone can tell, is antithetical to the authors of this bill. Remember, you can purchase oranges from Florida and whiskey from Kentucky, yet you're prohibited from buying health insurance from anywhere outside your state . . . so sayeth Nancy Pelosi.
Instead of creating a new market with interstate trade, what we get is the institution of the pleasant-sounding "Health Insurance Exchange," which exists, it seems, only to accommodate a non-competitive, government-run insurance option.
Now, finding a name for a state-run program without offending the lingering capitalistic sensibilities of bourgeoisie has been problematic. So Pelosi went with the innocuous "consumer option" - known for a fleeting moment as the "competitive option" and popularly as the "public option." Whatever your preference is, it's the option that leads to a single-payer insurance program.
Democrats say we can save billions by funding a plan that uses billions of wasted tax dollars from another public plan that we already supplement with billions. Make sense?
In actuality, we pay for all this by "cost sharing," or "sharing the cost" of insuring everyone through higher prices and taxes. But no fear. The legislation taxes "the rich." The bill doesn't index the tax to inflation so more of you will be on the hook as inflation rises due to the tragically irresponsible behavior of Congress and the White House. The rich - many of them small-business owners - are already set to see their rates go up in 2010.
Hey, who needs those jerks to create real jobs when we have Washington pretending to do it?
All of this, as Madame Speaker says, constitutes a "a historic moment for our nation and families." True. No legislation in modern American history compares when in comes to injecting itself into the everyday decisions of the citizen.
And few can compete with its deception. The bill's intentions are cloaked in euphemisms and it is teeming with ulterior motives, all cobbled together in closed-door meetings where industry payoffs are offered using taxpayer dollars to facilitate a power grab of unprecedented cost.
All of it, rolled right into a neat 1,900 pages.
Reach columnist David Harsanyi at


Baucus Bill Does Not Bend the Cost Curve
Posted November 4th, 2009 at 1.27pm in Health Care.
Lewin Group study commissioned by the Peter G. Peterson Foundation, finds that although the Baucus health care bill (the legislation that recently passed the Senate Finance Committee) is often touted as the most fiscally responsible of all of Congress’s reform plans, it “relies on certain cost containment approaches that have not worked in the past” and therefore “does not bend the total health care cost curve downward.”
Rather than fundamentally realigning incentives in the health sector to lower the overall cost of care, the Baucus bill imposes top down cuts in payments to medical providers which will only serve to shift costs around the current system. Here are some of the other key findings from the Lewin study on the America’s Healthy Future Act of 2009 (S.1796):
Adds to the Deficit. The bill would add to the federal deficit in the first ten years and beyond if it included a permanent “doc fix” to prevent cuts in Medicare payments to physicians under the Sustainable Growth Rate instead of only a one year temporary fix. Every year, Congress defers these reductions in pay to doctors but the bill creates false savings by pretending that Congress would suddenly let these cuts occur. More than $404 billion in savings over the first ten years are attributable to these savings– and reductions in uncompensated care funds for hospitals that treat the uninsured (DSH payments)– that are unlikely to fully materialize.
Increases Total Health Spending. Under the bill, total spending in health care would rise from 17 percent of GDP in 2010 to 25 percent in 2029. Spending by the federal government would rise by $400 billion over the next ten years and $1.6 trillion over the next twenty years.
Covers less than half the uninsured. Although the Baucus bill includes a an individual mandate, a personal requirement, to purchase insurance it would fall far short of universal coverage, only reducing the number of people who lack health insurance by 49 percent.
Adds Costs and Delivers Little Savings to Consumers. In the first ten years, the bill would increase consumer spending in the aggregate by 3 percent, or $254 million. After twenty years, consumer spending would increase by 6.4 percent, or roughly $1 trillion. Despite President Obama’s promise that the typical family would see $2,500 in savings under health reform, the Baucus bill would provide the vast majority of Americans who already have insurance an average of $8 in savings.
Increases Employer Spending. After 2016, employer spending on health care would increase steadily compared to current law due to the various fees and excise taxes included in the bill. As a result of rising costs and expansions in public coverage, 16 million people could lose their current employer-sponsored insurance as workers are dumped onto Medicaid or into an exchange to receive a public subsidy at the expense of federal taxpayers.
here to read the full Lewin report.
Co-authored by Kathryn Nix.
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Prescriptions for disaster
The true costs of the health-care bills
Last Updated: 2:49 AM, November 5, 2009
Posted: 12:41 AM, November 5, 2009

Don't buy the claim that the Sen ate health-care bill is substantially more moderate than the House measure. While Speaker Nancy Pelosi's legislation is even more onerous than the package created by Sen. Max Baucus and now championed by Senate Majority Leader Harry Reid, the larger story is how similar the two Democratic bills are.
First, we need to get past the misleading accounting games. Each bill is routinely "scored" for its 10-year costs from 2010-19. Yet this includes several years when the spending wouldn't yet have kicked in. According to the Congressional Budget Office, fully 99.9 percent of the Pelosi bill's costs would hit from 2013 onward. Similarly, 98.3 percent of Reid's spending would come after 2014.
If you start the tally when the bills' spending would actually start (in 2013 for the House bill and 2014 for the Senate bill), then the bills' real 10-year costs become clear -- and are remarkably similar.
The CBO reports that, in their true first 10 years, the House bill would cost $1.8 trillion, and the Senate bill would cost $1.7 trillion. Pelosi would raise Americans' taxes by $1.1 trillion over that period, while Reid would hike them by $1 trillion.
And the House bill would siphon about $800 billion from Medicare to spend it elsewhere, while the Senate bill would suck out about $900 billion.
So the financial bottom lines are almost the same.
And if we discount the bills' claims to divert hundreds of billions of dollars from Medicare (which is already on the edge of insolvency), the CBO says the House bill would raise our national debt by about $650 billion in its real first decade, while the Senate bill would up it by $740 billion.
So, the bills would either sock older Americans by taking huge sums of money from Medicare -- or hit future generations with huge tax hikes to cover the shortfall.
Whether it's our grandparents or our grandchildren, someone is going to pay.
To give an idea of how much $1.7 (or $1.8) trillion is, let's compare it to private insurance companies' profits. The 10 largest insurance companies in America (according to the Fortune 500) last year had combined profits of $8 billion. You could double that, and it still would be less than 1 per cent of $1.7 trillion.
The House and Senate bills are similar in another important way. Each seems to mandate that insurers cover all comers at any time, at only nominal added cost for waiting to sign up.
This would provide a perverse incentive for young, healthy people to avoid carrying insurance -- knowing that they could just wait until they're sick or injured and buy it then. Without question, that would cause premiums to skyrocket for most Americans who now have insurance.
Recent studies by PriceWaterhouseCoopers, Oliver Wyman and Wellpoint all support this conclusion. Top Democrats in Congress dispute those findings -- so they should agree to let the CBO do an independent study of the question, before any floor vote on the legislation.
Yes, the House and Senate bills differ in many ways, with the Senate approach being generally a bit less regulation- and bureaucracy-heavy. But it's really just a question of degree -- and either one is more than capable of sinking our already badly leaking federal budget.
Benjamin E. Sasse, a former US assistant secretary of health, advises private-equity cli ents and teaches at the University of Texas. Jeffrey H. Anderson, director of the Benjamin Rush Society, is a senior fellow at the Pacific Research Institute.
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The Republican's House Bill

CBO: Republican health plan would reduce premiums, cut deficit
By: Susan FerrechioChief Congressional Correspondent11/05/09 6:30 AM EST
The Congressional Budget Office Wednesday night released its cost analysis of the Republican health care plan and found that it would reduce health care premiums and cut the deficit by $68 billion over ten years.The Republican plan does not call for a government insurance plan but rather attempts to reform the system by creating high-risk insurance pools, allowing people to purchase health insurance policies across state lines and instituting medical malpractice reforms."Not only does the GOP plan lower health care costs, but it also increases access to quality care, including for those with pre-existing conditions, at a price our country can afford," House Minority Leader John Boehner, R-Ohio, said.According to CBO, the GOP bill would indeed lower costs, particularly for small businesses that have trouble finding affordable health care policies for their employees. The report found rates would drop by seven to 10 percent for this group, and by five to eight percent for the individual market, where it can also be difficult to find affordable policies.The GOP plan would have the smallest economic impact on the large group market that serves people working for large businesses that have access to the cheapest coverage. Those premiums would decline by zero to 3 percent, the CBO said. The analysis shows the Republican plan would do little to expand coverage, which Democrats were quick to point out in a late night missive to reporters."Here's the Bottom line - Americans lose and Insurance companies win under the Republican plan," Pelosi spokesman Nadeam Elshami said.The CBO found that under the Republican plan, insurance coverage would increase by about 3 million and that the percentage of insured non-elderly adults would remain at about 83 percent after ten years. The House bill would increase coverage to an additional 36 million people, raising the number of insured to 96 percent. The CBO put the price tag for the GOP plan at $61 billion, a fraction of the $1.05 trillion cost estimate it gave to the House bill that lawmakers are set to vote on this weekend. And the CBO found that the Republican provision to reform medical malpractice liability would result in $41 billion in savings and increase revenues by $13 billion by reducing the cost of private health insurance plans.

Republicans Release Their Own Health Care System Reform Bill
By Eric Pianin, KHN Staff WriterNov 04, 2009
House Republicans unveiled their 219-page health care overhaul legislation Tuesday night. The GOP asserts it would lower health care premiums for families and small businesses and that it would be a far less costly and intrusive approach to helping the uninsured than the Democratic proposals in the House and Senate. It is not expected to garner enough support to pass.
The bill's general approach expands state-based high-risk insurance pools for Americans with pre-existing health problems, permits trade associations to organize to purchase group insurance, imposes caps on medical liability lawsuits and allows health insurance companies to sell policies across state lines. Most of these ideas -- particularly efforts to reform medical malpractice laws -- were left out of the Democratic approaches.
The GOP plan would also explicitly prohibit all federal funds from being used to pay for abortions. Rep. Bart T. Stupak (D-Mich.) is leading an effort by anti-abortion forces to include such a prohibition in the
House Democrats' legislation.
A one page
summary of the bill released by House Republican in the late afternoon highlighted these other provisions: allowing dependents to remain on their parents' policies through age 25; enhancing Health Savings Accounts, and promoting healthier lifestyles by giving employers greater flexibility to financially reward employees who adopt healthier lifestyles; and encouraging innovative state programs that reduce premiums and the number of uninsured.
The party released the bill on the GOP Web site, saying: "The full text of the 219-page, common-sense Republican alternative to Speaker Pelosi’s 1,990-page government takeover of health care is now available." Over the weekend, House Minority Leader John Boehner
called the Democratic bill "unaffordable."
The Republican plan, which will be offered as an amendment to the Democratic bill when it is brought to the floor, also would authorize subsidies to states that reduce the annual per person premium for health insurance coverage or develop new programs that cover more of their residents over a 10-year period. The bill leaves out a number of important provisions of the Democrats' 1,990-page bill, including new mandates for many employers to provide insurance for their employees or pay a penalty and for nearly all Americans to purchase insurance.
Below is the Republican legislation:
Related Document
GOP alternative to "Affordable Health Care for America Act" (.pdf)


The Government Takeover of Health Care in Pictures
Posted November 4th, 2009 at 11.56am in Health Care.
Conservatives may have defeated Hillarycare fifteen years ago, but in the intervening years the left succeeded in passing a slew of
incremental reforms that have led to a slow but steady march toward a government takeover of health care in this country.
These Hillarycare-lite measures include adding more middle-class kids to the children’s health care program (known as SCHIP), along with expanding Medicaid eligibility. As of 2007, the federal government controlled 46% of every health care dollar spent compared to 44% in 1993.
But should Obamacare become law (specifically
the House bill) the government takeover of health care would be greatly accelerated. According to the Centers for Medicare and Medicaid Services in the Obama HHS department, the government could control more than 50% of all health care spending –even before most of the major spending provisions in the House bill are implemented.
Government takeover of the health care sector? You decide.
Conn Carroll
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Twenty Surgical Groups Say Senate Health Legislation Will Threaten Patient Access and Harm Quality
Wed Nov 4, 2009 1:00pm EST
WASHINGTON, Nov. 4 /PRNewswire/ -- Twenty surgical organizations, led by the
American College of Surgeons, sent a letter to the U.S. Senate today stating
they are prepared to oppose the Senate's health care reform bill because it
will threaten patient access and harm quality. Surgeons state that as the
legislation currently stands, it fails to address some of the fundamental
problems that plague the health care system.
"We strongly support health care reform that will expand access to quality
surgical and medical care to as many Americans as possible, but we cannot
support legislation that puts at risk both quality of care and patient
access," said A. Brent Eastman, MD, FACS, chair of the American College of
Surgeons' (ACS) Board of Regents and chief medical officer, Scripps Health.
"Our system is badly in need of reform but if the legislation does not address
these concerns, it will do little to fix its underlying problems and may make
it worse."
The surgical groups said they plan to oppose the Senate health care reform
bill if a number of provisions that were included in the Senate Finance bill
are retained. In addition to failing to permanently fix Medicare's broken
physician payment system and to include any meaningful proven medical
liability reforms, the surgical community opposes a number of the bill's
provisions including:
-- The legislation establishes a Medicare Commission that would shift the
responsibility for making difficult Medicare payment and coverage
decisions to an unelected Executive branch agency without appropriate
checks and balances.
-- The legislation includes mandatory participation in the seriously
Physician Quality Reporting Initiative (PQRI) - a program through
CMS is still attempting to address systemic problems dating back to
-- The legislation attempts to improve patient access to certain
services through reimbursement changes, but funds these changes
payment cuts to all other physicians - thereby exacerbating workforce
shortages, including general surgeons.
"The result of these serious deficiencies will make it more difficult for the
American people to receive the surgical care they will need in the future. We
will work with the Senate to improve the legislation, but if these
shortcomings remain in the final Senate bill, we will have no choice but to
urge Senators to vote no," Dr. Eastman added.
The American College of Surgeons met with policymakers over the past year to
educate them about programs that would improve quality, reduce costs and
increase patient access. One such program, the ACS National Surgical Quality
Improvement Program (ACS NSQIP), is helping to prevent thousands of surgical
complications each year. Each hospital in the program, on average, is seeing
250 to 500 fewer complications and thus an annual reduction of $3 million in
costs. Nine of the top 10 private hospitals in the nation, along with more
than 240 additional hospitals, use ACS NSQIP. The ACS believes that these
types of quality programs, if supported by Congress, could save the health
care system a minimum of tens of billions of dollars over the next decade.
"There are ways to improve quality, cut costs and increase patient access -
but the Senate isn't hearing those of us who are closest to the patient and
work in the system every day," Dr. Eastman said.
The surgical groups that signed the letter include:
American College of Surgeons
American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Ophthalmology
American Academy of Otolaryngology-Head and Neck Surgery
American Association of Neurological Surgeons
American Association of Orthopaedic Surgeons
American College of Obstetricians and Gynecologists
American College of Osteopathic Surgeons
American Osteopathic Academy of Orthopedics
American Society of Anesthesiologists
American Society of Breast Surgeons
American Society of Cataract and Refractive Surgery
American Society of Colon and Rectal Surgeons
American Society for Metabolic & Bariatric Surgery
American Society of Plastic Surgeons
American Urological Association
Congress of Neurological Surgeons
Society for Vascular Surgery
Society of American Gastrointestinal and Endoscopic Surgeons
Society of Gynecologic Oncologists
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization
of surgeons that was founded in 1913 to raise the standards of surgical
practice and to improve the care of the surgical patient. The College is
dedicated to the ethical and competent practice of surgery. Its achievements
have significantly influenced the course of scientific surgery in America and
have established it as an important advocate for all surgical patients. The
College has more than 74,000 members and is the largest organization of
surgeons in the world. For more information, visit
American College of Surgeons
Barbara Hemberger, +1-952-346-6232, or Sally Garneski, +1-312-202-5409, both
of American College of Surgeons

Email newsletter from the American College of Surgeons (ACS)

Today, the American College of Surgeons took two significant positions regarding comprehensive health care reform that we believe are consistent with our principles and will put us in the best position for the final weeks of negotiations on legislation currently being debated in the U.S. House of Representatives and Senate.

After nearly a year of providing numerous detailed comments highlighting our concerns over various Senate legislative proposals and with little acknowledgement, to date, that the Senate will address the concerns, the College, joined by 19 other surgical organizations, sent a letter to the Senate leadership stating that if a number of issues were not adequately addressed in the Senate version of health reform legislation, the College would oppose its passage.

In addition, after thorough analysis and thoughtful deliberation and consideration by the College's Health Policy and Advocacy Group, Board of Regents and the Executive Committee of the Board of Governors, the College sent a letter supporting the House health care reform bills: the Medicare Physician Payment Reform Act (H.R. 3961) and the America's Affordable Health Choices Act (H.R.3962). H.R. 3961 is legislation that would permanently reform the Medicare physician payment system by repealing the 21 percent payment cut scheduled for January 2010, rebasing the current system to bring the base back to zero, and replacing the SGR with a more stable payment system that will provide predictable payment updates from Medicare.

H.R. 3962 is the larger health care reform bill that would expand coverage, promote and incentivize high quality care and help ensure patient access to surgical care. The ACS also noted our desire to work with Congress on surgical workforce issues and medical liability reform. When the House and Senate bills are compared, the legislative differences and their impacts on surgeons and the surgical patient are striking: Independent Medicare Commission Senate - Establishes an independent Medicare commission whose primary task is to reduce overall Medicare spending (using only Part B dollars - hospitals are carved out) without appropriate checks and balances. House - No independent Medicare commission.Budget Neutral Bonuses for Certain Physicians Senate - Bonus payments to primary care physicians and rural general surgeons funded through reductions in payment to all other physicians (budget neutrality). House - No budget neutrality.Physician Quality Reporting Initiative Senate - Mandatory participation in a seriously flawed PQRI program with penalties for non-participation. House - PQRI remains voluntary and non-punitive.Penalties for Resource Utilization Senate - Reduces payments to physicians who are found to have the highest utilization of resources without regard for patient acuity or complexity of the care being provided. House - No penalties for physicians with the highest resource utilization.Application Fee Senate - Requires physicians to pay an application fee to cover a background check for participation in Medicare despite already being obligated to meet considerable requirements of training, licensure, and board certification. House - No application fee.The College's decisions were made on the substance of the provisions as well as from a strategic standpoint. The current Senate language is not favorable for surgeons and our patients and ultimately, the legislative process will require the House and Senate bills to be reconciled before Congress votes for final passage. By securing champions in the House, we can help ensure that the College's priorities remain intact during this process.The ACS leadership and staff remain very engaged in the health care reform efforts in Washington and continue to work with both the House and Senate to address concerns and ensure that any final package contains the College's priorities and promotes Americans' access to quality surgical care. Finally, this morning in concurrence with the delivery of the House and Senate letters, Dr. Eastman participated in a teleconference with several members of the media. Please find his opening remarks attached. In addition, you can find copies of the two letters to Congress as well as the College's press statement by going to, Brent Eastman, M.D., FACS, Chair of the ACS Board of Regents LaMar McGinnis, M.D., FACS, President of the American College of Surgeons Andrew Warshaw, M.D., FACS, Chair of the ACS Health Policy and Advocacy Group Christian Shalgian, ACS Director, Division of Advocacy and Health Policy


((This periodic newsletter is provided by former AMA President Donald J. Palmisano, whom I respect and admire greatly. He is also the spokesperson for the Coalition to Protect Patients' Rights

DJP Update 11-5-2009
AMA and another rush to judgment - Failure to wait for debate at AMA House of Delegates this weekend!I find this SHOCKING! Why could not the AMA leadership wait for the debate in Houston this weekend which will have resolutions stating that AMA follow long-standing specific policy and that policy would preclude "support" of H.R. 3962, the 1990 page bill from Speaker Pelosi and the U.S. House of Representatives. This bill has disaster in the details. The AMA House of Delegates is the policy-making body of AMA!I would like to see the AMA membership numbers after this announcement!Truly a sad day. See you at the meeting in Houston!AMA supports House bills to make health reform a reality

H.R. 3962 and H.R. 3961 would go a long way toward making the health system better for patients and physiciansFor immediate releaseNov. 5, 2009HOUSTON – The American Medical Association (AMA) today announced support for concurrent passage of H.R. 3962 and H.R. 3961, U.S. House of Representatives health system reform bills.“The time to make health system reform a reality is now,” said J. James Rohack, AMA president. "These two bills were introduced together, and they need to be passed together. Both are essential to achieving meaningful health system reform this year."

((So what happens when the House passes HR 3962 WITHOUT the SGR fix in order to pretend to keep the costs down...?))“On balance, H.R. 3962, The Affordable Health Care for America Act, is consistent with our principles of pluralism, freedom of choice, freedom of physician practice and universal access. It will significantly expand health insurance coverage to Americans to empower patient and physician decision making; institute meaningful insurance market reforms; make substantial investments in quality; institute prevention and wellness initiatives; provide incentives to states that adopt certificate of merit and/or early offer liability reforms, and reduce administrative burdens.”“H.R. 3962 is not the perfect bill, and we will continue to advocate for changes, but it goes a long way toward expanding access to high- quality affordable health coverage for all Americans, and it would make the system better for patients and physicians,” Dr. Rohack said. "This is not the last step but the next step toward health system reform. We will remain actively engaged with patients, physicians, Congress and the administration to ensure that the final bill results in marked improvements to our health system."
AMA also called on Congress to pass the Medicare Physician Payment Reform Act of 2009 (H.R. 3961) to permanently repeal the broken physician payment formula and preserve access to care for seniors, baby boomers and military families."Ensuring the security and stability of Medicare must serve as the foundation for any serious health system reform this year," Dr. Rohack said. “In less than 60 days, Medicare physician payments are scheduled to be cut by 21 percent, with more cuts in years to come. According to a recent AARP poll, 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 patches have temporarily averted widespread access problems, they have also grown the size of the problem – and the cost of reform,” Dr. Rohack said. “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.”
“As Congress considers new coverage commitments to the American people through health reform, it must ensure that commitments already made are fulfilled,” Dr. Rohack said. “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. A permanent solution to the flawed Medicare physician payment formula is an essential element of comprehensive reform and is needed to fulfill Congress’ existing obligations to current and future Medicare and TRICARE patients.”“Compromise is a necessity in the legislative process, but we, as physicians, will never compromise our principles or the public trust. That is why we are supporting H.R. 3962 and H.R. 3961 – two bills that passed together will go a long way toward making health system reform a reality in 2009,” Dr. Rohack said.# # #--------Stay well.Donald J. Palmisano, MD, JDIntrepid Resources® / The Medical Risk Manager Company5000 West Esplanade Ave., #432Metairie, Louisiana USA 70006504-455-5895 office
DJP@intrepidresources.comwww.intrepidresources.comwww.onleadership.usThis DJP Update goes to 2051 leaders in Medicine representing all ofthe State Medical Associations and over 100 Specialty Societies plussome other friends.You can share it with your members and it has the potential to reach800,000 physicians.To join the list, send me an email stating "Join DJP Update"To get off the list, state "Remove DJP Update". Best to put in Subject line so I can do immediately.=


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