Thursday, December 17, 2009

12/16/09 - Health Care Reform - It's in, it's out, it's on, it's off, it's....confusing....

12/16/09 - Liability and Health News Update
Health Care Reform - It's in, it's out, it's on, it's off, it's.....confusing

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

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This LIABILITY AND HEALTH NEWS UPDATE "newsletter" is a free service which I provide, as a volunteer, to help supply medical liability reform, 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 (and make no apologies for those I choose). I am an advocate for quality health care, physicians and patients, a breast cancer survivor, a physician's spouse, a journalist, a political noisemaker, a mom, and a freelance writer. I am not nor will I ever claim to be unbiased (I am....biased, I mean), unlike many in the mainstream media claim (falsely) on a daily basis.

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The public option is vital and health care reform will NOT pass without it.

Now it's gone.

Medicare will be expanded to people as young as 55.

No it won't.

Drug reimportation will be allowed.

No it won't.

Are we sensing a trend here?

Nothing is carved in stone. Oh, wait, that's wrong. Everything is negotiable.

EXCEPT THIS: SOMETHING will be passed.

ANYTHING, really.

Doesn't matter if it covers more people, costs too much money, or reduces the quality of health care in America (it will). But SOMETHING has to pass.

Because the American people don't want it, and they get to go back to the ballot box next year.

If they don't get it done NOW, no matter what the American people think, they won't get it done at all ('it" being a fundamental restructuring of the American health care delivery system to shift significantly more power into the hands of the federal government.)

But we need to remind our leaders that we ALSO get to go back to the ballot box next year if they DO pass something we don't want just to say they've "fixed" health care.

Yeah, we know, our leaders are still squinting their eyes closed and plugging up their ears with their fingers and going "La, la, la, la, la, I can't HEAR you!"

So YOUR job is to get right in their faces (politely, please), uncover their eyes, and pull their fingers out of their ears.

Noise, folks, LOTS of noise. Phone calls, emails, faxes, post cards, letters. Over and over again. There's a list of Senators at the bottom of this Update with contact information. You don't have to say a LOT to them - just tell them you want them to VOTE NO on the Senate health care bill and more government intrusion into health care.. Elaborate if you're given an opportunity, but JUST SAY NO is a good rule of thumb to follow.

Lots of articles and links follow. Since things change hourly, it's hard to keep on top of it.

I've included almost whole daily newsletters from Kaiser Health and Conservatives for Patients' Rights Daily Dose and the Heritage Foundation's Morning Bell newsletters. The synopses are fairly easy to scan for important information. If you're a health care news junkie like I am, you might want to go to the sites and sign up for your own free newsletters. These are just some of the resources I use every day when creating Liability and Health News update, and while I generally pick a couple of stories and offer them to you in their entirety, there are just too many right now for me to decide what you should have access to, so I'm giving you a LOT more than usual. Do with it as you wish....

So the House has voted to postpone the 21% Medicare reimbursement cut UNTIL February 28. The Senate will take up the appropriations bill into which it was shoved this week.

No, this isn't enough to make doctors "happy" with what they're trying to do.

Not even CLOSE. And doctors in specialty societies and state medical societies are making their OWN noise about health care reform - MANY in opposition to the AMA's position on the current bills. Way to GO, Dr. Palmisano! One of his updates follows as well, with some insight into the Congressional Record.

Noise, please...LOTS AND LOTS OF NOISE....



Modern - Breaking News

The House voted 395-34 to approve a fiscal 2010 defense appropriations bill that includes a measure to stave off Medicare physician payment cuts until March 2010.

House OKs measure delaying Medicare doc-pay cuts
Posted: December 16, 2009 - 2:00 pm ET

The House voted 395-34 to approve a fiscal 2010 defense appropriations bill that includes a measure to stave off Medicare physician payment cuts until March 2010.

Various proposals in the House and Senate seek to attain a more permanent fix to Medicare's sustainable growth-rate, or SGR, formula, which is based on the economy's health, and has threatened payment cuts to physicians every year since 2003. Physicians, however, aren't banking on any of those proposals getting approved before Jan. 1, the date when their Medicare payments are expected to get cut by 21.2% under the SGR formula. In a letter to Senate Majority Leader Harry Reid (D-Nev.), major medical groups stressed the urgency for fixing the SGR formula, but said they would support a “very short postponement of the imminent cuts for a period of 30-45 days, so that Congress has enough time to pass Medicare physician payment reform legislation that will be signed into law.”

Their wish was granted in the $636 billion defense appropriations bill, which contains a provision to delay the 21% cut through Feb. 28.The Senate is scheduled to vote on the defense appropriations bill by Friday. The House last month approved a stand-alone bill to address a fix to Medicare's physician payment problem, and the comprehensive healthcare reform bill in the Senate additionally contains a one-year solution. A year-long fix, however, “would push the issue into the election period and it would be even more difficult to reason a consensus on what to do. So we all thought it better to accept a short-term extension in order to help make sure Congress addresses the fix while it is still thinking about healthcare,” said Kevin Burke, director of the division of government relations with the American Academy of Family Physicians.


Posted on Wed, Dec. 16, 2009
Obama presses health care bill
Saying historic approval was in reach, he urged senators to put aside lingering differences.
By David Espo
Associated Press

WASHINGTON - Prodded by President Obama, Senate Democrats won tentative backing from one holdout and worked intensely to satisfy another yesterday as they grappled with the last, lingering disputes blocking passage of health-care legislation by Christmas.

Despite the push, Sen. Ben Nelson of Nebraska remained publicly uncommitted, even after a private meeting with Obama.

At the White House, Obama said his congressional allies were "on the precipice" of a historic accomplishment that has eluded presidents and lawmakers for generations, adding that the emerging bill included "all the criteria that I laid out" in a speech to a joint session of Congress earlier in the year.

"It is deficit-neutral," he said. "It bends the cost curve. It covers 30 million Americans who don't have health insurance, and it has extraordinary insurance reforms in there to make sure that we're preventing abuse." ((Where's Rep. Wilson when you need him? Ooops, did I say that out loud?))
In the privacy of a presidential meeting, liberal supporters of the bill vented their frustration at having to abandon the last vestige of a government-run insurance option in the legislation, a slow-motion concession made over many months, most recently to moderates including Sen. Joe Lieberman (I., Conn.).

Two days after jolting the leadership by threatening to oppose the measure if it included an expansion of Medicare, Lieberman said that with the agreed-upon changes, "I'm going to be in a position where I can say what I've wanted to say all along, that I'm ready to vote for health-care reform."

That left Nelson, the only known holdout among the 60 senators who are members of the party's caucus, a group that includes 58 Democrats, Lieberman, and Sen. Bernie Sanders (I., Vt.).
Nelson already has won key concessions from Majority Leader Harry Reid, including an agreement to leave in place the insurance industry's exemption from antitrust laws. He also is seeking changes to increase restrictions on abortion coverage in a new insurance marketplace the bill would establish.

"I have spoken with the president, and he knows they are not wrapped up today," Nelson said of the changes he wants. Later, the normally talkative Nebraskan avoided reporters after casting a series of votes on the Senate floor.

The White House meeting unfolded as Democrats awaited a final cost analysis from the Congressional Budget Office on the latest version of the bill, and the full Senate rejected an amendment to permit the importation of prescription drugs from Canada and elsewhere. The vote was 51-48, short of the 60 required. Among Philadelphia-area senators, Arlen Specter (D., Pa.) voted for the amendment; the five other senators voted against it.

In the complicated politics of the moment, that counted as a victory for the bill, since the drug industry opposes importation but is working with the White House to pass the overhaul effort.
Sen. Byron L. Dorgan (D., N.D.), who had pushed the change, said it was a loss for consumers. "This is not over," he said, "and it's never going to be over as long as Americans pay the highest prices in the world" for drugs.

At its core, the health-care legislation is designed to spread coverage to 30 million Americans who now lack it, impose new consumer-friendly regulations on the insurance industry, and slow the rate of growth in health-care spending nationally. Most Americans would be required to purchase insurance, and the government would establish a new series of "exchanges" through which consumers could shop for policies.

The measure includes hundreds of billions of dollars in subsidies to defray the cost of insurance for families with incomes up to about $88,200 a year for a family of four. Additional assistance would go to small businesses to help them afford coverage for workers.

The White House meeting followed an intense two days in which Democrats struggled - apparently successfully - to keep the legislation moving forward despite a flare-up over a proposal to expand Medicare to uninsured people as young as 55. Lieberman announced Sunday he opposed the proposal. He threatened to join Republicans in voting against the overall measure if it stayed in the bill, and while no formal announcement has been made, officials said he had prevailed.

With Obama urging lawmakers to look beyond disappointments they may have about parts of the legislation, several Democrats said that in the private session, liberals lamented the absence of a government-run insurance option they had long sought. "There was frustration and angst," said Sen. Jay Rockefeller (D., W.Va.).

Obama, in his remarks, took issue with assertions by critics about the bill's impact on the federal budget, citing earlier CBO estimates that predicted it would reduce the deficit. "So all the scare tactics out there, all the ads that are out there are simply inaccurate," he said.

"There are still disagreements that have to be ironed out," Obama said. "There is still work to be done in the next few days."

But in a clear signal of his commitment to the bill, he said: "I told my former colleagues today . . . that we simply cannot allow differences over individual elements of this plan to prevent us from meeting our responsibility to solve a long-standing and urgent problem for the American people."

The House approved its version of the bill - with public option - earlier this fall, and final negotiations between the two houses would follow a vote in the Senate


Kaiser Health News Morning Edition
Wednesday, December 16, 2009

For Congress, When It Comes To Medicare: Letting Go Is Hard To Do
[Dec 16, 2009]
Kaiser Health News staff writer Mary Agnes Carey explores some key issues related to Medicare and cost. "In an effort to rein in health costs, Senate Democrats are proposing steps that would give federal agencies more power to overhaul how Medicare pays for medical care -- and thus reduce Congress' own role in running the giant program for the elderly" (Carey, 12/16). Read entire story.

Senate Democrats Trying To Push Health Reform Bill Ahead
[Dec 16, 2009]
The Associated Press: "History may be calling but time's running out to act by Christmas, so Senate Democrats are coming to terms with the idea they won't get everything they want from health care overhaul. ... The public plan liberals hoped for appeared dead in the Senate, as did a Medicare buy-in scheme offered as a fallback." And, though Majority Leader Harry Reid is still trying to secure the 60 votes he needs to overcome a GOP filibuster, some Democratic fence sitters are saying it is time to pass a bill. Connecticut Independent Joe Lieberman appeared to be coming around fast. But others, like Nebraska moderate Ben Nelson, remains uncommitted (Alonso-Zaldivar, 12/16).
The Wall Street Journal: President Barack Obama nudged Senate Democrats Tuesday, a day after they "signaled they would abandon plans to open Medicare to people as young as 55. The Medicare expansion had been proposed as an alternative to a government-run insurance plan, which was dropped from the bill last week. But the idea, popular among liberals, was received coolly by some Democrats and provoked opposition from Sen. Joseph Lieberman, the Connecticut independent." And now, even with these adjustments, hurdles remain -- most notable, abortion related provisions and cost estimates from the Congressional Budget Office. "If final divisions can be ironed out, Sen. Reid is expected Friday to take the required steps to close off debate on the legislation. That would likely set the stage for a vote on the bill on Dec. 23, or possibly Christmas Eve" (Hitt and Adamy, 12/16).
The Washington Post: "Yet even as Reid appeared to be closing in on his target, Senate leaders were weighing whether to take a break from the debate to act on a $626 billion measure to fund military operations. Under a schedule sketched out by senior aides, Reid could announce the final health-care compromise as soon as Wednesday, switch to the defense spending bill, then return to a crucial procedural vote on health care this weekend. The target for final passage is Dec. 23, aides said" (Montgomery and Murray, 12/16).
CongressDaily reports that even Sen. Bernie Sanders, I-Vt., "was critical of the bill Tuesday and would not say whether he will vote for it without a public option." Sanders caucuses with the Democrats and Senate leadership is counting on his vote to pass the bill. "Sen. Jim Webb, D-Va., said he is waiting to see CBO scoring before making a final decision. Sen. Roland Burris, D-Ill., said he needs to see the bill before deciding. Burris reiterated Monday he could not support a bill without a public option" (Edney, 12/16).
NPR: "One lingering problem is how to make liberals happy now that it appears that both a government-sponsored insurance plan and a proposal to let those not quite old enough for Medicare buy into the program will be dropped from the bill." It will take six days to get all the procedural votes on the bill, NPR reports, so leaders will likely have to "tie things up by Thursday if they want to finish before Christmas" (Rovner, 12/16).
The Boston Globe: "Leaders believe that once a compromise bill is written by a House-Senate conference committee, lawmakers will be more reluctant to vote against it because of the historic nature of the bill" (Wangsness and Milligan, 12/16).

Obama 'Cautiously Optimistic' On Reform After Meeting With Senate Democrats
[Dec 16, 2009]
President Obama told Senate Democrats Tuesday in an hour-long meeting that they are on the "precipice" of health reform and said that he was "cautiously optimistic" that health reform would get done, the
Los Angeles Times reports. "President Obama, acknowledging that he will have to accept serious compromises in the passage of a healthcare overhaul, insisted today that he would not let the public down on an issue that he had made the centerpiece of his first-year domestic agenda." Obama also asked Democrats to not let infighting stop them from passing the health reform legislation. "The American public is 'waiting for us to act,' Obama said, 'and I don't intend to let them down'" (Levey and Hook, 12/15).
NPR: "The point is that health care is really coming down to the line. The Christmas deadline is looming. This is a crucial moment. The president is really putting his capital on the line. He feels that he's close to a historic victory, and the message for the Senators today was to focus on the big picture. ... I think his tone also tells you a little bit about the stakes. He sounded pretty peeved at times. He talked about the misinformation that was out there and the scare tactics. I think he's really trying to provide some cover for his Democrats who are nervous about this bill, which is unpopular in some polls, despite the fact that he keeps on saying he's optimistic we're going to get this (Liasson, 12/15).
USA Today: "In his brief remarks, Obama said there is general agreement on provisions to extend coverage to most Americans and reduced medical costs" (Jackson, 12/15).
The Associated Press reported that Obama said the bill, "no matter what its final form, will be the greatest legislative achievement on health care since the passage of Medicare four decades ago." ((It WILL? No matter WHAT it's final form? No matter what they pass - or don't pass, it will be the greatest legislative achievement in health care? WHATEVER they do will be the "greatest?" Can you believe the ARROGANCE?)) There was "frustration and angst" expressed in the meeting, according to Sen. Jay Rockefeller, D-W.Va., but Obama asked lawmakers to get beyond their personal disappointments with the bill to pass reform (Espo, 12/15).
Politico reports that Lieberman acknowledged tension at the meeting but said he "had to do what I thought was right." Lieberman told "Obama and the Senate Democratic caucus Tuesday that he 'understood how people were upset with the position I took.'" "At one point during the private White House meeting, Lieberman said: 'I haven't really had a lot of fun the last couple of weeks.' His comment prompted a retort from Sen. Sherrod Brown (D-Ohio), a staunch public option supporter: 'I haven't been having fun either,' Brown said, according to Lieberman. Obama, who was described as upbeat in what was an otherwise serious meeting, responded: 'Why don't we all begin to have some fun? Let's pass this bill'" (Budoff Brown, 12/15).
Dow Jones Newswires/The Wall Street Journal: "Reid faces the difficult task of winning the support of senators in the Democratic ranks and closing debate on the $848 billion measure by Christmas." Despite "liberals' disappointment over the Medicare expansion's likely omission from the Senate bill, as well as its omission of a government-run health insurance plan, they have not yet suggested that they would withhold their support for the bill. Sen. Debbie Stabenow (D., Mich.) said Tuesday she would be able to support the bill even if it didn't include the Medicare buy-in or a government-run plan (Yoest, 12/15).

Liberals Agitated By Compromise, But Appear To Back Health Reform
[Dec 16, 2009]
Politico reports that liberals are accruing a long list of reasons to be upset about the health reform negotiations: "A single-payer plan, a public option, a state 'opt-out' of the public option, a trigger and a Medicare buy-in -- all ideas pushed by Democrats and blessed by [President] Obama at various times but now gone from the bill." "Obama's need to pass a reform bill ahead of the 2010 elections drove the political calculus as the calendar turned to December, when the days grew short and the pressure to sign something, anything, began to take precedence," Politico writes. "Otherwise, Democrats risked facing voters next fall with little to show for a full year of twin congressional majorities." The thing that may have most angered liberals, however, "is that Obama himself never seemed willing to push hard enough for the public option -- and, in fact, all but took it off the table in August when he said he could sign a bill that didn't include it" (Gordon, 12/15).
Meanwhile, Senate liberals demurred to more moderate members of their caucus earlier this week, acknowledging that they would need to compromise in order to pass the legislation, The Hill reports. "Some liberals who said they would back the legislation hinted they would do so with disappointment, while liberal activists and House members expressed deep displeasure with the Senate's move to the center" (Young, 12/15).

Amendment To Allow Drug Importation Fails In Senate
[Dec 16, 2009]
A bipartisan plan to allow Americans to buy cheaper prescription drugs from suppliers in other countries, such as Canada, failed Tuesday in the Senate.
The Wall Street Journal reports the two top supporters of the plan, Sens. Byron Dorgan, D-N.D., and John McCain, R-Ariz., said shopping overseas via the Internet and mail-order companies could save consumers up to $80 billion over a decade if their amendment were added to the health overhaul legislation. Drug makers had opposed the bill. The Journal reports: "In June, the industry agreed to put up $80 billion over 10 years to support a health overhaul, including steps to improve drug coverage for seniors in Medicare, provided they wouldn't be asked for further contributions to the cost-cutting effort. The deal continued to hold up in the Senate Tuesday as the drug-importation measure opposed by the industry fell short." It failed by a vote of 51-48, nine votes less than the 60 needed to approve the amendment (Mundy, 12/16).
Bloomberg reports, "Proponents said the plan would have allowed pharmacies, wholesalers and consumers to buy medicines made by U.S. companies sold at lower cost in other nations. Drugmakers, who have to contend with foreign health systems that regulate prices, said they need the open market in the U.S. to thrive and warned of safety risks from counterfeiting." After the amendments failed, AARP executive Nancy LeaMond, a supporter of the plan, said, "Tonight, senators had a choice between meaningful savings for their constituents and higher profits for the drug industry" (Gaouette and Jensen, 12/15).

"Other senators backed a separate measure to allow imports that have been certified as safe by U.S. health officials. Also needing 60 votes, the proposal lost, 56-43," Reuters reports. "But allowing cheaper drugs could hurt revenues for the roughly $315 billion pharmaceutical industry, which boasts one of the strongest lobby groups in Washington and is a major backer of [President] Obama's broader drive for healthcare reform" (Heavey, 12/15).

The Senate's Democratic leadership backed the second, more limited amendment, Roll Call reports. Democrats and the White House lobbied to defeat Dorgan's proposal, which may have jeopardized the drug industry's support for reform. "With Republicans attempting to be spoilers by reversing their previous opposition to the proposal, 24 Senate Democrats who supported the bill last year voted to kill the amendment. Sixteen Republicans who had previously voted against the plan voted for it (Pierce and Drucker, 12/15).

"The defeat of the drug importation proposal ... was a crucial victory for Obama and the pharmaceutical industry," the
Los Angeles Times reports. "The politically charged amendment had held up the Senate for a week and threatened to derail the whole healthcare bill" (Hook and Levey, 12/16).

10. On And Off Capitol Hill, Politicians Are Taking Positions On Health Bill
[Dec 16, 2009]
Roll Call: "Sen. Susan Collins (R-Maine) on Tuesday said she does not believe that the Senate Democratic health care reform bill will garner her vote, despite significant changes that are likely to be made to rid the bill of a public insurance option and an expansion of Medicare. Democrats have regarded Collins, along with fellow moderate Maine Republican Sen. Olympia Snowe, as potentially persuadable on the bill. In comments that aired on MSNBC, Collins said her friend Sen. Joe Lieberman's (ID-Conn.) achievements in ridding the bill of liberal priorities are not sufficient to assuage her concerns" (Pierce, 12/15).
NPR interviews Sen. Sherrod Brown, D-Ohio, who "supported a public option and the proposal to let Americans between the ages of 55 and 64 buy into Medicare, two items no longer included in the health care bill." Brown said "there are lot of really good things in this bill. I'm just disappointed that it's not as good as it could be, but we're going to keep trying. ... I never said I would vote against it. I never said I will draw a line in the sand. I did say I'm done negotiating the public option. I was hopeful that Senator Lieberman and others, but it's not really about any individual senator, but I was hopeful that they all wanted to be on the right side of the history and they would vote to stop the filibuster" (Block, 12/15).
Politico interviews Mike Leavitt, former secretary of Health and Human Services during President George W. Bush's second term. In terms of passing a health reform bill, he said, "I put the scenarios into four buckets. One extreme would be something like the House bill passing. I'd put that at 5 percent. Another possibility would be nothing happening, and I'd put that at a relatively low number. The third bucket ... a light version of the Senate Finance Committee bill, where they take enough things out to get the votes they need. The fourth would be a Medicaid expansion. ... A lot of moderates most likely wouldn't object to that" (Mark, 12/16).
CBS News interviewed former Democratic leader Howard Dean, who said the "Senate health care bill in its current form should be scrapped." Dean told Vermont Public Radio: "This is essentially the collapse of health care reform in the United States Senate. ... Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill" (Condon, 12/15).

ABC News also reports on blog reports that Dean essentially said "the removal of the Medicare buy-in means the Senate health care bill is no longer worth supporting" (12/15).
The Hill: "Dozens of congressional Democrats have threatened this year to hold healthcare reform hostage until they get what they want. The myriad of threats has been a headache for senior White House officials and congressional leaders who have to determine the difference between what lawmakers want and what they absolutely need in order to get them to 'yes.' That is why the House effort to pass healthcare reform stalled for months, and why Senate Democratic leaders are struggling to find a bill, any bill, that will get 60 votes." The Hill includes the positions of several critics from liberal senators such as Sherrod Brown (D) of Ohio, Roland Burris (D) of Illinois and Bernie Sanders (I) of Vermont" as well as "conservatives like Ben Nelson (D) of Nebraska and Joe Lieberman (I)" (Rushing and Cusack, 12/16).
Politico reports: "House Democrats' long-simmering frustration with the slow pace of the Senate has begun to boil over, with a broad swath of Democratic representatives accusing their Senate colleagues of failing both their party and their country" (O'Connor and Raju, 12/16).

11. Poll: Public Cooling To Health Reform As Debate Drags On
[Dec 16, 2009]
"As the Senate struggles to meet a self-imposed, year-end deadline to complete work on legislation to overhaul the nation's health-care system, a new Washington Post-ABC News
poll finds the public generally fearful that a revamped system would bring higher costs while worsening the quality of their care," The Washington Post reports. "A bare majority of Americans still believe government action is needed to control runaway health-care costs and expand coverage to the roughly 46 million people without insurance." "More than half of those polled, 53 percent, see higher costs for themselves if the proposed changes go into effect than if the current system remains intact. ... 37 percent say the quality of their care would be better under a new system; 50 percent see it as better under the current set-up." The Post reports that the poll found the uninsured (nearly one in 5 adult Americans doesn't have coverage) "are evenly divided on the question of whether their care would be better if the system were overhauled" (Balz and Cohen, 12/16).
ABC News: The 7-point margin against reform "is its most to date -- indeed statistically significant for the first time -- and the differential in intensity of sentiment has grown since September." "Americans by 2-1, 45 percent to 22 percent, think reform would weaken rather than strengthen the popular Medicare system; seniors in particular think so, by 57 percent vs. 12 percent." But the poll found support for "the idea of extending Medicare to cover people 55 and older who don't have other insurance; 63 percent are in favor, a sizable majority albeit down from 75 percent in 2006. ... There's a much sharper split on a public option for people who are uninsured vs. a program, as proposed in the Senate, in which the federal government would negotiate with private insurers for this coverage. Thirty-six percent prefer the former; 30 percent, the latter; and an additional 30 percent say the current system simply should be left as it is." The poll was conducted by telephone Dec. 10-13, 2009, and it has a 3.5-point error margin for the full sample (ABC Polling Unit, 12/15).

Tea Party Protestors Rally Against Health Bills At Capitol
((Many thanks to all who participated in national and local demonstrations against the Senate Bill!))
[Dec 16, 2009]
The most vocal opponents of the health bills, Tea Party protestors, took to the Capitol yesterday.
Politico: "Clad in red and armed with Grinch dolls, grim reaper scarecrows, posters and their loud voices, several thousand tea party protesters rallied near the Capitol Tuesday to send a single message: 'Kill the Bill.' The crowd's message and energy was only intensified by the encouragement of some of the nation's best known conservatives, including Sens. Jim DeMint (R-S.C.), Tom Coburn (R-Okla.), Richard Burr (R-N.C.), Rep. Michele Bachmann (R-Minn.), former House Majority Leader Dick Armey (R-Texas) and radio personality Laura Ingraham" (Shiner, 12/15).
NPR: "'We fought the British over a 3 percent tea tax. We might as well bring the British back,' says William Temple of Brunswick, Ga., an American re-enactor dressed head to toe in a costume from the Revolution. ... 'People are fed up. They've had enough of big government.' ... So as the lawmakers inside the Capitol make a last push at negotiating a bill, protesters outside are also making a last push: trying to shove the entire health care bill off a cliff" (Seabrook, 12/15).

A Selection Of Today's Opinions And Editorials
[Dec 16, 2009]
President Obama Writes A New Health Reform Prescription The Washington Post On the campaign trail, Barack Obama vowed to take on the drug industry by allowing Americans to import cheaper prescription medicine. "We'll tell the pharmaceutical companies 'thanks, but no, thanks' for the overpriced drugs. ... On Tuesday, the matter came to the Senate floor -- and President Obama forgot the "no, thanks" part (Dana Milbank, 12/16).
Health reform and US immigrants Inquirer Global Nation Would you wait five years for a doctor's appointment? If you are a legal immigrant living in the United States, you might have to (Jennifer Ng'andu, 12/16).
Joe Lieberman: An Easy Scapegoat Politico I realize it's fashionable to say that Sen. Joe Lieberman (I-Conn.) is to blame for making the Senate health care bill what it's going to be. But really, that's unfair. Majority Leader Harry Reid (D-Nev.) and President Barack Obama have been setting the table for months for Lieberman to do exactly what he's doing right now (Jane Hamsher, 12/16).
Obama's Forgotten Health-Care Promises The Baltimore Sun The more details that emerge from health care reform plans coalescing and colliding on Capitol Hill, the more one wonders how President Barack Obama could possibly justify supporting any of them -- much less signing one into law. Congressional Democrats are threatening to serve up legislation that would cause the president to break any number of pledges (Matt Patterson, 12/16). ((I wonder if NBC news will ever ask him about any of those broken pledges...))
ISO A Watchdog For Health-Care Costs The Washington Post Help wanted: Brave senator or senators willing to champion amendment creating fail-safe mechanism to control health-care spending (Ruth Marcus, 12/16).
What Public Option Supporters Won CBS News The public option is dead this morning. And this time, it isn't coming back to life. The Senate isn't going to include any version of the idea in its bill. And while the House can still demand a public option in conference, nobody I know expects the House to prevail (Jonathan Cohn, 12/15).


Monday, December 14, 2009
Kaiser Daily Health Policy Report:
Check back on Kaiser Health News for the latest headlines
Medicare Actuary: Health Costs Would Rise After Overhaul
[Dec 14, 2009]
The Senate's health overhaul plan would cover 33 million more people but fail to curb rising health costs, could threaten some Medicare patients' access to care, and may sink profits for one-fifth of hospitals and nursing homes, according to news accounts of an HHS report released Friday afternoon.
The Associated Press: "A new report from government economic analysts at the Health and Human Services Department found that the nation's $2.5 trillion annual health care tab won't shrink under the Democratic blueprint that senators are debating. Instead, it would grow somewhat more rapidly than if Congress does nothing." The AP continues, "More troubling was the report's assessment that the Democrats' plan to squeeze Medicare for $493 billion over 10 years in savings relies on specific policy changes that 'may be unrealistic' and could lead to cuts in services."
"The actuaries' analysis of the Senate bill echoes their
previously released reports about the House bill" (Alonso-Zaldivar, 12/12).
The Washington Post: The report, by Rick Foster, chief actuary at the Centers for Medicare and Medicaid Services, concluded that plans "to reduce payments to hospitals and other providers, to force them to adopt more efficient practices, could prove particularly problematic for institutions that serve large numbers of Medicare patients." Those institutions could stop treating Medicare patients -- in Foster's words -- "possibly jeopardizing access to care for beneficiaries." As many as one in five may no longer be profitable within 10 years (Montgomery, 12/12).
The Wall Street Journal: "The report said 33 million more U.S. citizens and legal residents would be insured under the bill, resulting in 93% of Americans with health-insurance coverage. ((I thought the whole point was to cover EVERYONE....)) But it said the new demand for health care caused by the bill could prove 'difficult to meet initially' because doctors and hospitals would charge higher fees in response to the new demand. The report also said proposed cuts in Medicare spending 'may be unrealistic'" (Yoest, 12/11).
Bloomberg: "Republicans seized on the study, saying it shows the Democrats aren't fulfilling a pledge to slow spending growth. Democrats dismissed the criticism, saying the report shows the bill would strengthen Medicare and cut costs in the long term." Bloomberg adds, "Several features in the bill, including proposed reductions in Medicare payments, an independent Medicare advisory board to reduce spending growth rates and taxes on the most-expensive insurance plans, 'would have a significant downward impact on future health-care cost growth rates,' the report said." However, the cost of expanding coverage would initially outweigh those savings (Dodge, 12/11).


From Conservatives for Patients Rights
The Daily Dose
Giving Away the Store to Buy Votes
By CPR Staff on December 16, 2009 11:33 AM

Will a health care bill pass the Senate by Christmas? Hard to say. While the White House has given away the store to buy votes, there remain some obstacles for Majority Leader Harry Reid. 1) Reid needs actual language to file the three cloture motions; 2) actual language means they needed to have a deal wrapped up coming out of the White House meeting Tuesday -- sounds like they don't; 3) defense appropriations with all the stuff house will add to it will consume two or three days on senate floor. The math doesn't add up to the Senate completing a bill before Christmas.For about the tenth time, the media is reporting that the public option is dead. Do not be fooled. As The Heritage Foundation reports, "You can't take the public option out of Obamacare. Obamacare is a public plan." Here are
five reasons why.James Capretta writes in National Review that "The Democratic party is on the verge of enacting a requirement, enforced with federal tax penalties, which would effectively require hard-working Americans to hand over even more of their wages to profit-hungry, private insurance companies." He continues, "the Reid bill is a policy monstrosity. It's filled to the brim with mandates, fines, and new federal controls which will erode the quality of American medicine and lead to government-driven rationing of care. It's a governmental takeover by regulation and bureaucracy, not program enrollment." The CATO Institute's Michael Cannon argues that the individual mandate found in the House and Senate bills gives government more control over Americans' health care than even the so-called "public option" would. "As it has in Massachusetts, an individual mandate will allow government to control what kind of insurance you buy, how much you pay, how insurers pay doctors, where doctors report to work, how doctors practice medicine, and what kind of medical care you get."And yet another story out of the UK discussing the problems with government-run health care. This time, it's the government-run understaffed maternity wards sinking into chaos.

The Hidden Burdens Of Democrat's Health Reform
Michael Gerson -
The Washington Post
It is symbolic of the Senate's health-care bill that the section titled "No lifetime or annual limits" would allow insurance companies to impose annual dollar limits on medical care -- meaning that patients in need of expensive cancer treatment, for example, could still be bankrupted. Democratic health reform legislation promises everything to everyone while imposing a series of hidden burdens to make a massive new entitlement affordable, at least on paper. So its authors are in a game of beat the clock: Pass the legislation before those burdens are fully disclosed to the public. The case of annual dollar limits -- now being renegotiated after they were noticed -- is instructive. In the "reformed" insurance system, every plan would be a high-end plan, requiring insurance companies to cover people who are already sick and limiting the ability to charge higher premiums for those at higher risk. To avoid going out of business or dramatically increasing premiums across the board, insurance companies want the ability to cap yearly benefits. The Senate bill included this limit, because higher premiums would require greater government subsidies to help people afford them. Cutting off cancer patients helps Congress meet its budget target.
The House Prepares To Dig In
David M. Herszenhorn -
The New York Times
The House majority leader, Representative Steny H. Hoyer, Democrat of Maryland, on Tuesday predicted that health care legislation would be approved by Congress, but he acknowledged that Democrats may have little choice but to meet the demands of Senator Joseph I. Lieberman, independent of Connecticut, and other centrists. But Mr. Hoyer also ruled out the idea that the House would simply take up the Senate version of the bill, approve it and send it to Mr. Obama for his signature, as some observers have suggested. "There's significant, important differences between what the Senate is proposing and what we proposed, and those matters will have to be discussed," Mr. Hoyer said at news conference. "It will take some time, I think, to resolve those differences." Since adopting their version of the health care bill last month, House Democrats have been working quietly with the White House in an early effort to resolve differences between their measure and the expected Senate bill.
Obama Urges Senate to Pass Health-Care Bill; Lieberman Signals Support
Lori Montgomery and Shailagh Murray -
The Washington Post
President Obama urged Senate Democrats on Tuesday to overcome lingering disputes and push a health-care overhaul through the chamber before Christmas, as vigorous negotiations continued behind the scenes to lock down the last votes needed for final passage. Sen. Joseph I. Lieberman (I-Conn.), once a critic of the legislation, appeared to be warming to the $848 billion package after Senate leaders said they were ready to jettison a plan to extend Medicare coverage to uninsured people as young as 55, an idea Lieberman denounced over the weekend. He said Tuesday that he expects to support the bill if that provision is dropped. That would leave Sen. Ben Nelson (D-Neb.) as the only known holdout among the 60 lawmakers who caucus with Democrats. Senate leaders and White House officials were working hard Tuesday to convert the former Nebraska insurance commissioner, who has said he will not support the measure unless it bars the use of public money for abortion. The final negotiations followed months of debate and compromise on the administration's domestic centerpiece. Liberals fumed over the abandonment of a government-run insurance option, but they did not defect, and as a final vote neared, strenuous efforts to win the support of even a single Republican seemed increasingly unlikely to succeed.
Democrats Urged To Act On Health
Greg Hitt and Janet Adamy -
The Wall Street Journal
President Barack Obama pressed Senate Democrats to close ranks quickly behind a deal that has disappointed some liberals, saying Tuesday lawmakers are "on the precipice of an achievement that has eluded Congresses and presidents for generations." Standing with senior Democrats in the Roosevelt Room of the White House, Mr. Obama said there is "broad consensus" on the core of the bill, which would create tax breaks to help people purchase insurance and bar insurers from denying coverage to those with pre-existing conditions, among other things. Some differences remain, notably on abortion. But Mr. Obama -- who campaigned on the promise of expanding health-care coverage -- suggested it was time to compromise. "The final bill won't include everything that everybody wants. No bill can do that," he said. "We simply cannot allow differences over individual elements of this plan to prevent us from meeting our responsibility to solve a longstanding and urgent problem for the American people." Even after the latest changes, hurdles remained. Sen. Ben Nelson (D., Neb.) was pressing for tighter restrictions on insurance coverage of abortion procedures. The bill already includes provisions intended to limit the use of federal funds for abortion. But a spokesman for the antiabortion Democrat said that if the bill's language wasn't tightened further, the senator would not support efforts by Democratic leaders to close off debate and move to final passage.
President Obama Writes A New Health Reform Prescription
Dana Milbank -
The Washington Post
On the campaign trail, Barack Obama vowed to take on the drug industry by allowing Americans to import cheaper prescription medicine. "We'll tell the pharmaceutical companies 'thanks, but no, thanks' for the overpriced drugs -- drugs that cost twice as much here as they do in Europe and Canada," he said back then. On Tuesday, the matter came to the Senate floor -- and President Obama forgot the "no, thanks" part. Siding with the pharmaceutical lobby, the administration successfully fought against the very idea Obama had championed. "It's got to be a little awkward," said Sen. Tom Carper (D-Del.). It's even more awkward for millions of Americans who are forced to pay up to 10 times the prices Canadians and Europeans pay for identical medication, often produced in the same facilities by the same manufacturers, simply because the U.S. government refuses to rein in drug prices. Those favoring cheaper prescriptions amassed an impressive ideological coalition, from socialist Sen. Bernie Sanders (I-Vt.) to conservative Sen. David Vitter (R-La.). But they were no match for industry-friendly senators backed by the administration, who on Tuesday night easily voted down "reimportation," as it is called.
Lieberman vs. the "Public Option" Patriarch
David M. Herszenhorn -
The New York Times
Even as Senate Democrats seemed willing to give up on the idea of a government-run insurance plan, or public option, a war of words broke out Tuesday between the man credited with originating the idea and the senator who had the strongest hand in killing it. Jacob S. Hacker, the Yale University political science professor widely regarded as a patriarch of the public option, said in an interview Tuesday that he had been misquoted by Senator Joseph I. Lieberman, who cited Mr. Hacker's support for a proposed Medicare expansion as a reason to oppose the idea. Mr. Lieberman, independent of Connecticut, said in an interview Tuesday that the Democratic proposal to allow some people to buy coverage through Medicare starting at age 55 because it was enthusiastically embraced by supporters of a government-run health system. In an interview Tuesday, Mr. Lieberman included Mr. Hacker in the camp of people who favored the Medicare expansion: "Jacob Hacker, who's a Yale professor who is actually the man who created the public option, said: 'This is a dream. This is better than a public option. This is a giant step.'
"Obama "Cautiously Optimistic" Senate Will Pass Health-Care Bill
Shailagh Murray and Lori Montgomery -
The Washington Post
President Obama emerged from a White House meeting with Senate Democrats Tuesday afternoon and announced he was "cautiously optimistic" the legislation would pass. "It's clear that we are on the precipice of an achievement that's eluded Congresses and presidents for generations, an achievement that will touch the lives of nearly every American," said Obama. "There are still some differences that have to be worked on. This was not a roll call. This was a broad-based discussion about how we move forward." Participants described the meeting as a frank exchange of views. Lawmakers expressed numerous concerns about the bill, including its lack of a government-run insurance plan, the top priority for liberals that was dropped at moderate insistence. "Because of the moment we're at, there was probably a little more candor than usual," said Sen. Robert C. Casey Jr. (D-Pa.) He said Democrats agreed that a finish line was in sight, and that it was "days from now, not weeks."
Obama Health Care Meeting Aims To Rally Senators
Sheryl Gay Stolberg and Robert Pear -
The New York Times
As the battle over health care lurches toward a conclusion, President Obama is confronting an increasingly sharp divide on the Democratic left, with liberals in the Senate and the House split on a critical question: How much of what they want is enough? In the Senate, where time is running out for Democrats to meet the president's deadline of passing a bill by Christmas, liberals signaled on Tuesday that they would hold their noses and vote for a version of the measure that would strip out some of their most cherished provisions, including an expansion of Medicare and the possibility of a government-run insurance plan. But the House seemed unwilling to fall in line. The majority leader, Representative Steny H. Hoyer of Maryland, said flatly on Tuesday that the House would not "simply take the Senate bill" and adopt it unchanged. And Howard Dean, the former Vermont governor and presidential candidate who is a respected voice among liberals, stirred the pot on the Democratic left by saying, "the best thing to do right now is kill the Senate bill" and start over.
Public Cooling To Health Care Reform As Debate Drags On, Poll Finds
Dan Balz and Jon Cohen -
The Washington Post
As the Senate struggles to meet a self-imposed, year-end deadline to complete work on legislation to overhaul the nation's health-care system, a new Washington Post-ABC News poll finds the public generally fearful that a revamped system would bring higher costs while worsening the quality of their care. A bare majority of Americans still believe government action is needed to control runaway health-care costs and expand coverage to the roughly 46 million people without insurance. But after a year of exhortation by President Obama and Democratic leaders and a high-octane national debate, there is minimal public enthusiasm for the kind of comprehensive changes in health care now under consideration. There are also signs the political fight has hurt the president's general standing with the public. One bright spot for the president in the poll is Afghanistan. His announcement Dec. 1 that he was ordering an additional 30,000 U.S. troops to that country, to bolster the 68,000 already there, wins majority support. More than half of all Americans, 52 percent, approve of how he is handling the situation there, up from 45 percent before the speech. But Obama and the Democrats have had decidedly less success convincing the public that their health proposals will bring positive change. More than half of those polled, 53 percent, see higher costs for themselves if the proposed changes go into effect than if the current system remains intact. About as many (55 percent) say the overall cost of the national health-care system would go up more sharply. Moreover, just 37 percent say the quality of their care would be better under a new system; 50 percent see it as better under the current set-up.
Obama Huddles With Dems To Push Health Care
Jennifer Haberkorn -
The Washington Times
President Obama urged Senate Democrats on Tuesday to unify and pass a health-care-reform bill, even if it doesn't have all the provisions lawmakers once wanted. "There are still disagreements that have to be ironed out," Mr. Obama told reporters after meeting with the Democratic Caucus at the White House. "I'm feeling cautiously optimistic that we can get this done." Democrats are closing in on the 60 votes needed to overcome a Republican filibuster and pass their health care reform bill, Mr. Obama's top domestic priority. On Monday, Democrats said they were ready to remove the public insurance option and a Medicare expansion from their health bill to appease apprehensive moderates, despite the potential of angering liberals. Just weeks ago, liberal Democrats argued that the government's role was essential to bringing down health costs for all consumers. But as it became clear a bill with a strong government role wouldn't get 60 votes, they highlighted other, less controversial parts of the bill, such as tougher insurance industry regulations.


Conservatives for Patients" Rights
"Last Chance" for Real Reform
By CPR Staff on December 15, 2009 1:24 PM
The Daily Dose

On one end of Pennsylvania Avenue today, the President has called all Democrat senators to the White House to convince them to vote for the health care bill that only 19% of Americans strongly favor. On the other end of Pennsylvania Avenue will be conservatives rallying
against a government takeover of our health care system. Majority Leader Harry Reid (D-NV) in his scramble for 60 votes, has decided to remove the Medicare buy in program, which were, according to a deeper examination of Senator Joseph Lieberman's (I-CT) argument against the measure, the first step towards a single payer system.

Rick Scott of Conservatives for Patients' Rights,
released this response to the White House statement today that suggested this was the "last chance" for real health care reform: "If the President wants to blame someone for health care reform NOT passing yet, he should just look in the mirror. His reform plan has stalled because it isn't focused on lowering costs, improving care or protecting patients' rights. It's focused on a massive government takeover of our health care system through his public option plan. As far as American's are concerned, if the President's plan is the 'last train' leaving the station, Americans should let it leave because it is on the wrong track."

Is Reid Cursed by the Lucky Number 60?
David M. Herszenhorn - The New York Times
Maybe it was fate. Or just bad luck. But pity the Senate majority leader, Harry Reid, of Nevada. For months, Mr. Reid kept spinning the political roulette wheel and no matter how many times he tried, the ball kept landing on 60. Sixty is the number of senators in the Democratic caucus, and the precise number needed to overcome Republican filibusters. It is the magic number of votes that Mr. Reid needs to pull together to advance major health care legislation. In many ways, 60 is also a mirage -- falsely raising Democratic hopes, particularly those of more liberal senators, that they have the muscle to push the health care bill without making painful concessions to centrists in both parties. To be sure, controlling 60 votes has generally been advantageous to the Democrats. They have repeatedly cleared procedural obstacles that Republicans set in their path, even on routine bills that ultimately are approved by overwhelming majorities.
A Last Minute Surge
Katharine Q. Seelye - The New York Times
With the Senate facing a potential deadline next week for voting on its health care legislation, interest groups have unveiled a raft of television commercials -- most of them arguing against the bill. A group called the 60 Plus Association, which bills itself as a conservative alternative to AARP, is spending $1.7 million to run commercials for eight days starting Monday. They praise Senator John McCain, Republican of Arizona, for writing an amendment to "protect Medicare" from what the group calls a $500 billion cut over 10 years, although Democrats say the bill would reduce waste without affecting older Americans' access to services. Mr. McCain's amendment was defeated. The advertisements are running nationally on cable television and on broadcast TV in four states: Nebraska and Virginia, where one version thanks Democratic senators for showing the courage to vote for Mr. McCain's amendment; and Alaska and North Dakota, where another criticizes Democratic senators who voted against it.
Democrats Drop Plan to Expand Medicare
Senate Democrats on Monday evening dropped a plan to expand Medicare, winning the support of moderates and the reluctant acquiescence of liberals, in another major step toward building enough support to pass a health-care overhaul. The idea of letting people ages 55 to 64 buy into Medicare, announced just last week, had threatened to explode the Democrats' hopes of getting a bill through the Senate when Sen. Joseph Lieberman came out against it. At an evening caucus of all 58 Democrats and the two independents who sit with the party, including Sen. Lieberman, Majority Leader Harry Reid (D., Nev.) and other party leaders made clear they wanted to head off the dispute. Sen. Evan Bayh (D., Ind.) said Democrats agreed that the dispute over Medicare shouldn't hold up legislation that would extend coverage to tens of millions of Americans."There are a lot of good things here," he said. "To use an old cliché, the general consensus was we shouldn't make the perfect the enemy of the good."
Obama: "Last Chance" for Health Reform
Carrie Budoff Brown and Mike Allen - Politico
In a provocative argument designed to rescue his foundering health-care plan, President Barack Obama will warn Senate Democrats in a White House meeting Tuesday that this is the "last chance" to pass comprehensive reform. Obama will contend that if it fails now, no other president will attempt it, aides said. White House Communications Director Dan Pfeiffer told POLITICO: "If President Obama doesn't pass health reform, it's hard to imagine another president ever taking on this Herculean task. For those whose life's work is reforming health care, this may be the last train leaving the station." Previewing the message, Vice President Joe Biden said on MSNBC's "Morning Joe": "If health care does not pass in this Congress ... it's going to be kicked back for a generation." The new argument comes as the Senate races to pass the measure by Christmas, in the face of a costly setback this week. Senate Democrats say they are prepared to drop a plan to expand Medicare coverage after Sen. Joe Lieberman (I-Conn.) said he could not support it. That could keep the bill alive but would infuriate the party's liberals, who feel the moderate Lieberman has thwarted them once again. Biden said on MSNBC: ""Say it ain't so. ... Joe is a great guy. ... I think Joe's judgment is wrong on this."Senate strategists say the current impasse will have to resolved in the next couple days in order to allow passage by year's end.

Rasmussen Reports
December 14, 2009
Latest Polling
"Fifty-six percent (56%) of U.S. voters now oppose the health care plan proposed by President Obama and congressional Democrats."


Conservatives for Patients" Rights
70 New Government Programs to Manage Your Health Care
The Daily Dose
By CPR Staff on December 10, 2009 12:05 PM

Bob Moffit of
the Heritage Foundation writes about the latest power grab in the health care debate, "In the latest desperate search to find some form of government-run health plan to compete against private health plans that is somehow acceptable to Senate liberals and moderates alike, the Senate Democratic leadership is entertaining the idea of stripping the existing 'public option' from the big Senate health bill ( H.R. 3590), and replacing it with a combination of public options: an OPM/FEHBP sponsored plan ( that will be 'private' in name only) and an expansion of the two giant- and financially troubled or debt ridden- Great Society entitlements: Medicare and Medicaid. If the original idea of the public option was to keep costs down, as its champions have tiresomely insisted, a proposal to expand Medicaid and Medicare is curious to say the least: Both are major drivers of the health care spending curve upwards."
Michael Tenner of CATO reports that Senate Majority Leader Harry Reid's super secret compromise will ultimately "expand government health care programs and further squeeze private insurance, resulting in increased costs, result in higher insurance premiums, and provide a lower-quality of care." No wonder Senator Reid wants to keep it a secret.
Senate Republicans point out that the Senate health care bill creates 70 new government programs.Is the health care bill unconstitutional? Some legal experts think so. Only 38% of voters support the health care bill in Congress, while 52% oppose. And by a 71-21 percent margin, registered voters do not think universal coverage is worth lower quality of care. And more bad news for Congress. A new poll says Members of Congress rate as the least ethical and honest.



Will the SENATE SCROOGES ruin Christmas?
Even DEMOCRATS now say “KILL the BILL”

More from state legislators on healthcare deficits
Latest from the Senate negotiations
And live reports from
candlelight vigils around the country

“Twas the week before Christmas, and all through the House…..uh, ok, Senate.

Some Dems started bailing, just like a smart mouse….”

Call us to report on your candlelight vigils at Senate offices.
Call-in Number: (718) 506-1801
LISTEN LIVE (Wednesday 8-9pm Eastern) AT:
If you can’t get to computer, call the listen-only line from your phone:
(712) 432-3900 and enter access code 691338#

State legislators explain devastating impact of healthcare bills on state budgets.


Morning Bell: Howard Dean Is Right, This Is Not Health Care Reform

Posted December 16th, 2009 at 9.37am in
Health Care.
President Barack Obama yesterday hosted yet another health care
pep rally to shore up liberal support for his health care bill. Obama’s “rally” followed Majority Leader Harry Reid’s (D-NV) latest capitulation to Sen. Joe Lieberman’s (I-CT) health care demands, whereby Reid removed a Medicare expansion that Lieberman had initially supported. From the Roosevelt Room, Obama claimed Democrats were “on the precipice of an achievement that’s eluded congresses and presidents for generations.” But hours later, former Governor and Democratic National Committee Chairman Howard Dean told Vermont National Public Radio:

This is essentially the collapse of health care reform in the United States Senate. And, honestly, the best thing to do right now is kill the Senate bill and go back to the House … You have the vast majority of Americans want the choices, they want real choices. They don’t have them in this bill. This is not health care reform and it’s not close to health care reform.

Later on MSNBC’s Countdown, Dean further responded to President Obama’s claims that “You talk to every healthcare economist out there and they will tell you that whatever ideas are — whatever ideas exist in terms of bending the cost curve and starting to reduce costs for families, businesses and government, those elements are in this bill.” Dean told guest host Lawrence O’Donnell: “There is no cost control of any substance. … You’re going to be forced to buy health insurance from a company that is going to take on average of 27% of your money … and there is no choice about that. If you don’t buy that insurance you are going to get a fine.” Continue reading…
The President’s own the Centers for Medicare and Medicaid Services (CMMS) agrees with Dean and contradicts Obama. CMMS found that the Senate bill, instead of bending the cost curve down, actually drives health care costs up, adding $234 billion to national health expenditures. But the President’s fantastic claims did not end there. Obama then asserted: “And in terms of deficits — because we keep on hearing these ads about how this is going to add to the deficit — the CBO has said that this is a deficit reduction, not a deficit increase. So all the scare tactics out there, all the ads that are out there are simply inaccurate.”

But the President leaves out this all important caveat in the CBO’s report: “In the subsequent decade, the collective effect of its provisions would probably be small reductions in federal budget deficits if all of the provisions continued to be fully implemented.” But nobody believes that all of the provisions in the bill will be fully implemented. For example, the Senate bill includes a 20% cut in the payments Medicare sets for doctors. Nobody believes these cuts will be allowed to happen. By changing just that provision, Obamacare ends up adding $196 billion to the deficit in the first 10 years and $765 billion in the second decade.

The American people already do not trust President Obama’s health care claims. Just today, the Washington Post released a poll finding that 51% of adults oppose Obamacare, with 40% in strong opposition. Meanwhile only 44% support the bill with only 25% feeling strongly about it. Digging deeper we find that 66% of Americans believe Obamacare will increase the federal budget deficit, 53% believe it will cause their own health care to cost more, 55% believe it will increase the country’s health care costs overall, and 50% believe it will not improve their quality of care. These findings echo an earlier CNN poll which found that 61% of Americans opposed Obamacare, with 79% believing it would add to the deficit and 85% believing it would raise their taxes.

It has become obvious to any American following the debate that President Obama has adopted a get-a-deal-at-any-cost mentality that puts a higher priority on the political victory of passing any bill over the policy substance of what is actually in the bill and how it would effect the American people. As Dean told O’Donnell last night: “You can’t vote for a bill like this in good conscience. … It costs too much money. It isn’t health care reform. It isn’t even insurance reform.”


Obamacare: America is saying no. Congress, can't you hear us?
November 23, 12:30 PM
Kelly Anderson Wright

Apparently, the more we know about Obama's health care reform bill, the more people are just saying
no. According to Rasmussen’s weekly telephone poll, only 38% of voters now favor the health care plan proposed by President Obama and congressional Democrats, the lowest level of support in nearly two dozen tracking polls since June.
Senators know the majority of Americans are against this massive government takeover of 1/6 of the economy, but still they voted to debate this bill. Nevada's own Harry Reid led the charge, oblivious to the mutinous voters waiting for him back

Most Americans agree something must be done to "fix" what ails our health care system. But is the answer this bill? The more we know about this bill, the more we should just say no. Why?
The simplest answer is the best answer: This bill won’t fix what's broken. A new report from the non-partisan and independent
Centers for Medicare and Medicaid Services, the agency in charge of running Medicare and Medicaid, debunks each of left’s health care reform promises.
According to the CMS, this health care reform bill:

won't protect and secure the insurance plan you already have.
won't provide quality, affordable options if you need insurance.
won't reduce health care costs for families, businesses and government.
won’t strengthen the financial health of Medicare.
So if this bill doesn't do what Congress promised it would do, what does it do that's so bad for America?

The bill expands Medicaid, the lousy government-run plan that already exists. Welcome to your new "public option." This bill simply increases the number of people allowed to go on Medicaid. Why is that so bad? Ask people who have Medicaid how hard it is to find a pediatrician who will take this low-paying, bargain-basement insurance. Ask parents in Reno, Nevada, who wait for hours in noisy, crowded public health dental clinics, because few private dentists take Medicaid. Sure, Medicaid covers braces, but no orthodontist in Reno will take these patients, because the government does not pay enough for orthodontists to stay in business. And if your kid falls off his bike and breaks an arm or leg, good luck finding a neurosurgeon who'll take Medicaid. The only one I could find in Reno is very glad he's about to retire.

The bill will put one-fifth of America on welfare. This bill will make millions more Americans dependent on the government to finance their health care. In addition to massively expanding Medicaid, the Feds will also provide a new medical subsidy program, paid for by Joe Q. Taxpayer. The bill will provide humongous taxpayer-funded subsidies to the middle class, subverting this once independent group into low-class, government dependency.

The bill will cause you to lose your private insurance coverage. Obama’s own Centers for Medicare and Medicaid Services recently certified that the bill will cause millions of Americans to lose their existing employer-based coverage, agreeing with what many others have already concluded: this bill will ruin the health care insurance that 85% of Americans enjoy.

The federal government will take over and regulate the entire health insurance industry. The Senate health care bill will impose sweeping, complex new federal health insurance regulations that will create a one-size-fits-all federal health plan that will drive up (not down, as promised by the President) the cost of everyone’s health insurance premiums

The bill taxes employers, so kiss that raise or even your job goodbye. Employers will be required to provide all employees health care insurance mandated by the government, regardless of the company's ability to absorb this cost. Low-income workers and economic growth will suffer the most. Can America’s businesses really afford another employment tax at a time of 10.2% unemployment?

The bill fines YOU, or puts you in jail if you don't comply. The Senate bill requires all Americans to buy “government qualified” health insurance. If you don’t, you’ll be hit with new tax penalties and possibly, jail time. Government scholars and patriots alike wonder loudly if such a requirement is even constitutional. And if so, what will the government make us buy next?

Americans want health care reform, but is this the change we were looking for? Do we want our government taking over our health and thus, our lives? Ask the Dean of Harvard Medical School, Dr. Jeffrey Flier, who wrote in the Wall Street Journal.

"...the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multi-year process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit. We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead."
Ominous words, indeed. Just say no.


DJP Update 12-11-2009
500,000 physicians entered into Congressional Record opposing Senate bill,
H.R. 3590; Reflections
December 10, 2009
Mr. MCCAIN. Mr. President, I ask unanimous consent that a list of physician organizations that oppose this act, representing nearly one-half million physicians, be printed in the RECORD.There being no objection, the material was ordered to be printed in the RECORD, as follows:
PHYSICIAN ORGANIZATIONS THAT OPPOSE SENATE’S PATIENT PROTECTION AND AFFORDABLE CARE ACTTo date over 40 state, county and national medical societies, representing nearly one half million physicians, have stated their public opposition to the Senate healthcare overhaul bill, the Patient Protection and Affordable Care Act (H.R. 3590). It is time for Congress to slow down, take a step back, and change the direction of current reform efforts to ensure that it is done right!
American Academy of Cosmetic Surgery,American Academy of Dermatology Association,American Academy of Facial Plastic and Reconstructive Surgery,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 College of Surgeons,American Osteopathic Academy of Orthopaedics,American Society for Metabolic & Bariatric Surgery,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 of General Surgeons,American Society of Plastic Surgeons,American Urological Association,Association of American Physicians and Surgeons,Coalition of State Rheumatology Organizations,Congress of Neurological Surgeons,Heart Rhythm Society,National Association of Spine Specialists,Society for Vascular Surgeons,Society of American Gastrointestinal and Endoscopic Surgeons,Society for Cardiovascular Angiography and Interventions,Society of Gynecologic Oncologists.
Medical Association of the State of Alabama,California Medical Association,Medical Society of Delaware,Medical Society of the District of Columbia,Florida Medical Association,Medical Association of Georgia,Kansas Medical Association,Louisiana State Medical Society,Missouri State Medical Association,Nebraska Medical Association,Medical Society of New Jersey,Ohio State Medical Association,South Carolina Medical Association,Texas Medical Association,Westchester (NY) County Medical Society.

Various letters from the multiple medical coalitions also were printed. If anyone wants the entire printing of the pertinent pages from the Congressional Record, drop me an email and I will send the attachment. Many thanks to Katie Orrico, Director of the Washington Office of the American Association of Neurological Surgeons/ Congress of Neurological Surgeons, for alerting me to this posting in the Congressional Record and forwarding the pages to me!Let me share one excerpt from a letter sent and printed in the Congressional Record citation above. I also will list the organizations that signed that letter as well as three former AMA presidents."
Senator Reid, we are at a critical moment in history. America’s physicians deliver the best medical care in the world, yet the systems that have been developed to finance the delivery of that care to patients have failed. With congressional action upon us, we are at a crossroads. One path accepts as ‘‘necessary’’ a substantial increase in federal government control over how medical care is delivered and financed. We believe the better path is one that allows patients and physicians to take a more direct role in their healthcare decisions. By encouraging patients to own their health insurance policies and by allowing them to freely exercise their right to privately contract with the physician of their choice, healthcare decisions will be made by patients and physicians and not by the government or other third party payers."We urge you to slow down, take a step back, and change the direction of current reform efforts so we get it right for our patients and our profession. We have a prescription for reform that will work for all Americans, and we are happy to share these solutions with you to improve our nation’s healthcare system."
Thank you for considering our views.
Sincerely,"Medical Association of the State of Alabama,Medical Society of Delaware,Medical Society of the District of Columbia,Florida Medical Association,Medical Association of Georgia,Kansas Medical Society,Louisiana State Medical Society,Missouri State Medical Association,Nebraska Medical Association,Medical Society of New Jersey,South Carolina Medical Association,American Academy of Cosmetic Surgery,American Academy of Facial Plastic and Reconstructive Surgery,American Association of Neurological Surgeons,American Society of Breast Surgeons,American Society of General Surgeons,Congress of Neurological Surgeons.
Past Presidents of the American Medical Association:Daniel H. Johnson, Jr., MD, AMA President 1996–1997;Donald J. Palmisano, MD, JD, FACS, AMA President 2003–2004;William G. Plested, III, MD, FACS, AMA President 2006–2007

------Mr. MCCAIN. Mr. President, I thank the Senator from Montana for his courtesy.--------Reflections: Ideas and actions have consequences! When physicians stand up, the message gets out.Wouldn't it be nice if AMA took out ads and wrote letters to Congress pointing out that the hallmark of the Free Enterprise System is the right to privately contract! And strongly advocated AMA policy which is "among our highest advocacy priorities", namely, the AMA will “actively and publicly support the inclusion in health system reform legislation the right of patients and physicians to privately contract, without penalty to patient or physician.” After all, that is the policy! To put this concept as an addendum in a letter does not, in my opinion, carry out the mandate of actively and publicly supporting the inclusion. Millions have been spent in the co-sponsored ads with AARP. These ads are too nebulous and can be interpreted to mean many difference changes in health system reform. AMA should consult with the Geico people who use the Gecko ad approach. That delivers a message! Or the Ally Bank ads about the promise of a real toy truck and then a paper truck is given (failure to read fine print). Does this remind you of bills being pushed in Congress?See "It is a piece of Junk" at: for sample of one of the ads.Liberty is the absence of coercion. Let's not give up liberty by default.On the positive side, thanks to AMA following policy to oppose expansion of Medicare, a system going bankrupt, and publicly stating so!Onward. Don't falter. We can win this battle for our patients and colleagues! The outcome of the upcoming short and intense debate will affect Medicine for decades and could drastically influence the financial viability of America. Congress can't keep building up debts and opening new credit cards to pay off the debts. One day the bill collector knocks on the door!
"Economics in One Lesson" by Henry Hazlitt still would be a good book for Congress to read.
Stay well,
Donald J. Palmisano, MD, JDIntrepid Resources® / The Medical Risk Manager Company5000 West Esplanade Ave., #432Metairie, Louisiana USA 70006504-455-5895 office504-455-9392 fax
This DJP Update goes to 2177 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.You can share it with your members and it has the potential to reach 800,000 physicians.


From the Manhattan Institute
December 11, 2009
Analyzing the Health Bills

All's not fair in health reform bills
Douglas Holtz-Eakin, Boston Globe, December 10, 2009
Health care reform has been cloaked in an aura of moral ascent. President Obama has called it a "core ethical and moral obligation." House Speaker Nancy Pelosi introduced her bill by saying, "We also have a moral responsibility to pass health insurance reform and we will do so this year." And Senate majority leader Harry Reid has opined that "health care is a moral issue." Strong words on ethics and fairness. But the actual bills are unimaginably unfair.

Five Questions On Health Reform Americans Should Be Asking Now
Stephen Parente and Paul Howard, Investor's Business Daily, December 10, 2009
We're not going to not pass a bill." So says New York Sen. Chuck Schumer, echoing Democrats' determination to pass health reform legislation. But it may be premature to declare victory. Failure is still very much an option, particularly if the Senate doesn't address serious concerns about the 2,074-page bill designed to rewrite the rules governing one-sixth of the U.S. economy for decades to come.

Three Strikes against Obamacare
Paul Howard, National Review Online, December 8, 2009(This article was linked by the Dallas Morning News, 12-8-09)
Joseph Lieberman's words, "I'm going to be stubborn on this," must be giving Harry Reid heartburn. Lieberman may caucus with the Democrats, but he's more than willing to go his own way - especially when it comes to his staunch opposition to the "public option," a proposed government-run insurance plan that would compete with private insurers. "Once the government creates an insurance company or plan, the government or the taxpayers are liable for any deficit that government plan runs, really without limit," Lieberman told the Wall Street Journal.

The High Price Of Health Care Reform
David Gratzer,, December 8, 2009(This piece was linked by the Council on Foreign Relations, 12-8-09)
In March, White House budget director Peter Orszag testified before the Senate Finance Committee. The prior afternoon, the Dow dropped to its worst close since April 1997. Administration officials began using the term deep recession, and trillion-dollar deficits were projected as far as the eye could see.

Why Tax Botox?
Josh Barro,, December 7, 2009
The Senate health care reform bill, released last month, is over 2,000 pages long. It would generate nearly $850 billion in new federal spending over 10 years, cut over $400 billion from currently scheduled Medicare spending and levy $372 billion in new taxes. Washington is abuzz, dissecting the bill, analyzing and demagoguing it, trying to figure out what it all means.

Yet another new entitlement
David Gratzer, Washington Times, December 6, 2009
Well known is the Democratic plan to create a new health insurance program - modeled after Medicare - to compete against private coverage. But buried deep in the 2,074-page draft legislation released last week by Sen. Majority Leader Harry Reid of Nevada, is another insurance option for millions of Americans. In fact, this one has all the markings of a new entitlement and - even before its enactment - doesn't appear to be financially sustainable


Kiss Your Freedoms Goodbye If Health Care Passes
Why we cannot afford to sit out this fight
Andrew Napolitano November 16, 2009

Congress recognizes no limits on its power. It doesn't care about the Constitution, it doesn't care about your inalienable rights. If this health care bill becomes law, America, life as you have known it, freedom as you have exercised it, and privacy as you have enjoyed it will cease to be.
Last week the House of Representatives voted on a 2,000 page bill to give the federal government the power to micromanage the health care of every single American. The bill will raise your taxes, steal your freedom, invade your privacy, and ration your health care. Even the Republicans have introduced their version of Obamacare Lite. It, too, if passed, will compel employers to provide coverage, bribe the states to change their court rules, and tell insurance companies whom to insure.

We do not have two political parties in this country, America. We have one party; called the Big Government Party. The Republican wing likes deficits, war, and assaults on civil liberties. The Democratic wing likes wealth transfer, taxes, and assaults on commercial liberties. Both parties like power; and neither is interested in your freedoms.

Think about it. Government is the negation of freedom. Freedom is your power and ability to follow your own free will and your own conscience. The government wants you to follow the will of some faceless bureaucrat.

When I recently asked Congressman James Clyburn, the third ranking Democrat in the House, to tell me "Where in the Constitution the federal government is authorized to regulate everyone's healthcare," he replied that most of what Congress does is not authorized by the Constitution, but they do it anyway. There you have it. Congress recognizes no limits on its power. It doesn't care about the Constitution, it doesn't care about your inalienable rights, it doesn't care about the liberties protected by the Bill of Rights, it doesn't even read the laws it writes.

America, this is not an academic issue. If this health care bill becomes law, life as you have known it, freedom as you have exercised it, privacy as you have enjoyed it, will cease to be.

When Congress takes away our freedoms, they will be gone forever. What will you do to prevent this from happening?

We Can't Sit Back and Allow the Loss of Our Freedoms

We elect the government. It works for us. As we watch the Democrats' plans for health care take shape, we can only ask how did our government get so removed, so unbridled, so arrogant that it can tell us how to live our personal lives?

On Saturday November 7, at 11 o’clock in the evening, the House of Representatives voted by a five vote margin to have the federal government manage the health care of every American at a cost of $1 trillion dollars over the next ten years.

For the first time in American history, if this bill becomes law, the Feds will force you to buy insurance you might not want, or may not need, or cannot afford. If you don’t purchase what the government tells you to buy, if you don’t do so when they tell you to do it, and if you don’t buy just what they say is right for you, the government may fine you, prosecute you, and even put you in jail. Freedom of choice and control over your own body will be lost. The privacy of your communications and medical decision making with your physician will be gone. More of your hard earned dollars will be at the disposal of federal bureaucrats.

It was not supposed to be this way. We elect the government. It works for us. How did it get so removed, so unbridled, so arrogant that it can tell us how to live our personal lives? Evil rarely comes upon us all at once, and liberty is rarely lost in one stroke. It happens gradually, over the years and decades and even centuries. A little stretch here, a cave in there, powers are slowly taken from the states and the people and before you know it, we have one big monster government that recognizes no restraint on its ability to tell us how to live. It claims the power to regulate any activity, tax any behavior, and demand conformity to any standard it chooses.

The Founders did not give us a government like the one we have today. The government they gave us was strictly limited in its scope, guaranteed individual liberty, preserved the free market, and on matters that pertain to our private behavior was supposed to leave us alone.

In the Constitution, the Founders built in checks and balances. If the Congress got out of hand, the states would restrain it. If the states stole liberty or property, the Congress would cure it. If the president tried to become a king, the courts would prevent it.

In the next few weeks, I will be giving a public class on Constitutional Law here on the Fox News Channel, on the Fox Business Network, on, and on Fox Nation. In anticipation of that, many of you have asked: What can we do now about the loss of freedom? For starters, we can vote the bums out of their cushy federal offices! We can persuade our state governments to defy the Feds in areas like health care—where the Constitution gives the Feds zero authority. We can petition our state legislatures to threaten to amend the Constitution to abolish the income tax, return the selection of U.S. senators to state legislatures, and nullify all the laws the Congress has written that are not based in the Constitution.

One thing we can’t do is just sit back and take it.

Judge Andrew Napolitano is Fox News' senior judicial analyst. This article originally appeared in two parts on


November 27, 2009
Kill the Bills. Do Health Reform Right
By Charles Krauthammer

WASHINGTON -- The United States has the best health care in the world -- but because of its inefficiencies, also the most expensive. The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.

Worse, they are packed into a monstrous package without any regard to each other. The only thing linking these changes -- such as the 118 new boards, commissions and programs -- is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony.

The result is an overregulated, overbureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:

-- You'll find mandates with financial penalties -- the amounts picked out of a hat.
-- You'll find insurance companies (who live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Currently insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates the young shall now pay at minimum one-half; the Senate bill, one-third -- numbers picked out of a hat.
-- You'll find sliding scales for health-insurance subsidies -- percentages picked out of a hat -- that will radically raise marginal income tax rates for middle- class recipients, among other crazy unintended consequences.

The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool.

Then do health care the right way -- one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.

First, tort reform. This is money -- the low-end estimate is about half a trillion per decade -- wasted in two ways. Part is simply hemorrhaged into the legal system to benefit a few jackpot lawsuit winners and an army of extravagantly rich malpractice lawyers such as John Edwards.

The rest is wasted within the medical system in the millions of unnecessary tests, procedures and referrals undertaken solely to fend off lawsuits -- resources wasted on patients who don't need them and which could be redirected to the uninsured who really do.

In the 4,000-plus pages of the two bills, there is no tort reform. Indeed, the House bill actually penalizes states that dare "limit attorneys' fees or impose caps on damages." Why? Because, as Howard Dean has openly admitted, Democrats don't want "to take on the trial lawyers." What he didn't say -- he didn't need to -- is that they give millions to the Democrats for precisely this kind of protection.

Second, even more simple and simplifying, abolish the prohibition against buying health insurance across state lines.

Some states have very few health insurers. Rates are high. So why not allow interstate competition? After all, you can buy oranges across state lines. If you couldn't, oranges would be extremely expensive in Wisconsin, especially in winter.

And the answer to the resulting high Wisconsin orange prices wouldn't be the establishment of a public option -- a federally run orange-growing company in Wisconsin -- to introduce "competition." It would be to allow Wisconsin residents to buy Florida oranges.

But neither bill lifts the prohibition on interstate competition for health insurance. Because this would obviate the need -- the excuse -- for the public option, which the left wing of the Democratic Party sees (correctly) as the royal road to fully socialized medicine.

Third, tax employer-provided health insurance. This is an accrued inefficiency of 65 years, an accident of World War II wage controls. It creates a $250 billion annual loss of federal revenues -- the largest tax break for individuals in the entire federal budget.

This reform is the most difficult to enact, for two reasons. The unions oppose it. And the Obama campaign savaged the idea when John McCain proposed it during last year's election.

Insuring the uninsured is a moral imperative. The problem is that the Democrats have chosen the worst possible method -- a $1 trillion new entitlement of stupefying arbitrariness and inefficiency.
The better choice is targeted measures that attack the inefficiencies of the current system one by one -- tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill, not 2,000 -- and provide the funds to cover the uninsured without wrecking both U.S. health care and the U.S. Treasury.
Copyright 2009, Washington Post Writers Group


((Rep. Schroder has been one of medicine's best friends in the PA House - personally, I consider him the champion of PA's medical liability reform efforts. Now he's running for the Congressional seat of another med mal champion - Jim Gerlach, who isn't running for reelection due to his campaign for Governor in 2010. I can't think of ANYONE other than Curt Schroder I'd rather see representing us in Congress and bringing his deep understanding about health care issues to the national political stage. If there's anyone reading this Update who'd like to get involved with Curt's campaign, please email me at and I'll make sure you get in contact with the right people to support this GOOD friend of Pennsylvania's health....))
I have recently attended two health care forums, both dominated by concerns over “ObamaCare” and the damage to our healthcare system should the government ever take control. When the discussion turned to what is really needed to improve our health care and reign in costs that increase premiums, there was a common theme at both events: the need to reform medical malpractice.

Medical malpractice law suits have had a devastating impact on the practice of medicine in Pennsylvania. Thanks to jury verdicts, expensive settlements to avoid trials, and increasing premiums for malpractice insurance, high risk specialists are in short supply across the state. Medical students educated in Pennsylvania schools leave to practice in other states with more reasonable liability systems. Obstetric units at hospitals have closed all across our region, and trauma care has suffered.

The expensive malpractice premiums paid by our doctors add to their overhead and the cost of their services. The fear of being sued causes doctors to practice “defensive medicine”, ordering more tests and procedures than might be necessary out of fear of being second-guessed by a trial lawyer should something go wrong. This drives up the utilization of medical services and virtually everyone is in agreement that such utilization is a major cost driver in our health care system.

Earlier in this decade, we in Pennsylvania had the opportunity to address and resolve this issue. Instead, legislative leaders literally snatched defeat from the jaws of victory. The high water mark of medical malpractice reform came with House passage of my amendment which was a complete package of medical malpractice solutions. My amendment allowed for a system to limit, or cap, so called non-economic damages (”pain and suffering”), reformed “joint and several” liability to prevent those with deep pockets but no liability from being sued, kept our county doctors out of the lottery-like Philadelphia court system as well as providing reforms to the way in which malpractice awards were paid out. It had all of the necessary ingredients to solve the problem once and for all.
What happened? The bill went to the Senate where it was eviscerated. When it came back to the House it was so watered down that it was no longer recognizable as the bold effort contained in the amendment. The only meaningful provision to survive was the limitation on “venue” to keep suburban doctors out of the Philadelphia court system.

Later we made a second attempt at capping malpractice damages. This took the form of a constitutional amendment. When it became obvious that House leadership was going to allow this effort to die, I took the extraordinary step of filing and bringing a discharge petition to the floor. This was a direct challenge to my own House Republican Leadership as I was bound and determined to bring caps on damages to a vote. I did get the discharge resolution to the floor but we fell about 7 votes short of the numbers needed to pass it.

The current debate on health care makes it clear to me that we need to revive this effort to bring limits and common sense to our malpractice system and litigation in general. Yet it seems no one in Washington is championing this reform that would help lower healthcare costs. It is time the President and Congress drop their single-payer, public option, government controlled, nationalized healthcare fantasies and take the steps necessary to reform our current system while maintaining the best aspects of our health care.

Medical malpractice reform is a good place to start. Providing competition among insurers by allowing the purchasing of insurance across state lines would also help. Greater transparency in pricing for services would allow the consumer to make informed health care decisions. Expanding the use of consumer driven healthcare through Health Savings Accounts (HSAs) will allow individuals to make cost/benefit decisions for their own healthcare as opposed to rationing by federal bureaucrats.

There are plenty of good ideas to reform our healthcare and promote affordability and access for everyone without government control. Once we defeat “ObamaCare” perhaps these good ideas will be taken seriously.

Curt Schroder is in his eighth term representing the 155th District of Pennsylvania. He is currently running for US Congress in the 6th District of Pennsylvania. More information can be found at


Health Alert Squeezing the Providers, Part I
Nov 11, 2009
by John Goodman

The political left in the United States, and for that matter, throughout the world, only knows two ways to try to control health care costs: (1) squeeze the providers and (2) deny patients care. Since they don’t believe in markets or economic incentives or entrepreneurship (the way costs are controlled in other markets), all that’s left is to take it out on doctors and patients.

Today I will address the doctors. To help our thinking, consider these four questions:

Since Medicare pays doctors less than private plans, can we lower the cost of care by enrolling everyone in Medicare?
If through force of law or power of negotiations, we managed to suppress all provider fees, would that lower the cost of care?
Since nonprofit entities don’t have to earn a profit, could we lower the cost of care by outlawing the profit motive in health care?
Have other countries lowered their cost of health care by paying providers less than what we pay?

The answer to all these questions is basically “no.” If you are inclined to answer “yes,” you don’t understand the concept of social cost. But don’t feel too bad. That would put you in the company of some very smart people — who I will charitably decline to name.

In thinking about these questions, the only “cost” that really matters is “social cost.” That is the cost to all of us collectively. I can always lower my private cost of care if I can get you to pay part of the bill. And you can always lower your private cost of care if you can find a way to shift some of your health care costs to me. These observations are both true and trivial.

Social cost is society’s opportunity cost. It is what society as a whole must give up in order to be able to consume something. For example, the social cost of one more doctor is what we must forgo in engineering or architecture or accounting or legal services that we could have had if a bright, talented young doctor entered some field other than medicine.

The same concept applies to other providers. For example, the social cost of a hospital is the value of the forgone uses of the labor and materials that made the hospital possible.

We can divide the aggregate social cost into units. Even though we are still thinking very abstractly, we can talk about the social cost of an hour of a doctor’s time or the social cost of a hospital bed day. But the social cost of a doctor’s hour or of a hospital’s bed day is independent of what anybody happens to pay for it, or even whether anyone pays at all.

To take an extreme example, imagine that we enslave all the doctors — paying them only a subsistence level wage. Let us ignore for a moment the difficulty of forcing a mind and assume they keep right on practicing as before. Would we have lowered the social cost of doctor services? Not by one penny. But we would definitely have changed the incidence of that cost. The private cost to payers would have been lowered by shifting much of that cost to doctors.

Suppose we nationalized a hospital. In the process, we cancel all of its outstanding financial obligations, telling the stockholders and creditors and mortgage holders to take a hike. Similarly, suppose we tell the manufacturers that we plan to keep all the hospital’s CT, MRI and PET scanners without making any more monthly installment payments. Would nationalization of this type lower the social cost of the hospital? Not one whit. Again, what I am describing is a mere shifting of costs from the buyers of care to the people and entities that make that care possible.

Even if these actions don’t lower the social cost of care, why not do them anyway? What’s wrong with screwing the providers if it helps the patients? In general, economists think it’s a good thing for people to pay prices that reflect the social cost of the goods and services they consume. On the buyer side, that means we won’t purchase items unless their value to us is at least as great as the social cost of their production. (Note: As explained elsewhere, ideal insurance contracts help us afford high prices without distorting these incentives.) On the seller side, producers are encouraged to supply services so long as their cost of production is at or below the value people place on them.

By contrast, if the price is way below the social cost of production there will be perverse incentives that lead to three bad outcomes. First, since health care is underpriced, buyers will overconsume it. That means too many doctor visits, too many CT scans, etc. Second, potential producers will withhold valuable services. Returning to my examples, there will be runaway slave doctors, as physicians seek more lucrative opportunities in other markets; future talented people will avoid medicine altogether; and nobody will be building any new hospitals. Third, in absence of prices that reflect social value, care will have to be rationed in some other way — for example, by waiting. But waiting uses up real resources, forces people to delay gratification of needs and in other ways adds to the social cost of care. (More on this in a future Alert.)

In most markets, the principles described here are easily grasped. That’s because in a normal competitive market, price reflects the marginal social cost of real resources used to produce the product.

In health care, things are different. Normal market forces have been so completely suppressed that in health care people rarely face a real price for anything. For the most part there are only reimbursement rates; and for each payer, there can be a different rate. Moreover, these rates almost never reflect the real social cost of the resources used to produce the services we get. For example, charts produced by the International Federation of Health Plans show the following wide range of prices paid in the private sector and in Medicare.

So let’s now answer the first three questions:

Neither Medicare nor private insurers typically pay the real social cost of care. The different fees paid often reflect the results of shifting of costs. An NCPA study by Andrew Rettenmaier and Thomas R. Saving suggests that when Medicare spending is low, private sector spending tends to be high and vice versa — with hospitals at the end of the day managing to cover their outlays.
Although it is possible to suppress provider fees across the board, doing so only shifts costs. It does not lower the true social cost of care.

The cost of capital (including the cost of risk-taking) also cannot be avoided. Just because it does not show up on the books of nonprofit and government entities does not mean it goes away. Either taxpayers or some other entity is always bearing this cost.


Today, the Pennsylvania Medical Society testified in front of the Pennsylvania Senate Insurance and Banking Committee concerning SB 400, a proposal that would create a single-payer health care system in Pennsylvania. Pasted below is written testimony provided by Dr. James Goodyear, president of our organization. I thought you'd like a copy of what Dr. Goodyear presented.

Chuck Moran
Director, Media Relations
Pennsylvania Medical Society
(717) 558-7820

Follow the I4GM and Medical Society on Twitter at

Testimony: Health System Reform Proposals and the Single Payer Initiative

Presented December 16, 2009
To Pennsylvania Senate Banking and Insurance Committee
By James A. Goodyear, MD
Pennsylvania Medical Society

Good morning Mr. Chairman and members of the Pennsylvania Senate Banking and Insurance Committee. I am James A. Goodyear, MD, president of the Pennsylvania Medical Society. I am an active practicing, Board Certified General Surgeon in Montgomery County.

While the purpose of today’s hearing is to discuss Senate Bill 400 in the broader context of health system reform, I need to be clear that the language contained in this specific legislation is not only untenable to our physician members, but in my opinion contrary to our collective efforts to expand access to health care. The Medical Society’s policy on a “single payer” health system is clear. We believe that any health system reform proposal that unfairly concentrates the market power of payers is detrimental to both our patients and physician colleagues. Furthermore, we believe that patient freedom of choice and physician ability to select mode of practice would be limited or even denied under a single payer system as proposed in Senate Bill 400. The bill also contains certificate of need provisions that have already been the subject of intense scrutiny at the federal level through the US Department of Justice (DOJ) and the Federal Trade Commission (FTC). Both the DOJ and the FTC have testified across the country in opposition to certificate of need. We obviously share that position and oppose reestablishing the certificate of need program.

I do believe that the sponsor of Senate Bill 400, Senator Ferlo, as well as the co-sponsors, is well intentioned. We all recognize that our current health care delivery system is not as efficient as it should be and that in some cases fails those most in need. Moreover efforts mentioned within the bill to control health care costs, achieve measurable improvement in health care outcomes, promote a culture of health awareness and develop an integrated health care database to support health care planning and quality assurance are indeed laudable. But to simply place the entire health system in the lap of state government would not help us to reach our objective. Additionally, such a program will potentially interfere with the patient-physician relationship, and the shared decision making so important to our already high quality care.

What we’re really addressing is a much bigger picture … specifically the future of patient access to affordable, safe and quality health care.

The Pennsylvania Medical Society has recently taken extensive steps to develop core principles on the topic of Health System Reform. Over the course of multiple meetings, in coordination with an outside, independent facilitator, we developed eight principles that we believe are essential to achieving effective and efficient health system reform.

As we begin our discussion this morning, I believe it is important to recognize that the national debate on health care is really about “systems” reform and not “health care” reform. Health care reform is too narrow, and doesn’t do justice to what everyone is attempting to achieve. Pragmatically this issue is much greater than how physicians and other health care providers treat patients. It must include all areas involving the delivery of patient care as well as how to expand access.

Regarding our Eight Essential Principles of Health System Reform, they include

Health care coverage should be available and affordable to all American citizens and legal residents.
Patient care should be based on either demonstrated evidence of, or expert consensus on safety, efficacy, and effectiveness.
Health care business transactions and administrative processes should be transparent and use available technology to facilitate information sharing, reduce costs, and improve efficiency.
Health care expenditures should be adequate to improve population-based outcomes, sustain research and innovation, and support workforce training needs.
Health care delivery markets should be constructed to be competitive, thus increasing efficiency, innovation, and quality as well as reinforcing a physician’s ability to compete.
Comprehensive medical liability reform is essential.
The health care system must ensure the choice of provider and health plan or care system.
The health care system must promote the patient-physician relationship, with an emphasis on physician-directed primary and specialty care.

For the Pennsylvania Medical Society, the merits of any proposal, whether here in Harrisburg or in Washington, DC, will be judged on whether or not our core principles are addressed.

More importantly, we understand that the viability of any proposal must ultimately be acceptable to our patients. I believe that you will all agree that as the health care debate intensifies in Washington patients are growing increasingly uneasy. Everyday my patients ask me my opinion about the most recent proposal in the news and express concern about how it may or may not impact the care that I am able to provide to them. Every time I walk into a patient exam room or draw a scalpel across a patient’s abdomen I am focused on one thing and one thing only…the health and well being of my patient. I hope that as policy makers you maintain your focus on my patient as well.

Last year, in the heat of the presidential race, the Institute for Good Medicine at the Pennsylvania polled Pennsylvanians and learned two things. First, there is considerable interest to address some form of health insurance available to all. Second, the public is unwilling to have their taxes increased to make this happen.

Hence, the big question – how do we create better health for all without unwanted taxation? And that’s where our principles come into play.

As you can see, a number of our principles would wisely help lower overall costs and unnecessary spending. So consider several possible ways to reduce costs.

n First, the Pennsylvania Medical Society fully supports meaningful Comparative Effectiveness Research. Reform proposals must be based upon demonstrated scientific evidence of effectiveness for care. It will take some investment of both time and money to build a body of scientific evidence about efficacy of care. But in the long run it will save money by lowering utilization, and improving outcomes.

n Insurance industry reforms must be part of a comprehensive health system reform proposal. Duplicative, cumbersome and confusing insurance practices can directly increase costs. We need to streamline those processes. Managing and minimizing administrative costs is an important step to keep health care costs down.
n Competition must be encouraged to ensure competitive pricing. A truly competitive health insurance market can not only drive down premiums, but can also improve benefits and services to our patients.
n Defensive medicine, which is defined as unnecessary tests, consultations, and treatments utilized to insulate a physician against frivolous lawsuits, needs to be addressed via meaningful medical liability reform.
A 2009 analysis from the nonpartisan Congressional Budget Office estimates that government health care programs could save $41 billion over 10 years if nationwide limits on jury awards for pain and suffering and other similar curbs were enacted.[1][1][1][1] That’s about 5 percent of the cost of some of the federal proposals, which isn’t small change. Estimates for costs of defensive medicine in the private sector have been reported as high as of $100 billion annually.

The Pennsylvania Medical Society is actively comparing every health system reform proposal to the Eight Essential Principles that we’ve developed. Whether we’re discussing the merits of SB 400 or any other proposal here in Pennsylvania or Washington, our goal remains the same; objectively analyze each proposal based upon these core principles gauge our level of support accordingly.

As the issue of health system reform continues to heat up, let me conclude my remarks by saying that the Medical Society isn’t simply sitting back waiting for reforms to take shape. There are a number of things we are doing everyday without legislative intervention to get patients on track for better health.

We are encouraging our youth to be physically active. We want Pennsylvanians to stop smoking. And, we want our patients to receive safe and effective treatments. And that’s just a sampling of our many ongoing projects. Why? According to the 2009 Good Medicine Report produced by the Institute for Good Medicine, the greatest need within health care is patient education so that patients themselves can become a more active participant in their own health and well being.

I would be remiss if I didn’t add just one more comment before I conclude this morning. As our nation debates health system reform, please know that Pennsylvania physicians are rolling up the sleeves every day to treat, without compensation, your constituents who are not fortunate enough to have health care insurance. Interestingly enough, the Medical Society’s 2008 Good Medicine Report also revealed that medical society members alone donated the equivalent of about $400 million in charitable care and supplies. If I may, I’d like to repeat that. Every day patients are treated for free by physicians in private practice. I believe it is important that we don’t lose sight of the caring and committed nature of the physician community.

As I mentioned at the beginning of my remarks, I care deeply about my patients. I appreciate this opportunity to provide our views, my views, to the Committee on these critical matters affecting Pennsylvania’s patients and physicians. I am convinced that if physicians, patients, and policy makers work together we can achieve our collective goal of ensuring that everyone has access to quality and cost effective health care services in Pennsylvania.

Thank you.

((Well DONE, Dr. Goodyear))


November 11, 2009
The U.S. House of Presumptuous Meddlers By John Stossel

As an American, I am embarrassed that the U.S. House of Representatives has 220 members who actually believe the government can successfully centrally plan the medical and insurance industries.

I'm embarrassed that my representatives think that government can subsidize the consumption of medical care without increasing the budget deficit or interfering with free choice.

It's a triumph of mindless wishful thinking over logic and experience.

The 1,990-page bill is breathtaking in its bone-headed audacity. The notion that a small group of politicians can know enough to design something so complex and so personal is astounding. That they were advised by "experts" means nothing since no one is expert enough to do that. There are too many tradeoffs faced by unique individuals with infinitely varying needs.

Government cannot do simple things efficiently. The bureaucrats struggle to count votes correctly. They give subsidized loans to "homeowners" who turn out to be 4-year-olds. Yet congressmen want government to manage our medicine and insurance.

Competition is a "discovery procedure," Nobel-prize-winning economist F. A. Hayek taught. Through the competitive market process, we producers and consumers constantly learn things that force us to adjust our behavior if we are to succeed. Central planners fail for two reasons:

First, knowledge about supply, demand, individual preferences and resource availability is scattered -- much of it never articulated -- throughout society. It is not concentrated in a database where a group of planners can access it.

Second, this "data" is dynamic: It changes without notice.

No matter how honorable the central planners' intentions, they will fail because they cannot know the needs and wishes of 300 million different people. And if they somehow did know their needs, they wouldn't know them tomorrow.

Proponents of so-called reform -- it's not really reform unless it makes things better -- have shamefully avoided criticism of their proposals. Often they just dismiss their opponents as greedy corporate apologists or paranoid right-wing loonies. That's easier than answering questions like these:

1) How can the government subsidize the purchase of medical services without driving up prices? Econ 101 teaches -- without controversy -- that when demand goes up, if other things remain equal, price goes up. The politicians want to have their cake and eat it, too.
2) How can the government promise lower medical costs without restricting choices? Medicare already does that. Once the planners' mandatory insurance pushes prices to new heights, they must put even tougher limits on what we may buy -- or their budget will be even deeper in the red than it already is. As economist Thomas Sowell points out, government cannot really reduce costs. All it can do is disguise and shift costs (through taxation) and refuse to pay for some services (rationing).
3) How does government "create choice" by imposing uniformity on insurers? Uniformity limits choice. Under House Speaker Nancy Pelosi's bill and the Senate versions, government would dictate to all insurers what their "minimum" coverage policy must include. Truly basic high-deductible, low-cost catastrophic policies tailored to individual needs would be forbidden.
4) How does it "create choice" by making insurance companies compete against a privileged government-sponsored program? The so-called government option, let's call it Fannie Med, would have implicit government backing and therefore little market discipline. The resulting environment of conformity and government power is not what I mean by choice and competition. Rep. Barney Frank is at least honest enough
to say that the public option will bring us a government monopoly.
Advocates of government control want you to believe that the serious shortcomings of our medical and insurance system are failures of the free market. But that's impossible because our market is not free. Each state operates a cozy medical and insurance cartel that restricts competition through licensing and keeps prices higher than they would be in a genuine free market. But the planners won't talk about that. After all, if government is the problem in the first place, how can they justify a government takeover?

Many people are priced out of the medical and insurance markets for one reason: the politicians' refusal to give up power. Allowing them to seize another 16 percent of the economy won't solve our problems.
Freedom will.

Copyright 2009, Creators Syndicate Inc.
Page Printed from: at November 11, 2009 - 08:53:08 AM CST

December 16, 2009
Senate's Solution: Consumer Choice Is Dead on Arrival
Linda Halderman, MD

According to the health care reform bill being debated in the U.S. Senate, there's an easy way to solve the problem of the uninsured in this country:

Force people to buy health insurance just like we do with auto insurance.
Make insurance companies accept everyone who applies, including those who want insurance only when they're sick.
Don't let companies get away with selling plans that don't cover everything.
These three forms of health insurance regulation -- individual mandates, guaranteed issue, and coverage mandates -- have been attempted in a number of states, including California, Massachusetts, New Jersey, New York, and Washington. The results are described below.

Individual Mandates: "You'll buy it or else."

A popular theme in the health care reform debate is "shared responsibility." Attempting to increase individual responsibility, a number of states have enacted a mandate that all citizens must purchase health insurance.

The theory behind individual mandates is that insurance becomes more affordable when purchased by a larger, healthier group of applicants. Adding individuals to the risk pool who are less expensive to insure (and currently the least likely to buy it) would theoretically lower the cost for all those insured.

But in practice, individual mandates have had a different effect on what people pay for health insurance. The impact of mandates on insurance premiums is in large part a consequence of "Guaranteed Issue," which is described in detail in the next section.

Part of the problem with individual mandates is enforcement. Voters have consistently rejected mandates that would use the tax code or wage garnishment to ensure compliance.

Without "teeth," mandates provide no compelling reason to purchase expensive, unwanted insurance policies before an individual becomes ill. And even harsh penalties would miss the unemployed and non-citizens, who represent a large percentage of the growth in the uninsured.

This has the effect of driving up costs: Less healthy individuals requiring expensive treatment expand the insurance pool while healthy individuals avoid buying policies.

Some proponents of individual mandates try to make an analogy to the auto insurance industry. But this is not a logical comparison:

Auto insurance is mandated only for those who drive, a far smaller pool than those who would be mandated to buy health insurance.

Consumers shopping for auto insurance have competition on their side: Policies can be purchased from insurance companies offered in other states, driving down premiums as agencies compete with other carriers. Inexpensive policies are available across state lines, unlike health insurance plans sold only within a single state. Bostonians are prohibited from buying North Dakota health plans that cost 60% less than those sold in Massachusetts.

Limited-coverage auto insurance policies can be purchased, offering only the liability coverage required by law rather than more expensive comprehensive plans. Under California's Low Cost Auto Insurance Program, premiums can be less than $25 per month. State regulations bar the health insurance industry from offering low-cost plans with limited coverage even when the consumer wants that choice.

Despite the fact that all fifty states mandate auto insurance coverage for drivers, up to 25% of state residents remain uninsured. Even with far simpler opportunities available for enforcing the auto insurance mandate (e.g., requiring proof of coverage before obtaining a driver's license and registration), the California Department of Insurance estimated in 2003 that 14.3% of all registered vehicles were uninsured. This does not account for unregistered vehicles or those with expired registrations, of particular importance in parts of the state with a high percentage of undocumented immigrants on the road.

Governor Mitt Romney succeeded in imposing an individual government mandate for health care on the citizens of Massachusetts. Taxpayers in that state now fund subsidies for insurance premiums that have risen more than 30% since the governor's plan was enacted.

Individual mandates, though popular in political rhetoric, do not address the fundamental problem people face when buying health insurance: expense.

Guaranteed Issue: "You'll sell it or else."

For an individual government mandate to compel the purchase of health insurance, another government requirement for something called "Guaranteed Issue" must first be enacted.

"Guaranteed Issue" forces every insurance company to sell health insurance to every applicant regardless of age, health history, lifestyle, or
risk factors.

In theory, this appears sound. If health insurance companies can't "just say no" to high-risk applicants, no one will be left without access to coverage.

Unfortunately, the law of unintended consequences trumps this logic. Under Guaranteed Issue mandates, "access to coverage" becomes "access to higher premiums."

In New Jersey and Massachusetts, unlike in California, laws were passed to force every insurance carrier to sell plans to every individual applicant. Individual insurance premiums in New Jersey and Massachusetts are three times higher than those in California.

Washington State tried Guaranteed Issue. With no way to mitigate risk, insurance carriers in the state suffered severe
financial losses related to high-risk patients. They then exited the individual market; no individual health insurance plans were accessible to Washington residents at any price.

Senator Clinton was not a New Yorker in 1993. But that was the year New York State forced Guaranteed Issue on the health insurance market. Five hundred thousand New Yorkers then canceled their health insurance plans, as rates for a third of all those insured had increased by 20%-59%.

The Heritage Foundation published a 1998 study evaluating the sixteen states in which the most aggressive health insurance mandates and regulations were passed between 1990 and 1994. The goal of these individual, employer, and insurance industry mandates -- including individual mandates, Guaranteed Issue, and price fixing of premiums -- was to increase access to coverage and decrease the uninsured population in a given state. The effects were than compared to conditions in the thirty-four states that had not enacted such regulations.

The two groups of states shared nearly equivalent rates of uninsured residents before the reforms. But by 1996, the sixteen states with the most aggressive reforms (including New Jersey, New York, and Washington) experienced a growth rate in their uninsured population eight times higher than the thirty-four states without such mandates. Additionally, the percentage of the population covered by private or individual insurance declined.
Coverage Mandates: "We'll tell you what you need."

Insurance coverage mandates refer to the restrictions each state sets on which type of policy can be sold legally within that market. For example, fourteen states require all insurance plans sold to cover infertility treatments, regardless of the patient's need or desire for these services. Other states ban the sale of insurance plans unless they include coverage for massage therapy, obesity surgery, pastoral care, and wigs.

Needle-phobic consumers cannot buy plans without acupuncture coverage, and teetotalers must pay for plans that include inpatient drug rehabilitation.

According to the National Center for Policy Analysis, just twelve of the most common insurance mandates currently in place raise premium rates by 30%.

The State of California forces over fifty such mandates on the employer-provided (group) insurance market, but not on individual plans. Consequently, it costs three times more for California employers to offer insurance than if a plan is privately purchased.

In mandate-heavy states, consumers are denied the option of buying low-cost, basic health insurance plans to cover major illness or injury. They cannot choose to save money by paying out of pocket for ten-dollar pneumococcus pneumonia vaccines and ninety-dollar mammograms, thereby reserving health insurance for significant expenses.

In those states, insurance is not insurance at all -- it is expensive, prepaid health care.

When Hummers and Ferraris are the only vehicles sold, people on Toyota
budgets can't afford transportation.

Dr. Linda Halderman is a General Surgeon and policy adviser in the California State Senate. Since the September 29, 2009 earthquake and tsunami that devastated the South Pacific, she has been providing medical relief on American Samoa.


Enzi: Common Sense Has Left the Building
By Sen. Mike Enzi
Special to Roll Call
Dec. 14, 2009, 12 a.m.

Before I came to the Senate, I was a small-business man. My wife and I owned three shoe stores. When I was showing someone a shoe and he said he didn’t like it or couldn’t afford it, I didn’t try another sales pitch. I knew it was time to find another shoe — one he liked and could afford.

There’s a lesson in that story when it comes to health care reform. The American people don’t like the partisan bills that Majority Leader Harry Reid (D-Nev.) and Speaker Nancy Pelosi (D-Calif.) are selling. And the American people can’t afford these bills, either. They’re begging us, in phone calls, letters, e-mails, town halls and protests, to go back to the stock room and show them something much different, and something much more affordable.

The American people want health care reform that will expand access, improve quality and reduce costs. Unfortunately, when they look at the partisan bills that Pelosi and Reid have put forward, they see 2,000-page monstrosities that will drive up their health care costs, increase their taxes, cut their Medicare benefits and rob them of the right to see the doctors they choose. They know these bills will add to the country’s debt, and they’re afraid that Congress is willing to mortgage their children’s and grandchildren’s futures in exchange for short-term political gain.

Luckily for all Americans, it’s not too late to send the flawed bills back to the stock room. The majority should get to work with Republicans on a series of bipartisan proposals that will earn the trust and confidence of the American people.

Here’s how it could work: Instead of one party trying to jam through a starkly partisan bill, we would work together on behalf of the American people. Rather than dealing with 2,000-page bills that bite off way more than we can chew, we would go step by step, dealing with the problems in our health care system, and earning public faith along the way. We would not hike taxes on middle-class families and small businesses, or cut Medicare benefits for seniors, to create costly new entitlements. We would work to reduce health care costs and make insurance more affordable. We would not resort to dishonest accounting gimmicks to hide the costs of our proposals. Washington, D.C., also should not tell you what kind of insurance to buy and fine you if you don’t.

If we took this approach, there are a number of areas where we could quickly find agreement and make progress to reduce health care costs, expand access to health insurance for all, and improve the quality of care that patients receive.

Study after study shows that the Pelosi/Reid bills would drive up health care costs for most American families, breaking the promises that President Barack Obama made to the American people. In 2005, I brought a bill to the Senate floor that would have allowed small businesses to band together across state lines and use their increased numbers to negotiate the kinds of lower-cost, higher-quality health insurance plans that larger companies get. The nonpartisan Congressional Budget Office said my bill would reduce costs for small businesses and save taxpayer money. Let’s make small-business health plans happen as part of health care reform.
The Pelosi/Reid bills expand the role of government, but they don’t promote real competition to bring down costs or improve quality. We know that by allowing people to buy health insurance across state lines, we can help people find affordable plans that meet their needs, and force insurance companies to reduce the costs and improve the quality of their plans. Let’s make insurance companies compete for our business.

Our country’s lawyer-centered medical liability system doesn’t serve patients or doctors, and it is a driving factor behind skyrocketing health care costs. Even Obama has called for medical liability reform. Yet the Pelosi/Reid bills specifically prohibit states from taking meaningful action to reduce the costs of junk lawsuits. That only makes sense if you’re counting campaign contributions from the trial bar. Let’s enact meaningful reform that will cut costs, improve patient safety, get more of the money for the injured party quicker, and get doctors out of the courtroom and back in the operating room — the American people will appreciate it, even if the trial lawyers don’t.
We need to protect patients by prohibiting insurance companies from discrimination based on pre-existing conditions. No one should be denied health insurance, and no one should lose their health insurance because they checked the wrong box on a form. Let’s make sure that all Americans can get the care they need.

By boosting competition and reducing costs, we could make these changes without increasing taxes on middle-class families and small businesses, cutting benefits for seniors or adding trillions to the deficit. These steps would put us on the right path toward health care reform that would truly reduce health care costs, improve quality and expand coverage. These changes could have bipartisan support and would earn the confidence of the American people.

It’s not too late for common-sense, bipartisan health care reform to give every American access to quality, affordable care. Let’s scrap the Pelosi/Reid bills, start over, and give the American people the right fit in reform — a bill they want, deserve and can afford.

Sen. Mike Enzi (R-Wyo.) is ranking member of the Senate Health, Education, Labor and Pensions Committee.


The Washington Times
The goals are laudable but elusive
Bills would add to paperwork, not real improvement
Sunday, December 13, 2009
By Dr. Eric Novack

Increased and broadened access to health care, control of costs and improved quality are goals all Americans share, regardless of party affiliation. No one is "against reform," contrary to the claims the defenders of the current bills.

The problem is that the bills as written not only fail to address the access, cost and quality challenges - they will make each one worse.

An appropriate, sustainable safety-net health care system is something nearly all Americans can agree is desirable. For the approximately 10 million Americans who are chronically uninsured, supposedly they merely have to wait until 2014 for relief under this bill. But complications abound.
Yes, a new "high-risk pool" is created in both the House and Senate versions, but it is woefully underfunded and the premiums will be 25 percent higher than premiums today. A prescription for health? Few think so.

The politicization of access even to preventive care has reared its head. A small group of "experts" who do not treat women dealing with breast cancer determined that women from ages 40 to 50 should forgo mammograms. Their opinion would matter little to women concerned about breast cancer and those who love them, except for the simple fact that Congress is considering giving that same group enormous power to influence what care will be available in the new "health exchanges," with or without a government-run plan.

Access to care for populations at risk due to income or ethnicity, which proponents seek to resolve, is also ignored in the bills. Low-income Americans are shoved into the Medicaid system, primarily because the Democratic leadership has determined that it is cheaper than allowing low-income Americans access to the health insurance exchanges available to those of better means.
How can those who claim to advocate for the poor stand silently? And, with the massive influx of millions into the system, who will care for them?

In Massachusetts, the model upon which these bills are based, 40 percent of primary care practices are closed to new patients. The Senate bill does nothing to address this impending, identifiable crisis.

And this is even before the nearly 40 percent cuts in payment to doctors under Medicare (before inflation) that are not addressed in the bill. What ensures that doctors will keep accepting Medicare and Medicaid patients?

With such unanswered questions about access, one would surely expect that Congress is tackling the cost problem.

Let's see. The bill would start generating revenue right away but give precious little to the American people in return for the next four years. Over the next several years, costs would begin to explode while revenues fail to keep pace.

The bill also forces massive spending through mandates on individuals, families and businesses. Failing to buy what the government would offer (and it is uncertain whether it will even be able to deliver the product the mandates propose) will result in penalties, taxes - and failing that, greater penalties and possibly even criminal prosecution.

And most amazingly, nobody - from the House to the Senate to the White House - is now even willing to say health care will become less expensive.

Nor can they prove that the quality of care would increase.

The House and Senate bills confuse the concept of quality care with creating dozens of new commissions and task forces to generate reports, create programs, write rules and enforce regulations, all while providing no actual health care to anyone.

The Senate bill being considered, and the House bill that squeaked by, are abject failures in the three main areas for which they were ostensibly written.

An ever-decreasing minority of Americans thinks Congress should actually pass these bills - and those who do are motivated by either a fear of political Armageddon or an irrational belief that the bill will be easier to "fix" once it is the law of the land.

Dr. Eric Novack, an orthopedic surgeon, is senior fellow in health policy for Americans for Prosperity and chairman of Arizonans for Health Care Freedom.


From Diana M Reimer
Tea Party Patriots National Coordinator
Hello to all

As I have learned on my many trips to DC our representative like to hear from their constituents. If you have friends or family in the states that your senator is not in, please have them fax, email and call their senators asking them to vote against the HealthCare Bill, no to mandates, compromise and cloture, no abortion, no bill.

We do not want this bill. HealthCare needs to be reformed. Fix what is broken.

Sen. Michael F Bennet, Colorado
DC Office Phone Number: 202-224-5852, DC Fax Number: 202-228-5036

Sen. Ben Nelson, Nebraska DC Office Number: 202-224-6551, DC Fax Number: 202-228-0012

Sen. Mary Landrieu, Louisiana DC Office Phone Number: 202-224-5824, DC Fax Number: 202-224-9735

Sen. Mark Pryor, Arkansas DC Office Phone Number: 202-224-2353, DC Fax Number: 202-228-0908

Sen. Blanche Lincoln, Arkansas DC Office Phone Number: 202-224-4843, DC Fax Number: 202-228-1371

Sen. Robert Byrd, West Virginia DC Office Phone Number: 202-224-3954, DC Fax Number: 202-228-0002

Sen. Jim Webb, Virginia DC Office Phone Number: 202-224-4024, DC Fax Number: 202-228-6363

Sen. Mark Warner, Virginia DC Office Phone Number: 202-224-2023, DC Fax Number: 202-224-6295

Sen. Jon Tester, Montana DC Office Phone Number: 202-224-2644, DC Fax Number: 202-224-8594

Sen. Joe Lieberman, Connecticut DC Office Phone Number: 202-224-4041, DC Fax Number: 202-224-9750

Sen. Mark Begich, Alaska DC Office Phone Number: 202-224-3004, DC Fax Number: 202-224-2354

Sen. Evan Bayh, Indiana DC Office Phone Number: 202-224-5623, DC Fax Number: 202-228-1377

Sen. Thomas Carper, Delaware
DC Office Phone Number: 202 224-2441, DC Fax Number: 202-228-2190

Sen.Olympia Snow, Maine
DC Office Phone Number: 202-224-5344, DC Fax Number 202-224-1946

Sen. Susan Collins, Maine
DC Office Phone Number: 202-224-2523, DC Fax Number 202-224-2693

Sen. Arlen Specter, PA
DC Office Phone Number: 202-224-4254, DC Fax Number 202-228-1229

Sen. Robert Casey, PA
DC Office Phone Number: 202-224-6324, DC Fax Number 202-228-0604

Thank you
Diana M Reimer
Tea Party Patriots National Coordinator
National Leadership Council
PA State Coordinator
Philadelphia Tea Party Patriots Organizer


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