Monday, March 15, 2010

3/15/2010 - Part 1 - NEWS - Homestretch Scramble for Votes

3/15/2010 - Liability and Health News Update
Part 1 - NEWS - Homestretch Scramble for Votes

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

This LIABILITY AND HEALTH NEWS UPDATE "newsletter" is a free service which I provide, as a volunteer, to help supply medical liability reform and health care reform news and information, legislative updates, and political insight to physicians, patients, liability reform and quality health care advocates. NO ONE pays me to do this. I am not employed by any physician or health care reform advocacy or liability reform organization, political party or candidate, although I volunteer for several. I am a quality health care, physician and patient advocate, breast cancer survivor, physician's spouse, journalist, political noisemaker, mom, and freelance writer. I am not nor will I ever claim to be unbiased (I am....biased, I mean), unlike many in the mainstream media. Most information in this newsletter is copied and pasted from other sources, and will always be identified with links. Opinions and clarifications are my own, and do not reflect the official position of any physician or patient advocacy organization, tort reform, or health care reform group unless stated as such. My opinions are placed in double parentheses (("my opinion")), italicized and appear in blue.
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Commentary

I've split this Update into two parts to make it easier for people to access.

This first part is the NEWS section, featuring a wide range of articles about what's going on in Washington this week that will impact how doctors and patients interact in the future. If you want a thorough education in the latest info about the health care reform debate, read this part first.

The second part is filled with ACTION ITEMS from various groups which oppose the measures - as well as some insider information about what the other side has planned for the coming days. If you're sick of reading the day by day articles and analysis (like I am) jump right to the second Liability and Health News Update in your email box, Part 2, and get started.

EVERYTHING you need to be an effective advocate, no matter who you are or what you do, is right there. Just click on the links, start dialing your phone, or start typing....

A Democratic PA representative who's been targeted as a POSSIBLE "NO" vote is complaining about those shameless insurance companies who are bothering him and trying to get him to oppose the bill. The article from the Sunbury News Item appears in Part 2 - right after Rep. Carney's contact information.

Any "big insurance companies" out there? You should be ashamed of yourselves, picking on this innocent little Congressman. Leave the poor man alone and pick on somebody your own size!

Citizens, patients, physicians, etc. - YOU just keep up the pressure. (Unless, of course, you're secretly being PAID by one of those big insurance companies, in which case YOU should be ashamed of yourselves, too!)

Ridiculous, isn't it? The people who support the health care plan, financed by Big Unions, the Democratic Party, ACORN, MoveOn.org and lots of other folks with a political agenda, are lovingly considered "grassroots" by the media, despite the fact that SOMEONE is making their signs and pins and bussing them from event to event. (There's proof of this in Part 2 as well - an "insider" email from the folks at Health Care for America Now and another from MoveOn.org.)

Yet people like YOU are accused of being shills for the insurance industry, puppets of the GOP, "astroturf" and God knows what else.

One of the items in Part 2 is an email from Health Care for America NOW - an outgrowth of the Obama Presidential Campaign and the administration's "army" of "grassroots" volunteers.

(Kind of like the "citizen militia" the President said he'd like to see formed that will be as large and well funded as the military. Of course, he only said that ONCE, in an interview before the election, and as soon as people started screaming about it, he never mentioned it again - until AFTER the election, on the transition website, where it was stated that college students would have to perform two years of mandatory "service," - presumably in the President's "citizen militia." After a little more screaming, that idea disappeared from the website, replaced by general encouragement to do public service....)

These are the people we've all seen demonstrating in favor of the massive health care bills supported by the White House and the Democrats in Congress. They're the ones with the slick pre-printed signs (which say SEIU or MoveOn.org in the teensy little print) and cutesy buttons with President Obama's campaign logo that say "Health Care for All" or some other such innocuous-sounding slogan. Not me, I only support health care for SOME....gag.

Of course, the group claims to be non-partisan, but we know better. This email was obtained through the efforts of a GENUINE grassroots group of Americans, one of PA's TEA Party/9-12 groups.

We're passing it along in the hope that knowing what THEY'RE doing to force this massive health care overhaul on Americans who DON'T WANT IT will urge all of us to do everything WE CAN to oppose it.

For example, they have demonstrations planned at all of Pennsylvania's "swing vote" members of Congress this week. Of course, so do WE. That's all in Part 2.

No, we don't have slick pre-printed signs and cutesy campaign buttons. But we DO know what's in the proposed legislation, and we know it doesn't have anything to do with providing quality health care at costs people can afford.

If that were true, 58% of Americans WOULDN'T oppose it, Nancy Pelosi wouldn't be telling people that we have to pass it to find out what's IN it or trying to find a stealth way in which they can pass it without ACTUALLY passing it by voting on an empty shell of a law changing some of the provisions of the Senate bill which "deems" it passed. That's so Democrats whose constituents oppose it and are spitting angry can say "Duh, well, don't take it out on ME, I never voted for a health care bill."

They must consider the American public to be SERIOUSLY STUPID if they believe they can so blatantly flout the rules of the legislature and the constitution to pass a bill when they don't have enough votes to pass a bill - and that there won't be consequences for their actions? Of course, this is the same administration which has stated on more than one occasion that the American people don't love the health care bill because they don't "understand it," (you dummies) and whose leader in the House of Representatives has told her colleagues that they should pass it so we can see what's IN it.

And they think WE'RE stupid?

If people really wanted this, Democrats in Congress would have passed it already, instead of blaming Republicans, who have no control whatsoever over it, for "obstruction." Smart Democrats who don't want to lose their jobs in November are listening to America - but we need to keep making noise, because the army of "volunteers" from the unions, ACORN, MoveOn and the Tides Foundation are yelling as loudly as THEY CAN - and, I suspect, the Chicago mob is making it very clear to the people who are wavering that their political careers will be "sleeping with the fishes" if they vote the way their consciences - and their CONSTITUENTS - want them to vote. MoveON.org is actually threatening swing votes with political retribution - along the lines of "Ya vote wrong, we're gonna get somebody to run against ya in your primary."

Lots of news and analysis in Part 1, including a piece by President Obama's cousin, a practicing radiologist who seriously opposes the health care plan. OUCH.

Please turn to Part 2 for ALL the ways you can get involved to keep this health care disaster from happening - and THANK YOU for all you've already done.

DBR

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From the Morning Bell Newsletter, from the Heritage Foundation
QUICK HITS

Minutes before midnight on Sunday, House Democrats released a 2,309 "reconciliation" bill that the Budget Committee will pass early this week. The bill is a replica of the bill reported to Ways and Means last year, except with a government takeover of the student lending industry tacked on. This entire shell of a bill will be scrapped and replaced with the real reconciliation bill Speaker Nancy Pelosi (D-CA) is writing behind closed doors.

House Democrats on Sunday night set into motion what they hope will be the final steps on healthcare reform.
The House Budget Committee on Sunday evening released text that will serve as the base legislation for the changes the House will seek to the Senate bill this week.
Specifically, the Budget committee released a 2,309-page effort that had been previously recommended to the Education and Labor Committee and Ways and Means Committee last year.
The measure posted online does not include the substantive changes to the Senate healthcare bill that House Democrats will seek. Those changes will be offered during the markups in the Budget and Rules committees, which the budget panel hopes to begin on Monday afternoon.
The House is expected to approve the Senate's healthcare bill along with the package of changes. The Senate would then be expected to approve the package of changes under budget reconciliation rules. ((No guarantee of that, though....))
Because the bill will be considered under budget reconciliation rules in the Senate, GOP senators will not be able to filibuster the package and Democrats will not need 60 votes to move the legislation through the Seante.
The House has demanded the Senate approve changes to its healthcare bill in exchange for the House voting for the Senate bill.
House Democrats hope to complete their work by this weekend, before President Barack Obama begins an overseas trip he delayed for several days to focus on healthcare.
The markup by the Budget Committee is the first step toward bringing the measure to the House floor.

Find the entire legislation here

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From Politico.com
Homestretch scramble for House votes
http://www.politico.com/news/stories/0310/34393.html
By PATRICK O'CONNOR 3/15/10 4:58 AM EDT

Barack Obama faces the stiffest test of his first-term agenda — and a defining moment in his presidency — as Democratic Party leaders mount a fevered campaign this week to round up votes for a historic health care bill. Two top aides — senior adviser David Axelrod and press secretary Robert Gibbs — said Sunday the votes will be there. Other Democrats aren’t so sure. After nearly a year of haggling, most of House Speaker Nancy Pelosi’s 252 Democratic colleagues still have concerns about passing the Senate bill, even with some fixes.
Their objections range from the ideological to the procedural, and the shape of the final package hinges on an obscure, unelected official — Senate parliamentarian Alan Frumin. Here are the five largest potential pitfalls: Abortion Back in November, Pelosi cut an eleventh-hour deal with opponents of abortion to salvage the first reform vote. It’s not clear this time how she will get around the issue to save the bill.
Rep. Bart Stupak (D-Mich.) said he has a dozen votes that could sink reform if party leaders don’t keep his language, which bans using federal subsidies to buy elective abortion coverage through the exchange. But Pelosi is calling his bluff, as Democrats are going ahead with the less strict Senate language. The result will come down to a handful of senior Democrats, such as Illinois Rep. Jerry Costello and Minnesota Rep. James Oberstar, and some younger members, such as first-term Reps. Kathleen Dahlkemper of Pennsylvania and Steve Driehaus of Ohio. Will their objections to the Senate’s restrictions be enough to kill their party’s top domestic priority for at least a generation?
The president and party leaders will make that case repeatedly during the next week. “We don’t want to go without their votes, but we do want to forge ahead,” House Majority Leader Steny Hoyer (D-Md.) said Friday. “Mr. Stupak has made it very, very clear that he’s very strongly in favor of achieving health care reform in this Congress. And I think that a lot of his colleagues feel the same way.”
But that appeal might not be enough for an issue of moral conviction to a core constituency of congressional Democrats, especially if the Roman Catholic Church, the National Right to Life Committee and other outside groups continue to oppose it. Catholic bishops brought the issue into the pews Sunday, asking local parishes to put an insert into the bulletins for Sunday’s Mass calling the Senate language “seriously deficient and unacceptable.” Bending the House rules Add the “Slaughter solution” to the long list of catchphrases Republicans have seized on to make the case that Democrats are bending the rules to enact a health care bill no one really likes.

The so-called solution, named for House Rules Committee Chairwoman Louise Slaughter (D-N.Y.), would “deem” the Senate bill passed if House Democrats approve a package of fixes.

In other words, House members wouldn’t have to formally cast a vote on a bill that most of them don’t want to defend on the campaign trail — but it would pass anyway. The speaker told her rank and file Friday that the decision was still up in the air but she thought this was the way most of her members wanted to handle the Senate bill.

Republicans are howling, calling it an only-in-Congress sort of trick that makes voters see red.
“We’re seeing a perversion of rules to ram through this trillion-dollar health care bill,” House Minority Whip Eric Cantor (R-Va.) said on “Fox News Sunday.” Republicans have been blasting Democrats for weeks about employing a parliamentary maneuver called reconciliation to get a health care bill through the Senate with only 51 votes, so some Democrats are quietly concerned that tweaking the rules again would look bad — and that they’ll have to answer for the Senate bill either way.
The parliamentarian
It’s not just the Slaughter solution. It’s not just reconciliation. It’s a complicated dance between the two chambers about who goes first and what that means. Enter Frumin, whose office issues rulings to the congressional leadership but generally steers clear of explaining itself to the public. So there was confusion last week about whether the Democrats could do what they wanted, which involves holding onto the Senate bill in the House to make sure the Senate passes the package of fixes. But Pelosi said Friday that the House will pass the Senate bill, then the reconciliation bill at roughly the same time. The Senate bill will then be sent to the president for his signature, she said. Then at some point, the Senate will still have to pass the fixes included in the reconciliation bill. But it means that final passage of health reform — the biggest package of social reforms in 50 years — will pass with an asterisk attached, a sort of “to be continued ...,” at least until the Senate vote on the reconciliation bill. Pelosi dismissed suggestions that the parliamentary machinations would cause wavering Democrats even more unease. “It isn’t going to make any difference, except maybe [to] the mood that people are in,” she said. “The fact is that once we pass it in the House, it’s going to be the law of the land.” ((So....the mood of the public doesn't matter....at ALL))

And if it seems like one unelected guy no one’s ever heard of has a lot of say over the process, that’s how some House members feel, too. “I’d really like to meet that guy in Philadelphia, whoever the parliamentarian is, anyway,” Rep. Bill Pascrell (D-N.J.) said. House-Senate distrust Last week, West Virginia Sen. John Rockefeller joked that Pelosi wouldn’t speak to Senate Majority Leader Harry Reid for 25 years if the House passes the Senate’s health care bill and Reid fails to get the 51 votes he needs for a package of fixes.

And that might be forgiving. Almost since Obama took the oath of office, House Democrats have complained that they’re doing all the work, only to watch the Senate screw it up or — worse — fail to do anything at all. The health care debate has only added to the decades-old animus, after liberals watched Connecticut independent Joe Lieberman almost single-handedly kill the public option.
“I don’t think we should simply assume Mr. Reid has 51 votes,” Pascrell said. “I don’t know what the hell is going on over there in the Senate.” Of course, Rep. Anthony Weiner, the ever-quotable New York Democrat, probably coined the best line when he said, “Fool me once, shame on you. Fool me 290 times, shame on me.”
It remains a problem that House Democrats are powerless to overcome. But it probably won’t be enough to force them to vote against legislation many have campaigned on for most of their public lives. Immigration Few issues stir more anger than health care reform. Immigration is one. Amid all the infighting about other issues, the White House has kept Hispanic Democrats largely silent this year by promising to move a comprehensive immigration bill once health care is finished. But first, they would have to vote for Senate health language many of them oppose — including a ban on undocumented immigrants buying insurance through a new exchange.
Obama met last week with the Congressional Hispanic Caucus and pledged to work with its members on a fix, lawmakers said. That meeting seemed to quiet — at least for now — one of the most vocal opponents of the Senate restrictions, Illinois Rep. Luis Gutierrez, who said the president has the authority to make changes outside the bill that would mollify these Democrats. But the Chicagoan said Hispanic lawmakers “need meaningful progress” on the question of what to do with illegal immigrants already in this country. And he said he’s rallying immigrant groups to push hard for an overhaul. “It’s in their court,” Gutierrez said of the White House.
Carrie Budoff Brown contributed to this report.

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Conservatives for Patients' Rights Newsletter - Today

For those of you who didn’t believe the liberals in Congress were crazy enough to push forward with ObamaCare after poll numbers continue to indicate that a vote for this bill is political death for many moderate Democrats, it is time to believe it. Speaker Nancy Pelosi has scheduled a vote this week after coming up with a complicated procedure to get the bill to the President’s desk without House members having to vote directly on the bill.
It is not surprising that Assistant to the Speaker Chris Van Hollen (D-MD) advised members to avoid any talk about the unconstitutional manner in which they are considering to pass the bill. In the Wall Street Journal, Michael McConnell, a constitutional law scholar, also explains why the Democrats' strategy is unconstitutional.
The Hill reports that Democrats are expecting to begin markup today on the 2,309-page draft health care legislation released by the House Budget Committee. "The measure posted online does not include the substantive changes to the Senate healthcare bill that House Democrats will seek. Those changes will be offered during the markups in the Budget and Rules committees, which the budget panel hopes to begin on Monday afternoon."
The Weekly Standard mocks Speaker Pelosi's declaration that the health care bill will allow artists to be blissfully unemployed. Congressman Bart Stupak (D-MI) states Congressman Henry Waxman (D-CA) told him flat out the House Democrats want to pay for abortions in health care legislation. The American Grassroots Coalition and The Tea Party Express are hosting a “Code Red Rally to… Kill the Bill” on March 16 at Taft Park on Capitol Hill beginning at 10:00 a.m.
Find more information here.

((And if you suddenly discover that you can make it to Washington tomorrow, see Part 2 for information about bus trips to the event.))

The Health Care "Shell" Game BeginsPhilip Klein - The American SpectatorShortly before midnight on Sunday, Democrats released a 2,309 page health care bill that will start the process of reconciliation -- but don't let that fool you, it's not the actual reconciliation bill with all the changes you've been reading about. Instead, as Rep. Paul Ryan, the ranking Republican member on the Budget Committee, explained to me last week, this is just the "shell" bill -- the vehicle that Democrats need to get moving on health care. Once the bill gets approved (likely Monday), Democrats will send this phantom bill over to the Rules Committee, where it will be stripped, and then they'll insert in all of the actual changes that they've negotiated.
Pelosi's RepublicMary Katharine Ham - Weekly StandardFrom Rachel Maddow's show last night, here's a jaw-dropper from the woman who brought you, "We have to pass the bill, so you can find out what's in it." As I keep saying, the Democratic message mavens are working overtime, apparently to woo the all-important swing vote in Williamsburg to health care: "Think of an economy where people could be an artist or a photographer or a writer without worrying about keeping their day job in order to have health insurance."
Van Hollen Advises Silence on Unconstitutional ObamaCare ProcedureBrian Darling - Red StateHouse leaders have scheduled a vote for next Friday or Saturday according to Politico on ObamaCare. Reports indicate that House leaders are planning to pass ObamaCare without a vote. Assistant to the Speaker Chris Van Hollen (D-MD) advised Democrats not to talk about the procedure to pass the bill. Speaker Nancy Pelosi (D-CA) has come up with a very complicated procedure to get ObamaCare to the President’s desk without House members having to vote directly on the bill.
The House Health-Care Vote and the ConstitutionMichael McConnell - Wall Street JournalDemocratic congressional leaders have floated a plan to enact health-care reform by a procedure dubbed "the Slaughter solution." It is named not for the political carnage that it might inflict on their members, but for Rep. Louise Slaughter (D., N.Y.), chair of the powerful House Rules Committee, who proposed it. Under her proposal, Democrats would pass a rule that deems the Senate's health-care bill to have passed the House, without the House actually voting on the bill.
Democratic leaders say health bill will passDan Eggen - Washington PostDemocratic leaders scrambled Sunday to pull together enough support in the House for a make-or-break decision on health-care reform later this week, expressing optimism that a package will soon be signed into law by President Obama despite a lack of firm votes for passage. The rosy predictions of success, combined with the difficult realities of mustering votes, underscore the gamble that the White House and congressional Democrats are poised to make in an attempt to push Obama's health-care plans across the finish line. The urgency of the effort illustrates growing agreement among Democratic leaders that passing the legislation is key to limiting damage to the party during this year's perilous midterm elections.
GOP to use amendments as tacticJennifer Haberkorn - Washington TimesCapitol Hill Republicans are crafting hundreds of amendments in hopes of tripping up the health care overhaul if Democrats scrape up the votes needed to resuscitate the long-stalled measure by week's end. Even though Democratic leaders on Sunday conceded they didn't yet have the votes to pass President Obama's overhaul out of the House, Senate Republicans are threatening to put up hundreds of amendments — one of the few weapons in their limited arsenal — to force Democrats to take difficult votes on politically sensitive subjects.
Gibbs: By Next Week Health Bill Will PassDavid Riedel - CBSIn the final crunch on health care reform legislation, there are serious questions for President Obama. Does he have the votes to pass it? If the legislation passes, who will be helped by it? And who will pay for it? The White House and Democrats say they'll have the votes to pass health care toward the end of the week, though the Democratic vote counter, James Clyburn (D-S.C.), has said he doesn't yet have the votes to pass legislation. White House press secretary Robert Gibbs weighed in on the health care reform debate.
Senator Graham Criticizes Obama's 'Arrogance' on Health CareBrendan Murray - BloombergPresident Barack Obama’s “arrogant” strategy to get health-care legislation passed threatens to divide the country and prevent cooperation on other national priorities, U.S. Senator Lindsey Graham said. “President Obama promised to come to Washington and deliver change we can believe in,” Graham, a Republican from South Carolina, said today in an interview on ABC’s “This Week” program. “The way he’s doing things, the way he’s governing on this health-care bill -- this arrogance, ignoring the American people -- and trying to jam through a bill that nobody likes and deal out Republicans is going to make it impossible for me or anyone else.”
The Health Care Plan You are Going to GetBruce Bialosky - Town HallThe itsy-bitsy spider climbed up the water spout and apparently bit the Speaker of the House. Ms. Pelosi had a delusional moment the other day, but she was clear on one thing. She never intended to listen to any Republican suggestions regarding the health care bill. Close observation of the Bipartisan Health Care Summit provided clarity within the first half hour that there was not much bipartisan here. After listening to President Obama, Harry Reid, and Nancy Pelosi, it was obvious that there was no way that they were going to overhaul their 2,400 page (or is it 2,600) health care bill.
Health Care 101: A consumer primer on Obama's billRicardo Alonso-Zaldivar - Associated PressIt took lawmakers a year to shape President Barack Obama's health care bill. If it finally passes Congress, it'll take the better part of a decade to write the user manual for consumers and doctors, employers and insurance companies. Some health insurance consumer protections would go into place immediately, significant but limited in scope. The big expansion in coverage comes about four years from now, allowing more than 30 million people to sign up for insurance, with financial help from the government for most. Ripple effects continue well after Obama has to leave office in 2017, assuming he's re-elected.Health care vote:
The final countdownChris Cillizza - Washington Post's The FixIn six days time, President Obama's health care bill will almost certainly have either passed or failed -- although which of those two options will be better for Democrats politically this fall remains an open question. With the president having pushed back his planned foreign trip three days to ensure all hands on deck as the bill maneuvers its way through the House, a host of party leaders and strategists spun their way through the Sunday talk shows yesterday as observers try to discern whether or not Democrats can find the votes to pass the measure.
Swing Districts Oppose Health ReformHeather R. Higgins and Kellyanne E. Conway - Wall Street JournalHouse Speaker Nancy Pelosi says she plans to bring health-care reform to a vote this week. Democratic leaders cite national polls that show support for individual provisions of the bill as a reason to pass this reform. Yet vulnerable politicians should be warned: Responses to questions about individual benefits, particularly when removed from a cost context, are different from those on the whole bill.
Millions Spent to Sway Democrats on Health CareJeff Zeleny - New York TimesThe yearlong legislative fight over health care is drawing to a frenzied close as a multimillion-dollar wave of advertising that rivals the ferocity of a presidential campaign takes aim at about 40 House Democrats whose votes will help determine the fate of President Obama’s top domestic priority. The coalition of groups opposing the legislation, led by the United States Chamber of Commerce, is singling out 27 Democrats who supported the health care bill last year and 13 who opposed it. The organizations have already spent $11 million this month focusing on these lawmakers, with more spending to come before an expected vote next weekend.
The Hitchhiker's Guide to Health Care This WeekChad Pergram - Fox News' The Speaker's LobbyOkay. Let me guess. This will be the make or break week for health care reform. Over the past year, I can count at least six weeks that have been billed as that singular, crucial week in which the fate of health care swings in the balance. But none of those weeks have been quite like this one. This is it. Starting today, the House launches a series of sequential committee meetings which the Democratic leadership team hopes will result in the health care bill hitting the floor late this week or over next weekend. So I’ve prepared a manual. A cheat sheet. A “hitchhiker’s guide” that will help you navigate the convoluted parliamentary labyrinth that the health care bill is expected to take this week.

Latest Polling
Independent Women's Voice/ Polling CompanyMarch 15, 2010 "Sixty percent want Congress to start from scratch on a bipartisan health-care reform proposal or stop working on it this year."
Conservatives for Patients' Rights, 700 12th street, NW, Suite 700, Washington, DC 20005

From previous issues:

Obamacare’s Procedural Fraud on the American PeopleBrian Darling - The FoundryThe Health Care Nuclear Option is still the stated plan to get Obamacare to the President’s desk. The latest wrinkle is designed to allow pro-life Democrats to vote for the Senate’s taxpayer funded abortion language while still claiming they never voted for taxpayer funded abortions. Don’t be fooled.

If Democrats ignore health-care polls, midterms will be costlyPatrick H. Caddell and Douglas E. Shoen - Washington PostIn "The March of Folly," Barbara Tuchman asked, "Why do holders of high office so often act contrary to the way reason points and enlightened self-interest suggests?" Her assessment of self-deception -- "acting according to wish while not allowing oneself to be deflected by the facts" -- captures the conditions that are gripping President Obama and the Democratic Party leadership as they renew their efforts to enact health-care reform. Their blind persistence in the face of reality threatens to turn this political march of folly into an electoral rout in November.

Parliamentarian's ruling deals blow to healthcare reform chancesAlexander Bolton - The HillThe Senate parliamentarian has delivered a blow to Democrats by ruling President Barack Obama must sign the broader Senate healthcare legislation before the upper chamber can take up changes demanded by the House. The ruling means House Democrats would have to rely on a good-faith promise that senators will pass the changes after the healthcare bill is signed into law, a difficult prospect at a time when lower-chamber lawmakers have grown distrustful of their Senate counterparts.

Latest Polling
Rasmussen ReportsMarch 9, 2010 "Eighty-one percent (81%) believe it is at least somewhat likely that the health care reform plan will cost more than official estimates."

Obama promised $2,500 health care savings; CBO says plan is $2,300 price increaseMark Hemingway - Washington Examiner's Beltway ConfidentialFrom a fact sheet on Obama's campaign website (PDF link): Obama’s plan will save a typical family up to $2,500 on premiums by bringing the health care system into the 21st century: cutting waste, improving technology, expanding coverage to all Americans, and paying for some high-cost cases. However, the CBO just produced this analysis of the senate health care bill (another PDF link) which concludes that the Senate health care bill will raise the average family's health care premiums by $2,300.

Down the Health Care Homestretch, White House Pitches Talking Points to House DemocratsChad Pergram and Trish Turner - Fox News' Row 2 Seat 4On the verge of the most fateful week in the life of President Obama's signature domestic initiative, the White House on Tuesday told House Democrats exactly what to say to sell the idea of health reform -- even as they know the final package of reforms has yet to be written. David Simas, an assistant to Senior White House adviser David Axelrod, led House Democrats through a 13-slide power point presentation Tuesday night. The presentation was titled, simply, "Talking Points on Health Reform" (see below). It drew on policies found in the Senate health care bill and the recent changes to it suggested by President Obama.

Latest Polling
Associated Press/ GfKMarch 9, 2010 68% think the president and congressional Democrats should work with Republicans on health care reform, rather than pass a bill with no GOP support.

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from National Review Online
The Slaughter Strategy
http://www.galen.org/component,8/action,show_content/id,14/category_id,0/blog_id,1376/type,33/
National Review Online: Critical ConditionBy Grace-Marie TurnerMarch 13, 2010

This week will be the last stand for Obamacare, and the trickery that Speaker Pelosi is concocting to get the 2,700-page Senate bill through the House almost defies belief. It’s aptly called the “Slaughter Strategy,” after Rep. Louise Slaughter (D., N.Y.), who chairs the House Rules Committee.

Under this scheme, House members would vote on a bill of amendments to the despised Senate bill, and the Senate bill would be “deemed” to have passed if this companion bill is approved. This is supposed to inoculate House members, who could say they never actually voted for the Senate bill.

Former Speaker Newt Gingrich has the best line: Last year, the House was passing bills without reading them. This year, they’re passing bills without voting on them.

If you pull out your copy of the U.S. Constitution, you will find that in Article 1, Section 7, it clearly states that the House and Senate have to pass a bill before it is sent to the president to be signed into law.

The Senate bill is the only realistic vehicle for passage of Obamacare, but so many House members hate various provisions in it that Pelosi can’t round up the necessary 216 votes unless there are major changes. Undecided members say they will buy into the Slaughter Strategy only if they get a guarantee that the Senate will absolutely, positively pass a second health-care reform bill that makes the original Senate bill more to their liking by getting rid of things like the Cornhusker Kickback. (The Louisiana Purchase, apparently, will stay in.)

The Slaughter Strategy would allow the Senate bill to be approved by the House via a “self-executing rule.” (These terms, straight out of a Dickens novel, may well describe what will happen to Democrats who try this.) It is not surprising that Pelosi lieutenant Rep. Chris Van Hollen (D., Md.) has warned members to avoid any talk of the unconstitutional way they plan to pass the Senate bill.

The president has delayed his trip to Indonesia, presumably because the Senate parliamentarian has said the bill must be signed into law before the Senate can begin work on the bill of amendments. Will there be a big signing ceremony? Will House members show up to get their pictures taken as the president signs a bill they despise? Or will there be a stealth signing of the president’s signature domestic-policy legislation?

After he signs, the president will leave the country, and then the process will begin to pass the second health-care reform bill in the Senate. The legislation must go through committee before it comes to the floor for what surely will be a protracted and painful process and set of votes.
There is one simple fact behind all these bizarre contortions of the legislative process: The House completely distrusts the Senate. The House has passed nearly 300 bills that are stuck in the Senate. But House members are told that this time will be different. The House must trust the Senate to wage and win an incredibly difficult battle to pass a second bill to fix the things in the first bill that the Senate approved but the House hates.

Senate Republicans can’t keep the Democrats from reaching the 51-vote threshold for passing measures through the budget-reconciliation process, but they can make sure that any provisions proposed for this process are thrown out unless they strictly adhere to its narrow rules. The bill of amendments likely will be turned into a Swiss cheese. And then Senate Democrats will be forced to take a series of painful votes as Republicans propose amendment after amendment to the bill.
What possible incentive would the Senate have to carry through with this tedious and troublesome maneuver once its own bill has been signed into law? If the Senate fails to do so, House members will be on the hook to defend their votes for all the special deals in the original Senate bill that have repulsed the American people.

The longer the debate goes, the more heat members take, and, as Rep. Bart Stupak (D., Mich.) says, “They just want this over.” But it will be far from over if the House approves the Senate bill. Whether House members vote directly for that bill or for a measure that “deems” it passed, they will still be on the hook for everything in it.

Their leadership should be asking, “Do you want to walk off this cliff yourself, or should I give you a shove?” For House members, the end result is likely to be the same. They are being asked to take a fall so the president can claim passage of a health overhaul bill the American people despise almost as much as House members do.

Rep. Mike Pence (R., Ind.) gave the rallying cry for opponents in a speech this week: “This is a five-alarm fire! Think about the biggest battle you have ever fought and double your effort. This is the most important fight of our time!”

Galen Institute P.O. Box 320010 Alexandria, VA 703-299-8900 www.galen.org

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Monday, March 15, 2010
Kaiser Daily Health Policy Report:
Check back on Kaiser Health News for the latest headlines
(Excerpts)

5. As The Push To Gather Votes Continues, Democrats Express Confidence Health Overhaul Bill Will Pass
[Mar 15, 2010]
Democrats spent Sunday trying to pull enough votes together in the House to pass a health care reform bill later this week but said they were optimistic that they can get the support they need.
The Washington Post reports that the "rosy predictions of success, combined with the difficult realities of mustering votes, underscore the gamble that the White House and congressional Democrats are poised to make in an attempt to push [President Barack] Obama's health-care plans across the finish line. ... The most optimistic talk on Sunday came from the White House. Obama senior adviser David Axelrod predicted that Democrats 'will have the votes to pass this,' and press secretary Robert Gibbs declared that 'this is the climactic week for health-care reform.'" Others were not so optimistic, however. Rep. Jim Clyburn, the Democrats' "chief head-counter in the House, cautioned that the party has not yet found the 216 votes needed to win approval of the health-care bill passed by the Senate in December." House Democrats expect to receive a final cost estimate of their reconciliation bill Monday before it goes to committees for consideration and aides expect a vote as soon as Thursday, but it's more likely to happen Friday or Saturday (Eggen, 3/15).
Los Angeles Times: "Despite the White House bravado that healthcare legislation will pass the House, most political odds-makers predict it will be close and could go either way. And a key House Democratic leader cautioned Sunday that they didn't have the votes yet." Most observers estimate that Democrats remain about a half a dozen votes short in the House (Serrano, 3/15).
Roll Call: "Because their whip efforts have been so sensitive, leaders wouldn't say it outright last week, but they essentially have a deal on what to include in the crucial health care reconciliation bill. The chief uncertainties are whether they can get 216 House Members and 51 Senators to vote for it and whether the measure will remain intact during an expected onslaught of amendments and points of order from Senate Republicans." Leaders are also favoring simply passing the reconciliation bill and attaching to it a provision that would deem the Senate bill passed in the House to shield politically vulnerable members from casting votes on it, Roll call reports. "A second senior Senate Democratic aide said the negotiations have been so sensitive and the votes so precarious that people should not expect any dramatic announcements that they have sealed a deal and are certain of victory" (Pierce, 3/15).
The Christian Science Monitor: "House Republican leader John Boehner said there was 'bipartisan opposition' to efforts to pass healthcare reform. 'I'm doing everything I can to prevent this bill from becoming law,' he said" (Nichols Douglass, 3/14).

Bloomberg/Business Week: "House members are seeking assurance the changes will be passed after the Senate parliamentarian decided that Obama would first have to sign the Senate bill into law. 'Members of the House are being asked to trust an untrustworthy body,' said Representative Anthony Weiner, a New York Democrat. (House Speaker Nancy) Pelosi said many members don't trust the Senate because so much House-passed legislation has languished there" (Jensen and Litvan, 3/15).
The New York Times: As Democrats look for votes, the amount of money being spent to sway about 40 of them has risen. "The coalition of groups opposing the legislation, led by the United States Chamber of Commerce, is singling out 27 Democrats who supported the health care bill last year and 13 who opposed it. The organizations have already spent $11 million this month focusing on these lawmakers, with more spending to come before an expected vote next weekend." An alliance of groups in support of the health bills has spent far less. "But after pharmaceutical companies made a $12 million investment for a final advertising push, spending by both sides for the first time is now nearly the same" (Zeleny, 3/14).

USA Today: "In a backlash against President Obama's health care legislation that stretches from Virginia to California, lawmakers in more than two-thirds of the states are scrambling to undercut the bill before it even passes Congress." Legal scholars say that state legislation isn't the final word, however. "The state measures are likely to be challenged in court, setting up new legal battles over whether federal law can trump state laws. ... [Wake Forest University law professor Mark Hall] says federal laws typically trump state laws, making the health care efforts in the states little more than 'a form of civil disobedience.' States' rights proponents are undaunted" (Hall, 3/15).

Minneapolis Star Tribune: About 2,000 protestors attended a rally at the state Capitol in Minnesota against the health care bill on Saturday. Republicans, social conservatives and members of the Tea Party movement were in attendance to protest the bill. "The headliner and clear crowd favorite was Republican Sixth District Rep. Michele Bachmann, who said Democrats 'are spending us into bondage we can never dig ourselves out of'" (Von Sternberg, 3/13).

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National Review
‘Explaining’ Obamacare . . . by Bashing Insurers
http://article.nationalreview.com/427740/explaining-obamacare-by-bashing-insurers/paul-howard
by Paul Howard
March 12, 2010 4:00 A.M.

The president is attacking the insurance industry in a desperate attempt to shore up support for a deeply flawed bill.

Obama’s plan is a bad, poll-driven idea that would wreak havoc on the individual insurance market. State insurance experts interviewed in the New York Times this week explained why: Rate reviews at the state level are primarily designed to make sure that insurers will remain solvent and can pay their claims. The experts called this the “ultimate consumer protection.”
“You’re not necessarily helping the consumer if you keep the rates artificially low,” one state regulator told the Times. “What’s worse for the consumer: having a premium increase or having to pay the full amount of a medical expense because the company is out of business?”
The president also ignores the logic of competitive markets: If one insurer raises rates above what is justified by underlying costs, competitors will undercut them, shaving off market share and profits.
For instance, according to eHealthInsurance.com, a 40-year-old single male resident of Santa Monica, Calif., has 124 plans to choose from, starting at $88 a month for an Anthem Blue Cross plan. If a 39 percent increase hit this plan, its new cost would be about $122 a month — leaving it vulnerable to competition from Kaiser Permanente or Aetna.
A 2009 survey from eHealthInsurance also found that individual health-insurance premiums are less expensive in California than the national average: $150 a month versus $161. New York — a state with many of the health-care regulations found in Obamacare — was more than twice as expensive as the national average: $339. Individual insurance markets undoubtedly need more competition, but the Democrats’ embrace of heavy-handed regulations and mandates would drive prices up, not down.

This brings us back to why the president is talking about insurance companies, and not about the fine print in his plan. Skeptical voters know that the administration is cherry-picking its budget numbers to make the Democrats’ legislation look much cheaper than it really is. For instance, the president claims that the nonpartisan Congressional Budget Office scores the Democrats’ legislation with a small savings in its first ten years and lowers the deficit by $1 trillion the following decade.
This estimate reflects what David Brooks calls “gimmicks and dodges [that are] designed to get a good score from the Congressional Budget Office but don’t genuinely control runaway spending.” The score leaves out $300 billion in Medicare physicians’ payment increases that were dropped from earlier versions of the Democrats’ legislation because it made the price tag look too high. The estimate also depends on massive reimbursement cuts to Medicare and Medicaid providers that are unlikely to ever actually materialize.
Major legislation, the CBO also observes drily, does not often remain unchanged for 20 years. Translation: Good luck collecting that $1 trillion.The administration and its allies have been trying to have it both ways by invoking the CBO score as if it was handed down by God’s own accounting office, while ignoring CBO assumptions that don’t fit their narrative — like the fact that their favorite demonstration projects and pilot programs don’t save any real money.
Once you peel off the gimmicks, the legislation will create a massive new health-care entitlement that the country cannot afford. Attacking insurance companies is meant to distract voters — and wavering Democrats in Congress — from Obamacare’s glaring deficiencies. If it becomes law, expect this to be a health-care “cure” that’s worse than the disease.
— Paul Howard is director of the Manhattan Institute’s Center for Medical Progress and managing editor of MedicalProgressToday.

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From the Washington Times
WOLF: Obama family health care fracas
A doctor savages his cousin Barack's reform plan
((I guess Dr. Wolf can write off his invitation to a White House Christmas party...))
http://washingtontimes.com/news/2010/mar/11/obama-family-health-care-fracas/
By Dr. Milton R. Wolf

"Primum nil nocere."First, do no harm. This guiding principle is a bedrock of medical care. Sadly, those politicians who would rewrite our health care laws do not live in the same universe as do the doctors and health care professionals who must practice it.

Imagine if, like physicians, politicians were personally held to the incredibly high level of scrutiny that includes civil and financial liability for any unintended consequence of their decisions. Imagine if they were forced to spend tens of thousands of dollars each year on malpractice insurance and still faced the threat of multimillion-dollar lawsuits with every single decision they made. If so, a government takeover of health care would be the furthest thing from their minds.

Obamacare proponents would have us believe that we will add 30 million patients to the system without adding providers, we will see no decline in the quality of care for the millions of Americans currently happy with the system, and -if you act now!- we will save money in the process. But why stop there? Why not promise it will no longer rain on weekends and every day will be a great hair day?

America has the finest health care delivery system in the world. Let's not forget that and put it at risk in the name of reform. Desperate souls across the globe flock to our shores and cross our borders every day to seek our care. Why? Our system provides cures while the government-run systems from which they flee do not. Compare Europe's common cancer mortality rates to America's: breast cancer - 52 percent higher in Germany and 88 percent higher in the United Kingdom; prostate cancer - a staggering 604 percent higher in the United Kingdom and 457 percent higher in Norway; colon cancer - 40 percent higher in the United Kingdom.

Look closer at the United Kingdom. Britain's higher cancer mortality rate results in 25,000 more cancer deaths per year compared to a similar population size in the United States. But because the U.S. population is roughly five times larger than the United Kingdom's, that would translate into 125,000 unnecessary American cancer deaths every year. This is more than all the mothers and fathers, aunts and uncles, cousins and children in Topeka, Kan. And keep in mind, these numbers are for cancer alone. America also has better survival rates for other major killers, such as heart attacks and strokes. Whatever we do, let us not surrender the great gains we have made. First, do no harm. Lives are at stake.

Obamacare: Fixing price at any cost

The justification for Obamacare has been to control costs, but the problem is there is little in Obamacare that will do that. Instead, there are provisions that will ration care and artificially set price. This is a confusion of costs and price.

As one example, consider the implications of Obamacare's financial penalty aimed at your doctor if he seeks the expert care he has determined you need. If your doctor is in the top 10 percent of primary care physicians who refer patients to specialists most frequently - no matter how valid the reasons - he will face a 5 percent penalty on all their Medicare reimbursements for the entire year. This scheme is specifically designed to deny you the chance to see a specialist. Each year, the insidious nature of that arbitrary 10 percent rule will make things even worse as 100 percent of doctors try to stay off that list. Many doctors will try to avoid the sickest patients, and others will simply refuse to accept Medicare. Already, 42 percent of doctors have chosen that route, and it will get worse. Your mother's shiny government-issued Medicare health card is meaningless without doctors who will accept it.

Obamacare will further diminish access to health care by lowering reimbursements for medical care without regard to the costs of that care. Price controls have failed spectacularly wherever they've been tried. They have turned neighborhoods into slums and have caused supply chains to dry up when producers can no longer profit from providing their goods. Remember the Carter-era gas lines? Medical care is not immune from this economic reality. We cannot hope that our best and brightest will pursue a career in medicine, setting aside years of their lives - for me, 13 years of school and training - to enter a field that might not even pay for the student loans it took to get there.
Giving power back to people

I believe there is a better way. The problems in the American health care system are not caused by a shortage of government intrusion. They will not be solved by more government intrusion. In fact, our current problems were precisely, though unintentionally, created by government.

World War II-era wage-control measures - a form of price controls - ushered in a perverted system in which we turn to our employers for insurance and the government penalizes us if we choose to purchase insurance for ourselves. ((This may be the best sentence explaining our perverse tax system as it pertains to health care that I've ever read.)) You are not given the opportunity to be a wise consumer of health care and compare prices as well as quality in any meaningful way.
Worse still, your insurance company is not answerable to you because you are not its customer. It is answerable to your employer, whose interests differ from your own.

Insurance companies have been vilified for following the perverse rules that government has created for them. But it gets worse. The government, always knowing best, deploys insurance commissioners across the land to dictate what the insurance companies must provide, whether you want it or not, and each time, your premiums increase. Obamacare will make all of this worse, not better.

One of America's founding principles is our trust in the people and their economic freedom to rule their own lives. We should decouple health insurance from employers and empower patients to be consumers once again. Allow them to determine the insurance plan that best meets their families' needs and which company will provide it. This will unleash a wave of competition that will drive costs down in a way that price controls never have. Eliminate the artificial state boundary rules that protect insurance companies from true competition and watch as voters demand that their state insurance commissioners get the heck out of the way. Innovative companies will drive down costs similar to how Geico and Progressive have worked for automobile insurance. And it won't cost taxpayers a trillion dollars in the process.

This free-market approach has worked for everything from high-definition TVs to breakfast cereals, but will it work for medicine? It already is. Take Lasik eye surgery, for example. Because patients are allowed to be informed consumers and can shop anywhere, doctors work hard for their business. Services, availability and expertise have all increased, and costs have decreased. Should consumers demand it, insurance companies - now answerable to you rather than your employer - would cover it.

Between Barack and a hard place

I have personally trained and practiced in both the government-run and free-market segments of American medicine. The difference is vast. Patients see this for themselves, and this may be why, according to a recent CNN poll, they oppose Obamacare nearly 3 to 1. I am with them. It is difficult for me to speak publicly against the president on his central issue, but too much is at stake.

I wish my cousin Barack the greatest of success in office. But I feel duty-bound to rise in opposition to Obamacare. I must take a stand for my patients, my profession and, ultimately, my country. The problems caused by government will not be solved by growing government. Now that this new era of big-government takeovers has spread to our health care system, it's not just our freedoms or our wallets that are at stake. It's our lives.

Dr. Milton R. Wolf is a radiologist in Kansas. He is Barack Obama's second cousin once removed. President Obama's great-great grandfather, Thomas Creekmore McCurry, is Dr. Wolf's great-grandfather. Dr. Wolf's mother, Anna Margaret McCurry, was five years older than Mr. Obama's mother, Stanley Ann Dunham. The two were childhood friends until the Dunhams moved from Kansas to Seattle in 1955.

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AMA Health Care Reform Bulletin
If you're having trouble viewing this email, you may see it online.
March 12, 2010
Here's your regular update on efforts by the American Medical Association (AMA) to work with lawmakers in reforming the nation's health care system in a way that provides quality, affordable health care for all.

Speaker Pelosi announces timeline for reform legislation
House Speaker Nancy Pelosi informed House Democrats today that there are plans to hold a House floor vote on health system reform in the coming week, and said that members should be prepared to stay in session through next weekend and into the following week, if necessary. The House Budget Committee is scheduled to start the process on Monday, March 15, with a mark-up of the reconciliation bill scheduled to begin at 3 p.m. and conclude at midnight.

Legislative language for the reconciliation bill, which will contain amendments to the Senate-passed health system reform legislation as well as a college student aid package, has not yet been circulated. It has been widely reported that at least two provisions designed to obtain key Senate votes will be eliminated by the reconciliation bill and that the tax on high-cost health plans will be modified to apply only to individuals with incomes of more than $250,000.

Currently, the House plans to hold a single floor vote that will include the reconciliation provisions and the health reform bill passed by the Senate on Christmas Eve. After House passage, the original Senate bill will be sent to President Obama for signature and the reconciliation bill will be sent to the Senate for passage. Details on the reconciliation bill are expected to be released by the administration and House leadership on or before Monday.

At press time, the reconciliation legislative language had yet to be finalized. The AMA continues to be involved in ongoing discussions with administration officials and congressional leaders regarding necessary changes in the Independent Payment Advisory Board provisions that apply to physicians.

General AMA news

1) Senate votes to again delay Medicare cutBy a vote of 62-36 on March 10 the U.S. Senate passed H.R. 4213, deciding to again delay this year’s steep 21 percent Medicare physician payment cut, this time to Oct. 1. The legislation will now be sent to the U.S. House of Representatives, where amendments are possible.

"If the House also adopts this Senate bill, America’s seniors and their physicians will be left in limbo, and access to health care for Medicare patients will continue to be in grave danger," said AMA President J. James Rohack, MD. "Short-term actions are the wrong answer to a long-term problem."

It is not certain if this extension can be signed into law before the current Medicare physician payment freeze expires April 1. In the meantime, keep the pressure on your legislators by calling (800) 833-6354 or send them an e-mail and tell them to permanently repeal Medicare’s flawed sustainable growth rate formula.
View Dr. Rohack’s full statement.
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From the Washington Post
Rep. Paul Ryan on what real health reform should look like
http://www.washingtonpost.com/wp-dyn/content/article/2010/03/14/AR2010031401388.html?utm_source=Newsletter&utm_medium=Email&utm_campaign=Morning%2BBell
By Paul RyanMonday, March 15, 2010

Today, the House Budget Committee is to mark up a "reconciliation" vehicle, initiating the greatest expansion in government and entitlement spending in a generation through a partisan process to push "health-care reform" across the finish line.

Despite claims of transparency and calls for a "simple up-or-down vote," there is nothing simple about this process. This convoluted legislative charade demonstrates how far the Democratic majority has wandered from real health-care reform and cost control, employing any means to achieve political victory.

Through any analytical lens, the legislation will not address the central problem of skyrocketing health-care costs. The Congressional Budget Office estimates that families' premiums could rise 10 to 13 percent; private-sector actuarial estimates top these already high numbers. The higher costs are driven by federalizing the regulation of insurance, narrowing consumers' options and reducing competition among providers. The health-care market would be dominated by government programs and the largest insurance companies, operating as de facto government utilities.

Rather than tackle the drivers of health inflation, the legislation chases the ever-increasing premiums with huge new subsidies. Already, Washington has no idea how to pay for the unfunded promises in Medicare, Medicaid and Social Security -- and creating this new entitlement would accelerate our path to fiscal ruin. When you strip away the double-counting, expose the hidden costs that must be funded and look at the price tag when the legislation is fully implemented, the claims of deficit reduction are as hollow as claims of cost containment.

This legislation includes a range of job-killing tax hikes and controls on all Americans -- to fund this new entitlement and to penalize employers and individuals who don't play by Washington's new rules. The CBO said last July that "requiring employers to offer health insurance, or pay a fee if they do not, is likely to reduce employment." The mix of mandates and higher costs will drive Americans into government exchanges, with an ever-enlarging number reliant upon taxpayer subsidies for their care. The architecture is designed to give the government greater control over what kind of insurance is available, how much health care is enough and which treatments are worth paying for.
The debacle of the past year's "debate" has been a missed opportunity for real reform.
Democrats and Republicans alike have put forward proposals that address the drivers of health-care costs, yet they have been ignored in this sharply partisan crusade. House Republicans continue to offer common-sense solutions, with specific legislation. Last May, Sens. Tom Coburn and Richard Burr and Rep. Devin Nunes and I collaborated to address rising costs while securing access to quality, affordable health coverage for all Americans.
The Patients' Choice Act takes on the discriminatory and inflationary tax exclusion, delinking the tax benefit from employers and attaching it to individuals through universal tax credits. The tax exclusion for employer-provided health coverage subsidizes insurance instead of health care, hides the true cost of coverage and disproportionately favors the wealthy at the expense of the self-employed, the unemployed and small businesses. Health-care economists across the political spectrum and reform-minded Democrats such as Sen. Ron Wyden identify the backward tax treatment of health care as a problem that must be addressed.

The Patients' Choice Act includes additional reforms -- such as an emphasis on preventive care, medical malpractice reform and interstate shopping -- that could be advanced one at a time in a bipartisan fashion to fix what's broken in health care without breaking what is working.
This year I re-introduced my own proposals to tackle our entitlement crisis head-on. My plan, "A Roadmap for America's Future," fulfills the mission of health and retirement security, lifts our crushing burden of debt, and spurs economic growth and job creation. In stark contrast to the vision being pushed by the majority in Congress, my plan unapologetically seeks to apply our nation's timeless principles -- our Founders' commitment to individual liberty, limited government and free enterprise -- to today's challenges. It does so in a way that honors our historic commitment to strengthening the social safety net for those who need it most.

If this debate had actually been about health care, we could have worked together to get a grip on costs, make quality care more accessible, address exclusions for preexisting conditions and realign the incentives of insurance companies with those of patients and doctors. Yet this process -- including its embarrassing conclusion -- demonstrates that the debate has never been about health-care policy but, instead, paternalistic ideology.

Should the Democrats' health-care train wreck make it to the president's desk, it will be a pyrrhic victory, and its devastating consequences will take their toll on our health-care system, our budget and our economy.

Paul Ryan (Wis.) is the ranking Republican on the House Budget Committee

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Monday, March 15, 2010

"What we need from the next president is somebody who will not just tell you what they think you want to hear but will tell you what you need to hear."
-- Barack Obama, Feb. 27, 2008

One job of presidents is to educate Americans about crucial national problems. On health care, Barack Obama has failed. Almost everything you think you know about health care is probably wrong or, at least, half wrong. Great simplicities and distortions have been peddled in the name of achieving "universal health coverage." The miseducation has worsened as the debate approaches its climax.

There's a parallel here: housing. Most Americans favor homeownership, but uncritical pro-homeownership policies (lax lending standards, puny down payments, hefty housing subsidies) helped cause the financial crisis. The same thing is happening with health care. The appeal of universal insurance -- who, by the way, wants to be uninsured? -- justifies half-truths and dubious policies. That the process is repeating itself suggests that our political leaders don't learn even from proximate calamities.

How often, for example, have you heard the emergency-room argument? The uninsured, it's said, use emergency rooms for primary care. That's expensive and ineffective. Once they're insured, they'll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument. Unfortunately, it's untrue.
More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was "more convenient" to go to the emergency room or they couldn't "get [a doctor's] appointment as soon as needed." If universal coverage makes appointments harder to get, ((and it WILL)) emergency-room use may increase.
You probably think that insuring the uninsured will dramatically improve the nation's health. The uninsured don't get care or don't get it soon enough. With insurance, they won't be shortchanged; they'll be healthier. Simple.

Think again. I've written before that expanding health insurance would result, at best, in modest health gains. Studies of insurance's effects on health are hard to perform. Some find benefits; others don't. Medicare's introduction in 1966 produced no reduction in mortality; some studies of extensions of Medicaid for children didn't find gains. In the Atlantic recently, economics writer Megan McArdle examined the literature and emerged skeptical. Claims that the uninsured suffer tens of thousands of premature deaths are "open to question." Conceivably, the "lack of health insurance has no more impact on your health than lack of flood insurance," she writes.

How could this be? No one knows, but possible explanations include: (a) many uninsured are fairly healthy -- about two-fifths are age 18 to 34; (b) some are too sick to be helped or have problems rooted in personal behaviors -- smoking, diet, drinking or drug abuse; and (c) the uninsured already receive 50 to 70 percent of the care of the insured from hospitals, clinics and doctors, estimates the Congressional Budget Office.

Though it seems compelling, covering the uninsured is not the health-care system's major problem. The big problem is uncontrolled spending, which prices people out of the market and burdens government budgets. Obama claims his proposal checks spending. Just the opposite. When people get insurance, they use more health services. Spending rises. By the government's latest forecast, health spending goes from 17 percent of the economy in 2009 to 19 percent in 2019. Health "reform" would probably increase that.

Unless we change the fee-for-service system, costs will remain hard to control because providers are paid more for doing more. Obama might have attempted that by proposing health-care vouchers (limited amounts to be spent on insurance), which would force a restructuring of delivery systems to compete on quality and cost. Doctors, hospitals and drug companies would have to reorganize care. Obama refrained from that fight and instead cast insurance companies as the villains.

He's telling people what they want to hear, not what they need to know. Whatever their sins, insurers are mainly intermediaries; they pass along the costs of the delivery system. In 2009, the largest 14 insurers had profits of roughly $9 billion; that approached 0.4 percent of total health spending of $2.472 trillion. This hardly explains high health costs. What people need to know is that Obama's plan evades health care's major problems and would worsen the budget outlook. It's a big new spending program when government hasn't paid for the spending programs it already has.
"If not now, when? If not us, who?" Obama asks. The answer is: It's not now, and it's not "us." Pass or not, Obama's proposal is the illusion of "reform," not the real thing.
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