The Politics of Health Care

[ccp]

It was inevitable with 60 crats.  My Federal tax dollars are going to fund medicaid programs in states like Louisianna, Nebraska and who knows where else.

Why try to pay one's own bills or be a success when it is easier just to get on line and have others pay for all your bills, health care, employment, retirement, diasabilities, food stamps and eveything else?

And what is worse it is not even for Americans.  It is for illegals and for all those who were born here from illegals.  This has to be at least 20 if not more like 30 million people.
I have pts who cannot speak one word of English who could not have been in the US for even a few years and they walk into my office with Medicare cards.  Why?  Because there must be some loop hole that extends to them from their relatives who are citizens.

And we wonder why we are going broke?  It ain't the bankers you Democrat f**ks!

***Sen. Ben Nelson to announce support for health-care bill

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Saturday, December 19, 2009; 10:55 AM

Sen. Ben Nelson (Neb.), the final Democratic holdout on health care, announced to his caucus Saturday morning that he would support the Senate reform bill, clearing the way for final passage by Christmas.

"We're there," said Sen. Kent Conrad (D-N.D.), as he headed into a special meeting to outline the deal.

Democratic leaders spent days trying to hammer out a deal with Nelson, and worked late Friday night with him on abortion coverage language that had proved the major stumbling block. Nelson also secured other favors for his home state.

Under the new abortion provisions, states can opt out of allowing plans to cover abortion in insurance exchanges the bill would set up to serve individuals who don't have employer coverage. Plus, enrollees in plans that do cover abortion procedures would pay for the coverage with separate checks - one for abortion, one for rest of health-care services.

Nelson secured full federal funding for his state to expand Medicaid coverage to all individuals below 133 percent of the federal poverty level. Other states must pay a small portion of the additional cost. He won concessions for qualifying nonprofit insurers and for Medigap providers from a new insurance tax. He also was able to roll back cuts to health savings accounts.

"I know this is hard for some of my colleagues to accept and I appreciate their right to disagree," Nelson told reporters at the Capitol, of the many changes made at his behest. "But I would not have voted for this bill without these provisions."

With Nelson on board, Senate Majority Leader Harry M. Reid unveiled the final version of a sweeping overhaul of the nation's health insurance system that would expand coverage to an additional 31 million Americans, coming closer to attaining the Democrats' long sought goal of universal medical coverage.

The package closely tracks the $848 billion measure Reid (D-Nev.) drafted this month, before he entered into negotiations aimed at winning the 60 votes he needs to avert a GOP filibuster, aides said. Since then, Reid has made numerous concessions to moderate Democrats, scrapping an effort to create a government-run insurance plan and beefing up prohibitions on spending federal funds for abortion coverage, a change demanded by the final holdout, Sen. Ben Nelson of Nebraska.

Instead of a public option, the final product would allow private firms for the first time to offer national insurance policies to all Americans, outside the jurisdiction of state regulations. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.

Starting immediately, insurers would be prohibited from denying children coverage for pre-existing conditions. A complete ban on the practice would take effect in 2014, when the legislation seeks to create a network of state-based insurance exchanges, or marketplaces, where people who lack access to affordable coverage through an insurer can purchase policies.

Insurers competing in the exchanges would be required to justify rate increases, and those who jacked up prices unduly could be barred from the exchange. Reid's package also would give patients the right to appeal to an independent board if an insurer denies a medical claim. And all insurance companies would be required to spend at least 80 cents of every dollary they collect in premiums on delivering care to their customers.

Every American would be required to obtain coverage under the proposal, and employers would be required to pay a fine if they failed to offer affordable coverage and their workers sought federal subsidies to purchase insurance in the exchanges. Reid's package would offer additional assistance to the smallest businesses, however, increasing tax credits to purchase coverage by $12 billion over previous versions.

The overall cost of the package was not immediately available, but aides said it would be more than covered by cutting future Medicare spending and raising taxes in the health sector, including a 40 percent excise on the most expensive insurance policies. The package would reduce budget deficits by $130 billion by 2019, aides said, and by as much as $650 billion in the decade thereafter.

Reid officially filed the package early Saturday with plans to hold a first critical vote after midnight Sunday. Barring unexpected delays, Democrats were still hoping to push the package to final passage by Christmas Eve.****

[ccp]

"And what is worse it is not even for Americans"

I meant to say it is not even *only* for Americans.  Plenty of Americans certainly have their hands outstrected.

The *roles of people on the doles* is expanding exponentially thanks to the ONE and his merry widely spending clowns in the Congress and Senate. 

Cicero's words, as posted by Crafty circa 50 BC certainly ring true today here in the US.  Rome last over another 400 years.   But will we?

I don't know.  Trememdous damage has been done by the liberals.  It may not be too late.  Our multiple enemies overseas are laughing their brains out at what fools we are.

[Crafty_Dog]

I fear even with a major Tea Party type of a groundswell in the coming elections, deep lasting damage has been done.  Without such a groundswell, I fear we ARE done.
================
An e-conversation amongst some friends:

Crocodile Tears For Primary Care
The Top 10 Most Overblown Health Stories of the Past Decade
By Richard N. Fogoros, M.D., About.com Guide

Updated December 08, 2009

About.com Health's Disease and Condition content is reviewed by our Medical Review Board

 

We are in the midst of a contentious debate over the future of our healthcare system, in which the opposing parties find almost nothing in common. But there is one thing everybody agrees upon - Republicans and Democrats, Keynsians and Reaganites, Buckeyes and Wolverines alike. Namely, robust primary care medicine is the backbone of healthcare, and whatever else we may end up doing, we need to re-invigorate primary care and restore it to the position of central importance it deserves.

To the notion that primary care medicine is vitally important to American patients, DrRich says hooray. To the notion that anyone with authority in our healthcare system actually wants to fix primary care, however, DrRich says hooey.
The fact of the matter is that in recent years, our healthcare system has taken exquisite pains to make primary care a completely untenable proposition for American doctors. Consider the plight of the modern primary care physician (PCP):

 

Their pay is determined arbitrarily by Acts of Congress, not by what they’re worth to their patients or to the market, and indeed in this way PCPs have a lot in common with workers in the old Soviet collectives.
They are directed to “practice medicine” by guidelines handed down from on high; guidelines which, being forcibly based on what is called “evidence-based medicine,” necessarily address the average response of some large group of patients to the treatment being considered and do not allow much if any latitude for an individual patient’s needs; and which are often promulgated less to assure the excellent care of patients than to further the agenda of various interest groups, professional, governmental and otherwise.
They are limited to 7.5 minutes per "patient encounter," and the content of those 7.5 minutes is scripted in advance by Pay for Performance checklists, strictly limiting any exchanges between doctor and patient that do not meet the approved agenda.
Their every move must be carefully documented according to incomprehensible rules, on innumerable forms and documents, that confound patient care but that greatly further the convenience of healthcare accountants and other stone-witted bureaucrats.
They are expected to operate flawlessly under a system of federal rules, regulations and guidelines that cover hundreds of thousands of pages distributed in countless volumes that are never available in any readily accessible form, and if they fail to do so, they are guilty of the federal crime of healthcare fraud. Furthermore, the specific meanings of these rules, regulations and guidelines are not merely opaque and difficult to ascertain, but indeed they are fundamentally indeterminate. So, PCPs operate under a massive quantum cloud of rules as best they can, but their actual status (regarding healthcare fraud) is, like Schrodinger’s cat, fundamentally unknowable - until the “box is opened” (typically through criminal prosecution), whereupon the meaning of the rules is finally crystallized in a court of law, and doctors who had been practicing in good faith find that they have at least a 50- 50 chance (like the cat) of learning that they are actually professionally dead.
Worst of all, PCPs have been charged with the duty of covertly rationing their patients’ healthcare at the bedside, and they have been pressed to nullify the classic doctor-patient relationship, by the healthcare bureaucracy that determines their professional viability, by the United States Supreme Court, and by the bankrupt, new-age ethical precepts of their own profession.

The healthcare system has (intentionally, DrRich argues) rendered primary care medicine such a soul-wrenching, personally and professionally demeaning endeavor that it has pushed most PCPs beyond mere anger, frustration, or resignation. Most American PCPs over the age of 50 with any measurable degree of self-respect are desperately looking for a way to retire early, and the ones under 50 are looking for some feasible way to change careers. Current medical trainees have learned to avoid primary care in droves.

The idea that the central authorities of healthcare are going to cede back to PCPs any degree of professionalism or independent thought - when strictly controlling the behavior of PCPs is Job One in their effort to reduce costs, and when they've worked so hard to put the PCPs where they've now got them - is laughable.

 

The plan, DrRich believes, is to give PCPs a few perks - a small increase in their paltry pay, for instance - to entice them to not to quit just yet, while they "train up" a new class of professionals who eventually will take over the job of primary care from the physicians, and who (they think) will be more malleable and controllable than physicians ever could be. At the moment, nurse practitioners have been identified as a likely PCP replacement.

 

Indeed, the House healthcare reform bill (HR 3692, Section 1303) specifically enumerates nurse practitioners as members of the category "PCPs" (a term now defined as "primary care practitioner," and not "primary care physician"). So soon, nurses will be, by law, functionally equivalent to doctors practicing primary care.

 

DrRich happens to greatly admire nurses, counts some of them among the finest healthcare professionals he has known, and believes that nurses' commitment to doing what's best for patients is at least equivalent to physicians'. Furthermore, he is convinced that nurses can function just fine as primary care practitioners, as the central authorities have now fashioned that profession. To the degree that nurses will chafe less than doctors at the forced restrictions, they may even function better.

 

Indeed, DrRich's respect for nurses is so great that he predicts most of them will forego the opportunity to become PCPs for the same reason doctors are - doing this job as it is now laid out, they will find, is an insult to their professional integrity.

But whether the central planners' vision comes to pass or not, DrRich finds their current lamentations for the plight of PCPs (a plight they engineered) to be just a tad disingenuous, and certainly overblown.
 


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  ==============================

  I was talking to a urologist from an academic center in St. Louis whose wife is an internist.  He stated that his wife made $90000 and his wife's NP made $95000 and that the only way that most of the primary care physicians get by in the academic centers is by being the spouse of the specialty physicians.  One of the many problems with our system is that instead of insuring that everyone has access to a minimum level of care, at least for the Medicare population, the make sure that no one has access to the maximum level of care.  For a physician to accept Medicare payments as a non-participating physician, they are limited to billing 115% of the Medicare fee schedule, which makes it hardly worth the trouble and added financial risk that the payment from Medicare which will go to the patient in that situation doesn't get passed back to the physician but covers some other essential needs for the patient like cigarettes and cellphone service.  In order to completely break from the Medicare system and work on a cash basis, a physician cannot even see Medicare patients for 2 years.  The bar is set so high for withdrawal that it is difficult to make a living while you are waiting for the 2 years to pass.  You also have to have a fairly well to do clientele to make that scheme work.  The free market has been stripped from the healthcare system.  You can be the very best of your specialty but get paid no more than some slub who barely made it out of training.

John
=====================
"""The free market has been stripped from the healthcare system"""
 
Healthcare has been surviving - for decades - under a price control regime.  Government pricing of medical services is hiding under the pretense of being based on a "scientific" approach, but that's bullsh*t.  In reality it's arbitrary, decided by a few bureaucrats sitting on a committee.  Over time this, of course, resulted in huge dislocations.
 
Real reform would be a combination of tort reform (which would be a good first step in a fight against the culture of defensive medicine), AND massive deregulation.  Instead, we are due for even more pervasive regulation.
 
As far as Primary Care is concerned, I think that over the next few years we will experience a shortage which will be severe beyond anyone's expectations.  Think about it -- Traditionally, aging Docs would continue working in their practice well into their 60's, 70's and even 80's.  They would slow down, work part time, fewer hours, BUT - they would continue working.  The way things stand today, it is hard to make a living in private practice even when one works full blast.  Forget about part time low volume work.  All those older baby boomer docs will have no choice but to retire - in large numbers.       
 
The way things are going, I wouldn't be surprised if the government will use the shortages as an exuse for a total takeover.  Collectivist solutions appear to be shockingly acceptable and even popular... these days.
 
Ol' Fred Hayek must be turning in his grave.
================

"The free market has been stripped from the healthcare system."


I am sure there exist individual exceptions, many here included, but doctors have no one to blame but themselves for this turn of affairs. Really, if true, it could not happen to a more deserving profession. Their greed, insensitivity, and rude and imperious treatment of their patients (read: customers) begged to be countered.


And now it has, or is. Good.

=============
The Anti Nationalized Health Care Resource
The problem with the U.S. Health Care system is a combination of third party payments, government regulations and an artificial limited supply of doctors. Since the average person does not directly pay for their health care they do not care about the costs. Medical insurance encourages unnecessary procedures and waste due to the illusion of it being "free" via a co-pay. In a true free market, direct price competition would drive down prices and encourage others to enter the market, further reducing costs. The problem is government regulation and organizations such as the AMA (American Medical Association) have created an artificial scarcity of doctors, limiting the supply. This is done by limiting the number of medical schools, medical licenses and increasing requirements. Thus the excessive demand cannot be met by normal market forces. Most people are well aware that a limited supply of a good or service increases it's value (cost). Few are aware that attempting to restrict a good or service's price (price controls) limits it's supply causing shortages. It is thus impossible for government controls to either increase the supply of medical care or lower it's price. Government can only "fix" the U.S. health care system by getting out of the way.


===========
D.

   If that is truly the way you feel then you must have had some bad doctors, but one of the reasons that physicians are in the place they are in is because they generally are not greedy and are sensitive to their patient's needs.  We have been more interested in our patient's welfare than the economics of medicine.  One of the dilemma's in my practice is whether to continue seeing Medicaid and Indigent patients in our office.  We have always done so  because there was enough fat in the system to soften the blow even though we knew we were taking a loss, but if the Medicare cuts come through then we will probably have to stop seeing those patients.  We are the only game in town and they will have to travel 50 miles to the state hospital for care even though they as a group are the least likely to be able to afford transportation.  In my experience, at least in my town, the rude, greedy, insensitive physician is the exception as opposed to the rule.  I am sorry that you have become so jaded against my profession.

J.

[ccp]

Dr. Rich is dead on.
Primary care physicians will die out and be replaced completely by nurses in a decade.
Already we are hearing not "consult your doctor" but consult your "health care provider".
What you will see is specialists using their extra dollars hiring nurse practitioners and physician assistents and taking all the primary care under their wing because they can make dollars off it.  Esp. so when their own reimbursements go down.

Patients will not see doctors for basic care - they will be treated by nurses.

Clayton Christensian pointed this out ten years ago with his disruption theories.  Of course he is from Harvard where all this is stuff is being seeded from anyway.

Primary care will not be strengthened but will be "dumbed down".  They will give prmary doctors a laughable 1-2% raise like that is going to do anything and all the while increase taxes from some other end to get the money and back at an even higher rate.

PCPs and doctors in general are already controlled and are de facto government employees - just with NO benefits.  Only edicts.

That said I am not sure why anyone would want to become a doctor at all and not just a primary care doctor.
Specialists will tell you medicine is not a pleasure anymore.

As for "even with a major Tea Party type of a groundswell".
I fear this will not happen.  I am not sure Obama is going down in polls so much because of his socialist agenda.  I think some of his drop in the polls is due to liberals who are annoyed he is NOT socialist enough.

It was a pleasure to have a woman who was born in Chechnia in the office the other day giving me cookies made there.
She said this is still the greatest country in the world.  I feel many of the Eastern Europeans do feel this way. It seemed when I was growing up this is what I would usually hear.  How could one not feel proud of one's country?  Now we have a President and government in general that has an intense visceral dislike of this country. 

I am not sure about the Asians and certainly I question many of the Latinos who come here and vote for handouts in droves.  OTOH there are many Latinos in the military which make me proud and grateful of them.   Some of the Africans I have as patients are hard working. If I see one more unmarried young mother who states everyone should get health care in this country.....the government should be providing it!!!!

The bottom line I guess is if they can come here and play a system that will give them handouts and benefits paid for by taxpayers they figure why not.
Only Eastern Europeans who were previously under totaltarism (sp?) seem to have the work ethic without the outstretched hand.  The Indians and Chinese have work ethic but also learn to play the system.

Just my anecdotal take.
Of course some would immediately claim I am a bigot and pig for even stating such observations.
How dare I state what I see?

[DougMacG]

Politics:  I am amazed that not one democrat senator from any of the other 49 states has enough backbone to stand up to the special rewards offered to Nebraska to purchase Ben Nelson's vote, to Louisiana to purchase Mary Landeau's vote or to the mystery state that will receive a free hospital on the federal taxpayers' dime. 

Legal issue:  I will also be amazed if a court can twist original meaning of the constitution far enough to uphold special treatment of states in the legislation to buy votes can somehow be considered to be 'equal treatment under the law'.

Voter fraud:  The ACORN takeover of Mn Secretary of State and Minneapolis vote count control provided the 60th vote with uneven counting standards applied to heavily liberal voting precincts.  Who says crime doesn't pay?

Even if there is a major political shift and Dems lose both the house and senate, almost impossible, it is still impossible to repeal legislation without a veto-proof majority.

Whatever happened to the concept in law that one congress should not have the power to bind future congresses.  We deserve these liberal policies, marxism, socialism, statism, released terrorists, you name it for these 2 years.  Then a new congress should come in and pass news laws, funding etc. based on THE WILL OF THE PEOPLE.

60% oppose this legislation.  60 senators voted for it.  I have not seen numbers like that since Chavez exit polls showed him losing 40-60 and sure enough he 'won' by 60-40.

[ccp]

"Voter fraud:  The ACORN takeover of Mn Secretary of State and Minneapolis vote count control provided the 60th vote with uneven counting standards applied to heavily liberal voting precincts."

Doug, not that it matters at this point but do you think Coleman was robbed of the election?
The msm of course is dead silent on this issue.

[Crafty_Dog]

I certainly suspect so, but if anyone wants to continue the conversation, please take it over to the relevant thread.

[Body-by-Guinness]

Change Nobody Believes In
A bill so reckless that it has to be rammed through on a partisan vote on Christmas eve.
And tidings of comfort and joy from Harry Reid too. The Senate Majority Leader has decided that the last few days before Christmas are the opportune moment for a narrow majority of Democrats to stuff ObamaCare through the Senate to meet an arbitrary White House deadline. Barring some extraordinary reversal, it now seems as if they have the 60 votes they need to jump off this cliff, with one-seventh of the economy in tow.

Mr. Obama promised a new era of transparent good government, yet on Saturday morning Mr. Reid threw out the 2,100-page bill that the world's greatest deliberative body spent just 17 days debating and replaced it with a new "manager's amendment" that was stapled together in covert partisan negotiations. Democrats are barely even bothering to pretend to care what's in it, not that any Senator had the chance to digest it in the 38 hours before the first cloture vote at 1 a.m. this morning. After procedural motions that allow for no amendments, the final vote could come at 9 p.m. on December 24.

Even in World War I there was a Christmas truce.

The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that "reform" has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state. An increasing roll of leaders in health care and business are looking on aghast at a bill that is so large and convoluted that no one can truly understand it, as Finance Chairman Max Baucus admitted on the floor last week. The only goal is to ram it into law while the political window is still open, and clean up the mess later.

***
• Health costs. From the outset, the White House's core claim was that reform would reduce health costs for individuals and businesses, and they're sticking to that story. "Anyone who says otherwise simply hasn't read the bills," Mr. Obama said over the weekend. This is so utterly disingenuous that we doubt the President really believes it.

The best and most rigorous cost analysis was recently released by the insurer WellPoint, which mined its actuarial data in various regional markets to model the Senate bill. WellPoint found that a healthy 25-year-old in Milwaukee buying coverage on the individual market will see his costs rise by 178%. A small business based in Richmond with eight employees in average health will see a 23% increase. Insurance costs for a 40-year-old family with two kids living in Indianapolis will pay 106% more. And on and on.

These increases are solely the result of ObamaCare—above and far beyond the status quo—because its strict restrictions on underwriting and risk-pooling would distort insurance markets. All but a handful of states have rejected regulations like "community rating" because they encourage younger and healthier buyers to wait until they need expensive care, increasing costs for everyone. Benefits and pricing will now be determined by politics.

As for the White House's line about cutting costs by eliminating supposed "waste," even Victor Fuchs, an eminent economist generally supportive of ObamaCare, warned last week that these political theories are overly simplistic. "The oft-heard promise 'we will find out what works and what does not' scarcely does justice to the complexity of medical practice," the Stanford professor wrote.

• Steep declines in choice and quality. This is all of a piece with the hubris of an Administration that thinks it can substitute government planning for market forces in determining where the $33 trillion the U.S. will spend on medicine over the next decade should go.

This centralized system means above all fewer choices; what works for the political class must work for everyone. With formerly private insurers converted into public utilities, for instance, they'll inevitably be banned from selling products like health savings accounts that encourage more cost-conscious decisions.

Unnoticed by the press corps, the Congressional Budget Office argued recently that the Senate bill would so "substantially reduce flexibility in terms of the types, prices, and number of private sellers of health insurance" that companies like WellPoint might need to "be considered part of the federal budget."

With so large a chunk of the economy and medical practice itself in Washington's hands, quality will decline. Ultimately, "our capacity to innovate and develop new therapies would suffer most of all," as Harvard Medical School Dean Jeffrey Flier recently wrote in our pages. Take the $2 billion annual tax—rising to $3 billion in 2018—that will be leveled against medical device makers, among the most innovative U.S. industries. Democrats believe that more advanced health technologies like MRI machines and drug-coated stents are driving costs too high, though patients and their physicians might disagree.

"The Senate isn't hearing those of us who are closest to the patient and work in the system every day," Brent Eastman, the chairman of the American College of Surgeons, said in a statement for his organization and 18 other speciality societies opposing ObamaCare. For no other reason than ideological animus, doctor-owned hospitals will face harsh new limits on their growth and who they're allowed to treat. Physician Hospitals of America says that ObamaCare will "destroy over 200 of America's best and safest hospitals."

• Blowing up the federal fisc. Even though Medicare's unfunded liabilities are already about 2.6 times larger than the entire U.S. economy in 2008, Democrats are crowing that ObamaCare will cost "only" $871 billion over the next decade while fantastically reducing the deficit by $132 billion, according to CBO.

Yet some 98% of the total cost comes after 2014—remind us why there must absolutely be a vote this week—and most of the taxes start in 2010. That includes the payroll tax increase for individuals earning more than $200,000 that rose to 0.9 from 0.5 percentage points in Mr. Reid's final machinations. Job creation, here we come.

Other deceptions include a new entitlement for long-term care that starts collecting premiums tomorrow but doesn't start paying benefits until late in the decade. But the worst is not accounting for a formula that automatically slashes Medicare payments to doctors by 21.5% next year and deeper after that. Everyone knows the payment cuts won't happen but they remain in the bill to make the cost look lower. The American Medical Association's priority was eliminating this "sustainable growth rate" but all they got in return for their year of ObamaCare cheerleading was a two-month patch snuck into the defense bill that passed over the weekend.

The truth is that no one really knows how much ObamaCare will cost because its assumptions on paper are so unrealistic. To hide the cost increases created by other parts of the bill and transfer them onto the federal balance sheet, the Senate sets up government-run "exchanges" that will subsidize insurance for those earning up to 400% of the poverty level, or $96,000 for a family of four in 2016. Supposedly they would only be offered to those whose employers don't provide insurance or work for small businesses.

As Eugene Steuerle of the left-leaning Urban Institute points out, this system would treat two workers with the same total compensation—whatever the mix of cash wages and benefits—very differently. Under the Senate bill, someone who earned $42,000 would get $5,749 from the current tax exclusion for employer-sponsored coverage but $12,750 in the exchange. A worker making $60,000 would get $8,310 in the exchanges but only $3,758 in the current system.

For this reason Mr. Steuerle concludes that the Senate bill is not just a new health system but also "a new welfare and tax system" that will warp the labor market. Given the incentives of these two-tier subsidies, employers with large numbers of lower-wage workers like Wal-Mart may well convert them into "contractors" or do more outsourcing. As more and more people flood into "free" health care, taxpayer costs will explode.

• Political intimidation. The experts who have pointed out such complications have been ignored or dismissed as "ideologues" by the White House. Those parts of the health-care industry that couldn't be bribed outright, like Big Pharma, were coerced into acceding to this agenda. The White House was able to, er, persuade the likes of the AMA and the hospital lobbies because the federal government will control 55% of total U.S. health spending under ObamaCare, according to the Administration's own Medicare actuaries.

Others got hush money, namely Nebraska's Ben Nelson. Even liberal Governors have been howling for months about ObamaCare's unfunded spending mandates: Other budget priorities like education will be crowded out when about 21% of the U.S. population is on Medicaid, the joint state-federal program intended for the poor. Nebraska Governor Dave Heineman calculates that ObamaCare will result in $2.5 billion in new costs for his state that "will be passed on to citizens through direct or indirect taxes and fees," as he put it in a letter to his state's junior Senator.

So in addition to abortion restrictions, Mr. Nelson won the concession that Congress will pay for 100% of Nebraska Medicaid expansions into perpetuity. His capitulation ought to cost him his political career, but more to the point, what about the other states that don't have a Senator who's the 60th vote for ObamaCare?

***
"After a nearly century-long struggle we are on the cusp of making health-care reform a reality in the United States of America," Mr. Obama said on Saturday. He's forced to claim the mandate of "history" because he can't claim the mandate of voters. Some 51% of the public is now opposed, according to National Journal's composite of all health polling. The more people know about ObamaCare, the more unpopular it becomes.

The tragedy is that Mr. Obama inherited a consensus that the health-care status quo needs serious reform, and a popular President might have crafted a durable compromise that blended the best ideas from both parties. A more honest and more thoughtful approach might have even done some good. But as Mr. Obama suggested, the Democratic old guard sees this plan as the culmination of 20th-century liberalism.

So instead we have this vast expansion of federal control. Never in our memory has so unpopular a bill been on the verge of passing Congress, never has social and economic legislation of this magnitude been forced through on a purely partisan vote, and never has a party exhibited more sheer political willfulness that is reckless even for Washington or had more warning about the consequences of its actions.

These 60 Democrats are creating a future of epic increases in spending, taxes and command-and-control regulation, in which bureaucracy trumps innovation and transfer payments are more important than private investment and individual decisions. In short, the Obama Democrats have chosen change nobody believes in—outside of themselves—and when it passes America will be paying for it for decades to come.

http://online.wsj.com/article/SB10001424052748704398304574598130440164954.html

[Crafty_Dog]

How does one handle this debating method?

http://www.youtube.com/watch?v=gNfG8gwamKM&feature=player_embedded

[DougMacG]

"How does one handle this debating method?"

Admit it.  They are better at getting their message out.  Think what they could do with a better message.

Did I really hear them all say at the end that they pledge allegiance to the government??

[Crafty_Dog]

Upon reflection, I am going to take this over to "The Way Forward" thread.

[Crafty_Dog]

http://money.cnn.com/2009/12/23/news/economy/healthcare_doctors_in_prison/index.htm

[Crafty_Dog]

By BOB HERBERT
Published: December 28, 2009
There is a middle-class tax time bomb ticking in the Senate’s version of President Obama’s effort to reform health care.

Recent developments on the struggle over health care with background, analysis, timelines and earlier events from NYTimes.com and Google.

The bill that passed the Senate with such fanfare on Christmas Eve would impose a confiscatory 40 percent excise tax on so-called Cadillac health plans, which are popularly viewed as over-the-top plans held only by the very wealthy. In fact, it’s a tax that in a few years will hammer millions of middle-class policyholders, forcing them to scale back their access to medical care.
Which is exactly what the tax is designed to do.

The tax would kick in on plans exceeding $23,000 annually for family coverage and $8,500 for individuals, starting in 2013. In the first year it would affect relatively few people in the middle class. But because of the steadily rising costs of health care in the U.S., more and more plans would reach the taxation threshold each year.

Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.

Proponents say the tax will raise nearly $150 billion over 10 years, but there’s a catch. It’s not expected to raise this money directly. The dirty little secret behind this onerous tax is that no one expects very many people to pay it. The idea is that rather than fork over 40 percent in taxes on the amount by which policies exceed the threshold, employers (and individuals who purchase health insurance on their own) will have little choice but to ratchet down the quality of their health plans.

These lower-value plans would have higher out-of-pocket costs, thus increasing the very things that are so maddening to so many policyholders right now: higher and higher co-payments, soaring deductibles and so forth. Some of the benefits of higher-end policies can be expected in many cases to go by the boards: dental and vision care, for example, and expensive mental health coverage.

Proponents say this is a terrific way to hold down health care costs. If policyholders have to pay more out of their own pockets, they will be more careful — that is to say, more reluctant — to access health services. On the other hand, people with very serious illnesses will be saddled with much higher out-of-pocket costs. And a reluctance to seek treatment for something that might seem relatively minor at first could well have terrible (and terribly expensive) consequences in the long run.

If even the plan’s proponents do not expect policyholders to pay the tax, how will it raise $150 billion in a decade? Great question.

We all remember learning in school about the suspension of disbelief. This part of the Senate’s health benefits taxation scheme requires a monumental suspension of disbelief. According to the Joint Committee on Taxation, less than 18 percent of the revenue will come from the tax itself. The rest of the $150 billion, more than 82 percent of it, will come from the income taxes paid by workers who have been given pay raises by employers who will have voluntarily handed over the money they saved by offering their employees less valuable health insurance plans.

Can you believe it?

I asked Richard Trumka, president of the A.F.L.-C.I.O., about this. (Labor unions are outraged at the very thought of a health benefits tax.) I had to wait for him to stop laughing to get his answer. “If you believe that,” he said, “I have some oceanfront property in southwestern Pennsylvania that I will sell you at a great price.”

A survey of business executives by Mercer, a human resources consulting firm, found that only 16 percent of respondents said they would convert the savings from a reduction in health benefits into higher wages for employees. Yet proponents of the tax are holding steadfast to the belief that nearly all would do so.

“In the real world, companies cut costs and they pocket the money,” said Larry Cohen, president of the Communications Workers of America and a leader of the opposition to the tax. “Executives tell the shareholders: ‘Hey, higher profits without any revenue growth. Great!’ ”

The tax on health benefits is being sold to the public dishonestly as something that will affect only the rich, and it makes a mockery of President Obama’s repeated pledge that if you like the health coverage you have now, you can keep it.

Those who believe this is a good idea should at least have the courage to be straight about it with the American people.

[DougMacG]

Acouple of asides: Despite the deafening silence here at my attempt to get at the right and wrong of abortion, it may be the (side) issue that brings down this horrendous, limited government ending legislation.

Only 17% of Nebraskans support the special deal to buy Ben Nelson's vote.  That question should push-polled to death across the rest of the states and publicized nationally:  Do you know of the special deal where 49 states pay expenses for one state too buy their spineless Democrat's vote on health care and do you favor or oppose this form of legislated unequal protection under the law??

Now the (un)constitutionality of the individual mandate: Obviously there are liberal scholars who will say it is fine or they wouldn't be able to write and support any of these liberal policies that violate the founding tenets of our republic.  They can make lame and pretend arguments such as that we already require auto insurance, but how do they hold water compared to these:
--------
http://www.heritage.org/Research/LegalIssues/lm0049.cfm
(This piece is long so I will just quote one section.  Please follow link to read in its entirety!)

Personal Health Insurance v. Drivers' Auto Liability Insurance

Some have argued that a federal mandate requiring all citizens to obtain health insurance is no different than state laws that require licensed drivers to carry proof of auto insurance when driving on the public roads.[37] But there are several important constitutional differences that render the comparison decidedly inapposite.

First, there is a fundamental constitutional difference between the inherent police powers of the states and the enumerated powers of the national government. A bedrock principal of the American republic is that, whereas states enjoy plenary police powers (albeit subject to various constitutional limits), the national government is limited to the enumerated powers "herein granted" to it by the Constitution. Thus, states may craft numerous regulations for the protection of their citizens which are beyond Congress's power. In striking down the federal Gun-Free School Zones Act, the Lopez Court acknowledged that the states already enforced similar criminal laws even though Congress could not. Likewise, when it struck down the federal tort action for rape in Morrison,the Court did not question state laws allowing similar causes of action. State laws regulating the level of insurance that licensed state drivers must have to operate on state roads stem from a completely different source of constitutional authority--a state's police power--than Congress can invoke. Congress has never been thought to have such power, and the Supreme Court has always denied that such plenary federal power exists.

Second, automobile insurance requirements impose a condition on the voluntary activity of driving; a health insurance mandate imposes a condition on life itself. States do not require non-drivers, including passengers in cars with potentially bad drivers, to buy auto insurance liability policies--even though such a requirement undoubtedly would lower the auto insurance premiums for those who do drive. The auto insurance requirement is linked to driving and to the possibility that bad driving may cause injuries to others, including passengers in the driver's car, not to those who benefit from roads generally.

Third, state auto insurance requirements are limited to those who drive on public roads. The public roads are mostly constructed, owned, and maintained by the government, or in some other cases, are built on public rights of way or through the use of eminent domain. What a state (or private citizen) may require of someone using its property is wholly different than what it may do to control their purely private behavior. Driving on government roads is a privilege--one easily distinguished from merely living. For those who choose to drive on public roads, the state can establish terms and conditions reasonably related to preventing injury to others. States may issue drivers licenses, establish and enforce traffic laws, and may require that all those driving on their roads be adequately insured to compensate others for their injuries. These same rules do not extend to driving on private roads or property. Indeed, one may drive vehicles on private property without ever obtaining a state driver's license.

Finally, states require drivers to maintain auto insurance only to cover injuries to others.[38] The mandate does not require drivers to insure themselves or their property against injury or damage. Thus, the auto insurance requirement covers the dangers and liabilities posed by drivers to third parties only, even though many of those same risks apply to the driver himself. The auto insurance mandate seeks to avoid the all-too-common problem of an uninsured and insolvent motorist severely injuring a third party on a public road, leaving the injured party to cover her own medical expenses. But the driver remains free to assume the risk that she will injure herself, even if she is insolvent to pay for her own expenses. Thus, states only seek to ensure that drivers can pay the equivalent of tort judgments for their wrongful conduct to others on state roads; they do not tell drivers how to take care of themselves.

[Body-by-Guinness]

ObamaCare: 'New frontier in pork barrel politics'
by Rowan Scarborough (more by this author)
Posted 12/30/2009 ET


What was championed by Democrats a year ago as a high-minded endeavor to reform health care has instead descended into a grotesque piece of legislation larded with pork, payoffs, back room deals and huge tax increases, say Republicans and experts on Congress.

"We have former members of Congress in jail and a lobbyist  in jail for this sort of behavior," said David Williams, who has been tracking pork-barrel spending for 15 years for Citizens Against Government Waste. "People are really fed up with it."

The close-door deal making is just getting revved up. House and Senate leaders will hold private negotiations next month to reconcile their bills. Envious of the deals Democratic senators extracted from Senate Majority Leader Harry Reid, House members are sure to demand their share of pork favors in exchange for floor votes.

"The wonderful conference committee where a lot of bad things happen," is how Williams described the upcoming process to HUMAN EVENTS. "We never see any good things happen in a conference committee. It's always bad things. We're just putting up the wood paneling getting ready for the January hurricane that is the conference committee because we just suspect it's going to be a doozy."

Reid, the bill's behind-the-scenes architect, used Medicare and Medicaid payments like just another round of pork projects, called earmarks. He handed out a hundred million dollars here and a few hundred million dollars there to secure 60 votes needed for cloture to vote on his bill.

"It's hard to ignore the billions of dollars this is a giveaway for," Williams said. "On one hand, even a $100,000 earmark to get reelected has a huge corrupting influence on the process. But, oh my goodness, here are billions of dollars that were traded like monopoly money is just mind boggling."

The Senate version, and its more than 2,000 pages, is so studded in special favors to various states that Washington watchdogs groups, such as Williams' pork fighters, are still mining new gems a weeks after Reid wrote the $400 billion in tax increases and $2.5 trillion in spending over 10 years.

"Unfortunately, Congress is getting smarter," Williams said. "It's like when a cock roach builds up an immunity to bug spray. It figures out how to survive when it gets sprayed with that stuff. What congressmen do now is they will change a formula now for a state. So, it's not the teapot museum. It's not the 'bridge to no where.' But it's still these spending issues that are driving people in this country insane. They are getting away from the traditional silly projects. There's still pork in the appropriations bill. Don't get me wrong. But this is kind of the new frontier in pork barrel politics."

The magnitude of Reid's wheeling-dealing became so immense as his bill passed Christmas Eve on a party-line vote that some senators abandoned polite debate.

“Democrats have truly hit the bottom on their reckless pursuit of a government takeover of health care," said Sen. Jim DeMint, South Carolina Republican. "The Democrat majority just voted to retain the culture of corruption in Congress. Just two years ago, Democrats bragged about draining the swamp, but now they’re endorsing political bribery. This is Washington at its worst.”

Over in the House, GOP leader John Boehner declared, “Senate Democrats have sunk to plenty of new lows to jam through this government takeover of health care, but putting their votes on the auction block tops them all.”

The Democrats' legislative horse-trades are in addition to a whole pot of goodies President Obama handed out to doctors, hospitals, advocacy groups and drug makers to ensure they worked on behalf of a totally partisan bill.

Reid's plan provides money to the uninsured  many of whom do not want health coverage  by raiding Medicare. It cuts a half-trillion dollars in payments to certain providers.

You would think the most prominent voice for seniors in Washington  The Association for the Advancement of Retired Persons  would be up in arms. But it is silent. Moreover, it actually supports Obama-care.

Why? Republicans say it's because the bill will force more seniors to buy supplemental insurance. And AARP is a big provider of so-called "Medigap" plans, pulling in more than a half-billion dollars in 2008.

"Shame on AARP," Sen. John McCain, Arizona Republican, said on the Senate floor. "Take your AARP card, cut it in half and send it back. They've betrayed you."

Among the Reid handouts, the most infamous are hundreds of millions of dollars on Medicaid payments for the votes of Sen. Mary Landrieu of Louisiana and Ben Nelson of Nebraska. The payments cover the state cost of Medicaid, which will go up under HarryCare. Other states will likely be forced to raise taxes to meet new enrollee demands.

Then we learned that Sen. Chris Dodd, who is in a tough reelection battle in Connecticut, received another big Reid favor: $100 million for a new hospital.

The deals have become known as the "Louisiana Purchase" and "Cornhusker Kickback." To lump the vote-buying process under one banner, someone coined, "Cash for Cloture," a reference to the Obama subsidy for car buyers.

Now, more deals are surfacing. Williams said his group will likely issue a report once it finishes combing through over 2,000 pages of taxes, mandates, government panels, earmarked projects and federal aid.

Other Reid deals:
•    A tax break for Mutual of Omaha Insurance Company (Nelson).
•    Federal money for ACORN, the left-wing activist group connected to phony voter registration lists (Sen. Roland Burris of Illinois).
•    Medicaid payments of $600 million for Vermont. (Patrick Leahy).
•    More than $10 billion for government health centers (Bernie Sanders of Vermont).
•    Florida seniors get to keep extra Medicare benefits that the elderly in other states will lose (Bill Nelson).
•    Higher Medicare payments for hospitals in North Dakota (Byron Dorgan and Kent Conrad).
•    Extend Medicare benefits to a small group of miners in Montana sickened by asbestos (Max Baucus).
AARP is not the only organization who stands to reap more revenue under ObamaCare. The White House enticed drug companies (Big Pharma) with all sorts of favors. In fact, the industry is go gaga over the House and Senate bills it is spending well over $100 million on media ads.

(Some of that money has flowed to two Chicago political/media companies founded by David Axelrod, Obama's closest White House adviser. Axelrod sold his interest to partners, and continues to receive the $2 million buyout in yearly installments. He has an interest in his former firm staying afloat.)

John Berlau of the Competitive Enterprise Institute is writing about one of the many favors the legislation gives drug firms. It has do with Flexible Spending Accounts (FSA) and Health Savings Accounts (FSA). People can contribute pre-tax dollars to both and use the money to buy drugs. But under the pending bills, only prescription drugs  not over-the-counter medicines, as is the case now  can be bought with FSA or FSA money, Berlau told Human Events.

"I think this provision itself, in addition to the harm it does to consumers, is an example of egregious pork for Big Pharma," Berlau said. "By taking away the tax advantages for over-the-counter drugs in FSAs and HSAs, but leaving them in there for prescription medicine, this law encourages folks to go to prescription drugs when they're sick even if OCT drugs will do the trick -- a huge gift to pharmaceutical firms that make expensive prescription drug that will raise health care cost by the billions over time."

And for those who say HarryCare is simply good old fashion horse-trading, critics say the sheer magnitude of the voting buying for what was supposed to be largely a policy bill puts it in class by itself. Berlau said, for example, that Congress has never agreed to pay a state's Medicaid bill in perpetuity, as it did for Sen. Ben Nelson.

Robert E. Moffit, a health care analyst at the Heritage Foundation, said there is an overriding issue that makes HarryCare pork unique.

Reid is handing out money and projects in a bill that affects 300 million Americans, as opposed to a yearly appropriations bill that hands out local bridge and highway projects. Thus, giving various states a special break on paying for Medicaid, means taxpayers elsewhere will have to make up the difference.

"I cannot recall a time where we had anything like this ever happen," said Moffit, a longtime Washington hand. "This transaction is being done to affected 300 million Americans. In other words, the project back home just doesn't affect the people back home. It's to further an agenda that affects every body in every state of the union."

To lawmakers, he said, "what's happening back home, I really don't care that they don't like what I'm doing. I'm going to do it anyway. And in order to get it done, they are doing this horse-trading, trading away literally hundreds of millions of dollars in taxpayer dollars in these payoffs to Louisiana and Nebraska and other states in broad day light. It's never been so blatant before for a lot of people and that's why people are referring to this as legalized corruption and bribery in daylight."

Moffit said the dealing may produce a backlash. Nelson's poll numbers have plummeted in Nebraska, according to a Rasmussen survey.

"The sense of fair play and the sensibilities of ordinary Americans are deeply offended by all this," he said.

Mr. Scarborough is a national security writer who has written books on Donald Rumsfeld and the CIA, including the New York Times bestseller Rumsfeld's War.

http://www.humanevents.com/article.php?id=35027

[ccp]

Doug,

A topic close to your heart.
I think you can see in full bloom the liberal bias of a frequent contributer to NEJM.
Notice he cannot just give us the legal perspective but he has to shove at the end his true political bias.
Many of the public health people from the giant liberal "think tanks" of liberal academia are the true architects of this huge health care legislation that began 16 years ago and lied dorment while awaiting the right political moment to re-emerge its cancerous (IMHO) metastesis.  Liberals just cannot help themselves, they seem to have some disease that drives them to tell the rest of us what we ought to do.

Notice, not one comment about poor women should not be getting pregnant to start with just that it is their right to have taxpayers pay for their abortions.

Anyway it is people like this, behind the scenes who crafted the legislation.  I wonder how much this "humanitarian" makes?

***from the publishers of
the New England
Journal of Medicine
Abortion Politics and Health Insurance Reform
Posted by NEJM • December 2nd, 2009 • Printer-friendly
George J. Annas, J.D., M.P.H.

President Barack Obama has made it clear that he does not want abortion politics to sabotage health care reform. In his September 10 speech about health care to a joint session of Congress, he said, “Under our plan, no federal dollars will be used to fund abortions.” Nonetheless, the centrality of abortion in U.S. politics makes it likely that abortion funding will play a major role in determining whether there is any health care reform law at all. The current abortion controversy concerns the Stupak amendment, whose presence or absence from the final bill may determine the votes of enough members of Congress to determine the outcome. This makes it critical to understand both this amendment and the current state of the law on federal funding for abortion.

The Stupak amendment provides that “No funds authorized or appropriated by this Act . . . may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of rape or incest” (italics added).

The House passed this amendment by a vote of 240 to 194, with 64 Democrats voting in favor (the House health care bill itself passed 220 to 215). Many have blamed the Catholic bishops who lobbied fervently for passage of the Stupak amendment. More influential, however, has been the previously secret fundamentalist Christian political leadership group known variously as the Family or the Fellowship, which includes among its members both of the amendment’s main sponsors, Bart Stupak (D-MI) and Joe Pitts (R-PA).1

The Stupak amendment has been defended as merely continuing the practice created by the Hyde amendment. That amendment, named after the late Congressman Henry Hyde (R-IL), which has been attached to every Health and Human Services Appropriations Act passed since 1976 (and has been added to appropriations legislation for the Defense Department, the Indian Health Service, and federal employees’ health insurance plans) prohibits the use of federal funding for “any abortion” or for any “health benefits coverage that includes abortion,” unless the pregnancy is the result of “rape or incest” or “would, as certified by a physician, place the woman in danger of death unless an abortion is performed.” Under the Hyde amendment, states may use their own funds to finance abortion services through their Medicaid programs, and 17 states currently do so.

The U.S. Supreme Court has ruled on the government funding question twice. The first case, in 1977, involved a Connecticut regulation that limited state Medicaid funding to “medically necessary” abortions, thus excluding those not necessary to preserve a woman’s life or health. The Court ruled that women have a constitutional right to choose to have an abortion, but the state has no obligation to pay for the exercise of this right and may constitutionally encourage women to continue their pregnancies to term by providing funding for childbirth and not abortion. The state may not constitutionally create obstacles to abortion, but it has no obligation to remove obstacles, such as poverty, that are not of its own making.2

Three years after the Connecticut decision, the Court upheld the Hyde amendment, which prohibited federal funding for medically necessary abortions.3 Under this ruling, even low-income women who would have devastating health outcomes if they continued a pregnancy could not have an abortion paid for by Medicaid. In both cases, the Court ruled that the government could make “a value judgment favoring childbirth over abortion and [implement] that judgment by the allocation of public funds.” There is no constitutional requirement for the federal government to fund any abortion. Federal funding is a political question to be addressed by Congress.

The current version of the U.S. Senate bill on health care reform, which Majority Leader Harry Reid (D-NV) created by blending bills from two committees, does not contain the Stupak amendment but specifically excludes federal funding for abortions as prohibited by any federal law (including the Hyde amendment) that was in effect “6 months before the beginning of the plan year involved.” States must also ensure that “no federal funds pay or defray the cost” of abortion services in new health plans that cover abortion. Moreover, states are required to offer at least two plans in the proposed health insurance exchanges (where most people who currently lack coverage will purchase insurance): one that covers abortion services and one that does not. Nonfederal funds for abortion coverage in any plan must be segregated, and payment must be made separately, in an amount estimated by the secretary of health and human services, to cover this benefit.

The primary promoters of the Stupak amendment in the Senate, Orrin Hatch (R-UT) and Sam Brownback (R-KS), who is also a member of the Family,1 would not vote for a health care reform bill even if it outlawed federal payments for all abortions because both men object to more government involvement in health care. Since 51 votes would be required for the Senate to adopt the amendment, it seems unlikely that it will be added to the Senate bill.

Three major questions have been raised about the House and Senate approaches: Do they fulfill Obama’s no-federal-funding promise? Do they follow the Hyde amendment “tradition”? And do they represent good health insurance policy?

As for the first question, the Senate version fulfills the President’s promise by requiring abortion funding to come from sources other than federal tax dollars. This aspect of the provision has been denigrated as a “bookkeeping trick,” but all payments involve bookkeeping. Even federal employees who pay for abortions with their government salaries are using funds that came from federal tax dollars. As for the second question, the Stupak amendment goes far beyond the Hyde amendment by prohibiting the use of federal tax dollars not only for abortion itself but also for any health plan available on the proposed exchanges that covers abortion. The goal is to limit access to abortion, even when no federal funds are being used for it.

The third question relates to public health policy. The Hyde amendment institutionalizes the moral view of some members of Congress that even medically necessary abortions should not be considered health care. This view, for example, led Congress to criminalize an abortion procedure without an exception for the health of the pregnant woman.4 These are the types of federal government intrusions into health care that opponents of public insurance plans usually decry.

President Obama is nonetheless on solid political ground in leaving for another day the toxic issue of federal funding for abortions. Should the current Senate bill get to conference committee, the Senate conferees should insist that their abortion-funding–neutral language be adopted in the final bill. The House conferees are unlikely to object. The Stupak amendment cannot be fairly termed a health care bill because it further restricts funding, and voting against it seems to me a reasonable response from senators and representatives who support social justice and equality between the sexes.***

[DougMacG]

Thanks CCP,  If I read through their spin correctly they are saying don't let abortion details kill the bill.  Set it aside, get it passed and add it back later.  In 99+% of the cases, the issue has nothing to do with health care, except to keep women from harming themselves, assuming (falsely) that they would get pregnant and terminate at the same rate if medical services, free ones in particular, were not readily available. Funding solution could be simple, just dedicate all the dollars spent on marketing, legal and political for the abortion industry and the terminations would be fully funded.  But then the liberal law firms and lobbyists would be defunded. 

The ending description for abortion just can't be ignored: "...social justice and equality between the sexes", just as provocative as my description of it as slaughtering your young.

China is different, but as far as I know we terminate equally between the genders.  The social justice elephant in the room they won't say isn't free terminations, it is that we terminate black babies at 3.1 times the rate of white babies and that rate is even higher for taxpayer funded abortions.  Assuming abortion on demand is a good thing for women, it looks like white women are being treated unfairly.  The unspoken racist argument implied is that these unwanted, mostly inner city babies would live miserable lives and be a net drain on our society anyway.  That's quite a judgment!  If true that issue should be aimed back at those 'parents' not the innocent unborns who have yet do anything wrong IMHO.

[Rarick]

On the health care Issue.  Who is going to be in charge of operating this new beast.   I would suggest giving the AMA something to do aside from running lobbyists.  Postmen run the post office.  Bankers run the FED.

Just trying to provoke some discussion that would maybe be constructive, and get me some more info on the issue?

[Crafty_Dog]

http://www.foxnews.com/politics/2010/01/02/senate-dem-asks-south-carolinas-attorney-dogs/?test=latestnews

 

Updated January 02, 2010

Senate Dem Asks South Carolina's Top Attorney to 'Call Off the Dogs'
FOXNews.com



A Democratic senator from Nebraska who played a crucial role in getting health care legislation passed in the Senate last month has asked South Carolina's top attorney to "call off the dogs" -- a reference to the state official's threat to challenge the constitutionality of the bill.

In a phone call Thursday, Sen. Ben Nelson, D-Neb., urged South Carolina Attorney General Henry McMaster to reconsider, Politico reported. McMaster is  the head of a group of 13 GOP state attorneys general who are threatening to file a lawsuit against the Senate health care bill.

Nelson asked McMaster to "call off the dogs," according to a copy of the memo sent by McMaster's chief of staff to other GOP state attorneys general detailing the call and obtained by Politico.

The attorneys general are challenging the constitutionality of a Medicaid provision in the bill that they say benefits Nebraska at the expense of other states.

The deal Nelson cut with Senate Democratic leaders to gain his critical vote would exempt Nebraska from having to pay for the coverage of new enrollees into its Medicaid program and leave the tab with the federal government -- a move expected to cost Uncle Sam $100 million over the next 10 years.

But Nelson told McMaster that the deal wasn't his idea and that the same Medicaid exemption would be offered to every state, according to the memo.

McMaster told Nelson that the state attorneys were seeking to remove the Nebraska Medicaid provision from the bill and that "he saw no way that he -- nor any of the state attorneys general " will support extending the provision to every state, the memo said.

 

[Crafty_Dog]

A private sector IPO with numbers like this would get people sent to jail.
========================================

http://www.cato.org/pubs/tbb/tbb-58.pdf

No. 58 • November 2009

Will Federal Health Legislation Cause the Deficit to Soar?
by Daniel J. Mitchell, Senior Fellow, Cato Institute


The health care plan approved by the Senate Finance Committee is supposed to reduce budget deficits over 10 years by $81 billion, according to the Congressional Budget Office.1 Similarly, the House version of health legislation would reduce 10-year deficits by $104 billion, according to the CBO.2 Supporters of these health care proposals thus argue that the plans are fiscally responsible.

However, enacting a $1 trillion entitlement program would greatly increase the burden of government spending. In addition, promises of lower deficits are a triumph of hope over experience. Government forecasters have a very poor track record of predicting costs. More realistic assumptions suggest that health legislation could easily push up 10-year deficits by $600 billion.

Government-run health care will cost more than the politicians are telling us. The tax increases will not collect as much money as the politicians think. And, to put it mildly, promises of future spending restraint are naïve. The following are some of the reasons why current federal health proposals will mean not just more spending and higher taxes, but also larger deficits and added debt.

1.      The Senate plan would increase federal spending by nearly $900 billion, while the House plan would increase spending by more than $1.2 trillion, according to the CBO. These estimates are far too low because they do not properly measure how people and businesses change their behavior in response to government handouts.

 

1.      Errors in forecasts by the Congressional Budget Office and Joint Committee on Taxation could have large fiscal implications. If revenues and offsets are 25 percent below the forecast and spending is 50 percent higher than estimated, the 10-year deficits will be $602 billion to $860 billion higher.

 

1.      There are incentives for companies to dump their health plans since workers will then get more take-home pay and be able to obtain health insurance using subsides and handouts from the government. This will dramatically increase budgetary costs.

 

1.      The spending estimates are far too low because they do not recognize that politicians in the future will be tempted to expand subsidies as part of routine vote-buying behavior, similar to what happened with Medicare and Medicaid.

 

1.      Future savings in the Senate plan are based on unrealistic gimmicks such as a “Medicare Commission” and a “Failsafe Budgeting Mechanism.” These absurd ploys share one thing in common—a hollow commitment to be frugal in the future while spending more today.

 

1.      Even the savings that might be real—such as reductions in Medicare payment rates for physicians’ services in the Senate plan—are pushed off into the future, where they can be cancelled by politicians seeking to curry favor with key constituencies.

 

1.      Much of the new spending is “backloaded,” meaning that it does not take effect for several years. This makes the long-run costs appear deceptively low. More than 90 percent of the spending in the Senate plan takes place in the second five years of the 10-year projection, and more than 84 percent of the spending in the House plan is also in the last five years.

 

1.         Outlays in both plans will be climbing by about 8 percent annually toward the end of the 10-year period, much faster than growth in the overall economy.3

 

 

1.         The federal government’s ability to predict healthcare spending leaves much to be desired. When Medicare was created in the 1960s, the long-range forecasts estimated that the program would cost about $12 billion by 1990. It ended up actually costing $110 billion that year, or nine times more than expected.4

 

Source: Joint Economic Committee.Medicare Spending in 1990,Estimated and Actual$12$110$0$40$80$1201967 Estimate for 1990Actual Spending in 1990Billions of Dollars

1.      When Medicaid was created in 1965, it was supposed to be a very small program with annual expenditures of about $1 billion.5 It has now become a huge $280 billion per year burden for federal taxpayers.

 

1.         Medicaid’s disproportionate share hospital (DSH) program is a sobering example. Created in 1987 to subsidize hospitals with large numbers of uninsured patients, the program was supposed to cost $1 billion in 1992, but actually cost a staggering $17 billion.6

 

Source: Joint Economic Committee.Medicaid DSH Spending in 1992,Estimated and Actual$1$17$0$5$10$15$201987 Estimate for 1992Actual Spending in 1992Billions of Dollars

1.         The Medicare Catastrophic Coverage of 1988 was repealed after less than two years, in part because some provisions were already projected to cost six times more than originally forecast. 7

2.      The tax provisions in the health proposals will impose considerable damage while raising less revenue than expected. The House legislation will supposedly raise more than $460 billion from higher income tax rates, but actual collections would likely be far smaller because of reduced incentives to earn income and increased incentives to avoid and evade taxes.

 

1.      The Senate plan has big tax increases on high-cost insurance policies, medical devices, and health insurance providers. However, a substantial share of those projected revenues would evaporate as businesses and consumers alter their behavior to protect themselves from the taxes.

 

1.         With the phase-out of insurance subsidies in some plans, taxpayers with modest incomes will face marginal tax rates of nearly 70 percent, a staggering penalty on upward mobility that will hinder overall economic performance.8

 

1.      To add insult to injury, the Internal Revenue Service would get new enforcement powers to determine if people have acceptable (in the eyes of politicians and bureaucrats) health insurance.

 

Deficits and debt will skyrocket if government-run healthcare is expanded. This will happen if either the House or Senate plan becomes law. Big increases in federal spending and higher taxes are a bleak combination that would substantially slow U.S. economic growth.

1 Congressional Budget Office, letter to Senator Max Baucus (D-MT), October 7, 2009.

2 Congressional Budget Office, letter to Representative Charles Rangel (D-NY), October 29, 2009.

3 Congressional Budget Office, letter to Senator Max Baucus (D-MT), October 7, 2009.

4 Joint Economic Committee, “Are Health Care Reform Cost Estimates Reliable?” July 31, 2009. The JEC cites 1967 testimony by Robert J. Myers.

5 Clay Chandler, “Health Care Costs a Long-Term Headache,” Washington Post, October 17, 1993.

6 Joint Economic Committee, “Are Health Care Reform Cost Estimates Reliable?” July 31, 2009.

7 Marilyn Moon, “The Rise and Fall of the Medicare Catastrophic Coverage Act,” National Tax Journal 43, no. 3 (September 1990).

8 Greg Mankiw, “Marginal Tax Rates from Health Reform,” October 10, 2009

[Body-by-Guinness]

Coakley's Saviors
The health-care industry rides to the Democratic rescue.
We've argued that the leading health industry CEOs will one day be exposed as the most short-sighted business leaders in history, but how to explain the gala fundraiser that their top lobbyists hosted for Martha Coakley last night?

Amid a Beltway panic, the health lobby is riding to the rescue of the Massachusetts liberal, whose defeat in the special Senate race next Tuesday could deny Democrats the 60th vote for ObamaCare and thus maybe spare the U.S. health system from the coming damage.

As first reported by Timothy Carney of the Washington Examiner, the host committee for the fundraiser at Pennsylvania Avenue's Sonoma Restaurant includes lobbyists for Pfizer, Merck, Eli Lilly, Novartis and sundry other drug companies that have been among the biggest of ObamaCare's corporate sponsors. Other hosts—who have raised at least $10,000 for Ms. Coakley—include representatives from UnitedHealthcare, Blue Cross Blue Shield, Humana and other insurers. As far as we can tell, the insurance industry claims to oppose ObamaCare's current incarnation.

Naturally, lobbyists from America's Health Insurance Plans and Pharmaceutical Research and Manufacturers of America, the major trade groups, were on hand too. Money follows power in Washington, obviously, though this example seems especially inexplicable given that Ms. Coakley's GOP opponent, state senator Scott Brown, may be the last chance to defuse the health-care doomsday machine. But maybe someone in the press corps will bother to mention this episode the next time President Obama takes aim at the "special interests" he claims are opposing his agenda.

Against overwhelming public opposition, the only things keeping ObamaCare alive at this point are power politics and the misguided corporate cease-fire that Democrats have either coerced or bought—or is homegrown at companies like Pfizer that are deeply invested in more government control of the economy. Ms. Coakley's election would make that outcome a certainty.

http://online.wsj.com/article/SB10001424052748704586504574654704100186542.html?mod=WSJ_Opinion_AboveLEFTTop

[Crafty_Dog]

Business is often the enemy of free enterprise and the friend of fascism.

==================
In a different vein , , ,

http://www.daybydaycartoon.com/2010/01/07/

[Body-by-Guinness]

Pelosi says House cannot pass Senate's health-care bill without changes
By Shailagh Murray and Paul Kane
Washington Post Staff Writer
Thursday, January 21, 2010; 11:43 AM

House Speaker Nancy Pelosi said Thursday that the Senate will have to amend its version of a health-care reform bill before her chamber can pass it.

"I don't think it's possible to pass the Senate bill in the House," Pelosi told reporters after a morning meeting with her caucus. "I don't see the votes for it at this time."

Pelosi has been struggling for days to sell the Senate legislation to reluctant Democrats in order to get a health-care bill to the president's desk quickly. But moderates in her caucus have raised doubts about forging ahead without bipartisan support -- a challenge as the midterm election approaches -- while liberals rejected the Senate bill as not going far enough.

Most problematic for many House Democrats was how the Senate bill handled federal subsidies to buy health insurance, and the Senate's new excise tax on high-value policies, which could hit union households.

Republican Scott Brown's victory Tuesday in a Senate special election in Massachusetts blindsided Obama and Democratic leaders, who had nearly reached the finish line on an ambitious overhaul of the nation's health-care system and were beginning to turn their attention to other challenges, namely creating jobs and lowering the deficit.

The loss of their Senate supermajority has required a frantic reassessment of their strategy. Pelosi (D-Calif.) and Senate Majority Leader Harry M. Reid (D-Nev.) have pledged to complete work on the massive bill they started nearly a year ago, but they have yet to identify a clear way forward that will appeal broadly to their rank-and-file.

Obama added to the confusion Wednesday when he seemed to endorse one option: having both the House and the Senate start from scratch, by voting on a scaled-back package of popular provisions that would crack down on insurance companies but provide health coverage to far fewer additional people.

"We know that we need insurance reform, that the health insurance companies are taking advantage of people," Obama told ABC News in an interview. "We know that we have to have some form of cost containment because, if we don't, then our budgets are going to blow up. And we know that small businesses are going to need help."

But the White House quickly moved to clarify that the president still wants comprehensive reform.

"Right now there are a lot of discussions going on about the best path forward," spokesman Reid Cherlin said in a statement. "But let's be clear that the president's preference is to pass a bill that meets the principles he laid out months ago: more stability and security for those who have insurance, affordable coverage options for those who don't, and lower costs for families, businesses, and governments."

reiterated Wednesday her resolve to send a health-care bill to Obama's desk. "We heard the people, and hopefully we will move forward with their considerations in mind. But we will move forward in the process," Pelosi told the U.S. Conference of Mayors in a speech.

Reid, meanwhile, struck a more cautious note. "We're not going to rush into anything," he told reporters after a Senate Democratic lunch. "Remember, the bill we passed in the Senate is good for a year. There are many different things that we can do to move forward on health care, but we're not making any of those decisions now."

Caution from moderates
Moderate members of Reid's caucus also urged restraint, interpreting the Massachusetts outcome as a clear signal against advancing such a huge bill along party lines.

"I felt from the beginning that the best way to adopt anything as major as health-care reform was to do it in a bipartisan way," said Sen. Joseph I. Lieberman (I-Conn.). "You've got to listen to the message from Massachusetts, and I think it was all about, they want us to work together, they don't want us to do too much at once, and they want to feel that we're listening to them."

The health-care legislation is only one of several major bills on which Reid now needs, in the wake of the Massachusetts result, to win Republican votes.

The Senate on Wednesday took up a proposal to increase the nation's debt ceiling, but it is not clear whether, even before Brown is sworn in, enough Democrats are willing to vote for the measure to overcome GOP objections. Bills to change immigration laws and curtail greenhouse-gas emissions, two other Obama priorities, will not even come to the Senate floor without Republican support.

Tuesday's election also deepened the uncertainty surrounding another top administration goal -- overhauling the nation's financial regulatory system. A version of the legislation passed the House last month, but it has met stiff resistance from Republicans on the Senate banking committee, primarily over the creation of a Consumer Financial Protection Agency.

Brown on health care
Brown was elected to replace the late Edward M. Kennedy (D), the Senate's longtime champion of universal health care. He struck a conciliatory note during a Wednesday news conference in Boston, telling reporters that he supports expanding health-care coverage.

"I think it's important for everyone to get some form of health care," Brown said. "So to offer a basic plan for everybody, I think, is important. It's just a question of whether we're going to raise taxes, we're going to cut half a trillion from Medicare, we're going to affect veterans' care. I think we can do it better."

But if the senator-elect was willing to consider a health-care bill, most Republicans voiced relief that they may have dodged the current Democratic effort. Asked Wednesday whether the bill is dead, Senate Minority Leader Mitch McConnell (R-Ky.) responded, "I sure hope so."

Sen. Susan Collins (Maine) is one of a handful of Republican moderates whose votes are certain to be sought by Obama and Reid in the months ahead on various bills. She said she remains open to a health-care compromise, but she worried that economic issues are more pressing.

"Many of us have heard from our constituents that, in addition to their overall concern about health care, they would like to see the administration and Congress focus on economic issues," Collins said. "That's the message from back home."

Staff writers Lori Montgomery and Perry Bacon Jr. contributed to this report.

http://www.washingtonpost.com/wp-dyn/content/article/2010/01/21/AR2010012101604.html

[ccp]

I felt like we were going to the gallows and at one minute before the switch was to be pulled the governor calls and grants a pardon.  I was even wondering what GS level I would start at. 
The only pity is we still have three years left for JC 2.
A culture of government doles won't get this country back on its feet.

*****Jewish World Review January 21, 2010

Democrats on the precipice of failure

By George Will

http://www.JewishWorldReview.com |

"We are on the precipice of an achievement that's eluded Congresses and presidents for generations."

-- President Barack Obama, Dec. 15, on health-care legislation

Precipice, 1. a headlong fall or descent, esp. to a great depth -- Oxford English Dictionary

Trying to guarantee Americans the thrill of the precipice, the president dashed to Massachusetts on Sunday, thereby conceding that he had already lost Tuesday's Senate election, which had become a referendum on his signature program. By promising to cast the decisive 41st vote against the president's health-care legislation, the Republican candidate forced all congressional Democrats to contemplate this: Not even frenzied national mobilization of Democratic manpower and millions of dollars could rescue one of the safest Democratic seats in the national legislature from national dismay about the incontinent government expansion, of which that legislation is symptomatic.

 FREE SUBSCRIPTION TO INFLUENTIAL NEWSLETTER

  Every weekday NewsAndOpinion.com publishes what many in the media and Washington consider "must-reading". HUNDREDS of columnists and cartoonists regularly appear. Sign up for the daily update. It's free. Just click here.
 
 

Because the legislation is frightening and unpopular, Democrats have had to resort to serial bribery to advance it. Massachusetts voted immediately after the corruption of exempting, until 2018, union members from the tax on high-value health insurance plans. This tax was supposedly the crucial component of what supposedly was reform's primary goal: reducing costs.

The late Sen. Daniel Patrick Moynihan (D-N.Y.) thought Bill Clinton's presidency was crippled by the 1993 decision to pursue health-care reform rather than welfare reform. So slight was public enthusiasm for the former that Clinton's program never even came to a vote in the House or Senate, both controlled by Democrats. There was such fervor for welfare reform that in 1996, after two Clinton vetoes, he finally signed the decade's most important legislation.

In their joyless, tawdry slog toward passage of their increasingly ludicrous bill, Democrats now cling grimly to Robert Frost's axiom that "the best way out is always through." Their sole remaining reason for completing the damn thing is that they started it. The Democrats seem to have convinced themselves that they lost control of Congress in 1994 because they did not pass an unpopular health bill in 1993. Actually, their 1994 debacle had more to do with the arrogance and malfeasance arising from 40 years of control of the House of Representatives (e.g., the House banking scandal), a provocative crime bill (gun control, federal subsidies for midnight basketball) and other matters.

With one piece of legislation, President Obama and his congressional allies have done in one year what it took President Lyndon Johnson and his allies two years to do in 1965 and 1966 -- revive conservatism. Today, conservatism is rising on the steppingstones of liberal excesses.

Between FDR's reprimand by voters in the 1938 midterm congressional elections (partly because of his anti-constitutional plan to enlarge and pack the Supreme Court) and LBJ's 1964 trouncing of Barry Goldwater, there was no liberal legislating majority in Congress: Republicans and conservative Democrats combined to temper liberalism's itch to overreach. In 1965 and 1966, however, liberalism was rampant. Today, Democrats worrying about a reprise of 1994 should worry more about a rerun of the 1966 midterm elections, which began a Republican resurgence that presaged victories in seven of the next 10 presidential elections.

The 2008 elections gave liberals the curse of opportunity, and they have used it to reveal themselves ruinously. The protracted health-care debacle has highlighted this fact: Some liberals consider the legislation's unpopularity a reason to redouble their efforts to inflict it on Americans who, such liberals think, are too benighted to understand that their betters know best. The essence of contemporary liberalism is the illiberal conviction that Americans, in their comprehensive incompetence, need minute supervision by government, which liberals believe exists to spare citizens the torture of thinking and choosing.

Last week, trying to buttress the bovine obedience of most House Democrats, Obama assured them that if the bill becomes law, "the American people will suddenly learn that this bill does things they like." Suddenly?

If the Democrats' congressional leaders are determined to continue their kamikaze flight to incineration, they will ignore Massachusetts's redundant evidence of public disgust. They will leaven their strategy of briberies with procedural cynicism -- delaying certification of Massachusetts's Senate choice, or misusing "reconciliation" to evade Senate rules, or forcing the House to swallow its last shred of pride in order to rush the Senate bill to the president's desk. Surely any such trickery would be one brick over a load for some hitherto servile members of the Democratic House and Senate caucuses, giving them an excuse to halt their party's Gadarene rush toward the precipice.*****

[prentice crawford]

Woof,
 One might ask, what is so damn important about the Healthcare Bill that the Dem's and President Obama would risk losing power in both the House and Senate, tarnishing the Presidency of the first African American President, basically making him a lame duck with three years to go, and handing 2012 to the Republicans, if they don't throw up on themselves before then?    
 Was it a matter of moral principle that demanded the uninsured be covered after all these years without universal healthcare? Was it about lowering healthcare cost? Improving care? Just plain Ole' doing what's right for America? Does anyone think they really cared that much about any of those things that they used to justify what they were doing? I don't. So what is it? It's because the healthcare system could provide a government controlled framework that could be changed, added on to, and morphed into a socialistic system that could operate outside our current governmental framework of a constitutional republic. In other words it could easily be used as a shadow government to control the behavior of citizens and erode personal independence from government, freedom of choice, and individual rights. It's the Holy Grail of Socialism. That is why these Liberal, ideologically driven politicians were willing to go so far, even to the point of self destruction to grab the brass ring of healthcare reform. And I've got news for you, they are not giving it up yet, not if Obama and the Left is sticking to their playbook written by their hero Saul Alinsky.
 www.americanthinker.com/2008/10/obamas_radical_revolutionits_a.html
                                              P.C.

[Rarick]

It ain't over, what other elections are out there?

[Crafty_Dog]

Well, there is that little matter of the entire House of Representatives and one third of the US Senate being up for election in ten months , , ,

[Rarick]

EXactly.........

[prentice crawford]

Woof,
 You don't understand; they are not going to let elections or any form of the will of the people like the tea parties or townhall revolts, get in their way and they havn't been kicked out yet.
         http://news.yahoo.com/s/ap/us_health_care_overhaul
                                    P.C.

[ccp]

The triumvarite's efforts continue:

***IN THE COFFINPELOSI AND REID PLOT SECRET PLAN FOR OBAMACARE
By Dick Morris And Eileen McGann 01.25.2010 Highly informed sources on Capitol Hill have revealed to me details of the Democratic plan to sneak Obamacare through Congress, despite collapsing public approval for healthcare “reform” and disintegrating congressional support in the wake of Republican Scott Brown’s victory in Massachusetts.

President Obama, House Speaker Nancy Pelosi, and Senate Majority Leader Harry Reid all have agreed to the basic framework of the plan.


Their plan is clever but can be stopped if opponents of radical healthcare reform act quickly and focus on a core group of 23 Democratic Congressman. If just a few of these 23 Democrats are “flipped” and decide to oppose the bill, the whole Obama-Pelosi-Reid stratagem falls apart.

Here’s what I learned top Democrats are planning to implement.

Senate Democrats will go to the House with a two-part deal.

First, the House will pass the Senate’s Obamacare bill that passed the Senate in December. The House leadership will vote on the Senate bill, and Pelosi will allow no amendments or modifications to the Senate bill.

How will Pelosi’s deal fly with rambunctious liberal members of her majority who don’t like the Senate bill, especially its failure to include a public option, put heavy fines on those who don’t get insurance, and offering no income tax surcharge on the “rich”?

That’s where the second part of the Pelosi-deal comes in.

Behind closed doors, Reid and Pelosi have agreed in principle that changes to the Senate bill will be made to satisfy liberal House members — but only after the Senate bill is passed and signed into law by Obama.

This deal will be secured by a pledge from Reid and the Senate’s Democratic caucus that they will make “fixes” to the Senate bill after it becomes law with Obama’s John Hancock.

But you may ask what about the fact that, without Republican Scott Brown and independent Democrats such as Joe Lieberman, Reid simply doesn’t have the 60 votes in the Senate to overcome a Republican filibuster that typically can stop major legislation?

According to my source, Reid will provide to Pelosi a letter signed by 52 Democratic senators indicating they will pass the major changes, or “fixes,” the House Democrats are demanding. Again, these fixes will be approved by the Senate only after Obama signs the Senate bill into law.

Reid also has agreed to bypass Senate cloture and filibuster rules and claim that these modifications fall under “reconciliation” and don’t require 60 Senate votes.

To pass the fixes, he won’t need one Republican; he won’t even need Joe Lieberman or wavering Democrats such as Jim Webb of Virginia.

His 52 pledged senators give him a simple majority to pass any changes they want, which will later be rubberstamped by Pelosi’s House and signed by Obama.

This plan, of course, is a total subversion of the legislative process.

Typically, the Senate and House pass their own unique legislation and then both bills go to a conference committee. In conference, the leadership of both Democrat-dominated houses wheels and deals and irons out differences.

The final compromise bill is then sent back to the full Senate and full House for a vote and has to pass both to go to the president.

In the House, a simple majority passes the legislation. But under Senate rules, major legislation requires 60 votes to end a filibuster.

As it stands, the House bill and Senate bill have major discrepancies. Reid does not have 60 votes to pass a compromise bill that would no doubt include some of the radical provisions House members have been demanding.

But if the House passes the exact Senate bill that passed by a 60-39 Senate vote last month, there is no need for a conference on the bill. It will go directly to the president’s desk.

There is a rub to all of this.

This secret plan being hatched by Pelosi and Reid requires not only a pledge by 52 Democratic senators to vote later for the House modifications. House liberals must actually believe these Senators will live up to their pledge and pass the fixes at some future date.

A Senate source cautions: “Senators more than House members and both more than ordinary people, lie.”

Still, my Senate source and others in Washington believe that the liberals in the House, grasping at straws after the stunning Massachusetts defeat, will go along with the Reid-Pelosi plan to bypass a conference bill and ultimately will vote for the Senate version without changes.

Among the key “fixes” House liberals are demanding the Senate pass in reconciliation at some later date include a “carve out” for unions from the “Cadillac policy” insurance tax. The Senate plan funds their healthcare plan by heavy taxes on so-called “Cadillac” insurance plans that provide those insured with exceptionally good coverage including almost unlimited health access with little or no co-payments. The Senate’s view was that rich people have such plans and should be taxed for them to pay the less fortunate.

But many unions have Cadillac plans for their members, and they are furious their members will be hit with the Senate tax. The unions have told their minions in the House to oppose the Senate Cadillac plan tax.

House liberals also are requiring a fix that increases fines for those who flout the law and don’t buy health insurance (the Pelosi-passed plan includes criminal penalties, including possible jail time if a person doesn’t purchase insurance). Another fix will raise subsidies for low-income families seeking to buy insurance.

In the original House bill that passed, healthcare expansion costs would have been paid for by an income tax surcharge on the “rich.” House liberals are pushing for that fix as well.

So what is the counter-move? How do opponents of Obamacare stop this?

Opponents cannot rely on liberal Democrats in the House who might balk at passing the Senate bill with just a “pledge” from 52 senators. I have no doubt House liberals, despite their skepticism, will fade under pressure from Pelosi and Obama. They will do their duty and pass the Senate bill, whatever their current posturing.

Instead, the key to stopping the Pelosi-Reid plan lies with conservative or “moderate” Democrats who voted for the healthcare bill the first time.

There are 23 of these conservative-leaning Democratic House members who voted for Pelosi’s Obamacare back in November, which passed by just five votes, with 39 Democrats defecting to vote against the bill.

All 23 of these congressmen who did vote for the Pelosi bill are extremely vulnerable.

Opponents of Obamacare need to climb all over these 23 congressmen with TV ads and advocacy campaigns in their districts to get them to change their vote this time, to vote “no” to the Senate bill when it comes before the House.

Voters need to say, “You voted for Obamacare the first time. But your district opposes it by 2 to 1. Now it is coming up for a vote again. Listen to your constituents and vote no. We don’t want Medicare cuts or premium increases or rationing of medical care. Don’t monkey with our healthcare. Vote no this time.”

Since the House healthcare bill passed by five votes, much has happened and the political landscape has changed dramatically.

The Massachusetts election of a Republican to Ted Kennedy’s Senate seat has sent shock waves through Washington. Every one of these 23 Democrats knows they will face an angry backlash in their districts if they vote for the Senate bill and go along with Pelosi-Reid plan to ram through Obamacare.

I believe now is the time for opponents to act. The truth is that Obamacare is hanging by a thread.

Opponents, if they move now, can drive a stake through its heart.

Once these congressmen hear from their aroused constituents, they won’t be able to back Obamacare.

As I mentioned, the Pelosi health bill passed the House by only 220-215. Nancy Pelosi knows she has no margin for error.

If only a handful of these 23 congressmen change their vote under public pressure, the Pelosi-Reid plan is stopped and Obamacare is dead.

Click here to help fund ads in the districts of these swing Congressmen.

--------------------------------------------------------------------------------
Jan 25 2010 | Category: Dick's Articles | 10 Comments
Copyright © 2010 DickMorris.com*****   

[Body-by-Guinness]

Health Care: Who Knows 'Best'?

By Jerome Groopman
One of the principal aims of the current health care legislation is to improve the quality of care. According to the President and his advisers, this should be done through science. The administration's stimulus package already devoted more than a billion dollars to "comparative effectiveness research," meaning, in the President's words, evaluating "what works and what doesn't" in the diagnosis and treatment of patients.

But comparative research on effectiveness is only part of the strategy to improve care. A second science has captured the imagination of policymakers in the White House: behavioral economics. This field attempts to explain pitfalls in reasoning and judgment that cause people to make apparently wrong decisions; its adherents believe in policies that protect against unsound clinical choices. But there is a schism between presidential advisers in their thinking over whether legislation should be coercive, aggressively pushing doctors and patients to do what the government defines as best, or whether it should be respectful of their own autonomy in making decisions. The President and Congress appear to be of two minds. How this difference is resolved will profoundly shape the culture of health care in America.

The field of behavioral economics is rooted in the seminal work of Amos Tversky and Daniel Kahneman begun some three decades ago. Drawing on data from their experiments on how people process information, particularly numerical data, these psychologists challenged the prevailing notion that the economic decisions we make are rational. We are, they wrote, prone to incorrectly weigh initial numbers, draw conclusions from single cases rather than a wide range of data, and integrate irrelevant information into our analysis. Such biases can lead us astray.

 
The infusion of behavioral economics into public policy is championed by Cass Sunstein, a respected professor of law and longtime friend of President Obama; he is now in the White House, overseeing regulatory affairs, and will have an important voice in codifying the details of any bill that is passed. In Nudge: Improving Decisions About Health, Wealth, and Happiness, Sunstein and Richard Thaler, a professor of behavioral science and economics at the University of Chicago, propose that people called "choice architects" should redesign our social structures to protect against the incompetencies of the human mind.[1] Those who understand thinking better can make life better for us all.

Thaler and Sunstein build on behavioral economic research that reveals inertia to be a powerful element in how we act. Most people, they argue, will choose the "default option"—i.e., they will follow a particular course of action that is presented to them instead of making an effort to find an alternative or opt out. Further, they write,

These behavioral tendencies toward doing nothing will be re- inforced if the default option comes with some implicit or explicit suggestion that it represents the normal or even the recommended course of action.
Sunstein and Thaler propose to use default options as "nudges" in the service of "libertarian paternalism." For example, to promote a healthy diet among teenagers, broccoli and carrots would be presented at eye level in the cafeteria and would be easily available, while it would take considerable effort for students to locate junk food, thereby nudging them into accepting a healthier diet. But all choices should be "libertarian"—people should be free to opt out of "undesirable arrangements if they want to do so." The soft paternalistic nudge Sunstein and Thaler envisage should try "to influence choices in a way that will make choosers better off, as judged by themselves." They are very clear that nudges are not mandates, and that behavior should not be forcefully directed by changing economic incentives. Your doctor should not be paid less if she follows a course of treatment that she can defend as reasonable, even if she deviates from officially issued guidelines. To prevent policy planners from going down the slippery slope of coercion, there should, in Sunstein's view, be safety rails. Whatever the proposal put forward, he has written, people must retain "freedom of choice" and be able to oppose the more objectionable kinds of government intervention.

uch freedom of choice, however, is not supported by a second key Obama adviser, Peter Orszag, director of the Office of Management and Budget. In June 2008, testifying before Max Baucus's Senate Finance Committee, Orszag—at the time director of the Congressional Budget Office—expressed his belief that behavioral economics should seriously guide the delivery of health care. In subsequent testimony, he made it clear that he does not trust doctors and health administrators to do what is "best" if they do no more than consider treatment guidelines as the "default setting," the procedure that would generally be followed, but with freedom to opt out. Rather, he said,

To alter providers' behavior, it is probably necessary to combine comparative effectiveness research with aggressive promulgation of standards and changes in financial and other incentives. [Emphasis added.]
The word "probably" is gone in the Senate health care bill. Doctors and hospitals that follow "best practices," as defined by government-approved standards, are to receive more money and favorable public assessments. Those who deviate from federal standards would suffer financial loss and would be designated as providers of poor care. In contrast, the House bill has explicit language repudiating such coercive measures and protecting the autonomy of the decisions of doctors and patients.[2]

On June 24, 2009, when President Obama convened a meeting on health care at the White House, Diane Sawyer of ABC News asked him whether federally designated "best practices" would be mandated or simply suggested. That is, would he recommend Orszag's shove or Sunstein's nudge?

Obama: ...Let's study and figure out what works and what doesn't. And let's encourage doctors and patients to get what works. Let's discourage what doesn't. Let's make sure that our payment incentives allow doctors to do the right thing. Because sometimes our payment incentives don't allow them to do the right things. And if we do that, then I'm confident that we can drive down costs significantly.
Sawyer: Will it just be encouragement? Or will there be a board making Solomonic decisions... about best practices?
Obama: What I've suggested is that we have a commission... made up of doctors, made up of experts, that helps set best practices.
Sawyer: By law?
Obama: ...If we know what those best practices are, then I'm confident that doctors are going to want to engage in best practices. But I'm also confident patients are going insist on it.... In some cases, people just don't know what the best practices are. And certain cultures build up. And we can change those cultures, but it's going to require some work.
Sawyer: But a lot of people... say..."I'm very concerned that there's going be a reduction in treatment someplace in all of this." And the question is if there is a board that is recommending, that's one thing. If there is a board that is dictating through cost or through some other instruction, that's another thing. Will it have the weight of law? Will it have the weight of regulations?
Obama: ...I don't think that there's anybody who would argue for us continuing to pay for things that don't make us feel better. That doesn't make any sense. [Yet] that's the reason why, in America, we typically pay 50 percent more for our health care than other advanced countries that actually have better health care outcomes.
Still, the President appears not to be entirely in Orszag's camp. He has repeatedly deflected accusations of a "government takeover of health care" by asserting that no federal bureaucrat will come between the doctor and patient in clinical decision-making. The President has also repeatedly told physicians that reform would sustain them as healers, not make them into bean counters and paper pushers. In an interview on NPR two days before passage of the Senate bill, the President said that changes in how doctors and patients think about health care should come from giving them the "best information possible" and did not invoke the coercive measures favored by Orszag.

ow do we reconcile this apparent difference between Sunstein and Orszag? The President contends that sound policies are built on data, but which data? Here the evidence is strongly in favor of Sunstein and his insistence on the need for freedom of choice and retaining the ability to oppose objectionable forms of government intervention. Over the past decade, federal "choice architects"—i.e., doctors and other experts acting for the government and making use of research on comparative effectiveness—have repeatedly identified "best practices," only to have them shown to be ineffective or even deleterious.

For example, Medicare specified that it was a "best practice" to tightly control blood sugar levels in critically ill patients in intensive care. That measure of quality was not only shown to be wrong but resulted in a higher likelihood of death when compared to measures allowing a more flexible treatment and higher blood sugar. Similarly, government officials directed that normal blood sugar levels should be maintained in ambulatory diabetics with cardiovascular disease. Studies in Canada and the United States showed that this "best practice" was misconceived. There were more deaths when doctors obeyed this rule than when patients received what the government had designated as subpar treatment (in which sugar levels were allowed to vary).

There are many other such failures of allegedly "best" practices. An analysis of Medicare's recommendations for hip and knee replacement by orthopedic surgeons revealed that conforming to, or deviating from, the "quality metrics"—i.e., the supposedly superior procedure—had no effect on the rate of complications from the operation or on the clinical outcomes of cases treated. A study of patients with congestive heart failure concluded that most of the measures prescribed by federal authorities for "quality" treatment had no major impact on the disorder. In another example, government standards required that patients with renal failure who were on dialysis had to receive statin drugs to prevent stroke and heart attack; a major study published last year disproved the value of this treatment.

Other "quality measures" recommended by the government were carried out in community health centers to improve the condition of patients with asthma, diabetes, and hypertension. The conclusion of subsequent research was that there was, as a result, no change in outcome for any of these three disorders. Finally, Medicare, following the recommendations of an expert panel, specified that all patients with pneumonia must receive antibiotics within four hours of arrival at the emergency room. Many doctors strongly disagreed with such a rigid rule, pointing out that an accurate diagnosis cannot be made so quickly, and the requirement to treat within four hours was not based on convincing evidence. But the government went ahead, and the behavior of physicians was altered by the new default setting—for the worse. Many cases of heart failure or asthma, where the chest X-ray can resemble a pulmonary infection, were wrongly diagnosed as pneumonia; the misdiagnosed patients were given high doses of antibiotics, resulting in some cases of antibiotic-induced colitis. The "quality measure" was ultimately rescinded.[3]

hat may account for the repeated failures of expert panels to identify and validate "best practices"? In large part, the panels made a conceptual error. They did not distinguish between medical practices that can be standardized and not significantly altered by the condition of the individual patient, and those that must be adapted to a particular person. For instance, inserting an intravenous catheter into a blood vessel involves essentially the same set of procedures for everyone in order to assure that the catheter does not cause infection. Here is an example of how studies of comparative effectiveness can readily prove the value of an approach by which "one size fits all." Moreover, there is no violation of autonomy in adopting "aggressive" measures of this kind to assure patient safety.

But once we depart from such mechanical procedures and impose a single "best practice" on a complex malady, our treatment is too often inadequate. Ironically, the failure of experts to recognize when they overreach can be explained by insights from behavioral economics. I know, because I contributed to a misconceived "best practice."

My early research involved so-called growth factors: proteins that stimulate the bone marrow to produce blood cells. I participated in the development of erythropoietin, the red cell growth factor, as a treatment for anemic cancer patients. Erythropoietin appeared to reduce the anemia, lessening the frequency of transfusion. With other experts, I performed a "meta-analysis," i.e., a study bringing together data from multiple clinical trials. We concluded that erythropoietin significantly improved the health of cancer patients and we recommended it to them as their default option. But our analysis and guidelines were wrong. The benefits ultimately were shown to be minor and the risks of treatment sometimes severe, including stroke and heart attack.[4]

After this failure, I came to realize that I had suffered from a "Pygmalion complex." I had fallen in love with my own work and analytical skills. In behavioral economics, this is called "overconfidence bias," by which we overestimate our ability to analyze information, make accurate estimates, and project outcomes. Experts become intoxicated with their past success and fail to be sufficiently self-critical.

A second flaw in formulating "best practices" is also explained by behavioral economics—"confirmation bias." This is the tendency to discount contradictory data, staying wed to assumptions despite conflicting evidence. Inconsistent findings are rationalized as being "outliers." There were, indeed, other experts who questioned our anemia analysis, arguing that we had hastily come to a conclusion, neglecting findings that conflicted with our position. Those skeptics were right.[5]

Yet a third powerful bias identified in behavioral economics can plague expert panels: this is the "focusing illusion," which occurs when, basing our predictions on a single change in the status quo, we mistakenly forecast dramatic effects on an overall condition. "If only I moved from the Midwest to sunny California, I would be so much happier" is a classical statement of a focusing illusion, proven to be such by studies of people who have actually moved across the country. Another such illusion was the prescription of estrogen as the single remedy to restore feminine youth and prevent heart disease, dementia, and other complications of the complex biology of aging.[6] Such claims turned out to be seriously flawed.

here is a growing awareness among researchers, including advocates of quality measures, that past efforts to standardize and broadly mandate "best practices" were scientifically misconceived. Dr. Carolyn Clancy of the Agency for Healthcare Research and Quality, the federal body that establishes quality measures, acknowledged that clinical trials yield averages that often do not reflect the "real world" of individual patients, particularly those with multiple medical conditions. Nor do current findings on best practices take into account changes in an illness as it evolves over time. Tight control of blood sugar may help some diabetics, but not others. Such control may be prudent at one stage of the malady and not at a later stage. For years, the standards for treatment of the disease were blind to this clinical reality.[7]

Orszag's mandates not only ignore such conceptual concerns but also raise ethical dilemmas. Should physicians and hospitals receive refunds after they have suffered financial penalties for deviating from mistaken quality measures? Should public apologies be made for incorrect reports from government sources informing the public that certain doctors or hospitals were not providing "quality care" when they actually were? Should a physician who is skeptical about a mandated "best practice" inform the patient of his opinion? To aggressively implement a presumed but still unproven "best practice" is essentially a clinical experiment. Should the patient sign an informed consent document before he receives the treatment? Should every patient who is treated by a questionable "best practice" be told that there are credible experts who disagree with the guideline?

But even when there are no coercive measures, revising or reversing the default option requires a more complicated procedure than the one described by the President at the White House meeting. In November, the United States Preventive Services Task Force, reversing a long-standing guideline, recommended that women between the ages of forty and forty-nine do not need to have routine mammograms. To arrive at this conclusion, researchers made both a meta-analysis and computer models of data from seven clinical trials. The task force found that routine mammograms result in a 15 percent reduction in the relative risk of death from breast cancer for women in the forty to forty-nine age group, a similar level of benefit as in earlier analyses. For women in their forties, this means one life is saved for every 1,904 women screened. For older women in their fifties, one life is saved for every 1,359 women screened.[8]

If these estimates are correct, then how many lives might be saved in the United States for each age group if every woman received a mammogram? The 2008 US Census estimates the number of women between forty and forty-nine at 22.3 million. So if mammography were available to all these women, nearly 12,000 deaths could be potentially averted during these ten years in their lives. As for the 20.5 million women in their fifties, some 15,000 deaths could potentially be averted.

[Body-by-Guinness]

What are the risks of mammography for women in their forties? The task force estimated a higher rate of false positive findings in mammograms in women in their forties compared to older women. This translates into increased anxiety when women are told that there may be a cancer and there is not. A false positive reading may also result in a woman having a biopsy. For every case of invasive breast cancer in a young woman diagnosed by mammography, five women with benign findings will have biopsies. In addition, there are potential risks of radiation from the mammogram itself, although no one really knows how significant these are. Then there is an unanswered question in the biology of breast cancer: Which tumors are indolent and which are aggressive? We lack the molecular tools to distinguish between slow- and fast-growing cancers. Some slow-growing ones detected in young women might be treated later in life without any disadvantage in the rate of survival. But aggressive breast cancers in young women are notoriously difficult to treat and frequently result in death. And as with essentially all screening tests in a population, the majority of women receiving mammograms do not have any disorder.

hese, roughly, are the statistics and state of the science with regard to breast cancer. How do we weigh the evidence and apply it to individuals and to society at large? Setting the default option that doctors will present to patients requires us to make value judgments. Dr. Otis Brawley of the American Cancer Society, an oncologist who worked for decades at the National Cancer Institute, is well versed in preventive care; he disagrees with the new default setting, based on findings that mammograms save lives. (Brawley also happens to be an African-American and has long been concerned about the meager access among minority and poor groups to potentially lifesaving screenings.)

Dr. Diana Petitti, a professor of bioinformatics at Arizona State University and vice-chair of the task force, appeared with Brawley on November 17, 2009, on the PBS NewsHour. She had no disagreement with him about what the studies show, and emphasized that the task force did not say that women in their forties should not get mammograms, only that they were no longer routinely recommended since the benefit to patients did not clearly outweigh the risks. Cost considerations were not part of the task force's deliberations.

Other supporters of the new recommendations took a less temperate view. A statistician who developed computer models for the task force told The New York Times that "this decision is a no-brainer."[9] It did not appear to be so clear to Melissa Block of NPR when she interviewed an internist who agreed with the task force. The doctor said that stopping routine mammography for young women would spare them anxiety, distress, and unnecessary biopsies. Block replied, "I've heard this before.... When people say, you know, there's unnecessary anxiety and false positives and fear and worry." That, she said, is "a very patronizing approach to take toward women's health.... Women may very well be willing to assume those harms if it means that they may be diagnosed earlier." The internist replied that each woman should talk with her doctor and figure out what is best.[10] Sunstein's Nudge coauthor, the behavioral economist Richard Thaler, wrote a thoughtful analysis of the pros and cons of mammography in The New York Times and concluded that "one can make a good case that we don't want the government making these choices" for us.[11]

Two days after the task force recommendations were released, Health and Human Services Secretary Kathleen Sebelius put some distance between the Obama administration and the task force's conclusions, saying:

My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years....
Dr. Petitti later appeared before Congress to apologize for any "confusion" caused by the task force report. Petitti was not recanting a scientific truth. She correctly described the new recommendations as "qualitative." That is, they were offered as value judgments that could be modified or revised; and the political process offers one way of doing so. As Sunstein has written, if default options embody standards that many people judge as not better for themselves, those standards can be changed.

Shortly after the new mammography guidelines were announced, an expert panel of obstetricians and gynecologists recommended that teenage girls no longer have routine pap smears for cervical cancer.[12] The incidence of deadly cervical cancer among teens is at most one in a million and screening does not appear to save that one life. When false positive results from screenings are followed by cervical surgery, the risk may be injury that can predispose a young woman to later premature labor. There was no public uproar following this changed default setting for many women. It was consistent with how most people value the benefit of lives saved versus risks incurred. This is the reality of "comparative effectiveness" research. It is not simply a matter of "what works and what doesn't." Nor will patients always "insist" on being treated according to what experts define as "best practice." They should be aware that there are numerous companies, some of them "not for profit," issuing standards for treatment that are congenial to the insurance industry but are often open to the kinds of counterevidence I have described here.

hat of the President's statement that doctors will want to engage in federally approved "best practices"? The American College of Physicians, composed of internists, agreed with the task force conclusions about mammography. The American Society of Clinical Oncology, representing oncologists, did not. I am a member of both professional organizations. What do I do? As a physician who has cared for numerous young women with breast cancer, many dying an untimely death, my bias was that the dangers of mammograms do not outweigh the reduction in mortality. Notably, the oncologists who head the breast cancer programs at Minnesota's Mayo Clinic and Utah's Intermountain Health—described by President Obama as pinnacles of quality care using guidelines—also disagreed with the task force.

Such challenges to "best practice" do not imply that doctors should stand alone against received opinion. Most physicians seek data and views on treatments from peers and, as needed, specialists, and then present information and opinion to patients who ultimately decide.

While costs were not part of the task force calculations, they prominently entered the national debate on them. Dr. Robert Truog of Boston Children's Hospital allowed that mammography saves lives, but asked if it is "cost effective."[13] That is, should policy planners set a price on saving those young women?

Cost-effectiveness is going to be a hard sell to the American public, not only because of the great value placed on each life in the Judeo-Christian tradition, but because the federal government has devoted many hundreds of billions of dollars to bail out Wall Street. To perform mammograms for all American women in their forties costs some $3 billion a year, a pittance compared to the money put into the bank rescue. The Wall Street debacle also made many Americans suspicious of "quants," the math whizzes who developed computer models that in theory accurately assessed value in complex monetary instruments but in fact nearly brought down the worldwide financial system. When a medical statistician says that imposing a limit on mammography is a "no-brainer," people may recall George Tenet's claim that the case for invading Iraq was a "slam-dunk."

At the White House gathering, the President portrayed comparative effectiveness as equivalent to cost- effectiveness, noting that other countries spend half of what we do by only paying for "what works." This contention is not supported by evidence. Theodore Marmor, a professor of health care policy at Yale, writes in Fads, Fallacies and Foolishness in Medical Care Management and Policy that movements for "quality improvement" in Britain have failed to reduce expenditures.[14] Marmor, with Jonathan Oberlander, a professor at the University of North Carolina, has written in these pages that the President has offered up rosy scenarios to avoid the harsh truth that there is no "painless cost control."[15] Lower spending in countries like France and Germany is accounted for not by comparative effectiveness studies but by lower costs of treatment attained through their systems of medical care and by reduced medical budgets. In Europe, prescription drugs cost between 50 and 60 percent of what they do in the US, and doctor's salaries are lower. (Insurance premiums also are tightly constrained.) France and Germany have good records in health care, but in Great Britain, where costs are strictly controlled by the National Health Service, with rationing of expensive treatments, outcomes for many cancers are among the worst in Europe.[16]

The care of patients is complex, and choices about treatments involve difficult tradeoffs. That the uncertainties can be erased by mandates from experts is a misconceived panacea, a "focusing illusion." If a bill passes, Cass Sunstein will be central in drawing up the regulations that carry out its principles. Let's hope his thinking prevails.

—January 14, 2010

Notes
[1]Yale University Press, 2008; See the review in these pages by John Cassidy, "Economics: Which Way for Obama?," June 12, 2008.

[2]On June 16, 2008, at the Health Reform Summit of the Senate Finance Committee, Orszag explicitly invoked behavioral economics to explain some of the deficiencies in American health care and as the basis for legislative interventions that would remedy rapidly escalating costs and gaps in quality.

On August 7, 2008, addressing the Retirement Research Consortium in Washington, D.C., Orszag presented "Behavioral Economics: Lessons from Retirement Research for Health Care and Beyond." Here, he states the likely need for aggressive measures. The Senate Finance Committee, under Max Baucus, was widely reported to have worked closely with the White House, and many of Orszag's proposals are prominent in the bill that Majority Leader Harry Reid brought to the floor. See Senate Bill HR 3590, Title III—Improving the Quality and Efficiency of Health Care.

The House rejected many of the ideas from the President's advisers in favor of safeguards on patient–physician autonomy, causing Rahm Emanuel, the White House chief of staff, to quip that politics trumps "ideal" plans made in the shade of the "Aspen Institute." See Sheryl Gay Stolberg, "Democrats Raise Alarms over Health Bill Costs," The New York Times, November 9, 2009. Explicit language in the House bill is intended to safeguard patient–physician autonomy. See House Bill HR 3962, Title IV—Quality; Subtitle A—Comparative Effectiveness Research.

[3]These results, respectively, come from the NICE-SUGAR Study Investigators, "Intensive versus Conventional Glucose Control in Critically Ill Patients," The New England Journal of Medicine, March 26, 2009; Silvio E. Inzucchi and Mark D. Siegel, "Glucose Control in the ICU—How Tight Is Too Tight?," The New England Journal of Medicine, March 26, 2009; the Action to Control Cardiovascular Risk in Diabetes Study Group, "Effects of Intensive Glucose Lowering in Type 2 Diabetes," The New England Journal of Medicine, June 12, 2008; the ADVANCE Collaborative Group, "Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes," The New England Journal of Medicine, June 12, 2008; Robert G. Dluhy and Graham T. McMahon, "Intensive Glycemic Control in the ACCORD and ADVANCE Trials," The New England Journal of Medicine, June 12, 2008; Gregg C. Fonarow et al., "Association Between Performance Measures and Clinical Outcomes for Patients Hospitalized with Heart Failure," The Journal of the American Medical Association, January 3, 2007; Bengt C. Fellström et al., for the AURORA Study Group, "Rosuvastatin and Cardiovascular Events in Patients Undergoing Hemodialysis," The New England Journal of Medicine, April 2, 2009; Bruce E. Landon et al., "Improving the Management of Chronic Disease at Community Health Center," The New England Journal of Medicine, March 1, 2007; Rodney A. Hayward, "Performance Measurement in Search of a Path," The New England Journal of Medicine, March 1, 2007; Robert M. Wachter et al., "Public Reporting of Antibiotic Timing in Patients with Pneumonia: Lessons from a Flawed Performance Measures," Annals of Internal Medicine, July 1, 2008.

[4]The clinical development of other growth factors, like G-CSF for a low white blood cell count, fared better. G-CSF is a valuable treatment for many cancer patients, but, of course, not all.

[5]Contradictory evidence reverses "best practices" so frequently that within one year 15 percent must be changed, within two years, 23 percent are reversed, and at 5.5 years, half are incorrect. See Kaveh G. Shojania et al., "How Quickly Do Systematic Reviews Go Out of Date? A Survival Analysis," Annals of Internal Medicine, August 21, 2007.

[6]Focusing illusions are wonderfully illuminated by Daniel Gilbert, Stumbling on Happiness (Knopf, 2006). Also see the role of marketing in fostering the illusion: Natasha Singer and Duff Wilson, "Menopause, as Brought to You by Big Pharma," The New York Times, December 13, 2009. See also David A. Schkade and Daniel Kahneman, "Does Living in California Make People Happy? A Focusing Illusion in Judgments of Life Satisfaction," Psychological Science, September 1998.

[7]Dr. Clancy seeks new statistical methods to analyze heterogeneous groups of "real world" patients, so treatment guidelines become "personalized," delivering "the right treatment to the right patient at the right time." (See Patrick H. Conway and Carolyn Clancy, "Comparative-Effectiveness Research —Implications of the Federal Coordinating Council's Report," The New England Journal of Medicine, July 23, 2009; Harold C. Sox and Sheldon Greenfield, "Comparative Effectiveness Research: A Report From the Institute of Medicine," Annals of Internal Medicine, August 4, 2009.) This is a laudable goal and deeply attractive. It is more likely to come from basic science that classifies patients based on their genetic characteristics rather than statistics. Past attempts at observing groups of "real world" patients have often generated conclusions that were flawed, mistaking correlation for causation. A valiant attempt to apply research on comparative effectiveness to prostate cancer treatment options came up against similar hurdles. See Jenny Marder, "A User's Guide to Cancer Treatment," Science, November 27, 2009.

[8]US Preventive Services Task Force, "Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement," Annals of Internal Medicine, November 17, 2009; Heidi D. Nelson et al., "Screening for Breast Cancer: An Update for the US Preventive Services Task Force," Annals of Internal Medicine, November 17, 2009; Jeanne S. Mandelblatt et al. for the Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network (CISNET), "Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms, Annals of Internal Medicine, November 17, 2009.

[9]Gina Kolata, "In Reversal, Panel Urges Mammograms at 50, not 40," The New York Times, November 17, 2009. A detailed summation of the controversy is found in The Cancer Letter, November 20 and December 4, 2009.

[10]National Public Radio, All Things Considered, November 16, 2009.

[11]Richard H. Thaler, "Gauging the Odds (and the Costs) in Health Screening," The New York Times, December 20, 2009.

[12]acog Practice Bulletin, "Clinical Management Guidelines for Obstetrician-Gynecologists," Number 109, Obstetrics & Gynecology, December 2009; Denise Grady, "Guidelines Push Back Age for Cervical Cancer Tests," The New York Times, November 20, 2009.

[13]Robert D. Truog, "Screening Mammography and the 'R' Word," The New England Journal of Medicine, December 24, 2009.

[14]World Scientific, 2007.

[15]"Health Reform: The Fateful Moment," The New York Review, August 13, 2009.

[16]Theodore Marmor, Jonathan Oberlander, and Joseph White, "The Obama Administration's Options for Health Care Cost Control: Hope versus Reality," Annals of Internal Medicine, April 7, 2009; Donald M. Berwick, "Measuring Physicians' Quality and Performance, The Journal of the American Medical Association, December 9, 2009. A layman's journey seeking care abroad is described in the lively book by T.R. Reid. The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (Penguin, 2009). Concerning the uproar in Britain about poor cancer outcomes, see Nick Triggle, "NHS Must Get Better at Early Cancer Diagnosis," BBC News, November 30, 2009; Rebecca Smith, "Cancer Care on the NHS Falls Behind the Rest of Europe," The Daily Telegraph, November 30, 2009; NHS Department of Health, "Cancer Reform Strategy: Achieving Local Implementation—Second Annual Report," December 1, 2009.

http://www.nybooks.com/articles/23590

[Crafty_Dog]

http://news.yahoo.com/s/ap/20100204/ap_on_he_me/us_health_care_government_role_1;_ylt=AmE.saQYdwidM0OYXkG9N9.yQLN_;_ylu=X3oDMTE2Z2Zxc242BHBvcwMxBHNlYwN5bi1yLWItbGVmdARzbGsDZXYtZ292J3R0b3Bh

We often see criticisms that Obamacare will mean the govt is taking over 16% of GDP.  Actually this is rather misleading-- even without BO Care, the govt will shortly be paying over 50% of health care-- and the Medicaid and Medicare disasters are still coming down the rails.  We are in denial.  We consume more than we produce.  Entitlements already in the pipeline are accelerating the speed and momentum of the impending disaster.  We are lemmings headed for a cliff.

Prepare to have your assumptions shattered.

[ccp]

I got a request recently for a prescription for a hospital bed.  Of course it would be billed to Medicare.
Pt. walks with a cane and does have medical problems but a hosp. bed?

Someone probably told her to request it as she is entitled to it.

There is simply no end.

OTOH I've read some pieces that come to the conclusion that technological advances on the horizon appear to be slowing and there might be some sloping down to the increases from more technology.

[ccp]

The cans must *refuse* to participate.
They must negotiate on their terms - not those of the partisan ideologue misleader in chief.

There is not way they will look good, there is no way Bama will allow them to look good, it is at it always is about Bama.

They should have their own meeting have a few of them stand on podiums and have bama sit on a small chair down in the pit and manipulate and paraphrase, and distort everything he says to fit their own narrative.

They must NOT be stupid again and do this.  Let the crats claim they are calling them on being obstructionist.  They cna easily argue this away.  They will not win otherwise in such a  staged crafted planned trick  meeting:
 
***President Barack Obama is planning to host a televised meeting with Republican and Democratic congressional leaders on health care reform.

The Feb. 25 meeting is an attempt to reach across the aisle but not a signal that the president plans to start over, as Republicans have demanded, a White House official said.

“I want to come back [after the Presidents Day congressional recess] and have a large meeting — Republicans and Democrats — to go through, systematically, all the best ideas that are out there and move it forward,” Obama said in an interview with Katie Couric during CBS’s Super Bowl pre-game show Sunday.

Obama said he wants to “look at the Republican ideas that are out there.”

“If we can go, step by step, through a series of these issues and arrive at some agreements, then, procedurally, there’s no reason why we can’t do it a lot faster the process took last year,” he said.

In a statement, the official said, “What the president will not do is let this moment slip away. He hopes to have Republican support in doing so — but he is going to move forward on health reform.”

Obama first suggested reopening talks with Republicans during his State of the Union address last month, and reiterated the call at a Democratic fundraiser Thursday, but the White House had kept details of his plan under wraps until Sunday.

The idea has been met previously with skepticism by the congressional leaders of both parties. Republicans say they see little room for compromise because the bill should be scrapped, while Democrats argue they have already tried a bipartisan approach, but failed.

But since the Democratic loss in the Massachusetts Senate race, Obama has been forced to rework his legislative strategy – both by striking a more bipartisan tone, and returning to his campaign pledge of providing more transparency. He’s been dogged by questions about why he failed to live up to his campaign promise of televising the health care negotiations on C-SPAN.

The half-day meeting will take place at Blair House, and be broadcast live, presumably by C-SPAN, making it the first televised White House meeting involving the president since a forum last March.

There were 11 other roundtable discussions, usually led by White House health care reform director Nancy-Ann DeParle, that were webstreamed and, in some cases, carried live by C-Span.

“While he’s been very clear that he supports the House and Senate bills, if Republicans or anyone else has a plan for protecting Americans from insurance company abuses, lowering costs, reducing prescription drug prices for seniors, making coverage more secure, and offering affordable options to those without coverage, he’s anxious to see it and debate the merits of it,” the White House official said.

Legislators from both parties applauded the meeting, while holding to their positions on the health care legislation.

[Rarick]

The opposers of the policy can send a thundering message.  Do not attend..........then do their own program.

[ccp]

In my opinion. 

Well I like and usually agree with Dick Morris but I don't agree that his GOP proposals for containing the cost of health care is even remotely enough.  Of course as a doctor I like the idea of tort reform.  And contrary to Bama's contention there is no evidence it would reduce costs, anyone with half a brain knows it would.  But how much it would do so I admit I don't know.  I don't know it would be gigantic, but it certainly could be substantial/significant. 

What about the opening of insurance markets across state lines?  (One of the favorite memorized and for lack of anything else to offer lines from the car salesman Hannity.)  In addressing that idea I have included a bloggers (JIMH) rebuttel (see after Dick's piece) and tend to agree with him.  I really don't see how this would work at all.  It makes no sense.  Why is my being able to buy insurance from say a company in Idaho going to bring down my costs here in NJ without simply increasing that company's premiums. 

While Dick sounds off against rationed care there is simply no other way to reign in costs without someone rationing care.
Even now private insurers try to do it and cannot control costs.

As for doctor pay what can I say?

My colleague cardiologists are whining (and understandably so) about a 36 to 40% pay cut from Medicare.  They say I should be happy with a 1% pay raise!  Of course they could care less I've already had my pay cut for years and they tend to make anywhere from 200 to 1000 % more than me at this time and even after their pay cuts will do multiple times more than me.

Recently I reviewed a case for an administrative position.  I ten year old congenitally disabled and deformed child.  He is less than four feet tall and weighs 40 odd pounds.  He lives at home on a breathing machine and a feeding tube.  He has and requires 24 X 7 care.  One hears the ethicists and religious types emphatically pointing out this child's, this human beings Right to whatever care is available to stay alive.  One can feel the pain the parents feel when one reviews his medical bills - over 1.25 milliion over five years.  Yet there is an opposite ethical argument that can be made.  It may and would sound monstrous to some.  Yet think of the care that is not afforded to others because of the cost of this one child who is so mentally as well as physiccally deformed he must have no clue what is even going on - and that is 166,666 people could have a $70 yearly annual preventative physical exam paid for for that sum of money. 

Before we grandstand about how much we are against rationing care lets pause and think about what we are saying and doing. 

GOP’S HEALTHCARE MOMENT
By Dick Morris 02.10.2010 Published on TheHill.com February 9,2009

President Barack Obama has so lowered expectations for the Republican Party that if they come to the healthcare summit he has called at the White House with concrete and well-articulated proposals, it will blow the country away. Repeatedly, the president has fashioned the GOP as the party of “no,” goading them by saying, “If you have any ideas, bring them on.”


Well, let them do it.

Republicans need to be on their toes and aggressive in the meeting and not let it devolve into a question-and-answer session with the president hogging the mike. He asked for a meeting, not a lecture or a media conference, and Republicans need to demand equal time to present their ideas.

Start with tort reform. The Republicans need to explain how much of the unnecessary medical costs are being driven by useless tort litigation. In Mississippi, where they acted to preclude much of it, malpractice premiums have declined by 50 percent.

The GOP needs to explain to the nation that when the president says he is going to cut costs by eliminating tests that aren’t necessary, he is catching doctors in a vise. On the one side, they have the government prohibiting or discouraging them from tests, and on the other, the trial-lawyer bar waiting to pounce on them for failing to administer the proper tests if their care has a bad outcome.

The Republicans need to make the cost-cutting part of the healthcare summit about tort reform, constantly raising the subject as the counter to the president’s proposed $500 billion cut in Medicare.

Then Republicans need to discuss other cost-saving measures such as allowing health insurance to be sold across state lines and other measures to encourage competition.

Republicans should also zero in on the need for more doctors if we are to expand the number of patients covered. They must articulate the conclusion so much of the nation has come to (but official Washington has never embraced): that you cannot have more patients without more doctors unless you want to impose rationing. They should make the case that you need to phase in coverage for those who are not now covered so that you can increase the supply of doctors and nurses at the same time. Supply must keep pace with demand so that artificial scarcity does not leave the nation short of doctors.

The Republicans need to point out that in Massachusetts, where Romney inflicted a version of ObamaCare on the state, the waiting time to see a doctor in Boston is now 63 days. They need to stress that any rationing will be felt primarily by the elderly and will lead to premature deaths.

Finally, Republicans need to explain their own proposals for reforming healthcare — including Medical Savings Accounts and expansions of current tax breaks to encourage people and small businesses to purchase insurance.

Then, Republicans need to keep up a steady drumfire of criticism of the president’s proposals. They need to:

• Attack the proposed cuts in Medicare.

• Criticize the individual mandate as unconstitutional and paint a vivid picture of how much it will cost young families.

• Demand that young people be permitted to purchase catastrophic coverage to satisfy any mandate, rather than full coverage they don’t need.

• Spell out, in detail, how the tax on medical devices will raise the cost of pacemakers, automated wheelchairs, arterial stints, prosthetic limbs and all manner of necessary medical equipment.

• Attack the proposal to make a taxpayer spend 10 percent of his income — as opposed to 7.5 percent at present — on medical expenses in order to deduct them. Expose this tax as a tax on the sick.

• Criticize the idea that people could be imprisoned for failing to have health insurance or paying the fine the legislation imposes. There is a big difference between tax evasion and failing to have health insurance.

With proper preparation, the Republicans can turn this healthcare summit into a nationally televised town meeting such as those that frustrated Democratic congressmen last August.

  JimH on February 10, 2010 12:03 pm
Selling insurance across state lines will not work. The majority of insurance policies sold today are sold with a preferred provider network, aka PPO. What good does a policy I can purchase in Maine do me if I live outside the geographical service area of the network? I’ll be covered but out-of-network, with a higher deductible and out-of-pocket expense. Also, by living in an area where medical costs are higher than in Maine, what claims I do have will eventually have an effect on the the premium structure of the company. The insurer will have to raise premiums to account for the increased cost of my claims. Health insurance needs to be deregulated and we have to get back to the old indemnity style plans where there is no first dollar coverage. That will bring costs down because it will make people more cautious with their money and less likely to abuse the medical system for things such as colds and flu.

[Crafty_Dog]

"What good does a policy I can purchase in Maine do me if I live outside the geographical service area of the network?"

What good would it do the insurance company to have a network outside the State in which it is allowed to operate?

[Rarick]

being free has a price, that price is dying free.   I have lived most of my life without coverage, I see no need to worry if I do or don't have coverage.  If I am in an accident, I will probably get life saving treatment at one of the teaching hospitals, but that will be way better than 99% of humanity that has lived before me.  If I want coverage, I find a job that gives it to me, or make arrangements thru the many plans that are out there.   To be blunt, I would rather die than allow the government that degree of control of my life.  Your average High School graduate with a full bag of science electives can give better health care than any doctor who gained his credentials prior to the Civil War.

This health care thing is just a boogey man that both sides of the political issue are raising to distract everyone from the real issues.

[Body-by-Guinness]

[youtube]http://www.youtube.com/watch?v=0PqfXc4XtXM&feature=player_embedded#[/youtube]

What if you were injured and developed severe pain that wouldn't go away? Would your government let you take the kind of pain medication you need? If federal officials follow the recommendation of a Food and Drug Administration panel, many of the most effective prescription painkillers—including Vicodin, Percocet, and countless generics—would be banned.

Scott Gardner says that kind of a move would be "intensely cruel."

"I took Vicodin for three years," says Gardner. "I needed it. It got me through a very tough period of my life." The tough period began after a cycling accident shattered the left side of his body. After eight surgeries and countless hours of physical therapy, Gardner's once active life is now filled with limitations. He suffers from chronic pain that prevents him from sleeping more than a few hours at a time, and yet his pain today is nothing compared to the agonizing days and months following his accident.

"When there's nothing but pain, there's no reason to live," says Gardner. "There were times where the only way I could stay sane and civil was because I could take painkillers."

The fear of addiction and abuse already makes many suspicious of pain medication. Media reports about celebrities like Rush Limbaugh or Matthew Perry suggest that it's common for people to become addicted to medications they once took for legitimate medical conditions. And countless public service announcements remind us of the dangers of prescription drug abuse.

Now the old fear of prescription drug abuse takes a new twist. The FDA panel is targeting drugs like Vicodin and Percocet because they contain acetaminophen, a popular painkiller also found in many over-the-counter drugs. Panel members warn that some Americans ingest too much acetaminophen, and overdoses can lead to liver damage, even death.

But maybe the FDA panel isn't putting this threat into context. After all, mundane threats like falling down stairs claim more lives than acetaminophen overdoses. And it turns out the more common fear—that patients will become addicted to prescription drugs—is also overblown. In fact, the barrage of warnings we hear about prescription drugs obscures an important point—people saddled with severe chronic pain need these painkillers.

Says Gardner, "I  think people who haven't dealt with pain don't really know what it's like."

"Don't Get Hurt" is written and produced by Ted Balaker, who also hosts. The director of photography is Alex Manning, the field producer is Paul Detrick and the animation in the piece is from Hawk Jensen.

Approximately five minutes.

For iPod, HD, and audio versions of this and other videos, go to Reason.tv.

To watch this video on Reason.tv's YouTube channel, go here. If you subscribe to the channel, you can also get automatic notifications when new videos go live.

Related video: When Cops Play Doctor: How the Drug War Punishes Pain Patients.

For Reason.com's coverage of "opiophobia," or overblown fears by the government about prescription painkillers, go here.

[Crafty_Dog]

Editorial Exegesis
"Those unversed in the arcana of Congressional procedure should familiarize themselves with 'reconciliation.' It's just another word for nothing left to lose -- that is, it's the tactic Democrats seem increasingly likely to use to bypass the ordinary legislative rules and railroad ObamaCare into law with a bare partisan majority of 50 Senators, plus Vice President Joe Biden. Speaker Nancy Pelosi announced ... that Democrats 'have set the stage' for reconciliation. 'It's up to us to make sure the public knows that this is not extraordinary,' she said. 'It would be a reflection on us if we could not convince people that this is not an unusual place to go.' Yet the reconciliation gambit really would be unprecedented for social legislation of this cost and scale. And as a matter of procedure, it would also be unusual, to say the least. As Mrs. Pelosi's senior health adviser, Wendell Primus, explained ... House Democrats would pass a series of 'fixes' to the Senate bill. The Senate would then pass the House reconciliation bill, sending amendments to President Obama to a bill that -- strictly speaking -- didn't exist, because it hadn't yet emerged from the House. The House would then retroactively pass the Senate bill as is. Democrats say this will all be kosher as long as Mr. Obama signs the Senate bill before he signs the reconciliation bill. 'There's a certain skill, there's a trick,' Mr. Primus conceded, 'but I think we'll get it done.' So even as Democrats themselves acknowledge that one reason the public hates ObamaCare so much is the corrupt tactics they have used to advance it through Congress, they still plan to try to land this Pelosian triple-handspring-quadruple pole vault to passage." --The Wall Street Journal

Upright
"Obamacare flunks the first test of any potential federal law: It is not constitutional." --National Review's Deroy Murdock

"It's not a good idea for Republicans to accept President Barack Obama's invitation to a 'bipartisan' health care summit, because it would not advance acceptable health care reform. The only thing it likely would advance would be Obama's propaganda message -- and, thus, his socialist agenda." --columnist David Limbaugh

"It isn't to evil dictators with a lust for power that Americans have been slowly surrendering their autonomy. It is to well-intentioned authorities who believe sincerely that our freedoms must be circumscribed for our own good. ... First Lady Michelle Obama announced what The New York Times called 'a sweeping initiative ... aimed at revamping the way American children eat and play -- reshaping school lunches, playgrounds, and even medical checkups -- with the goal of eliminating childhood obesity.' Nothing in the Constitution authorizes the federal government to take charge of 'revamping the way American children eat and play.' It is only our passivity that makes such an encroachment possible. This used to be the land of the free. Is it still?" --columnist Jeff Jacoby

[Body-by-Guinness]

A good comeback to 'So what's YOUR health care reform plan?'

Cory Genelin
I've noticed a common rhetorical ploy being used at every echelon of the health care debate, from the President on down to the local coffee shop loudmouth: the assumption of common goals. I hear "Okay, if you don't like our plan to insure the 40 million uninsured Americans, what's your plan (or the Tea Partiers' plan, or the Republicans' plan, or the Libertarians' plan)?"

Sadly, what usually follows is the conservative debater's attempt to (at best) avoid the question or (at worst) justify conservative solutions by the standards of the liberals. "Well, you see, our plan would eventually cut cost which would then encourage . . . ." Instead, the conservative debater would do well to square off against that opening ploy and deal with it directly before moving on.
That question "If you don't like our plan to insure the uninsured, what's your plan?" is as logical as Scipio saying to the Carthaginians: "If you don't like my plan to destroy your city, I'd be happy to hear your ideas on how to destroy your city. See, I'm willing to listen and compromise! "

Here's a response I've found both persuasive and illustrative:

"I have no plan to order the lives of the 40 million uninsured. I have no plans for how you should run your life, what insurance you should have, or where you should spend you money; and frankly I find it a little creepy that you have a plan for ordering my private life. And let's face it, you don't plan to insure 40 million Americans, you plan to force the other 250 million Americans to do it."

Happy Hunting.

Cory Genelin



Page Printed from: http://www.americanthinker.com/blog/2010/02/a_good_comeback_to_so_whats_yo.html at February 27, 2010 - 08:48:41 AM CST

[Body-by-Guinness]

Second Post.

Myth Diagnosis
EVERYONE KNOWS THAT PEOPLE WITHOUT HEALTH INSURANCE ARE MORE LIKELY TO DIE. BUT ARE THEY?

By Megan McArdle
See web-only content:
http://www.theatlantic.com/magazine/archive/2010/03/myth-diagnosis/7905/

IMAGE CREDIT: EDEL RODRIGUEZ

OUTSIDE OF THE few states where it is illegal to deny coverage based on medical history, I am probably uninsurable. Though I’m in pretty good health, I have several latent conditions, including an autoimmune disease. If I lost the generous insurance that I have through The Atlantic, even the most charitable insurer might hesitate to take me on.

So I took a keen interest when, at the fervid climax of the health-care debate in mid-December, a Washington Post blogger, Ezra Klein, declared that Senator Joseph Lieberman, by refusing to vote for a bill with a public option, was apparently “willing to cause the deaths of hundreds of thousands” of uninsured people in order to punish the progressives who had opposed his reelection in 2006. In the ensuing blogstorm, conservatives condemned Klein’s “venomous smear,” while liberals solemnly debated the circumstances under which one may properly accuse one’s opponents of mass murder.

But aside from an exchange between Matthew Yglesias of the Center for American Progress and Michael Cannon of the Cato Institute, few people addressed the question that mattered most to those of us who cannot buy an individual insurance policy at any price—the question that was arguably the health-care debate’s most important: Was Klein (not to mention other like-minded editorialists who cited similar numbers) right? If we lost our insurance, would this gargantuan new entitlement really be the only thing standing between us and an early grave?

Perhaps few people were asking, because the question sounds so stupid. Health insurance buys you health care. Health care is supposed to save your life. So if you don’t have someone buying you health care well, you can complete the syllogism.

Last year’s national debate on health-care legislation tended to dwell on either heart-wrenching anecdotes about costly, unattainable medical treatments, or arcane battles over how many people in the United States lacked insurance. Republicans rarely plumbed the connection between insurance and mortality, presumably because they would look foolish and heartless if they expressed any doubt about health insurance’s benefits. It was politically safer to harp on the potential problems of government interventions—or, in extremis, to point out that more than half the uninsured were either affluent, lacking citizenship, or already eligible for government programs in which they hadn’t bothered to enroll.

Even Democratic politicians made curiously little of the plight of the uninsured. Instead, they focused on cost control, so much so that you might have thought that covering the uninsured was a happy side effect of really throttling back the rate of growth in Medicare spending. When progressive politicians or journalists did address the disadvantages of being uninsured, they often fell back on the same data Klein had used: a 2008 report from the Urban Institute that estimated that about 20,000 people were dying every year for lack of health insurance.

But when you probe that claim, its accuracy is open to question. Even a rough approximation of how many people die because of lack of health insurance is hard to reach. Quite possibly, lack of health insurance has no more impact on your health than lack of flood insurance.

Part of the trouble with reports like the one from the Urban Institute is that they cannot do the kind of thing we do to test drugs or medical procedures: divide people randomly into groups that do and don’t have health insurance, and see which group fares better. Experimental studies like this would be tremendously expensive, and it’s hard to imagine that they’d attract sufficient volunteers. Moreover, they might well violate the ethical standards of doctors who believed they were condemning the uninsured patients to a life nasty, brutish, and short.

So instead, researchers usually do what are called “observational studies”: they take data sets that include both insured and uninsured people, and compare their health outcomes—usually mortality rates, because these are unequivocal and easy to measure. For a long time, two of the best studies were Sorlie et al. (1994), which used a large sample of census data from 1982 to 1985; and Franks, Clancy, and Gold (1993), which examined a smaller but richer data set from the National Health and Nutrition Examination Survey, and its follow-up studies, between 1971 and 1987. The Institute of Medicine used the math behind these two studies to produce a 2002 report on an increase in illness and death from lack of insurance; the Urban Institute, in turn, updated those numbers to produce the figure that became the gold standard during the debate over health-care reform.

The first thing one notices is that the original studies are a trifle elderly. Medicine has changed since 1987; presumably, so has the riskiness of going without health insurance. Moreover, the question of who had insurance is particularly dodgy: the studies counted as “uninsured” anyone who lacked insurance in the initial interview. But of course, not all of those people would have stayed uninsured—a separate study suggests that only about a third of those who reported being uninsured over a two-year time frame lacked coverage for the entire period. Most of the “uninsured” people probably got insurance relatively quickly, while some of the “insured” probably lost theirs. The effect of this churn could bias your results either way; the inability to control for it makes the statistics less accurate.

The bigger problem is that the uninsured generally have more health risks than the rest of the population. They are poorer, more likely to smoke, less educated, more likely to be unemployed, more likely to be obese, and so forth. All these things are known to increase your risk of dying, independent of your insurance status.

There are also factors we can’t analyze. It’s widely believed that health improves with social status, a quality that’s hard to measure. Risk-seekers are probably more likely to end up uninsured, and also to end up dying in a car crash—but their predilection for thrills will not end up in our statistics. People who are suspicious of doctors probably don’t pursue either generous health insurance or early treatment. Those who score low on measures of conscientiousness often have trouble keeping jobs with good health insurance—or following complicated treatment protocols. And so on.

The studies relied upon by the Institute of Medicine and the Urban Institute tried to control for some of these factors. But Sorlie et al.—the larger study—lacked data on things like smoking habits and could control for only a few factors, while Franks, Clancy, and Gold, which had better controls but a smaller sample, could not, as an observational study, categorically exclude the possibility that lack of insurance has no effect on mortality at all.

The possibility that no one risks death by going without health insurance may be startling, but some research supports it. Richard Kronick of the University of California at San Diego’s Department of Family and Preventive Medicine, an adviser to the Clinton administration, recently published the results of what may be the largest and most comprehensive analysis yet done of the effect of insurance on mortality. He used a sample of more than 600,000, and controlled not only for the standard factors, but for how long the subjects went without insurance, whether their disease was particularly amenable to early intervention, and even whether they lived in a mobile home. In test after test, he found no significantly elevated risk of death among the uninsured.

This result is not, perhaps, as shocking as it seems. Health care heals, but it also kills. Someone who lacked insurance over the past few decades might have missed taking their Lipitor, but also their Vioxx or Fen-Phen. According to one estimate, 80,000 people a year are killed just by “nosocomial infections”—infections that arise as a result of medical treatment. The only truly experimental study on health insurance, a randomized study of almost 4,000 subjects done by Rand and concluded in 1982, found that increasing the generosity of people’s health insurance caused them to use more health care, but made almost no difference in their health status.

If gaining insurance has a large effect on people’s health, we should see outcomes improve dramatically between one’s early and late 60s. Yet like the Kronick and Rand studies, analyses of the effect of Medicare, which becomes available to virtually everyone in America at the age of 65, show little benefit. In a recent review of the literature, Helen Levy of the University of Michigan and David Meltzer of the University of Chicago noted that the latest studies of this question “paint a surprisingly consistent picture: Medicare increases consumption of medical care and may modestly improve self-reported health but has no effect on mortality, at least in the short run.”

Of course, that might be an indictment of programs like Medicare and Medicaid. Indeed, given the uncertainties about their impact on mortality rates—uncertainties that the results from Sorlie et al. don’t resolve—it’s possible that, by blocking the proposed expansion of health care through Medicare, Senator Lieberman, rather than committing the industrial-scale slaughter Klein fears, might not have harmed anyone at all. We cannot use one study to “prove” that having government insurance is riskier than having none. But we also cannot use a flawed and conflicting literature to “prove” that Lieberman was willing to risk the deaths of hundreds of thousands. Government insurance should have some effect, but if that effect is not large enough to be unequivocally evident in the data we have, it must be small.

Even if we did agree that insurance rarely confers significant health benefits, that would not necessarily undermine the case for a national health-care program. The academics who question the mass benefits of expanding coverage still think that doing so improves outcomes among certain vulnerable subgroups, like infants and patients with HIV. Besides, a national health program has nonmedical benefits. Leaving tens of millions of Americans without health insurance violates our sense of equity—and leaves those millions exposed to the risk of mind-boggling medical bills.

But we should have had a better handle on the case for expanded coverage—and, more important, the evidence behind it—before we embarked on a year-long debate that divided our house against itself. Certainly, we should have had it before Congress voted on the largest entitlement expansion in 40 years. Unfortunately, most of us forgot to ask a fundamental question, because we were certain we already knew the answer. By the time we got around to challenging our assumptions, it was too late to do anything except scream at each other from the sidelines.

This article available online at:

http://www.theatlantic.com/magazine/archive/2010/03/myth-diagnosis/7905/

[Freki]

"I have no plan to order the lives of the 40 million uninsured. I have no plans for how you should run your life, what insurance you should have, or where you should spend you money; and frankly I find it a little creepy that you have a plan for ordering my private life. And let's face it, you don't plan to insure 40 million Americans, you plan to force the other 250 million Americans to do it."

That is a brilliant way to put the conservative postion.  I have found myself in this spot a couple of times.  I wish I had thought of this...I will use it!

[Crafty_Dog]

The Right Prescription
Obamacare: Still a Threat to Your Life
By Peter Ferrara on 3.3.10 @ 6:08AM

The true reality of last week's health care summit, what was really going on between the lines, was ugly and scary. I have been deeply involved in these health care debates for almost 30 years, ever since I co-authored the first paper published on Health Savings Accounts (HSAs) with John Goodman in 1981. What the health summit made clear to me is that the Democrats do not understand what the Republicans are talking about on health care. Indeed, they have no idea what the American people are talking about either, or why growing majorities of us oppose what they are trying to do.

But it gets even worse. The health summit made clear that the Democrats do not understand what they themselves are doing on health care. They have been misled and manipulated by left-wing ideologues.

Why Your Life Is At Risk

Let me reveal my personal stake in this health care debate. My life is at risk. So is yours, as well as the lives of our children, our parents, and everyone else in our families. For the thorough government takeover of health care in America the Democrats are feverishly pursuing, and the outdated socialized medicine policies from other countries they are so religiously committed to adopting, would trash the very ability of the system to provide the health care many of us are likely to need in coming years to extend our lives, and to maintain our basic quality of life.

The decimation of our health care system under Obamacare begins with government mandates, regulations, bureaucracies, and controls. The House and Senate health care bills that President Obama and the Democrats refuse to take off the table create close to 100 new health care bureaucracies, boards, commissions and programs. This is the government takeover of health care.

These new authorities arrogate to the government the power to decide "what works" in health care, and what doesn't. The code words they use include "best practices" -- a government bureaucracy in Washington is going to decide what are the "best practices" in providing health care for you and your children, not you and your doctor. Another code phrase is "reward doctors for quality not quantity." Government bureaucracies in Washington do not know how to do this. But they will make a huge mess out of your health care in trying to.

These government bureaucracies will also have the power to cut off your health care when they decide it is no longer worth the money. We have already seen a glimpse of this in the declaration by a bureaucracy, to be expanded with more powers under Obamacare, that women over 72 should not have mammograms. What they are saying here is that if you are over 72 and get breast cancer, they don't want to know about it. Just take the painkiller and go home, to paraphrase President Obama. They believe they can buy more votes taking the money for your care and spending it somewhere else. This is called "cost effectiveness."

The destruction of the health care system is then expanded through the payment system. Among the code words here are "pay for performance" and "accountable care." This is how the bureaucracy will enforce its dictates concerning what works and what doesn't, best practices, cost effectiveness, and termination of health care no longer deemed worthy. Doctors and hospitals will be rewarded through payments if they follow the centralized bureaucracy's dictates; they will be penalized with reduced payments if they don't. You will never know what happened to you. The doctor is not going to tell you, "I could have saved your daughter's life with this new treatment, but that is not yet a best practice according to the government."

Health care obliteration then continues by constricting the payments overall to doctors, hospitals, specialists, surgeons, health care innovators, and other health providers. This is where the $500 billion in Medicare cuts come in, which is $800 billion in the first 10 years of full implementation under Obamacare. Seniors will soon find out that constricted payments mean constricted services, because President Obama has already begun cutting payments under Medicare, particularly for cancer and heart specialists, treatments, and diagnostics. But this is just part of the constricted payments to the entire health system under Obamacare, which is how President Obama thinks he will bring the cost curve down. The sad truth is that the only cost control in Obamacare involves health care rationing, which means denying you health care. Those union orchestrated sad sacks marching in the streets chanting for "health care" are suckers.

The final component ultimately leaving us with Potemkin Village health care is the effect of all of this on investment incentives. Nobody is going to invest the capital necessary to develop the new, life-saving health care treatments and technologies and miracle cure drugs, and build the new facilities and purchase the new equipment to provide them, with the constricted payments of Obamacare as their reward. That money will instead join the capital fleeing to build new factories providing good jobs in the increasingly booming economies of Brazil, India, and China.

We can begin to see these effects of Obamacare in Massachusetts, which adopted some of the Obamacare policies a few years ago. As John Goodman writes in his Health Alert ("Scaling the Summit") for February 26, "As a result, the waiting times to see a new doctor in Boston are twice as long as in any other U.S. city. And there are still as many people going to emergency rooms for care in Massachusetts today as there were before the Massachusetts health plan was adopted."

But none of the supporters of Obamacare -- the bloggers, the talk show hosts, the literal clowns like Bill Maher, Jon Stewart and Wanda Sykes that now get media coverage to lecture us on public policy -- understand any of this. They have their heads firmly and deeply stuck in the sand, and insist it is all made up. And as for Democrat members of Congress, they don't have a clue.

Fighting for Their Lives

But when their own lives are at risk, suddenly they can understand it quite well. Consider the case of Danny Williams, age 60, Premier of Newfoundland, Canada, who secretly snuck into the U.S. for his own heart surgery. After his surgery at Mount Sinai Medical Center in Miami, Williams told reporters, "This was my heart, my choice, and my health. I did not sign away my right to get the best possible health care for myself when I entered politics."

Why Williams felt he had to come to America was further illuminated by the recent heart surgery of former President Bill Clinton. As Dr. Marc Siegel explained in the New York Post,

Clinton, of course, got the best of care -- a cardiac stent (a tiny metal cylinder) coated with a drug to help keep his artery open. Recent studies in the New England Journal of Medicine and elsewhere have shown that these drug-eluting stents are more effective than bare metal ones. But they cost two-to-four times more -- and the technology is relatively new. That combination has left government run health-care systems slow to adopt them….Per capita, our neighbors to the north receive only half as many coronary [operations]. And only 30% of the stents placed in Canada are drug-eluting, compared to a whopping 80% in the United States. So a Canadian cardiac patient is less than a quarter as likely as an American to be outfitted with the kind of state-of-the-art stent that Clinton had. In Canada, land of single payer health insurance, you're also less likely to get the stent as soon as the need is clear.

Wanda Sykes owes Sarah Palin an apology.

Why Your Country Is at Risk

The Health Care Summit highlighted another issue that too many of us too easily conceded. House Republican Budget Chief Paul Ryan articulately exposed Obamacare as increasing the deficit by $460 billion over the first 10 years, and $1.4 trillion over the second 10 years. That is with half a trillion in tax increases, and half a trillion in Medicare cuts, over the first 10 years alone.

One of the chief tricks to hide these deficits is to provide for reversing some of the draconian cuts for doctors and hospitals in a separate bill scored as increasing the deficit by $371 billion. The Obamacare legislation also counts on raiding $52 billion in Social Security revenues. Still another trick to claim deficit neutrality is to count the 10 years of tax increases and Medicare cuts against only 6 years of increased Obamacare spending.

While we can't pay for all the entitlement programs we already have, Obamacare adds a new entitlement providing handouts to help pay for health insurance for families with incomes as high as $88,000 a year. That is why the true 10 year cost for Obamacare is really $2.3 trillion, as Ryan explained.

Filibuster Falsehoods

The ugly in the health care summit was the transparent trap President Obama and the Democrats laid for the Republicans. Obama was not the least bit interested in anything the Republicans had to say. He filibustered for 119 minutes of the summit, talking more than all the rest of the Democrats combined at 114 minutes. The Republicans were allowed only 110 minutes to speak altogether.

And as we have seen over and over on health care, much if not most of what President Obama had to say during his filibuster was just not true. The most embarrassing was the exchange with Sen. Lamar Alexander over whether Obamacare would cause health insurance premiums to rise. After Alexander cited CBO as saying they would, Obama imperiously disputed him as "not factually accurate," and then launched into a confused and convoluted argument as to why CBO had really said health insurance premiums would be going down. "But they didn't say that the actual premiums would be going up," Obama insisted. "What they said was they'd be going down by 14 percent to 20 percent." He insisted that he was sure he was right, and that he had gone over and over this with CBO, challenging Alexander to resolve the issue publicly "before we leave today" because "this is an example of where we've got to get our facts straight."

And so it was resolved before they left that day when Sen. Jon Kyl read from the CBO report saying that premiums would indeed rise under Obamacare, and Rep. Eric Cantor tried to explain to President Obama, "We just can't afford this. This government can't afford it, businesses can't afford it." Obama then retreated to saying, well, the premiums would be higher because his plan mandated richer benefits. But that is a concession that premiums would, in fact, be rising, not a demonstration that they would be falling. In fact, premiums will soar by much more than CBO admits, as much as 100% to 200% for young workers, as mathematically demonstrated in studies by WellPoint and others, which Obama and the Democrats have refused to even consider. Yes, the whole point is that premiums would be rising because of the benefits that the Democrats would mandate. And what the public and the critics have been telling them is that we can't afford those increases, and that in many cases the same can be achieved by different means.

President Obama and HHS Secretary Kathleen Sebelius perpetrated another falsehood in criticizing high risk pools, which, when done right, provide a safety net for the uninsured who have become too sick to buy insurance anywhere else. When you concentrate all the high cost risks in one pool, Sebelius insisted, then costs in that pool become very high, and it becomes too expensive for people. But the risk pools are all subsidized by tax funds precisely because those covered by the pool can't be expected to pay all the costs themselves. The point many conservatives and Republicans have been trying to make is that rather than trying to force these high cost uninsured onto the same insurance as everyone else, and massively increasing everyone's premiums as a result, provide them their own risk pool charging no more than they can afford, and subsidize remaining costs so that the pool is a real safety net ensuring that no one need lack essential health coverage and care. Experience shows this can be done at modest cost.

But the greatest ignorance of the day was reflected when President Obama said that a "high deductible plan" is "basically not health insurance." High deductible health plans are the only real insurance, spreading the risk of the high costs affecting only a few in any one year among the entire pool. It is the retro low deductible plans, covering routine yearly expenses that most incur, that are not health insurance, but prepaid health care involving enormously counterproductive incentives and unnecessary costs. Understanding this is essential to solving the health cost problem, but, again, Obama and the Democrats have no clue.

Instead, they repeated the canard that Health Savings Accounts are not workable for the poor, when the truth is they benefit the poor the most. An HSA includes a savings account that can be used to pay for expenses below the deductible. The poor are most in need of the savings they can keep if they don't waste money unnecessarily on health care. What Democrats don't like about HSAs is that they put the patient rather than the government in charge.

Those Who Live by the Reconciliation, Die by the Reconciliation

What was really going on at the summit was reflected in the persistent, obviously pre-arranged, transparently false theme among the Democrats that, hey, you know, we are not really that far apart, there is really a lot of agreement. That was meant to set the Republicans up so the Democrats could say afterward that the Republicans refused to support Obamacare simply for partisan, political reasons, or because they really were in the pocket of industry, and so the Democrats are justified in ramming it through without them, through reconciliation. That was the real point and goal of the summit.

That didn't work because the Republicans were surprisingly good in articulating their reasons for opposing the legislation, and those reasons resonated strongly with the American people. By giving the Republicans such a high profile forum to express these reasons and their far more common sense alternatives, the summit backfired into yet another disastrous loss for Obamacare.

Reconciliation is a process solely for enacting budgetary measures to reduce the deficit, not sweeping, historic reforms involving adoption of the costliest new entitlement in history. Proceeding with President Obama's health care overhaul through reconciliation would flout Congressional rules way beyond any historical precedent.

But what is adopted by reconciliation can and will be repealed by reconciliation, setting a precedent for future entitlement reforms using the same process.

Letter to the Editor

StumbleUpon| Digg| Reddit| Twitter| Facebook

Peter Ferrara is director of entitlement and budget policy at the Institute for Policy Innovation, a policy advisor to the Heartland Institute, and general counsel of the American Civil Rights Union. He served in the White House Office of Policy Development under President Reagan, and as Associate Deputy Attorney General of the United States under the first President Bush. He is a graduate of Harvard College and Harvard Law School.

[ccp]

"And so it was resolved before they left that day when Sen. Jon Kyl read from the CBO report saying that premiums would indeed rise under Obamacare, and Rep. Eric Cantor tried to explain to President Obama, "We just can't afford this. This government can't afford it, businesses can't afford it." Obama then retreated to saying, well, the premiums would be higher because his plan mandated richer benefits."

That's interesting!  Not one peep of this in the main stream propaganda machine.
Their pundits, and "news" anchors all came out in a chorus and said Obama stood his ground.  One even said something to the effect that the chosen one shot down all of the Republican attempts to "rattle him".

From now on when anyone disagrees with the One they need to tell *him* he needs to get the facts right.

[Crafty_Dog]

Reconciliation is still the buzzword on Capitol Hill as Democrat "leaders" Harry Reid and Nancy Pelosi try to figure out how to ram ObamaCare down our throats. Not that they see it that way; as House Majority Leader Steny Hoyer put it, "That's not ramming something through with a majority. It is doing what democracy calls for." Well, this isn't a democracy, it's a republic: and the Founders set it up that way for a reason.

Accompanied by his teleprompter, Barack Obama began a renewed push for a vote on the health care bill by Easter when he met a group of people wearing lab coats in the Rose Garden on Wednesday (and he accused Rep. Eric Cantor of using a "prop" by bringing the 2,400-page bill itself to last week's health care summit). Obama claimed that "new and improved" legislation "incorporates the best ideas from Democrats and Republicans." As we said Tuesday, however, the problem isn't whether the bill is "bipartisan." A few Republican ideas sprinkled in won't fix it. The problem, at its core, is that a plan for Congress to take over one-sixth of the U.S. economy is unconstitutional.

In the face of all evidence, the teleprompter continued, "I don't believe we should give government bureaucrats or insurance company bureaucrats more control over health care in America." Huh? Giving government bureaucrats control over health care in America is precisely what Obama is proposing to do.

For all the talk about reconciliation in the Senate, the House vote may be the more important one. The Associated Press reports, "The House passed health overhaul legislation by a narrow 220-215 vote in November, but since then several Democrats have defected or left the House. To avoid a filibuster in the Senate that Democrats can't defeat, Obama is now pushing the House to approve the Senate's version of the bill, along with a package of changes to fix elements of the Senate bill that House Democrats don't like, including a special Medicaid deal for Nebraska and a tax on high-value insurance plans that is opposed by organized labor."

If Pelosi is able to strong-arm the Senate bill through the House with a bare majority, Senate reconciliation becomes moot. With three vacancies, Democrats need just 217 votes for passage, and there are a handful of Democrats who voted "no" in November who now say they're undecided. On the other hand, 12 pro-life Democrats, led by Bart Stupak of Michigan, say they're prepared to switch sides and scuttle ObamaCare if sufficient protections against abortion funding aren't put in place. The Senate bill doesn't meet their benchmark.

Never underestimate this president's lack of shame, though -- or his penchant for Chicago-style politics. For example, Rep. Jim Matheson (D-UT) voted against ObamaCare in November, but he is now "undecided." So on Wednesday, Obama nominated Jim's brother Scott to the 10th Circuit Court of Appeals. Offering jobs for playing the White House way is nothing new, and Scott Matheson is, to be fair, a well-credentialed nominee. However, even the appearance of selling judgeships for health care votes would give pause to a more honorable president.

As for leftist sentiment, perhaps MSNBC host Ed Schultz best summed it up this week, saying, "mall government has never gotten anybody any health care."

"The Republicans have a choice," Schultz declared. "Lead, follow or get the hell out of the way. ... We have people in need and they need to be helped."

Memo to Ed: If government would get out of the way, those people might be able to help themselves, as our Founders intended. Democrats aren't about to let that happen because it really isn't about helping those in need.

[Body-by-Guinness]

One Giant Government Leap Backwards
With Obamacare, the government is selling a product that the rest of the country doesn’t want.
 
Rather than a post-partisan olive branch to congressional Republicans and the American public, President Obama’s latest health-care speech was a declaration of war. He’s more than willing to use a 51-vote reconciliation majority to jam through a roughly $2 trillion health-care plan that amounts to a government takeover of nearly one-fifth of the economy. He’s prepared to stick Uncle Sam right in the middle of the age-old relationship between patients and doctors, and doctors and hospitals, all while subjugating the private health-care insurance system to the status of a government-run utility — without bending the cost curve downward.

More spending. More tax hikes on investors, businesses, and individuals. New government boards to control prices, ration care, and redistribute income. The Obama administration is basically taking a giant government leap backwards that the country doesn’t want to take.

One of the most galling features of this plan is a taxpayer-subsidized government-insurance entitlement for people earning up to 400 percent above the poverty line, or nearly $100,000 for a family of four. In other words, a middle-class health-care entitlement that will add millions of people to the federal dole. It’s all too reminiscent of the political dictum of the old New Dealer Harry Hopkins: tax and tax, spend and spend, elect and elect.

The spending has been well chronicled by congressman Paul Ryan, who baffled President Obama at the so-called health-care summit with his cogent analysis of a ten-year cost of $2.3 trillion that sets a floor, rather than ceiling, for the likely expense of this entitlement package. Obama had no rebuttal.

On taxing, let’s not forget that the current health-care payroll tax of 2.9 percent will be expanded to cover all forms of investment and capital formation, on top of the repeal of the Bush tax cuts. The anti-growth consequences are incalculable. As the late Jack Kemp used to say, you can’t have capitalism without capital.

The White House says job creation is priority number one. But you can’t have new jobs without healthy businesses. And healthy businesses require investment. However, by taxing investment more we’ll get fewer jobs, reduced real wages, and slower economic growth.

And how stupid is it for the president to support a six-month payroll-tax cut for small businesses in the name of job creation while imposing a 1 percent permanent increase in that very same tax to fund the massive new health-care entitlement. Talk about self-defeating.

Oh, by the way, a government takeover of health care will cripple one of our most productive job-creating sectors. Over the deep two-year recession, while overall corporate payrolls fell by about 7.5 million, private health-care firms created almost 700,000 new jobs.

And the health-care industry is one of our fastest-growing, most technologically advanced areas. With constant breakthroughs in biotech, pharmaceuticals, medical equipment, and diagnostics, the growing demand for more health care could elevate this prosperous job-creating sector to a third of the economy in the decades ahead. What’s wrong with that? Why crush it?

Health-care reform was supposed to be about getting 10 million low-income, chronically uninsured people some health insurance. But that can be solved by playing small ball. Health-care reform also was supposed to slow down cost increases. But that will never happen until the third-party payment system, run by Big Government and Big Business, is replaced by true consumer choice and market competition.

Just give consumers the tax break, and let them shop across state lines to find the right insurance plan. And young people who are already paying taxes into Medicare should not be mandated to pay more taxes into this entitlement plan. The young will pay for health insurance when they’re ready to pay for it.

Clearly this new New Deal, or new Great Society, or whatever it is, is the government selling a product that the rest of the country doesn’t want. Ironically, polls show that roughly 80 percent of voters believe their health insurance is satisfactory, good, or excellent. Polls even show that the public knows that a simple majority vote on reconciliation is an insufficient check on runaway government.

The Byrd rule says that reconciliation is for budget control and deficit reduction. But the Obama Democrats think they can use reconciliation to install a massive new social policy that would emulate the socialist-labor entitlement state now prevalent in Western Europe. As the Greece crisis amply shows, that entitlement state is on the verge of bankruptcy.

Perhaps Obama’s throwing down the gauntlet on nationalized health care will be the political gift that keeps on giving, in terms of political regime change come November. But if Obamacare does pass, a future rollback will be very difficult, and American health care and economic prosperity will be put in grave jeopardy.
 
— Larry Kudlow, NRO’s Economics Editor, is host of CNBC’s The Kudlow Report and author of the daily web blog, Kudlow’s Money Politic$.

http://article.nationalreview.com/427062/one-giant-government-leap-backwards/larry-kudlow

[ccp]

Entitlement state

I psoek with one of my patients who lived through the 30's.  I said I thought times must have been terrible with bread lines etc.
I asked him though if times were in some ways worse now or worse then.
Many people now really question the future viability of the US.  Did people think that then?

He thought about it while answering.  He didn't say yes or no.  Just that it was really a "different" world back then.
People didn't expect what they expect now.  They were [hardier].  they learned to go through garbage dumps.  They grew their own food in gardens.

No one expected unemployment, pensions, free health care, medicare, social security.

So I guess they didn't look at the future of the US as being in jeopardy as we do today. 

I guess we didn't have the foreign threats we have now as well.

I asked him which is worse:

People on bread lines or a government that keeps expanding doles?

He didn't answer.  I think he just didn't have a chance to think it over.

To me this is the prime question facing us today (at least on the domestic front).
I

[Body-by-Guinness]

Myths about Reconciliation
Using reconciliation to pass Obamacare would be inappropriate and unprecedented. Here’s why.
 
How could you tell when the Democrats had finally settled on the reconciliation route? It was at some point between the time Harry Reid told Republicans at the health-care summit that “nobody has talked about reconciliation” and the time the White House stopped uttering the word altogether.

But though their diction has changed, the Left continues to perpetuate a number of myths about reconciliation that should be dispelled before Democrats in Washington use the procedure to force-feed the American people this $2.3 trillion behemoth.

Myth: Reconciliation is simply “majority rule.”
Democrats have referred to the maneuver that dare not speak its name as simple “majority rule.” In his March 3 speech, President Obama called for an “up-or-down vote” on health-care reform requiring “nothing more than a simple majority.” White House Press Secretary Robert Gibbs told MSNBC the next day that in most American households, “51 percent represents a majority viewpoint. I don’t think that’s a crazy concept.” Ezra Klein claimed that “a simple majority process” has been “key to getting anything done” in the Senate since the 90s.

But this isn’t about lowering the thresholds for passage, as most reconciliation measures initially pass the Senate with sizeable majorities — sometimes even by voice vote or unanimous consent. Rather, the process is explicitly about bypassing the Senate’s usual order of business — an open debate and amendment process with an emphasis on consent and consensus and robust protections for minority rights — to ensure the speedy passage of budget-balancing legislation. As a result, reconciliation measures are “privileged,” meaning that the Senate must consider them when they come to the floor. Likewise, debate on their substance is strictly limited to 20 hours and amendments are allowed only insofar as they address the contents of the measure itself (though, as author Foster notes here, there is nothing to stop a determined minority from gumming up the works indefinitely by forcing votes on the germaneness of extraneous amendments).

There is nothing wrong with the principled use of this “front-of-the-line” treatment for measures meant to bring budgetary outlays in line with revenues, but in a Congress that demonstrably no longer takes its duty to balance budgets seriously, reconciliation is once again being abused as a matter of political convenience.

The truth is that every single piece of successful legislation to emerge from the Senate — via reconciliation or otherwise — has done so via a final, up-or-down vote with a 50-plus-one threshold. The debate about reconciliation is a debate about the path to that vote. It’s about whether the Senate is and ought to be something more than a slightly smaller, slightly crustier House of Representatives.

When Harry Reid took over the majority leadership of the Senate, he vowed that “as our founding fathers intended, the Senate will perform its role as the ‘cooling saucer’ where debate and amendments play a role in forging consensus and compromise.”

Would that he lived up to those words.

Myth: Obamacare is in the main about cutting deficits, and therefore justifiably considered under reconciliation.
First, it’s important to understand why reconciliation might be necessary. The Senate bill includes an excise tax on high-cost employer-provided health-insurance plans — the kind that unions have acquired for their members through years of collective bargaining. The inclusion of this tax was almost an accident. Like many Democratic ideas, it started as a way to demagogue against the rich. Only later, after unions started voicing objections, did the Democrats realize what they had done, but by then it was too late. Health-care economists liked the idea of an excise tax on high-cost employer-provided plans, because the fact that these plans are otherwise untaxed is one of the great distortions in our health-care system that drive up the cost of insurance. Plus, the tax provided a real source of revenue to pay for new spending in the bill, thus improving its CBO score. The excise tax — dubbed the “Cadillac tax” by some — proved impossible to remove from the Senate bill without rocking the boat that was moving the bill toward passage.

But in the House, where union-backing progressives are stronger, objection to the tax made rubber-stamping the Senate bill impossible for Nancy Pelosi. Democratic leaders met with President Obama to devise a carve-out to protect the unions from the tax, and they had almost achieved a deal when a certain truck-driving Republican from Massachusetts won an election and upset the balance. Things fell apart for a while. The Democrats panicked. Health-care reform looked dead. Then Obama put forward a plan that would allow the Democrats to scrap the Cadillac tax through reconciliation. That’s where things stand.

As we’ve said, reconciliation is a process devised to ensure an easier process for shrinking budget deficits. Liberals have argued that according to the CBO, Obamacare would reduce the deficit, so amending it through the reconciliation process is appropriate. There are two problems with this argument. First, even taking the administration’s numbers at face value, its reconciliation plan would amend the legislation so that it reduces the deficit by less than the original bill. The CBO has not had time to score the president’s proposal, but the administration says that combined with the original legislation, the president’s plan would reduce the deficit by $100 billion. The CBO scored the Senate bill as reducing the deficit by $131 billion. Neither is a significant sum, but the point is that reconciliation in this case would actually move us backwards in terms of deficit reduction.

Second, the president’s plan replaces new revenue (the Cadillac tax) with revenue that is double-counted and, according to the CBO, cannot be used to offset new spending. Instead of the Cadillac tax, the president’s plan would raise revenue through a 2.9 percent Medicare excise tax on the investment income of people making more than $200,000. But as the CBO noted in objecting to a previous attempt to do this, that money must go into the Medicare trust fund, and the government must use it to pay out future Medicare benefits. It cannot simultaneously count that money as savings to be spent on a new health-insurance entitlement for the uninsured. So the president’s numbers are not to be taken at face value — by replacing Cadillac-tax revenue with double-counted revenue, his reconciliation plan would likely increase the bill’s cost by much more than $30 billion, increasing deficits in a manner contrary to the spirit of reconciliation.

Myth: We already passed health care with 60 votes in the Senate. Reconciliation is just for a few “fixes.”
In his March 3 speech, President Obama said that “reform has already passed the House with a majority. It has already passed the Senate with a supermajority.” Robert Gibbs has said “we got health-care done not with 51 but with 60 votes” in the Senate. By contrast, the Democrats argue, reconciliation will only be used to pass a small package of “fixes” introduced by the president to resolve the House and Senate versions of the bill. Ezra Klein and others have adopted the term “micro-reconciliation” to describe this strategy.

But to say that both chambers have already passed “reform” is deeply misleading, considering that reconciliation is necessary precisely because neither body’s bill is acceptable to the other. Indeed, the greatest impediment to the Democrats’ reconciliation strategy is not the Republicans, but the House’s mistrust of the Senate. Since the Senate acting first to “reconcile” a bill that has yet to become law would create a sort of legislative paradox, the White House and Senate Democrats have spent weeks trying to assure their colleagues in the lower chamber that they won’t be hung out to dry if they act first and pass the Senate bill before the reconciliation measure.

We’ve already noted the excise tax as a major source of tension between the chambers, but the Senate’s more permissive language on the federal funding of abortion is also a non-starter in the House, with Rep. Bart Stupak (D., Mich.) promising that a dozen or more pro-life House Democrats who voted yes on the House bill would balk at the Senate language. Since it will be nearly impossible to shoehorn a compromise into a reconciliation measure, the abortion issue could well doom Obamacare.

In short, the House and Senate are as far away from each other on reform as they were before Massachusetts, only now they’ve lost the supermajority that gave them the luxury of working out their differences in a conference report. So as it stands, there is not one health-care reform bill but two, and neither is in any shape to make it to the president’s desk without reconciliation.

Myth: This is just like when the GOP used reconciliation for the Bush tax cuts.
As we have noted, reconciliation would likely worsen the bill’s impact on the deficit, but the president’s supporters might say, “So what? The Bush tax cuts added to the deficit, and the GOP used reconciliation for those.” Here they have a point. But there are two reasons why health care is different. One, perhaps semantic, is that the Bush tax cuts were temporary — their impact on deficits was limited to the ten-year window specified by the Byrd Rule, which states that reconciliation bills cannot add to the deficit beyond the period covered by the budget resolution. Obamacare is designed to be a permanent new health-insurance entitlement. Second, and more important, is that the Bush tax cuts in addition to being temporary were strictly limited to fiscal policy — the kind of thing reconciliation was designed to handle — and therefore easy to score. As mentioned above, it is hard to know the true budgetary cost of Obamacare, because it is a tangled nest of tax hikes, regulations, twice-counted revenues, and unknowable costs tied to hard-to-predict factors such as health-care cost inflation.

Will Obamacare increase the deficit in a fiscal year after the ten-year period covered by the Byrd Rule? The answer is almost certainly yes. But unlike the Bush tax cuts, Obamacare will not sunset. Unless Republicans are able to repeal it — a difficult task, to put it mildly — its costs will be with us for good.

Myth: This is no different than what the Republicans did on Medicare Part D.
Again, charges of hypocrisy leveled at Republicans who object to using reconciliation to pass health-care measures have some force. It is true that reconciliation has been used more often by Republicans than Democrats since its adoption. And it is true that reconciliation has been used to pass big-ticket health-care measures such as COBRA and CHIP.

But most of the health-care measures passed via reconciliation did so with broad, bipartisan support. And as mentioned above, virtually all of the votes that were tight and/or partisan dealt with straightforward fiscal policy, without the massive unintended consequences that attend to a measure of the size and scope of Obamacare.

Perhaps the closest parallel to the Democrats’ current effort — and the one most often carted out in service of the hypocrisy charge — is Medicare Part D, which passed with 54 votes in a Republican-controlled Senate. But in fact it isn’t much of a parallel at all. For one thing, Medicare Part D wasn’t passed via reconciliation. Rather, Democrats could not or would not sustain a filibuster, and cloture on the conference report was secured 70–29 via the usual order of business. And when then-senator Tom Daschle (D., S.D.) tried to raise a point of order under the Congressional Budget Act — from which reconciliation rules stem — he was overruled with 61 votes.

Moreover, though the Republicans only had 54 votes, eleven Democrats (plus one Independent) voted with the majority, including the likes of Max Baucus, Kent Conrad, Mary Landrieu, Blanche Lincoln, and Ben Nelson.

During the floor debate, then-senator Pete Domenici (R., N.M.) raised the possibility of pursuing the bill under reconciliation, and rejected it:
Let me just tell you, without trying to take much time, that our distinguished leader had an opportunity to move this bill under what is called a reconciliation bill. Do you know what that would have done, Mr. President? That would have limited debate, and it would have made the bill almost not amendable and, indeed, besides that, there would be no points of order. He chose, as the bill progressed through, to do otherwise.

Medicare Part D is hardly a shining example of good legislation, but it passed under the standing rules of the Senate, under which the minority was afforded an open and extended debate. And it passed with significant support from that minority. Neither will be said of Obamacare if it is pushed through via reconciliation.

— Daniel Foster is National Review Online’s news editor. Stephen Spruiell is an NRO staff reporter.

http://article.nationalreview.com/print/?q=YWM3NzZlNWNiODUzOWQ3ZDI3MmE0NDE3YWFjNTM1NTI=