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Wednesday, January 27, 2010


Although the situation in a state of flux, the push for health reform of some sort is still on. In an interview with Politico newspaper this afternoon, Speaker Pelosi said that, “We have to get it done. What the process is doesn’t matter. The outcome is what is important, and what it means to working families in America.”

The idea of passing a comprehensive amendment via reconciliation in order to make the Senate bill palatable to the House is still very much alive. While some House Democratic leaders predict that they may be able to garner enough votes to pass the Senate healthcare overhaul bill through the House (contingent upon changes), Speaker Pelosi herself last night told reporters that "At this time, in this form, there aren't the votes in the House, not anywhere near, to pass the Senate bill.”

Meanwhile, the 80-member National Coalition on Health Care announced this afternoon that they are launching a campaign to promote this approach. The coalition’s CEO Ralph Neas said that President Obama and Congress should immediately resume negotiations, and then the Senate should use reconciliation to pass "corrections" - therefore only needing a simple majority.

Be it “corrections” to the Senate bill, or stand alone measures, an increasing number of Senate Democrats have voiced strong reservations about using the reconciliation process. (They include seven Democrats and one independent, Sen. Joe Lieberman)

Although the President is not expected to focus on health care in tonight’s State of the Union Address, we can expect that this issue will remain a top priority for both the White House and the Congress.

Monday, January 25, 2010


With this Wednesday's State of the Union address drawing near, Democrats have been tight-lipped on what strategy they may use to make a final push for health care reform. The White House and top Democratic congressional leaders, despite losing the seat previously held by Senator Ted Kennedy (D-Mass.) to Republican Scott Brown, are nonetheless determined to push ahead with broad health care legislation.

Although no formal strategy has been announced, multiple sources, including AP, have reported that House Speaker Nancy Pelosi (D-Ca.) will attempt to gather the votes needed to pass the Senate bill by addressing House concerns in a single comprehensive amendment. The Senate would then use a procedural maneuver known as reconciliation (which would only require 51 votes in the Senate) to adopt these House changes.

This modified Senate version will certainly contain dangerous and numerous mechanisms that would lead to rationing. Some of these include - premium price controls, a powerful Medicare cost-cutting board, and numerous grants of "quality" and "efficiency" discretion given to the Secretary of Health and Human Services. A full analysis of the rationing concerns present in the pending Senate bill is available here.

Friday, January 22, 2010


In a town hall meeting in Elyria, Ohio this afternoon, President Obama again expressed his commitment to passing some sort of reform, saying, "I am not going to walk away just because it's hard."

The form that health reform may take is evolving daily, but the idea of a scaled-back package – one that could attract Republican support - may be gaining steam. Several House Democrats, like Rep. Paul Grijalva (D-Ariz.), are pushing for the use of Reconciliation for some of the controversial portions, and a series of small measures which might attract Republican support.

This morning, Howard Dean (former Democratic Party Chairman) was also advocating passage of a series of scaled-back healthcare measures instead of one comprehensive bill, adding, "I would go back and do that though and run it through the reconciliation program."

Democratic leaders have said they will not hold votes on healthcare reform until Brown is seated. Further, Sen. Chris Dodd has called for lawmakers to "take a breather for a month, six weeks."
Although the timetable, as well as the direction of health reform is unclear, Obama and congressional Democrats are far from abandoning reform this session.

Thursday, January 21, 2010


Adding to information reported earlier today, Representative Paul Ryan (R-WI), the ranking Republican member on the House Budget Committee now says the majority will seek to use the reconciliation process to adopt as much as possible of the health care bill stalled by the Massachusetts victory of Senator-Elect Scott Brown.


National Right to Life Committee Press Conference
Zenger Room, National Press Building, Washington, D.C.
January 21, 2010
Since its inception, the pro-life movement has been just as concerned with protecting the lives of people with disabilities and older people from euthanasia as it has been with protecting unborn children from abortion, and we have regarded government-imposed rationing of lifesaving medical treatment, food and fluids as an unacceptable form of involuntary euthanasia.

Therefore, the pro-life movement has grave concerns about rationing elements in the pending health care legislation. This morning’s Washington Post quotes Harvard health policy professor Robert Blendon as saying that what Massachusetts voters heard was now Senator-elect Scott Brown’s message that the national health care bills would require Medicare cuts. Indeed, a great deal of the backlash, not just in Massachusetts but also nationally, comes from those with insurance realizing that their health care will be endangered if the proposed legislation is enacted.

That legislation is based upon a widely held but fundamentally fallacious assumption – that it is necessary to "bend the cost curve" of health care spending because America cannot afford to continue to increase health care spending in the future as it has in the past.

As it happens, foremost among the economists who have debunked this fallacy is the Obama Administration’s nominee for Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, Columbia University health care economist Sherry Glied, in her 1997 book "Chronic Condition: Why Health Reform Fails." The first two of these charts are based on data from that book, updated.

The percent of the average family budget devoted to health care (including what employers pay for employees’ health insurance) has steadily grown from 3% in 1940 to 17% in 2006. This trend, and fear that it will continue unless "the cost curve is bent," lies behind the increasingly widespread view that rationing, however unpalatable, is essential. But as Glied’s book demonstrates, the trend must be seen in context.

During that same period, the percent of the average family budget devoted to food declined from almost 30% to under 15%, because of ever-increasing improvements in agricultural productivity. We can look further at the three essentials of food, clothing, and shelter combined. From 1940 to 2006, the percent of the average family budget devoted to these necessities fell from about 53% to about 33%. Consequently, the percent for health care plus food, clothing, and shelter actually dropped from 56% in 1940 to 50% in 2006. Productivity improvements in such areas as agriculture, transportation, and the assembly of clothing freed up resources enabling Americans, on average, to put significantly more resources into obtaining better health care.
While we are presently coping with severe economic downturn, research by health care economists across the ideological spectrum, from David Cutler[1] to Robert Hall and Charles Jones, shows that there is no reason, so long as productivity growth continues, why we cannot indefinitely continue to increase the proportion of our incomes that is spent to keep us alive and healthy.

The pending health legislation contains numerous mechanisms to hold down the amount of their funds Americans are allowed to use to save their own lives. As documented on our website, both the House and Senate bills would not just limit government health care spending; they would empower bureaucrats to limit what private citizens can spend to get unrationed health insurance. Senior citizens, faced with massive Medicare cuts, could be prevented by the federal Centers for Medicare and Medicaid Services from exercising the choice current law allows them to add their own money on top of the diminishing government Medicare contribution in order to get Medicare Advantage private fee-for-service plans less likely to deny treatments and diagnostic tests. Those participating in the health insurance exchanges could see their insurance choices limited to those plans most likely to deny care if government bureaucrats exclude plans less likely to ration care on the claim that they cost too much.

Under the Senate bill, an almost omnipotent commission would be directed not only to hold Medicare increases below the rate of medical inflation, but also to recommend to the HHS Secretary measures to keep increases private health care spending below medical inflation as well. The HHS Secretary would be empowered to impose so-called "quality" and "efficiency" standards on ALL health care providers governing the health care they provide not only under government programs but also under private insurance.

We don’t need this U.K.-style rationing, and the National Right to Life Committee will be working to prevent or repeal it. Last night, in an interview with George Stephanopoulos, the President suggested the possibility of a stripped-down bill, but one of the three items he mentioned as being in such a bill was "cost-containment." We will be carefully watching any such stripped-down measure to determine whether it includes provisions that, like the pending bills, would ration health care, and will be quick to publicize and oppose them.

[1] David M Cutler, Your Money or Your Life: Strong Medicine for America's Healthcare System (Oxford: Oxford University Press, 2004).


Late this afternoon, it was reported by the New York Daily News that Nancy Pelosi is set to announce that the House is going to use the Reconciliation Process to try and pass health care reform. The Reconciliation Process only requires a simple majority to pass a bill. In terms of the Senate, the critical ability of the Senate to filibuster is gone, and only 51 votes would be needed to pass the bill.

The Reconciliation Process is complex and difficult to navigate. Very basically, each of the committees with jurisdiction over Healthcare would need to pass bills, and then the House Budget Committee would merge these into a reconciliation bill and report it to the House floor – needing 218 votes to pass.

Similarly, in the Senate, the Finance and HELP committees would need to report bills that the Budget committee would meld together and then report that product to the Senate floor. Only 51 votes would be needed to begin consideration of it. Debate is limited to 20 hours. Amendments are unlimited but must be germane to the bill.

As long as the bill has been drafted not to violate the budget resolution the Senate can pass the bill with a simple majority. This rule is very difficult to adhere to and would eliminate huge and key elements present in the current reform bills. After the Senate passes their reconciliation bill, they work out differences with the House, if any.

If the reports are true, then we can fully expect a bill – one potentially wrought with rationing concerns. President Obama, speaking to ABC news last night said, “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." It is precisely these cost-containment measures that raise rationing concerns. Continue checking back often, since health reform is far from dead.

Wednesday, January 20, 2010


With the historic victory of Scott Brown to the United States Senate last night, health care reform is in jeopardy. Propelled to victory by a large number of self-identified independents, Brown, a Republican, has vowed to vote against the current health reform being contemplated by Congress. For many months, the focus has been on Senate Majority Leader Harry Reid’s (D-Nev.) gathering of and tenuous hold on 60 Democrats. Once Brown is seated, and the Democrats lose their filibuster-proof majority, all bets are off.

Politico newspaper writes in an web article titled “Dazed Dems Rethink Reform” that,
“But what seemed a certainty a week ago feels unlikely today. Don't take the word of republicans or even reporters on this one. Listen to what Democrats are saying as they appraised the results overnight: Sen. Russ Feingold (D-Wis.) told a local reporter, “It’s probably back to the drawing board on health care, which is unfortunate.” Rep. Bill Delahunt (D-Mass.) told MSNBC this morning he will advise Democratic leaders to scrap the big bill and move small, more popular pieces that can attract Republicans. And Anthony Weiner (D-N.Y.) said his leadership is “whistling past the graveyard” if they think Brown’s win won’t force a rethinking of the health care plan. Sen. Evan Bayh (D-Ind.), who now might draw a challenge from Rep. Mike Pence (R-Ind.), said the party needs to rethink its entire approach to governing.”
With Democrats growing markedly uneasy, the options before them grow more politically undesirable almost daily. Supporters of the health bills may make a fast and furious push to get the House to pass the Senate version before Brown is seated. There are other assorted political tricks and maneuvers that could be attempted – involving reconciliation – which would only require 51 votes. However, there is no Congressional Budget Office score that includes the modifications known to have been negotiated, like organized labor’s changes to the tax on so-called “Cadillac Plans”. Further, using the Reconciliation process has many problems of its own. The Byrd rule, which ensures that bills passed using this process relate to the budget, would likely mean many key (like insurer reform) parts of the bill would be out. Further, that CBO score must comply with rules, but again has not yet been sought. Also, the process of using Reconciliation would mean that Republicans could offer endless amendments, creating tough votes for the Democrats.

Late this afternoon President Obama, himself taking note of the turning political tide, urged lawmakers not to try to "jam a bill through" but to reduce the scope of the restrucuring effort to "those elements of the package that people agree on."

It is unclear what the strategy is going to be, but check back soon as this unfolds. One thing is certain, if the Massachusetts election of Scott Browns is a referendum on the dislike of the current health restructuring effort, then many supporters who were already becoming uneasy, are now decidedly so.

Thursday, January 14, 2010


Last night Democrats held another late night closed door meeting attempting to negotiate a final health care package. This morning, Rep. Charlie Rangel (D-NY Chairman of Ways and Means) told reporters that Democratic leaders hope to send a package to the Congressional Budget Office by Saturday. Rangel has also said that an agreement on "core issues" may be reached as early as tomorrow. Democratic leaders, who have been working out the differences between the House and Senate versions behind closed-doors, were unclear if they will be sending a complete bill, or just portions. The Congressional Budget Office score, which provides cost estimates, may be key to many members (especially if the cost is higher than expected), and neither the House or the Senate can afford to lose votes.

One of the key recent sticking points has been over the so-called tax on "Cadillac Plans." For more on this see here. However, House Speaker Nancy Pelosi has, this afternoon, told colleagues that organized labor struck a deal with the White House. Labor groups have not yet claimed agreement. Democrats are still hopeful that they will reach agreement and still have their eye on passing health care restructuring right around the presidential state of the union address.

Monday, January 11, 2010


Today, leaders of organized labor met with President Obama at the White House to discuss the so-called “Cadillac Tax” on high-cost benefit plans that is a major source of funding in the Senate version of health reform. While the House levies a surtax on wealthy Americans to partially finance its version of health reform, the Senate and White House have indicated that they intend to stand by the Senate’s 40% tax on “generous plans.” They believe it is the only way to maintain the tenuous hold on the necessary 60 votes.

House Democratic leadership has promised a fight over the tax. 190 Democrats have signed a letter opposing the tax, and organized labor is mounting a major last change effort to fight the tax.

Despite the contentious debate, it has been a little looked-at fact that the Senate’s 40% levy on health insurance premiums is the one source of funding that could keep pace with the rising resources devoted to health care. Initially, this levy would apply (with some exceptions) to insurance plans that cost over $8,500 annually for an individual, or $23,000 annually for a family. These threshold amounts would increase each year by the average rate of inflation plus one percent.

What is spent on health care consistently rises substantially more each year than does the average inflation rate. Thus, over time, the effect of the “Cadillac Tax” would be that larger and larger proportions of those with health insurance would begin to pay the tax on gradually rising portions of their premiums.

This would mean that the level of health care for all would effectively be set by the collective decisions of many citizens (and employers) deciding what premiums they were willing and able to pay for health insurance, with the cost of covering the uninsured taken into account in those decisions. As the level of available health care changed, the health care available to those otherwise unable to afford it would change with it. A rising tide really would lift all boats. [Compare NRLC's plan to extend healthcare without rationing here and an explanatory webinar here.]

The Senate cannot even lose one Democrat and is standing by its 40% levy. The House continues to object. With the strong opposition from organized labor, combined with 190 Democrats in opposition to the provision, health care restructuring could be derailed by the defection of even a small number of House members.

Tuesday, January 5, 2010


The Mayo Clinic has long been an institution praised and emulated for its efficiency and forward-thinking policies. But now it has begun a pilot program that may set an undesirable precedent.

According to a story by David Olmos which ran at under the headline, “Mayo Clinic in Arizona to Stop Treating Some Medicare Patients,” its clinic in Glendale, Arizona is launching a pilot program where it will no longer accept Medicare patients and which will force its existing Medicare patients to pay up to $2,000 out of pocket to continue to be seen by their Mayo doctor.

The reason?...... The Mayo Clinic says it is no longer able to afford the low reimbursement rates Medicare offers providers. A Mayo spokesman, Michael Yardley, told Olmos that “The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic.”

The Mayo organization “had 3,700 staff physicians and scientists and treated 526,000 patients in 2008,” Olmos wrote in the December 30 story. “It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.” (See here for full story.)

According to the Medicare Payment Advisory Commission which makes recommendations to Congress, nationwide doctors receive around 20% less than the real cost of providing a service.

This move by the prestigious Mayo Clinic is very likely to a ripple effect. Olmos writes, “Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.”

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

Citing surveys taken by her organization, Heim pointed out “While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program.”

This problem will no doubt be exacerbated by the health care bills passed out of both houses of Congress. Both rely heavily on deep cuts to the Medicare program to finance extending subsidies and coverage to additional Americans. In addition, the bills passed by Congress do not address the reoccurring problem of what is known as “doc fix.”

Each year, the rates paid to Medicare providers are supposed to be cut in order to keep Medicare solvent. In truth Congress cobbles together expensive bills yearly to ensure those cuts do not take place.

National Right to Life has long recognized this dilemma of how underpayments in the Medicare program can lead to rationing. NRLC was instrumental in creating an option in the Medicare program known as private-fee-for-service. Seniors can add their own money on top of the government contribution, so that their plan could offer adequate reimbursement rates to secure insurance for senior citizens. However the Medicare private-fee-for-service option is threatened by both the Hosue and the Senate versions of health care reform. For more on this see here.

Although for now the Mayo Clinic is only rejecting Medicare patients at one primary-care clinic in Arizona, it will assess the financial effect of the decision in Glendale “to see if it could have implications beyond Arizona,” according to Michael Yardley. This may be the start of a dangerous trend where seniors in the Medicare program will have very few options for the kind of care they deserve.