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Thursday, February 25, 2010


President Obama and key congressional leaders just wrapped up a summit on health care late this afternoon. Despite the seeming spirit of bipartisanship, little agreement resulted from the meeting.

Although the tone of the meeting was generally amicable, while wrapping up the summit, the President chastised Republicans for attacking the "MedPac Commission". The “Independent Payment Advisory Board” he referred to is a board which is given the authority to recommend, and gives the HHS Secretary the authority to limit the right to use one's own money to save one's own life. He said, “If we are serious about squeezing out the waste, you should embrace those mechanisms [IMAP] that are in the bill.” For more on this controversial provision, see here.

Sen. Rockefeller (D-Wv.) also provided an interesting insight saying, "Sometimes decisions have to come from Washington." The 'decisions' he touched on in his remarks today were 1. government review of premium rates, 2. the imposition of "loss ratios", and 3. the establishment of a Medicare commissions (meant to make cuts to Medicare). For further analysis of Rockefeller promoting these same idea in the Senate see here and here. Other than Rockefeller's open and impassioned plea for more bureaucratic control, the congressional members mainly stuck to their usual rhetoric, be it - eliminating preexisting condition discrimination, or beefing up medical malpractice reform.

Despite the meeting, administration officials and Democratic congressional leaders already have made it clear that they remain committed to enactment of the essence of the rationing health bill passed by the Senate in December, H.R. 3590. Kathleen Sebelius, the secretary of Health and Human Services, has said that effort to enact the legislation will "accelerate" after the February 25 summit.

Obama, Pelosi (D-Ca.), and Senate Majority Leader Harry Reid (D-Nv.) have also been reported to be planning to have the Senate pass a second, smaller bill, containing certain changes to H.R. 3590, using reconciliation. This process would be immune from a Republican filibuster. Pelosi would then push the House to pass both the original Senate-passed H.R. 3590 and the new package of changes at about the same time, and President Obama would sign both bills into law.

Monday, February 22, 2010


The February 22, 2010, Obama Administration health care proposal imposes premium price controls on ALL insurance plans, not just those for Medicare-eligible senior citizens. That means that the right of Americans to spend their own money to get insurance plans less likely to deny treatment will be significantly limited. People will not be allowed to spend their own money, if they choose, to improve the chances of saving their own family’s lives.

It is basic economics that price controls force rationing.

Under the President’s proposal, states and the federal government would be empowered to review and reject premiums charged by any health insurance plan, even the supposedly "grandfathered" plans that Americans now have.

Yet the Administration has the temerity, even now, to state, "For Americans with insurance coverage who like what they have, they can keep it. Nothing in this act or anywhere in the bill forces anyone to change insurance they have, period."

It is as though a government, concerned about the high cost of restaurant food, imposed a price limit of $5 per meal, and then asserted that for those who like their restaurant food, nothing will force them to change their eating habits. The reality, of course, is that restaurants would be unable to afford to offer meals at prices below the cost of their ingredients. Consequently, about all restaurant-goers would be able to get would be fast food.

Similarly, when every premium increase is subject to veto by government officials, it means that instead of Americans making their own choices balancing the cost against the benefit in evaluating competing insurance plans, that decision will be taken out of their hands by bureaucrats whose principal duty is to hold health care spending down. Denial of lifesaving diagnostic tests and treatment would surely follow. This is rationing, pure and simple.


The Obama health care proposal issued this morning would take away from America’s senior citizens their current right to add their own money on top of the government Medicare contribution to get health insurance less likely to deny treatment through tightly controlled managed care. (See ). It would do so even as it cuts the government contribution to Medicare by hundreds of billions of dollars.

Under "Title III . . . Guaranteeing Benefits for Seniors by Ending Overpayments to Insurance Companies," the Obama proposal states that Medicare Advantage plans – the alternative that now allows older Americans, if they wish, to pay more to get insurance less likely to ration treatment– will "be prohibited from charging seniors more than they would pay for services delivered under the traditional Medicare program."

Thus, older Americans would be prohibited by law from making up the Medicare shortfall by using their own money to save their own lives. (See )
This means that, even as more and more doctors and other health care providers are leaving the Medicare program because of low government reimbursement rates – rates that under the Obama bill will decline still more in comparison to medical inflation– senior citizens will have nowhere to turn. Their only option will be tightly managed plans that provide less and less treatment.

In a case of genuine chutzpah, the Obama proposal then goes on to claim that "all ideas that ration care . . . will be banned" – even as it imposes what will be ever-increasing rationing on senior citizens.

Wednesday, February 17, 2010


With the White House health care summit slated for next week, Republicans have been vocalizing concerns over the genuineness of many Democrats and of the President’s willingness to come to bipartisan agreement.

Yesterday, Roll Call’s David M. Drucker wrote, “Senate Democrats say they see no need to abandon the idea of using reconciliation to pass health care reform this year just because President Barack Obama has scheduled a bipartisan summit next week to try to break the impasse on Capitol Hill.”

With many Democratic Senators already opposing reconciliation, it faces other challenges. Robert Dove, who a chief Senate parliamentarian for over a decade, told listeners on a Galen Institute conference call that reconciliation would be a tough road. Both in terms of procedural hurdles and of content, there are challenges at every turn.

Democrats would need to meet many 60 vote thresholds to overrule the parliamentarian should he, for example, rule any provision out of order because it is not related to the budget. The parliamentarian has the (mainly subjective) power to rule any provisions as "incidental" and strike it should the provision be aimed at creating new policy. And now the Democrats former 60 vote majority is gone.

To get an idea how serious the parliamentarian is at striking incidental provisions, The Hill writes “Dove oversaw some budget reconciliation measures in his time and, he notes, ruled out around 300 provisions from a 1995 budget reconciliation bill.”

Complicating matters further, in the letter inviting Republicans to the summit next week, the President stated that he intended to have any bill under discussion available online prior to the meeting. Although this would likely mean the Democrats would post a bill that worked out the House and Senate differences, the White House did not rule out submitting its own new bill.

With the renewed push brought on by next week’s summit, the possibility of comprehensive health care restructuring remains complicated, but is far from dead.

Tuesday, February 9, 2010


With a lack of clear direction on health reform, many Democrats have been calling on the president to take a stronger role and to signal the direction that Congress should move next. Over the weekend, this first signal arrived. During a pre-Super Bowl game interview with CBS’ Katie Couric, president Obama announced that there will be a bipartisan health summit late this month.

In the interview, the president seemed to indicate that the best shot at getting both the House and Senate on board would be to scrap the current bills. At the same, however, the White House is sending mixed messages -- indicating it has no plans to abandon the current health reform effort. Politico was told by a White House official that “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.”

In response to the invitation to the summit, Republican Minority John Boehner (Ohio), and Republican Whip Eric Cantor (Virginia) sent a letter to White House Chief of Staff Rahm Emanuel seeking clarification on this point,

“Assuming the President is sincere about moving forward in a bipartisan way, does that mean he has taken off the table the idea of relying solely on Democratic votes and jamming through health care reform by way of reconciliation? ....Eliminating the possibility of reconciliation would represent an important show of good faith to Republicans and the American people”

While Republicans sought assurances they would truly be included, at least one powerful member of the administration insisted that the partisan bills before the congress are still very much in play. On Monday, speaking before a health policy conference, H.H.S. Secretary Kathleen Sebelius indicated -- in no uncertain terms -- that this bipartisan meeting does not signal that the legislative process will start over.

Though there has been much speculation as to the will of the president to see this domestic policy initiative turned into law, Secretary Sebelius gives a clear answer. She told a Huffington Post reporter Monday that “I think [Obama] sees this as a step to actually accelerating the process forward. He wants to move forward. He wants a bill at his desk and he sees this as kind of closing the loop and let's go."

Tuesday, February 2, 2010


Today multiple sources have reported that Premier Danny Williams of Newfoundland and Labrador is heading to the United States for heart surgery that is unavailable in the province which he governs.

The Canadian Press, similar to the U.S.-based Associated Press, wrote today, “His decision to go to the U.S. for health care has triggered a heated debate online, particularly in a province that has tried to restore public confidence in its health care services after a major scandal involving botched breast cancer tests.”

Canada, a single payer system, is often held up by lawmakers as a model worth emulating (in whole or part) in the U.S. However, the system has also been plagued by claims of waiting lines, inadequate care, and poor survival rates.

In 2007, one of the problems --wait times-- had gotten so bad that the Prime Minister announced:
“During the last federal election campaign, I and my party made a clear and unequivocal commitment to Canadians. We promised to sit down with the provinces to develop Patient Wait Times Guarantees, and today, I’m proud to announce, we’re delivering.”
With the promise of delivering a solution by 2010, many Canadians remain skeptical. For more of the problems associated with Canada’s health care system see here.

NRLC has long argued that the cost of health care does not require rationing lifesaving treatment. (See here) As Congress contemplates how to move forward to pass health care reform intended to have universal coverage, it is essential that any health plan include a means of sustainable, adequate funding for it (see here), so as to lessen the real danger of rationing.

This high profile story from Canada is one among countless examples of what can go wrong in the rationed health care systems elsewhere that rely on general fund revenues.

Monday, February 1, 2010


“While the focus shifts to legislation on jobs, party leaders are taking advantage of a cooling-off period to strategize, seek a new compromise and improve the public's opinion of the legislation” begins a Los Angeles Times article from this past weekend.

It has been a widely articulated theory that many Democrats are facing an impossible choice of getting beat-up in the election over a “yes” vote they already cast on the initial round of reform, versus having nothing to show for it at the end of the day. Many see their only option as passing something and then attempting to exalt and defend the bill later.

While it appears that healthcare, for the time being, has taken a backseat to other policy concerns such as job creation, Democrats have nonetheless been continuing to meet in order to strategize on how best to move healthcare forward. It has been reported that there may even be hope of agreement on a procedural path forward by the end of this week.

Although Speaker Pelosi (D-Ca.) has repeatedly said that she does not have the votes for the Senate Bill as is, there is the general feeling that a modified Senate bill offers the Democrats their best shot. Rep. Connolly (D-Va.) was quoted saying "The more they think about it, the more they can appreciate that it may be a viable . . . vehicle for getting healthcare reform done."

This being said, in the current political climate, many (at least up to 8) Democratic Senators are squeamish about the idea of using reconciliation to make changes to make the effort palatable to the House. And with Speaker Pelosi having already lost some votes, is very likely to lose more if certain important elements are not resolved. These issues include abortion funding as well as the tax on “Cadillac Plans.”

While the House would surely like to drop the tax altogether, this would create a need for new revenue as well as make it tough to get the bill past the Senate’s fiscal conservatives.

Although many challenges lie ahead, Democrats and the White House have not yet abandoned the pending Senate and House bills for any sort of scaled-back or bi-partisan approach.