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An Agenda for Starting Over

During the House GOP retreat in Baltimore last week, Mr. Obama said that many Republican proposals were incorporated into legislation by the Democratic leadership, including:

• Allowing inter-state purchase of health insurance
• Catastrophic health insurance for young people
• High-risk pools for uninsured people with pre-existing conditions
• Small business health plans
• Incentives for wellness
• Allowing young adults to stay on their parents’ policies

While not every Republican or Democrat would agree with every item on the list, it is a start for a bipartisan discussion.

And to that list, I would add several others that were in the health policy platforms of both Sens. McCain and Obama during the campaign, including agreement on the importance of:

• Targeted financial help for the uninsured
• Incentives for prevention and early treatment
• Coordination of care and disease management
• Greater use of information technology and electronic medical records
• New approaches to “best practices” in treatment

There are serious differences about how to structure the underlying policy on any of these items and whether more power and control go to government or to doctors and patients. But these lists nonetheless could be a start for a bipartisan conversation.

Hitting the Wall on Health Overhaul

The frantic push for health-care reform has come to a screeching halt, as members of the House and Senate have rebuffed appeals from both President Obama and their leaders to swallow hard and quickly pass the legislation that has consumed Congress for a year.

The president and Hill leaders spent the weekend desperately trying to persuade members to disregard the Massachusetts Message and ram the Senate’s health-overhaul bill through the House, with a promise that the Senate would then use the 51-vote reconciliation process to fix it.

But that meant asking House Democrats to vote for a bill that contains the Cornhusker Kickback and the Louisiana Purchase, the tax on high-cost health plans without a labor-union exemption, and dozens of other provisions they hate.

The president reportedly told House Democrats in phone calls that since they had voted for reform legislation in November, they were already on board and were going to get hammered for their votes in campaign ads anyway. Their only hope, he argued, was to pass the final bill so that some of its early provisions would go into effect and he could spend the year telling the American people how wonderful the bill was. Rep. Marion Berry (D., Ark.) says the president assured him that it would be different from 1994 because “you’ve got me.”

No deal.

Senate Democrats balked, too, with at least eight of them saying they are wary of using reconciliation to push ahead with health-care reform. Senate majority leader Harry Reid can only afford to lose nine votes and still go the reconciliation route, so one more defector would scuttle the plan. (more…)

Health Reform is Not Dead

A new Washington Post poll taken in Massachusetts after Tuesday’s election blows apart the Left’s claims that the election was not about health reform.

The poll, conducted by the Washington Post, the Henry J. Kaiser Family Foundation, and Harvard University’s School of Public Health, found that health care topped jobs and the economy as the most important issue driving voters’ decisions.

Democratic leaders had tried to spin Scott Brown’s historic victory by saying the election wasn’t about health care, claiming it wasn’t an issue because Massachusetts already has implemented reform.

But the new poll shows a whopping 89% said health care was extremely important (56%) or very important (33%) in deciding who to vote for. Among Brown’s supporters, eight in ten said they were opposed to Washington’s overhaul plan, with 66% of them strongly opposed.

Overall, more voters felt they and their families would be worse off if Obamacare were to be enacted.

It can therefore be concluded that health care was the deciding issue in the Massachusetts Senate election. And Scott Brown’s position opposing to the health-overhaul legislation that has consumed Congress for the last year put him over the top.

But, amazingly, Democratic leaders are not giving up in trying to get their health-overhaul legislation passed, despite various pronouncements over the last several days that health reform is dead, that Congress needs to take a break, or that it needs to scale back.

President Obama said during a speech in Ohio on Friday he would continue to press for reform: “I am not going to walk away just because it’s hard,” he said. Top White House advisers David Plouffe, Valerie Jarrett, and Robert Gibbs all said over the weekend that passing health-reform legislation remains a top priority of the administration.

So what is the strategy? It’s a scenario that should send chills up anyone’s spine. The president reportedly spent the weekend working the phones urging House members who voted “Yes” on the House bill to stick with their vote to get the Senate bill passed, promising that it will be fixed to address their concerns in the reconciliation process that only needs 51 votes in the Senate.

House Speaker Nancy Pelosi said Wednesday “we will move forward” as she tried to convince colleagues to swallow the despised and pork-laden Senate bill. While she concluded she doesn’t have the votes to pass the Senate bill through the House “at this time,” the bill will remain alive all year long. The vote counting will continue as Pelosi tries to get to 218.

She will try to wear down members to get to a vote. Democrats will go down a number of dead-end roads to try to get a reform bill done and will conclude, probably sometime this summer, that the only hope is for the House to swallow hard and vote for the Senate bill.

Speaker Pelosi and Senate Majority Leader Harry Reid already have begun considering what changes must be made and how make them without needing 60 votes in to Senate so they can a vote for the Senate bill palatable to House members.

If enough Democrats who had voted “No” on the House bill in November either retire or otherwise switch to “Yes,” they could make up for those who say they never would vote for the Senate bill. If she gets to 218, the vote could happen with 24 hours’ notice, and the final bill could be on the president’s desk for his signature the next day. No Senate action required.

It is impossible to calculate the anger among voters if that were to happen. But if enough elected “representatives” were to decide that passing health reform is more important than their political futures, it still could happen. While she concluded she doesn’t have the votes to pass the Senate bill through the House “at this time,” the bill will remain alive all year long.

This debate will not be over until the final gavel falls and Congress adjourns for the year.

(First published in National Review Online: Critical Condition)

Massachusetts Miracle, or Muddle?

Here’s the executive summary of a new Galen Institute report (PDF):

Interest in the Massachusetts health reform plan remains high as observers at the federal and state levels monitor its progress toward achieving universal health insurance coverage and controlling rising health costs. Many of the features of the Massachusetts plan are contained in legislation under consideration in Congress, including a bill offered by Massachusetts Sen. Edward Kennedy’s Health, Education, Labor, and Pensions Committee. Therefore, it is worth assessing the experience with the Bay State’s reform initiative so far for lessons that may be useful for federal lawmakers.

When the state’s reform plan was enacted in 2006, then-Massachusetts Gov. Mitt Romney was hailed for achieving what no other political leader has been able to accomplish: Developing a broad health reform plan with strong bipartisan support. By enacting sweeping health reform legislation, Massachusetts sought to be the first state in the nation to have all of its citizens covered by health insurance.

Since then, state officials, including Gov. Deval Patrick, as well as many others in the health sector and business community, continue to advance the reform experiment. But implementation continues to pose many challenges — both in access and costs — and observers are cautious about the outcome.

For example, more than half of those newly enrolled in health coverage in Massachusetts are in free or heavily subsidized plans, causing significant budget pressures for the state. Rising costs for health coverage and health care pose the biggest challenge to the success of the reform effort. And physician and medical workforce shortages have been exacerbated, with half of the state’s internists and family physicians closing their practices to new patients.

Architects of the plan are confident it will succeed. Jon Kingsdale, head of the Commonwealth Health Insurance Connector Authority, and others implementing the plan say support remains strong among political leaders and the business community. Gov. Deval Patrick cites 439,000 newly insured residents in the state as evidence of its success. But major problems remain, and duplicating the Massachusetts experiment would be a significant challenge for any other state, much less the federal government.

Massachusetts’ reform initiatives that are being considered by Congress include an individual mandate, employer play-or-pay mandate, a national health insurance exchange, strict regulation of private health insurance, expansion of Medicaid, and establishing a government-mandated health benefits package. Before proceeding to implement this experiment on a nationwide scale, it would be wise to learn more about how the reform plan in this sophisticated, highly-motivated state is developing.

The Way Forward

The best path to real reform is for the president and the leaders in Congress to work with members from both sides of the aisle to come up with a step-by-step approach. The American people don’t want anybody’s 2,000-page overhaul legislation.

They have made it clear they want health insurance that is reliable and more affordable and that does not exclude people with pre-existing conditions. Congress could start by helping states to create more functional high-risk pools, by giving people more choices of how and where they purchase health insurance, and by assuring people that if they have coverage, they can keep it. They need to create a path toward ownership of health insurance and genuine competition among insurers. And now that people know how much wasteful spending there is in Medicare and Medicaid, they want that fixed.

There is a world of policy complexity behind these initiatives, but Congress must start by respecting that people value private health insurance, don’t want huge disruptions and losses of freedom, or massive new taxes and entitlement costs. Then a new conversation can begin.

The most important thing is to get the incentives right so that power and control over health care decisions rests with doctors and patients and not politicians and bureaucrats.

Freedom Wins

Scott Brown had the energy of the country behind him in his Senate race in Massachusetts because millions of people understood what was at stake and what the liberal agenda that has dominated the debate for the last year would do to America, our prosperity, and freedom.

This monstrous health overhaul came within a breath of passing. While the leadership in Congress still is talking about pushing forward to get it enacted, there is no way that they can get the votes to prevail. I believe the only path to passage of reform legislation now is for the president and the leaders in Congress to work with members from both sides of the aisle to come up with a smaller, more incremental bill.

The Public Plan Lives On

The “public plan” lives on, despite most claims that this central pillar of Big Labor’s agenda won’t be part of the final health-overhaul bill.

As Democrats meet behind closed doors, they’ve simply given their government-run health plan a new name. It’s now called a national health-insurance exchange, and it has the enthusiastic support of President Obama.

The president supports giving the federal government, rather than the states, the authority to set up a new “marketplace where consumers can comparison-shop for health coverage” – an Orwellian statement if ever there was one. The exchanges would be the vehicle to centralize health-insurance regulation, with Washington dictating which benefits must be covered, what insurers can charge, and how health plans must be run.

The House bill calls for the national exchange to be run by the equally Orwellian “Health Choices Administration,” thus giving vast new power for health-insurance regulation to the federal government and giving states, consumers, and businesses little or no say over the health “choices” available to them through the exchanges. The national exchange would quickly become a vehicle for price controls and excessive regulation of insurance markets — which have driven up costs and driven out competition in many states.

The exchanges seem to be one of the less onerous parts of the monstrous health-overhaul legislation, providing a vehicle to distribute federal subsidies for insurance and a place where individuals and small businesses can shop for health insurance. But it is clear that giving the federal government power over health insurance through this new regulatory mechanism would create the foundation for a government-run public plan. Speaker Pelosi gave a preview of the power that she believes will be invested in the national exchange when she said at a recent news conference that once the legislation is passed, the insurance companies “will be crying out for a public option.”

The Senate wants to allow the states to create and run the exchanges, recognizing their greater experience and expertise in regulating the health-insurance market and allowing them the flexibility to fit local needs. While many states have gone overboard in regulating their health-insurance markets, the solution is not to obliterate their role but to create more competition by allowing consumers to shop across state lines for health insurance. Economists Steve Parente and Roger Feldman of the University of Minnesota concluded that this one policy change would mean nearly 12 million more people would get health insurance — without the federal government’s spending a penny.

But that would mean allowing doctors and patients to be in charge of decisions involving health care and health coverage – a concept foreign to those writing health-reform legislation in Congress now.

Rather than “streamlining the purchase of health insurance,” as proponents claim, a new national health-insurance exchange would steamroll over private choice and patient preferences and would provide a vehicle to extend sweeping federal regulation into virtually every corner of our health sector. This would reduce choice for patients and discourage or prohibit innovation and flexibility in health-insurance offerings that today are helping many companies and families balance their health costs with other needs.

The national exchange is just one more reason to encourage Congress to stop and start over.

Nelson’s Ad Short on Facts

I have a commentary in yesterday’s Omaha World-Herald challenging the claims that Sen. Nelson makes in his new health care ad defending his vote for the Senate’s health reform bill. Given the opposition he has faced in the state and the findings of independent experts, Sen. Nelson may want to rethink his support for the legislation when it comes up for a final vote.

Here it is:

In his new television ad, U.S. Sen. Ben Nelson defends his vote for the Senate’s health overhaul bill with a number of compelling arguments — compelling, but not supported by the facts.

Sen. Nelson tells Nebraskans the bill “lowers costs for families and small businesses, protects Medicare . . . and reduces the deficit. And it’s not run by the government.”

In fact, polls show that a strong majority of Americans surveyed, including a majority of Nebraskans polled, oppose this health bill because they understand what independent experts have confirmed: The legislation would increase health insurance premiums for tens of millions of people, jeopardize access to care for many seniors, burden future generations with trillions of dollars of new debt and entrust government — not patients and doctors — with control over many personal health care decisions.

The independent, nonpartisan Congressional Budget Office (CBO) finds that families purchasing health insurance in the individual market (such as farmers, ranchers and other self-employed people) would actually see their premiums increase. They would be $2,100 higher in 2016 if the Senate bill is enacted than they would be if Congress did nothing. “Reform” for them means higher costs.
(more…)

A Death March to a Health Care Law

Health reform is the Holy Grail for Democrats, but it may turn out instead to be their political death march.

President Obama has told Democrats in Congress they must usher in “historic change” by courageously voting for reform, assuring them the voters will thank them later.

But “later” may be too late for many members who feel they are being forced to walk the plank and vote for a bill that becomes more unpopular by the day.

For starters, the bills cover only about half of the uninsured – missing by miles the Democrats’ goal of universal coverage. The Senate bill would leave 23 million people without insurance, and the House bill, at least 18 million, while spending nearly $2.5 trillion in the first year the program is implemented.

Next, people will feel the pain well before they see the gain. The bills start collecting new and higher taxes in 2010, but people won’t start seeing any subsidies to help them buy insurance until 2014. Sending collection agents out four years before benefits begin is one of the budget gimmicks that Senate Majority Leader Harry Reid, D-Nev., used to claim his bill is paid for.

But health insurers and medical suppliers who must pay the new taxes will quickly raise their prices, leading to higher health insurance costs. Because Obama repeatedly has claimed the legislation will lower health-care costs, small businesses and citizens expecting relief will feel especially betrayed.

The Congressional Budget Office says the legislation will actually make the cost problem worse. It found that families purchasing health insurance in the individual market would actually see an increase in their premiums by $2,100 in the year 2016.

That’s over and above the increases they already would face. A family would pay $15,200 for health insurance in 2016 with reform, and $13,100 if Congress does nothing.

Young people get hit the hardest with reform. Most of them don’t have a clue that the federal government is about to slap them with a new mandate requiring them to buy expensive health insurance. And studies show the legislation would force them to pay premiums two or three times the amount they otherwise would be charged based upon their age and expected use of health services.

And seniors already are outraged because of nearly $500 billion in cuts to Medicare and are on high alert about potential rationing.

The Democrats didn’t lose Congress in 1994 because they failed to enact the Clinton health reform bill, as members of Congress are being told. They lost because they were pushing a plan that was hugely unpopular with the voters. Just like today.

The latest NBC News/Wall Street Journal poll shows that only 32% of the American people support ObamaCare. Democrats will face a torrential backlash if they vote for legislation that is so unpopular with their constituents.

The only Democrats may able to save themselves are those who stand up and vocally oppose passage, becoming heroes to the majority of Americans who are desperate for somebody to put on the brakes.

Democratic Sen. Ben Nelson of Nebraska had a chance to be that one vote in the Senate, but he sold out for a few million dollars in Medicaid money for his state. Now his approval ratings have dipped so low that he has been forced to respond with a costly statewide advertising campaign defending his deal-making even though he’s not up for re-election until 2012.

Republicans don’t have the votes in either house of Congress to stop passage. Before Congress takes a final vote on compromise legislation, the only Democrats who may find health-care to be a political gain are those who stand up and say, “Stop!”

Fact-checking Sen. Ben Nelson

Sen. Ben Nelson is defending his vote to pass the Senate’s health-care legislation in a new television ad in his home state of Nebraska, but the points he makes show he either needs to force Congress to change the legislation to match his claims or rethink his support for final passage.

In an attempt to quell a firestorm of opposition to his casting the crucial 60th vote for the Senate bill, Nelson says, “With all the distortions about health-care reform, I want you to hear directly from me.”

He argues that the bill “lowers costs for families and small business, protects Medicare, finally guarantees coverage for preexisting conditions, and reduces the deficit. And it’s not run by the government.” Nelson adds, “I’m convinced this is right for Nebraska.”

Who wouldn’t vote for such a bill? If only Nelson’s comments were accurate.

Nelson wisely doesn’t mention the controversial “Cornhusker Kickback” that granted federal funding for his state’s Medicaid expansion, or the abortion language that the U.S. Conference of Catholic Bishops says does not guard against federal funding of abortion. But there are serious problems with the claims the senator does make.

Independent analysts show that health costs would continue to rise, access to care could be jeopardized for seniors, deficit reduction is an illusion created by budget gimmicks, and the preexisting-condition clause would come at the price of big-government control.

(more…)