A More Conservative Union

Boston Tea Party

2010-01-20T00:13:00.002-04:00

Massachusetts voters tell Democrats to shelve ObamaCare.

'It is to me a new and consolatory proof that wherever the people are well-informed they can be trusted with their own government; that whenever things get so far wrong as to attract their notice, they may be relied on to set them to rights."
—Thomas Jefferson to Richard Price, January 8, 1789.
Two hundred and twenty-one years later, the sage of Monticello has been proven right again. Aroused and well-informed by a year of watching a liberal majority go very far wrong, Massachusetts voters handed a Senate seat held by Ted Kennedy for 47 years to Republican Scott Brown, a little known state senator from Wrenthem.
The resounding five-point victory in one of America's most liberal states is an upset heard 'round Washington—and one that ought to force Democrats to rethink their entire agenda, national health care in particular. Despite an 11th-hour intervention by President Obama in a state he carried with ease only 14 months ago, state Attorney General Martha Coakley was routed even in such unlikely tea-party outposts as Andover (58%) and amid a large turnout for a midwinter special election.

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Democratic delusionists are already attributing Mrs. Coakley's defeat solely to her weaknesses as a candidate, and those were real enough (Curt Schilling, "Yankee fan"). But the last time the Bay State elected a Republican to the Senate was 1972, and a mere 15% of state voters now belong to the GOP. Mr. Brown won because moderates and independents swarmed to him, and because he had the wit and nerve to make the race a referendum on Democratic policies in Washington.

Associated Press

Scott Brown

The White House insists that the election had nothing to do with health care. But Mr. Brown ran explicitly on a promise to be the 41st Senator against ObamaCare. "I can stop it,'' he declared in one debate.
Massachusetts passed a prototype of the Obama plan in 2006, and residents have since watched as their insurance premiums have risen to the highest in the nation, budget costs have soared, and bureaucrats are planning far more draconian regulation of medical practice. Mr. Brown accurately said the national sequel would be too expensive and reduce the quality of care, and that it would be a "raw deal" forcing Massachusetts taxpayers to subsidize all other states.
It's telling, too, that at his rally for Mrs. Coakley on Sunday, Mr. Obama mentioned health care only by implication. The Commander in Chief did find time to deride Mr. Brown's pickup truck—six separate times. Mrs. Coakley also didn't mention health care in her final TV ad. The Democratic Party's top priority had become such a political albatross that Democrats didn't dare mention it lest it drive more votes to Mr. Brown.

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The question now is how Democrats will respond to this historic election rebuke. Only a fleeting supermajority and corrupt logrolling has allowed ObamaCare to advance as far as it has, but many liberals will be tempted to keep telling voters to shut up and learn to like what Democrats give them. "Let's remove all doubt," Speaker Nancy Pelosi told reporters this week. "We will have health care one way or another."
Sometimes politicians really are as obtuse as they seem.
One of those Pelosi ways would be to delay certifying the election or seating Mr. Brown, and then rushing a bill to a vote in the next 15 days. But even liberals can't relish that spectacle of disdain for voters. Another option is to use the budget reconciliation process that would require only 51 Senators. But that would take several more months of committee work and controversy when the White House desperately wants to move on to jobs and its "austerity budget."
A third bloody-minded option would be for the House to pass the Senate's Christmas Eve bill, word for word without amendment. Liberals might swallow that humiliation, but then again ObamaCare only slipped through the House by an eyelash before Thanksgiving, and the bill keeps getting more unpopular.
Many Members may be curled on the floor in a fetal position now that the GOP has won even in the People's Republic of Massachusetts. (We'd love to eavesdrop on the next Blue Dog caucus meeting, or Indiana Senator Evan Bayh's conversations with his pollster.) And assuming they're not paper tigers, Bart Stupak (D., Mich.) and his band of 10 or so pro-life Democrats have said they can't accept the Senate language on funding abortions.
Even if one of these partisan efforts in brute political force succeeded in passing a bill, the effort would only further enrage the public and lead to an even larger Democratic rout in November.
The sensible alternative would be for Democrats to concede how badly they have misread the mandate of their 2008 victory and the public mood. They were elected to fix the economy and to replace a tapped-out GOP, not to exhume and pass every dead 20th-century liberal dream.
The place to start such a rethinking is on health care, by dumping the House and Senate bills and negotiating one that can attract Republican votes. A de minimis package that fixed some of the cost-drivers embedded in the tax code and added refundable tax credits to help the uninsured wouldn't be our policy ideal, but it would be better than the vast new entitlement spending, taxation and central planning that is ObamaCare. Mr. Brown (like everyone) says he supports universal coverage, and what an irony it would be if he and other Republicans ultimately voted for a more moderate plan that saved Democrats from their worst ideological obsessions.
More broadly, Mr. Brown's entire platform was built on change in Washington, and his candidacy tapped into the economic anxiety and political estrangement that voters feel nationwide. The electorate is livid about bailouts, blowout spending and the coming tax increases that Democrats will claim are necessary because of the deficits they have created.
On the economy, Mr. Brown didn't merely oppose tax increases; he was forthright in proposing across the board tax cuts to spur the economy. One of his ads cited JFK's supply-side cuts, and Democrats would be wise to heed that message and reconsider their desire to let the Bush tax cuts expire at the end of this year. Cap and tax on energy, easier unionization and higher estate taxes should all be dropped as burdens holding back job creation and the pace of the economic recovery.

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Yesterday's vote wasn't a repudiation of Mr. Obama's Presidency, or at least it needn't be. The President remains more popular than his policies, and voters want him to succeed. But they are also telling him he needs to steer a more moderate, less partisan course, returning to the pragmatism and comity that shaped his political rise but have vanished in his first, squandered year.

Reform options may be hard to find

2010-01-19T00:48:00.002-04:00

: A harsh reality is sinking in among Democrats -- that a Republican victory by Scott Brown Tuesday could spell the end of health reform because there is no good option to rescue the plan from this latest brush with political death. Photo: AP

Ever since health care reform flamed out in the 1990s, Democrats thought lots of things might derail their longtime dream this time around. Losing a Senate seat in liberal Massachusetts was not on the list.

But that is the harsh reality sinking in among Democrats — that a Republican victory Tuesday could spell the end of health reform because there is no good option to rescue the plan from this latest brush with political death.

Publicly, the White House and top Democrats held firm to their stance that health care reform will pass this year. And Speaker Nancy Pelosi (D-Calif.) said Monday that Democrats will need to figure out a way to proceed if Republican Scott Brown wins, “but that doesn’t mean we won’t have a health care bill.”

“Let’s remove all doubt that we will have health care one way or another,” Pelosi told reporters in San Francisco.

But privately, Democrats are getting cold feet about pushing ahead full bore on health care. Moderate Democrats who have long been skeptical of the administration’s focus on the issue could begin to peel away in the face of a convincing loss for Democrat Martha Coakley, dealing a fatal blow to legislation that had no room for error in either chamber.

Democrats have options to salvage reform following a Brown victory, but all have serious deficiencies.

One idea that looked promising a week ago — passing a bill through the House and Senate before Brown was seated — has dropped down the list of alternatives, as Democrats fear it would look like a partisan power play that ignored the will of Massachusetts voters.

The White House-favored option is to ask the House to adopt the Senate bill, with a promise to make additional changes later through the budget reconciliation process. But House Democratic liberals, as well as some conservatives, don’t like key parts of the Senate bill and don’t want to make it their own.

Ron Pollack, a longtime health care insider and executive director of Families USA, has floated a variation on this theme with the administration and congressional aides: a two-step process that would reassure House members their wishes would be met in the bill.

Under Pollack’s proposal, the House would take up the Senate bill only after the White House and congressional leaders struck a deal on key issues, such as taxes and the subsidies to purchase insurance. They would incorporate those changes into a separate budget reconciliation bill.

The House would pass both the Senate bill and the reconciliation bill, possibly on the same day. The Senate would then take up the reconciliation bill, which would require only 51 votes for passage.

“It is eminently doable — and quickly,” Pollack said Monday. “It is the combination of two things that wouldn’t work separately but, when done in tandem, make a lot of sense.”

This approach, however, would prevent any fixes that did not have a direct impact on the federal budget, such as changes to language on abortion and immigration and, possibly, even the insurance exchanges. The exchange question could be particularly problematic for House Democrats who have sacrificed the public option in return for the national insurance exchanges under the House bill.

“Progressives and conservatives in the caucus won’t go for it,” one aide predicted Monday. But they may not have a choice. Another aide acknowledged a Brown win would force party leaders to recalibrate and said that Obama and Pelosi would have to convince a skeptical rank and file that this was the only course of action.

Democrats also could reopen negotiations with Sen. Olympia Snowe (R-Maine), who supported the Senate Finance Committee bill but has opposed key elements of the latest Senate bill, such as expanding the Medicare payroll tax. Any product of those talks very likely would alienate progressive Democrats.

If they decide to push forward on any front, Obama and congressional leaders will need to argue again, as they have all year, that failure to pass a bill is more perilous than passing a bill.

Liberal House Democrats have vigorously opposed pillars of the Senate bill. Last week, the White House cut a deal with organized labor to soften the impact of a Senate tax on high-end health care plans, in large part to quell unrest among Democrats in the House. Congressional negotiators are expected to announce additional compromises as early as this week, after sending large parts of the bill to the Congressional Budget Office for review.

The prospect of a Coakley loss threatens to upend those internecine negotiations, angering House Democrats who have been on the short end of just about every development in the health care fight. White House press secretary Robert Gibbs, along with multiple Senate and House offices contacted Monday, declined to comment on the way forward.

“We’re focused on two things: ironing out the differences in the bills, which you know the president has spent a lot of time working on over the past few days; and we think Martha Coakley is going to win this race,” Gibbs said.

Sen. Robert Menendez (D-N.J.) predicted a Coakley win but said Monday that a loss in Massachusetts wouldn’t end the Democratic push for health care.

“I’m sure there are other vehicles if the options are different and we don’t have 60 votes for some reason; I’m sure there are other vehicles that could be used to achieve the health care reform we want,” Menendez told POLITICO.

The debate could be moot for any number of reasons by 8 p.m. Tuesday. Coakley could pull out what would now be viewed as an upset, winning the seat after most political pundits declared her campaign dead. But a double-digit Republican win, which a Suffolk University pollster predicted Monday on MSNBC, could drastically alter the will among Democrats to push ahead with health reform.

Whatever fallback plan the Democrats come up with, it may be important for them to show that they have learned something from voters in Massachusetts. Simply finding a way around the 60-vote hurdle in the Senate may not be enough.

A Republican close to the Brown campaign told POLITICO that this is not just about health care but about a sense among voters that “they’re just not listening to us.” This helps explain the title of a Republican press release Monday on health care: “Plan B-ecause We Don’t Care What You Think.”

“This is the unanticipated glitch,” said Jim Kessler, a former longtime Senate aide who is vice president of policy at Third Way, a centrist Democratic think tank. “You have a combination of a bad candidate for the Democrats and a very good candidate for the Republicans, a low-turnout election and, essentially, a sour mood in the country and a candidate who was caught unawares. You would never expect this to happen in Massachusetts.”

Manu Raju and David Rogers contributed to this report.

The Health Lady Has Yet to Sing

2010-01-15T00:36:00.002-04:00

ObamaCare is still no sure thing.

Republican Scott Brown is running strong in Massachusetts on a promise to be the 41st vote against health care in the Senate. Democrats' bigger worry right now is whether Mr. Brown might prove the 218th vote against health care in the House.
The drama of a Christmas Eve health vote left the country with a feeling of ObamaCare inevitability. The Senate was, after all, the heavy lift. If the White House could just bag Nebraska's Ben Nelson and other Senate teases, this debate would be over, save the regulating. A brief ping-pong between the chambers, and Mr. Obama would have his State of the Union triumph.
Political memories are short. Think back to November, when Nancy Pelosi was attempting her own clean-and-jerk of health care. It took three weeks of bribes, cajoling and threats for speaker to eke out a three-vote margin. The action is now back in the House and here's what Ways and Means don Charlie Rangel had to say about it this week: We've got "a serious problem."

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Martin Kozlowski

The biggest problem is that January isn't November. In November, when moderates such as California's Dennis Cardoza were being squeezed for last-minute yes votes, they could take solace that the public was still open to congressional action. This week's Quinnipiac poll has 34% of respondents "mostly" approving the bill. A token 26% of independents back it. In November, House Democrats were being reassured by a relatively popular president. Gallup this week has a mere 37% of Americans approving of his handling of health care. The president has moved from asset to liability.

In November, House Democrats had not yet absorbed the wipeout of the Virginia and New Jersey elections. They hadn't witnessed four prominent House members choose to retire rather than face defeat, or two powerful incumbent senators follow suit. They hadn't seen Alabama Democrat Parker Griffith sprint to the Republican side. They weren't holding 40 of the 50 most competitive House seats.
They hadn't caught a new poll that is all the congressional gossip right now, showing that North Carolina freshman Democrat Larry Kissell remains relatively popular in his conservative district and easily leads potential Republican opponents. Mr. Kissell was a no vote on health care. What makes the poll particularly relevant is data that shows that among the 44% of voters who incorrectly believe Mr. Kissell voted for the bill, the matchups are tied. Among the 29% who correctly understand he voted against the legislation, Mr. Kissell wins huge.
Finally, House Dems hadn't been presented with the mind-blowing sight of a Republican Senate contender running openly against health-care reform—in a state that went 26 points for Mr. Obama—and getting somewhere. "There are a lot of [Democrats] asking the question: There's a need for health-care reform, but our constituents just don't want this, and who are we to say they are wrong?" said one Democratic staffer for a member from a more conservative House district.
This is why Mrs. Pelosi (still) has a math challenge. Of her three-yes-vote margin, Democrat Robert Wexler has resigned; his seat remains unfilled until April. Republican Joseph Cao won't be the final vote for a Democratic bill. As for the 39 Dems who initially voted against the legislation, a vote flip now would be an invitation to be singled out—a la Blanche Lincoln—as the individual who brought the nation ObamaCare.
The potential for flips the other way is big. Michigan pro-lifer Bart Stupak is still vowing that he and up to 10 other Democrats will bolt without his abortion language. Some 190 members have signed a letter demanding the end of the tax on high-value health plans—which President Obama needs to fund the bill. Liberals are still vowing revenge for the death of the public option (though the Award for Most Empty Threats in One Debate still goes to this crew.)
House Republicans smell at least a whiff of blood, enough to launch a campaign targeting 37 Democrats who may have a case of yes-vote regrets. These include members like Oregon freshman Kurt Schrader; 49% of his seniors are enrolled in Medicare Advantage, which will be gutted under the legislation. Also up for special attention are Democrats hailing from flat-broke states that will nonetheless be saddled with huge new Medicaid costs under the bill.
Critics of the legislation shouldn't get their hopes too high. The Democratic leadership is now clinically obsessed with passage. No first-round yes vote has yet jumped ship, and even if some do, Mrs. Pelosi has options. Prior no votes might be convinced that a more "moderate" Senate bill gives them cover to flip. Three no votes, including Tennessee's John Tanner, are retiring, and may feel liberated. The White House no doubt has a list of plum jobs it can offer people as consolation prizes for voting yes and losing their seats.
The point is rather that there is now officially enough nervousness that anything can happen. Whatever the Tuesday election outcome, Mr. Brown already claims victory for rattling Democratic minds. And should he win, health care becomes even more toxic. This isn't over yet.
Write to kim@wsj.com

Taxing Details That Harm Patients

2010-01-13T00:48:00.002-04:00

A new levy on Medicare Advantage plans would hurt lower-income seniors the most.

By BOB DOLE

While rushing to save a patient, a physician's first responsibility is to "do no harm." That requires remembering that sometimes a treatment can make things worse. And so it should be with the health-care reform moving through Congress. Clearly this issue is too big and too important to ignore. For America's sake, reform needs to happen. But it's also too complex an issue to rush a treatment with details that might cause harm.
Most of us agree that America's health-care system needs to be fixed. Families and businesses are struggling to keep pace with soaring costs. Too many Americans are without adequate coverage. And all of this is damaging our economy. But it will do no good to reform the system if it ends up degrading the quality of care most of us currently receive or saddling future generations of Americans with unconscionable debt.
As always, the devil is in the details, and we'd better be paying very close attention to their rich potential for unintended consequences. For example, one provision in the Senate's version of health-care reform would impose a new tax on a number of federally-funded health-care benefits.
In effect, the federal government would be taxing the money it provides for Medicare and a host of other important programs. By so doing, it would unintentionally jeopardize the quality of care that many of our oldest, sickest and most vulnerable citizens depend on.

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The Senate legislation imposes this yearly premium tax on for-profit and not-for-profit health plans, generating an estimated $60 billion in tax revenues over its first nine years. Government-run programs would be exempt from the tax. However, the tax would be levied on Medicare, the Children's Health Insurance Program, Medicaid, and Tri-Care for the families of military dependents when delivered by a private-sector plan.
Large private-sector health plans offering a diverse line of products would likely recover the cost of the tax by raising premiums on their other products.
But for those health plans specializing in Medicare, Medicaid and other government programs, there would be no such option. These providers are strictly bound by federal contracts and frequently operate at or near cost, serving America's older, higher-risk and higher-cost patient populations. Since they have no profits with which to absorb the tax or any ability to pass it on, they'll have only one option—to reduce the health-care services they provide. Certainly this isn't what the Senate intends.
Nonetheless, some 10.2 million Americans who now choose to purchase Medicare Advantage through private providers because it gives them better benefits at lower cost may be hurt. These are frequently lower-income elderly people with a multitude of serious health problems. The services they receive allow many of them to remain in their homes close to friends and family during their final years, rather than be moved into nursing homes where their care would be far more expensive and their days much emptier. They would be among the victims of this new federal tax.
What kind of Americans are we talking about? Here are a few real examples: An 89-year-old woman who lives alone recovering from a mastectomy, who has osteoarthritis, glaucoma and degenerative joint disease. An 81-year-old gentleman living in his daughter's home who has bone, liver and bladder cancer. An elderly couple where the wife has trouble walking because of arthritis, while the husband suffers from Alzheimer's requiring 24-hour care. These are the kind of people health-care reform should be helping, not hurting. Extending benefits to some Americans by cutting care for others isn't reform—it's unfair.
Fixing our nation's health-care system is a historic undertaking. As Congress works toward a solution, I encourage my former colleagues to pay very close attention to the details and be mindful of the unintended consequences of what they do today, because the impact of their decisions will be with us for generations. A treatment that leaves the system in worse shape isn't a cure.
Mr. Dole, a former Senate majority leader, was the 1996 Republican nominee for president. He is a founding advisory board member of the nonprofit Bipartisan Policy Center, which is working for principled compromise on health care and other issues. His firm, Alston & Bird, represents a range of health-care organizations.

Married Couples Pay More Than Unmarried Under Health Bill

2010-01-09T00:47:00.002-04:00

By MARTIN VAUGHAN

WASHINGTON -- Some married couples would pay thousands of dollars more for the same health insurance coverage as unmarried people living together, under the health insurance overhaul plan pending in Congress.
The built-in "marriage penalty" in both House and Senate healthcare bills has received scant attention. But for scores of low-income and middle-income couples, it could mean a hike of $2,000 or more in annual insurance premiums the moment they say "I do."
The disparity comes about in part because subsidies for purchasing health insurance under the plan from congressional Democrats are pegged to federal poverty guidelines. That has the effect of limiting subsidies for married couples with a combined income, compared to if the individuals are single.
People who get their health insurance through an employer wouldn't be affected. Only people that buy subsidized insurance through new exchanges set up by the legislation stand to be impacted. About 17 million people would receive such subsidies in 2016 under the House plan, the Congressional Budget Office estimates.
The bills cap the annual amount people making less than 400% of the federal poverty level must pay for health insurance premiums, ranging from 1.5% of income for the poorest to 11% at the top end, under the House plan.
For an unmarried couple with income of $25,000 each, combined premiums would be capped at $3,076 per year, under the House bill. If the couple gets married, with a combined income of $50,000, their annual premium cap jumps to $5,160 -- a "penalty" of $2,084. Those figures were included in a memo prepared by House Republican staff.
The disparity is slightly smaller in the Senate version of health-care legislation, chiefly because premium subsidies in the House bill are more targeted towards low-wage earners.
Under the Senate bill, a couple with $50,000 combined income would pay $3,450 in annual premiums if unmarried, and $5,100 if married -- a difference of $1,650.
Republicans say the effect on married couples whose combined income makes them ineligible for subsidies is even greater -- up to $5,000 or more -- but that is more difficult to measure because it includes assumptions about the price of insurance policies.
Democratic staff who helped to write the bill confirmed the existence of the penalty, but said it cannot be remedied without creating other inequities.
For instance, they said making the subsidies neutral towards marriage would lead to a married couple with only one bread-winner getting a more generous subsidy than a single parent at the same income-level.
"The Finance Committee, along with other committees in the Senate, took pains to craft the most equitable overall structure possible, and that's what we have here," said a Democratic Senate Finance Committee aide.
If the bill passes in its current form, it would be far from the first example of federal and social benefits creating incentives to remain single. Under current law, marriage can have a negative impact on a person's ability to claim the earned income tax credit and welfare benefits including food stamps.
In any progressive system of taxes or benefits, there are trade-offs between how well-targeted a subsidy is and how equitable it is, said Stacy Dickert-Conlin, an economics professor at Michigan State University.
"You might like to have it be progressive, equitable and marriage-neutral. But you have to decide what your goals are, because you can't accomplish all three," she said.
The marriage penalty in the health bill has not been a major focus of attack by Republican opponents of the bill, who are focusing on larger themes such as new taxes in the bill and growth in government spending.
But it has caught the attention of some conservative groups, who claim that the prospect of reduced subsidies will dissuade people from tying the knot.
"This seems to not only penalize the married, but also those who would have the most to gain from marriage -- the poor," said Jenny Tyree, an analyst at the Colorado-based Focus on the Family.
Ms. Dickert-Conlin said that isn't borne out by research in the area.
"Most of the literature says that people do not make decisions about whether or not to get married based on" government benefits, she said.
"You might see bigger effects on the timing -- someone choosing to get married in January, instead of December," she said.
Write to Martin Vaughan at martin.vaughan@dowjones.com

Obama Promised Eight Times During Campaign To Televise Health Hearings

2010-01-09T00:42:00.002-04:00

Sestak puts blame on Democratic leaders for slipping support

2010-01-08T00:24:00.002-04:00

By Salena Zito and Mike Wereschagin
TRIBUNE-REVIEW
Thursday, January 7, 2010
Last updated: 10:25 am

Rep. Joe Sestak blames Democratic leaders for the plunge in public support for overhauling the health care system, saying Wednesday they failed to defend proposals that helped carry the party to victories in 2008.
"They said it would be transparent. Why isn't it?" said Sestak, a Delaware County Democrat, in a meeting with Tribune-Review editors and reporters. "At times, I find the caucus is a real disappointment. We aren't transparent, not just to the public but at times to the members."
Sestak is challenging Sen. Arlen Specter in the May 18 primary, as is Dravosburg's state Rep. Bill Kortz. Former Rep. Pat Toomey of the Lehigh Valley and Peg Luksik, a Johnstown activist, are seeking the Republican nomination for the seat.
A Quinnipiac University poll last month showed Specter holding a 53 percent to 30 percent lead over Sestak, a former Navy admiral, in the primary. Kortz, who often is overlooked, is not included in the polls.
Sestak says the two defining aspects in the polls in his favor are the high number of undecided voters and Specter's re-election numbers. Recent polls have shown that fewer than 40 percent of people think Specter deserves re-election, a vulnerability considered dangerous by most pollsters.
Specter's office said the senator "carried the torch" for President Obama's health care message with town hall meetings and key caucus meetings, helping to secure provisions on tougher Medicare fraud enforcement.
"Senator Specter has consistently stated he has wanted the health care debate to be an open process, including supporting the bill being posted online 72 hours in advance of votes," his office said in an e-mailed response. "He's supportive, in general, of giving Americans more access to government goings-on."
Sestak said political deals that Democratic Sen. Ben Nelson of Nebraska and others cut in closing the health care bill were a disgrace: "To think that you would hold out to close a deal for a special interest is absolutely wrong."
Nelson gave his critical support to the Senate version of the health care bill after securing a provision for Nebraskans that will require the federal government to permanently pay the entire cost of Medicaid expansion in his state, while paying the costs of expansion in the other 49 states for just three years.
Nelson could not be reached for comment yesterday.
Sestak points to that move as one reason Americans are uneasy about Democrats. "They should be," he said. "I think that Democrats have failed as much as Republicans as erstwhile servants."
Specter's reception
As his campaign gears up, Sestak has distanced himself from the Washington establishment and the Democratic Party. For months, he said, Democratic Sen. Robert Menendez of New Jersey, the Senatorial Campaign Committee chair, urged him to run; yet Sestak said he was asked to forget the idea when Specter, who is seeking a sixth term, switched parties in April after 44 years as a Republican.
"Three, four weeks later, Arlen converts, and they call and say, 'Sit down,' " Sestak said. Party leaders said he should drop out of the race to make way for Specter. "What kind of deal is this? If there's anything that has to change, it has to be that."
"Clearly, the biggest obstacle that he must overcome is the Democratic leaders' mandate of the party apparatus to support Specter," said Keystone College political scientist Jeff Brauer.
Brauer said without such a mandate, there is little doubt Sestak could lead in polls because rank-and-file Pennsylvania Democrats have given Specter a lukewarm reception.
Financial gap
Brauer said Sestak's other challenges include fundraising and increasing his name recognition. That's why Sestak said he drove across the state in a snowstorm at 2:15 a.m. from Bucks County to Westmoreland County, to meet with voters and party faithful.
"I need to let people know there's a principled alternative," Sestak said. "How can you trust someone who switched parties to keep his job?"
Though Sestak's $4.7 million campaign account trailed Specter's by about $4 million at the end of the last reporting period in September, Sestak claims he has raised more than any challenger Specter has faced.
If Sestak beats Specter for the Democratic nomination, the most recent Quinnipiac poll showed Toomey winning over Sestak, 40 percent to 35 percent.
Sestak said he genuinely likes Toomey; in September, the two held a cordial health care town hall at Muhlenberg College, near Allentown, and drank beer together afterward. But he noted that he and Toomey have clear differences politically: "Pat Toomey voted for the same savage and regressive tax policies that favored the well-to-do. And he voted to deregulate Wall Street and let them gamble."
Toomey said that although he, too, likes Sestak, he finds it curious that Sestak would hit him on the topic of Wall Street. "Both he and Specter supported bailing out Wall Street, something that I vehemently and publically opposed," Toomey said. He described Sestak as a principled liberal, "which means he supports bailouts, spending, public options and a dramatic expansion of government."

Medicare and the Mayo Clinic

2010-01-08T00:15:00.002-04:00

The famous hospital will no longer take some senior patients.

President Obama last year praised the Mayo Clinic as a "classic example" of how a health-care provider can offer "better outcomes" at lower cost. Then what should Americans think about the famous Minnesota medical center's decision to take fewer Medicare patients?
Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.
Mayo says it lost $840 million last year treating Medicare patients, the result of the program's low reimbursement rates. Its hospital and four clinics in Arizona—including the Glendale facility—lost $120 million. Providers like Mayo swallow some of these Medicare losses, while also shifting the cost by charging more to private patients and insurers.
Of course, only governments can lose that much money and pretend they don't have to change. "Mayo Clinic loses a substantial amount of money every year due to the reimbursement schedule under Medicare," the institution said. "Decades of underfunding and paying for volume rather than value in Medicare have led us to this decision."

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Associated Press

Mayo is probably a leading indicator of where other hospitals and doctors are headed. Physicians on average earn 20% to 30% less from Medicare than they do from private patients, and many are dropping out of the program. While about 92% of family physicians participate in Medicare, only about 73% of those are now accepting new patients. In some specialties—neurology, oncology, gynecology—in places like Manhattan and Washington, patients can struggle to find any doctor who'll accept Medicare.

The $500 billion in Medicare cuts planned as part of ObamaCare won't help this trend. The hospital industry agreed earlier this year to chip in $100 billion over the next decade in lower annual payment increases for Medicare. The chief Medicare actuary estimates that up to 20% of hospitals could become unprofitable as a result of the scheme.
The irony is that the Obama Administration has repeatedly praised Mayo as an example of the efficiency and lower cost that will spread everywhere if ObamaCare passes. And it's true that Mayo is a sterling example of the kind of health reform that many economists—notably White House budget chief Peter Orszag—extol.
Mayo's doctors are salaried and work in teams, which have become known more broadly as accountable care organizations, or ACOs. Mayo would prefer to receive a bundled payment for an episode of illness, rather than the Medicare practice of reimbursing for individual procedures. As it is now under Medicare, Mayo's less-is-more model means it can't make up its true costs on volume.
We have our differences with this ACO model. It essentially converts health-care providers into the equivalent of managed care in the 1990s. While HMOs did lead to less health spending for a time, patients and doctors rebelled. Congress threatened to intervene with a "patients bill of rights" until insurers backed off. The promoters of ACOs are saying that managed care will work better this time because the providers will be reducing costs at the behest of government, instead of insurance companies.
That may work for Mayo, which has spent decades building an institutional culture by trial and error. But it takes a special kind of hubris to believe that government can replicate such a culture nationwide. The ACO model still hides the cost of care from individuals, who thus have no incentive to reduce their utilization. Mayo also serves a more affluent population than most hospitals, which may make cost-saving easier.
The double irony is that earlier this year Mayo itself came out against the House health bill as offering too little cost-saving reform. And, six months later, the truth is that neither bill in Congress includes the kind of cost-saving innovations that would lead to more Mayos. Instead, the highly touted insurance "exchanges" will essentially import Medicare's rules. Mr. Orszag and the Obama whiz kids have settled for "pilot programs" and cost-saving quarter measures because Congress doesn't want to give up political control over government health payments.
In other words, the real Mayo story is that sclerotic Medicare is preventing more Mayos, and ObamaCare is paving the way for all of health care to operate like Medicare.

Why Drug 'Reimportation' Won't Die

2010-01-07T00:44:00.002-04:00

The drug industry made a foolish bet in supporting health reform.

By GILBERT ROSS

As a threat to our nation's security, allowing imported drugs into our pharmacies ranks just below terrorism. Yet this idea refuses to die. Why is drug importation (and its twin the reimportation of American drugs from foreign countries) a bad idea? Aren't cheaper drugs good for low-income Americans?
The Food and Drug Administration's response—reasserted last month by FDA Commissioner Margaret Hamburg—is that imported and reimported drugs can't be guaranteed to be safe. Studies have shown that a significant percentage of drugs thought to be American-made and reimported are actually counterfeit, ineffective or even toxic. In one sting in 2003, for example, FDA and Customs officials found that 88% of the imported drug packages they inspected did not meet FDA safety standards.
But there is an even more important reason why importing drugs is dangerous. Importing foreign drugs or reimporting American-made drugs is a back-door way of introducing price controls in America. Many foreign countries, including Canada, impose price controls on drugs, which is why reimporting American-made drugs is cheaper than simply buying drugs that haven't left the country.

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Associated Press

And allowing price controls into this country is a sure path to destroying our drug industry, which is now a prime driver in developing new and innovative pharmaceuticals. The drug industries in countries with price controls lag behind our drug industry in developing new, important drugs.

It is unfair that Americans underwrite the cost of developing new drugs for much of the rest of the world. But the solution to that disparity isn't to destroy our innovative drug industry. It would be much better to find ways to make the rest of the world pays its fair share.
So why has the idea of reimporting drugs continued to pop up? It seems that it is just too easy for populist lawmakers to depict cheaper imported drugs as a panacea for rising health-care costs. It is much harder to explain the negative impact importing drugs would have on our drug industry's ability to meet health-care needs.
Some advocates in favor of importing foreign drugs were disappointed in President Obama when he struck a deal with the drug-industry group PhRMA to keep importing drugs out of the health-care reform legislation moving in Congress. The president struck the deal to get the drug industry on board with his health-care reform initiative and succeeded at getting drug industry officials to agree to have their companies swallow about $80 billion in new costs (most negotiated price reductions for government health-care programs) in return for the understanding that no further demands would be made of them. Drug makers held up their end of the deal by paying for ads supporting health-care reform.
Imagine the drug makers' surprise, then, when almost immediately after the Senate passed its reform administration spokesmen said that importing cheap "foreign" drugs was back on the president's agenda. This despite the fact that Ms. Hamburg wrote to the Senate asserting that her agency continued to strongly oppose importing drugs, a position that is in line with positions held by every prior FDA head. The drug executives, far from getting a seat at the negotiating table were made into an entrée on the menu.
As a senator, Mr. Obama was an outspoken supporter of drug importation and remained so on the presidential campaign trail. Only when cajoling the drug industry into signing on to his reform did he suddenly turn away from that position. Now, however, he is reverting to his original position by separating importation from the actual reform bill.
The result is that the importation of possibly dangerous foreign drugs may soon be on their way to our drugstores and hospitals, and along with them will come dangerous price controls that will demolish drug innovation and condemn our children and grandchildren to cope with obsolete drugs from the dawn of the 21st century.
Dr. Ross is medical director of the American Council on Science and Health.

AP sources: Obama OKs taxing high-end health plans

2010-01-06T21:22:00.002-04:00

By ERICA WERNER, Associated Press Writer Erica Werner, Associated Press Writer – 1 hr 29 mins ago

WASHINGTON – President Barack Obama signaled to House Democratic leaders Wednesday that they'll have to drop their opposition to taxing high-end health insurance plans to pay for health coverage for millions of uninsured Americans.
In a meeting at the White House, Obama expressed his preference for the insurance tax contained in the Senate's health overhaul bill, but largely opposed by House Democrats and organized labor, Democratic aides said. The aides spoke on condition of anonymity because the meeting was private.
House Democrats want to raise income taxes on high-income individuals instead and are reluctant to abandon that approach, while recognizing that they will have to bend on that and other issues so that Senate Majority Leader Harry Reid, D-Nev., can maintain his fragile 60-vote majority support for the bill.
Pelosi and four committee chairmen met with the president Wednesday as they scrambled to resolve differences between sweeping bills passed by the House and Senate. The aim is to finalize legislation revamping the nation's health care system in time for Obama's State of the Union address early last month.
Despite the dispute over the payment approach, Pelosi, D-Calif., emerged from the meeting expressing optimism.
"We've had a very intense couple of days," Pelosi said. "After our leadership meeting this morning, our staff engaged with the Senate and the administration staff to review the legislation, suggest legislative language. I think we're very close to reconciliation."
Congressional staff members stayed at the White House into the evening to continue work and a conference call of the full House Democratic caucus was scheduled for Thursday.

The Tom DeLay Democrats

2010-01-06T00:25:00.002-04:00

So much for the President's pledge of C-Span transparency.

Rehabilitating Tom DeLay's reputation always seemed hopeless, or so we thought—but then again, President Obama ran on hope. Against the odds Democrats are making the former GOP Majority Leader look better by comparison as they bypass the ordinary institutions of deliberative democracy in the final sprint to pass ObamaCare.
Instead of appointing a formal conference committee to reconcile the House and Senate health bills, a handful of Democratic leaders will now negotiate in secret by themselves. Later this month, presumably white smoke will rise from the Capitol Dome, and then Nancy Pelosi, Harry Reid and the college of Democratic cardinals will unveil their miracle. The new bill will then be rushed through both chambers with little public scrutiny or even the chance for the Members to understand what they're passing.
Evading conference has become standard operating procedure in this Congress, though you might think they'd allow for the more open and thoughtful process on what Mr. Obama has called "the most important piece of social legislation since the Social Security Act passed in the 1930s and the most important reform of our health-care system since Medicare passed in the 1960s."
This black-ops mission ought to be a particular embarrassment for Mr. Obama, given that he campaigned on transparent government. At a January 2008 debate he said that a health-care overhaul would not be negotiated "behind closed doors, but bringing all parties together, and broadcasting those negotiations on C-Span so the American people can see what the choices are."
The C-Span pledge became a signature of his political pitch. During a riff at the San Francisco Chronicle about "accountability," he added that "I would not underestimate the degree to which shame is a healthy emotion and that you can shame Congress into doing the right thing if people know what's going on."
Apparently this Congress knows no shame. In a recent letter to Congressional leaders, C-Span president Brian Lamb committed his network to airing "all important negotiations," which if allowed would give "the public full access, through television, to legislation that will affect the lives of every single American." No word yet from the White House.
At a press conference in December, even Mrs. Pelosi said that "we would like to see a full conference." One reason she mentioned was that "there is a great deal of work involved in reviewing a bill and seeing what all the ramifications are of it," though her real motive at the time was that a conference seemed like a chance to drag the bill closer to the House version.
With public support collapsing, however, Democrats now think the right bill is any bill—and soon. Democrats know that a conference forces the majority party to cast votes on awkward motions and would give the Republicans who have been shut out for months a chance to participate. This sunlight, and the resulting public attention, might scare off wavering Democrats and defeat the bill. Ethics rules the Democrats passed in 2007 also make it harder to "airdrop" into conference reports the extra bribes they will no doubt add to grease the way for final passage.
Democrats howled at the strong-arm tactics Mr. DeLay used to pass Medicare drug coverage in 2003, and so did we. But they've managed to create an even more destructive bill, and their tactics are that much worse. We can't even begin to imagine the uproar if the Republicans had tried to privatize Social Security with such contempt for the democratic process and public opinion.

Nebraska gift needs returning

2010-01-04T01:17:00.000-04:00

By John Suthers

Posted: 01/03/2010 01:00:00 AM MST

From the moment health care reform emerged as the issue of Congress' 2009 agenda, Republicans and Democrats have exchanged rhetorical volleys and parliamentary maneuvers aimed at passing, slowing or halting passage of a bill.
It's not my job as Colorado attorney general to immerse myself in the merits of the health care debate. But in an effort to secure 60 votes to pass a health-care overhaul, the U.S. Senate has crossed a line that should trouble Coloradans on both sides of the political divide.
The Senate bill, which must be reconciled with the House's take on reform, contains provisions that would dramatically expand Medicaid eligibility throughout the country and the amount various states must contribute to the expanded program. Colorado, for example, is likely to have to come up with an additional $1 billion over the next six years to fund the Medicaid expansion. To secure the 60th vote needed to pass a bill, Senate Majority Leader Harry Reid inserted a provision in the bill that effectively exempts Nebraska from any additional burden and requires that the other 49 states absorb the cost of covering any new Nebraska Medicaid recipients. The bill thus acquired the support of Sen. Ben Nelson and, in the eyes of several state attorneys general, a significant legal problem.
The U.S. Constitution and related case law bar Congress from arbitrarily funding or taxing the states differently. Any differences must have a rational basis. It is our opinion that the "Nebraska Compromise" has no rational basis. This sort of congressional action is not an expenditure promoting the general welfare of the United States. It is quite the opposite: an expenditure to the benefit of one state and the detriment of all others.
The Nebraska Medicaid amendment is substantially different from any other earmark in this or any other bill. Instead of being a one-time expense for a hospital expansion, highway resurfacing or other project, Nebraska is securing a perpetual benefit that taxpayers in every other state must bear.
To be sure, there can be rational taxing or funding discrepancies between the states. For example, the residents of one state might be poorer than Coloradans and, thus, qualify for more federal entitlements. That is an acceptable discrepancy. However, when one state is singled out for a benefit — being perpetually exempt from paying for any new Medicaid patients — for no other reason than securing a vote, it does not pass the smell test.
I have received dozens of calls and e-mails from Coloradans applauding me for my decision to explore the constitutionality of the Nebraska arrangement. The vast majority of these callers said they support me because they do not like the president's health care overhaul. My objections, however, have nothing to do with the merits of the Senate bill or the politics of Washington, D.C. My concerns are purely legal.
This is a matter of the U.S. Constitution and protecting Colorado and Colorado taxpayers' interests on the national stage.
Colorado's senators and congressional representatives should insist on removing the Nebraska Compromise from the bill as lawmakers reconcile the House and Senate proposals. In the meantime, several of my colleagues and I plan to continue to study this provision and our legal options.
John Suthers is Colorado's 37th attorney general.

The Tyranny of the Majority Party

2009-12-30T01:13:00.002-04:00

If Democrats insist on passing unpopular laws, they won't control Congress for long.

By FRED BARNES

Alexis de Tocqueville never met Harry Reid. Had he encountered the Senate Democratic leader—or President Barack Obama or House Speaker Nancy Pelosi—de Tocqueville might have learned about a new twist on his concept of the "tyranny of the majority."
The Frenchman toured America in the 1830s and published his conclusions in the classic "Democracy in America." He noted the powerful impact of public opinion. "That is what forms the majority," he wrote. Congress merely "represents the majority and obeys it blindly" and so does the president. They are free to brush aside minority opinion, creating a threat de Tocqueville described as the "tyranny of the majority."
Democrats in Washington do have large majorities in Congress. But instead of reflecting popular opinion, they are pursuing wide-ranging initiatives in defiance of the views of the majority of Americans. This stands de Tocqueville's concept on its head.
The most striking example is health-care reform. It is intensely unpopular but was approved by the House in November and the Senate on Christmas Eve. Asked in a Rasmussen poll in mid-December if they'd prefer no bill to ObamaCare, 57% said they would. Only 34% said they'd rather ObamaCare be enacted.

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Associated Press

Yet Democrats are forging ahead as if the public actually approves of their health-care reform. Why, when Republicans are preparing to hammer them on the issue in next year's elections, would they do that?

Democrats offer different explanations—besides their obsessive attachment to national health care—which suggests that they aren't quite sure of the political fallout.
After Senate Democrats locked up the 60th vote to assure Senate passage of ObamaCare, Mr. Obama sounded worry-free. Risk? What risk? The bill "is a major step forward for the American people," he said. The president didn't mention the public's disapproval as expressed in countless polls. Vice President Joe Biden, in an op-ed in the New York Times, didn't either.
David Axelrod, a senior adviser to the president, is more realistic. While acknowledging bad poll numbers, he suggested recently on ABC's "This Week" that enactment of sweeping health-care legislation will melt public misgivings. "The reality, I think, will trump poll numbers in the dead of winter as this debate is going on," Mr. Axelrod said.
Ms. Pelosi, too, is brimming with wishful thinking. "Now we will have the attention placed on the truly great things that are in the bill that we have in common," she declared recently. And Sen. Chuck Schumer (D., N.Y.) told Politico, "When people see what is in this bill and when people see what it does, they will come around."
Then there are the martyrs. Doing a reverse de Tocqueville, willingly endangering one's political career by voting for ObamaCare, hasn't fazed Democrat Michael Bennet, the appointed senator from Colorado. He was asked by CNN's John King whether he'd vote for ObamaCare "if every piece of evidence tells you, if you support that bill, you'll lose your job." Mr. Bennet said "yes."
Mr. Bennet isn't the only potential martyr. A Democratic strategist told Byron York of the Washington Examiner that Mrs. Pelosi "believes losing 20 or even 40 Democratic seats in the House would be an acceptable price for achieving a goal the party has pursued since Franklin Roosevelt." Now that Alabama Rep. Parker Griffith has bolted the Democratic Party, Republicans need 40 seats to capture control of the House.
With large congressional majorities, Democrats decided to forget about Mr. Obama's campaign theme of bipartisanship. They brook no compromise with Republicans and forge ahead on issue after issue—health care, cap and trade, Guantanamo, spending, the deficit—despite the public's mounting disapproval.
That arrogance shaped the economic stimulus passed in February. Republicans wanted tax cuts to spur investment and create jobs. Democrats rejected that idea and enacted a huge increase in spending. As unemployment continued to rise, public opinion turned against the stimulus. Nonetheless, House Democrats passed a new, smaller stimulus bill last week with the same emphasis on spending.
Large majorities create what de Tocqueville called a sense of "omnipotence." This leads to overreaching and spawns dubious ideas. Since Democrats believe they will benefit from passing any sort of health-care bill regardless of public opinion, they're committed to passing anything they can call a "historic" achievement. That makes little sense.
With history in mind, cutting procedural corners becomes acceptable. Thus Democrats have set arbitrary deadlines, scheduled post-midnight votes and put limits on debate, all in the name of achieving a breakthrough.
Not that such behavior is anomalous. To pass a Medicare prescription drug benefit in 2003, Republicans kept the House vote open for three hours to round up votes. Unlike ObamaCare, however, the drug benefit had popular support.
This is not the first time in recent memory when a sizeable congressional majority, feeling self-sufficient, ignored popular opinion at its peril. In 1995, Republicans, led by newly installed House Speaker Newt Gingrich, shut down the federal government in their fight over spending with President Bill Clinton. The public sided with Mr. Clinton, and the clash spurred his re-election in 1996.
William Daley, who was Mr. Clinton's Commerce secretary and is the brother of Chicago Mayor Richard Daley, worries that Democrats are doing now what Republicans did then: provoking a public backlash. Democrats must "acknowledge that the agenda of the party's most liberal supporters has not won the support of a majority of Americans," he wrote last week in the Washington Post. "Either we plot a more moderate, centrist course or risk electoral disaster not just in the upcoming midterms but in many elections to come."
"I regard as impious and detestable the maxim that in matters of government the majority of a people has the right to do everything," de Tocqueville wrote roughly 175 years ago. But what about a congressional majority—which lacks a mandate from a majority of Americans—seeking to do everything? The Frenchman might have dubbed that the "tyranny of the minority."
Mr. Barnes is executive editor of the Weekly Standard and a commentator on Fox News Channel.

Cross the River, Burn the Bridge

2009-12-28T02:15:00.002-04:00

Obamacare is the fast-track to a permanent left-of-center political culture.

By Mark Steyn

Last week, during a bit of banter on Fox News, my colleague Jonah Goldberg reminded me of something I’d all but forgotten. Last September, during his address to Congress on health care, Barack Obama declared: “I am not the first President to take up this cause, but I am determined to be the last.”

Dream on. The monstrous mountain of toxic pustules sprouting from greasy boils metastasizing from malign carbuncles that passed the Senate on Christmas Eve is not the last word in “health” “care,” but the first. It ensures that this is all we’ll be talking about, now and forever.

Government can’t just annex “one-sixth of the U.S. economy” (i.e., the equivalent of annexing the entire British or French economy, or annexing the entire Indian economy twice over) and then just say: “Okay, what’s next? On to cap-and-trade . . . ” Nations that governmentalize health care soon find themselves talking about little else.

In Canada, once the wait times for MRIs and hip surgery start creeping up over two years, the government distracts the citizenry with a Royal Commission appointed to study possible “reforms” which reports back a couple of years later usually with recommendations to “strengthen” the government’s “commitment” to every Canadian’s “right” to health care by renaming the Department of Health the Department of Health Services and abolishing the Agency of Health Administration and replacing it with a new Agency of Administrative Health Operations which would report to a reformed Council of Health Policy Administrative Coordination to be supervised by a streamlined Public Health Operations & Administration Assessment Bureau. This package of “reforms” would cost a mere 12.3 gazillion dollars and usually keeps the lid on the pot until the wait times for MRIs start creeping up over three years.

The other alternative is what the British did earlier this year: They created an exciting new “Patient’s Bill of Rights,” promising every Briton the “right” to hospital treatment within 18 weeks. Believe it or not, that distant deadline shimmering woozily in the languid desert haze can be oddly reassuring if you’ve ever visited a Scottish emergency room on a holiday weekend. And, if the four-and-a-half months go by and you still haven’t been treated, you get your (tax) money back? Ah, no. But there is a free helpline you can call which will give you continuously updated estimates on which month your operation has been rescheduled for. I mention these not as a preview of the horrors to come, but because I’ve come to the bleak conclusion that U.S.-style “health” “reform” is going to be far worse.

We were told we had to do it because of the however many millions of uninsured, yet this bill will leave some 25 million Americans uninsured. On the other hand, millions of young fit healthy Americans in their first jobs who currently take the entirely reasonable view that they do not require health insurance at this stage in their lives will be forced to pay for coverage they neither want nor need. On the other other hand, those Americans who’ve done the boring responsible grown-up thing and have health plans Harry Reid determines to be excessively “generous” will be subject to punitive taxes up to 40 percent. On the other other other hand, if you’re the member of a union which enjoys privileged relations with Commissar Reid you’ll be exempt from that 40 percent shakedown. On the other other other other hand, if you’re already enjoying government health care, well, you’re 83 years old and, let’s face it, it’s hardly worth us giving you that surgery for the minimal contribution you make to society, so in the cause of extending government health care to millions of people who don’t currently get it we’re going to ration it for those currently entitled to it.

Looking at the millions of Americans it leaves uninsured, and the millions it leaves with worse treatment and reduced access, and the millions it makes pay significantly more for their current health care, one can only marvel at Harry Reid’s genius: government health care turns out to be all government and no health care. Adding up the zillions of new taxes and bureaucracies and regulations it imposes on the citizenry, one might almost think that was the only point of the exercise.

That’s why I believe America’s belated embrace of government health care is going to be far more expensive and disastrous than the Euro-Canadian models. Whatever one’s philosophical objection to the Canadian health system, it is, broadly, fair: Unless you’re a cabinet minister or a bigtime hockey player, you’ll enjoy the same equality of crappiness and universal lack of access that everybody else does. But, even before it’s up-and-running, Pelosi-Reid-Obamacare is an impenetrable thicket of contradictory boondoggles, shameless payoffs, and arbitrary shakedowns.

That’s why Nebraska’s grotesque zombie senator Ben Nelson is the perfect poster boy for the new arrangements, and not just another so-called Blue Dog Democrat spayed into compliance by a massive cash injection. There is no reason on earth why Nebraska should be the only state in this Union to have every dime of its increased Medicare tab picked up by the 49 others. So either that privilege will be extended to all, or to favored others, or its asymmetry will be balanced by other precisely targeted lollipops hither and yon. Whatever happens, it’s a dagger at the heart of American federalism, just as the bill’s magisterial proclamation that the Independent Medicare Advisory Board can only be abolished by a two-thirds vote of the Senate strikes at one of the most basic principles of a free society — that no parliament can bind its successors.

These details are obnoxious not merely in and of themselves but because they tell us the truth about where we’re headed: Think of the way almost every Big Government project bursts its bodice and winds up bigger and more bloated than its creators allegedly foresaw. In this instance, the stays come pre-loosened, and studded with loopholes. Because the Democrat operators — the Nancy Pelosis and Barney Franks — know that what matters is to get something, anything across the river, and then burn the bridge behind you.

My Republican friends often seem to miss the point in this debate: The so-called “public option” is not Page 3,079, Section (f), Clause VII. The entire bill is a public option — because that’s where it leads, remorselessly. The so-called “death panel” is not Page 2,721, Paragraph 19, Sub-section (d), but again the entire bill — because it inserts the power of the state between you and your doctor, and in effect assumes jurisdiction over your body. As the savvier Dems have always known, once you’ve crossed the Rubicon, you can endlessly re-reform your health reform until the end of time, and all the stuff you didn’t get this go-round will fall into place, and very quickly.

As I’ve been saying for over a year now, “health care” is the fast-track to a permanent left-of-center political culture. The unlovely Democrats on public display in the week before Christmas may seem like just a bunch of jelly-spined opportunists, grubby wardheelers and rapacious kleptocrats, but the smarter ones are showing great strategic clarity. Alas for the rest of us, Euro-style government on a Harry Reid/Chris Dodd/Ben Nelson scale will lead to ruin.

— Mark Steyn, a National Review columnist, is author of America Alone.

Businesses Brace for Health Bill's Costs

2009-12-23T01:02:00.002-04:00

Resigned to Passage, Corporate Lobbyists Begin Jockeying for Modifications That Will Buffer the Impact

By NEIL KING JR.

Companies are alarmed at potentially costly provisions in the Senate health-care bill, many of which they hope will be scrapped during a final round of negotiations early next year.
A scramble to massage the hefty measure, instead of pushing to kill it, reflects the view of many in the business community that a sweeping remake of the U.S. health-care system now appears inevitable.
The U.S. Chamber of Commerce is among a few big business groups calling for Congress to scrap the overhaul effort.
Business is worried that President Barack Obama's push to extend coverage to millions more Americans will raise the burden on employers. Business groups have widely criticized the 2,074-page Senate bill, which looks set for passage on Christmas Eve. They also have offered a variety of fixes.

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UPI

From left, Democratic Sens. Christopher Dodd, Harry Reid and Max Baucus participate in a rally Tuesday after a series of votes on the health-care bill.

The legislation's scale and complexity, plus uncertainty over how the Senate bill will be meshed with the version that passed the House in November, make it difficult for most companies to gauge the effect it will have on the bottom line.
"We're still committed to the notion that health reform can be done right, but I know of no company that is warmly embracing what is in either the House or Senate bills," said Paul Dennett, top health-care adviser to the American Benefits Council, an advocacy group for large employers.
With all eyes now turning to House-Senate negotiations over a final bill expected next month, corporate lobbyists are jockeying for modifications that will buffer the impact.
Retailers want a longer delay before new employees qualify for company-subsidized benefits. Big employers such as Caterpillar Inc., Boeing Co. and Xerox Corp. want to modify Medicare tax provisions in the Senate bill that would cut their earnings. Small construction companies want an exemption from employee coverage that the Senate bill already applies to other businesses with fewer than 50 employees.
Across the spectrum, businesses worry that a series of new taxes and fees to pay for expanding health-care coverage will push up premiums, particularly for smaller employers.
The Senate bill calls for a nearly $70 billion tax over 10 years on insurance companies, plus a $2 billion-a-year tax on medical devices. Billions of dollars are also meant to be raised from added taxes and fees on wealthier seniors, higher-end insurance plans and tanning salons.
Companies of all sizes have been increasingly burdened by health-care costs, which topped $400 billion in 2007, according to data from the Employee Benefit Research Institute. Unrestrained, that figure is expected to double by 2017. About 70% of workers receive health insurance through their employers.
Groups representing smaller businesses say the threat of increased taxes and premiums could outweigh provisions intended to limit the impact on small employers. The Senate bill "will not only fail to reduce and control the constantly climbing health-care costs small-business owners face, but it will result in new and greater costs on their business," said Dan Danner, head of the National Federation of Independent Business.

Not all companies agree. David Ickert, vice president of finance for Air Tractor Inc., which produces airplanes used in agriculture and firefighting, said that from his analysis, the bill would have "no negative impact" on his operations. The company, based in Olney, Texas, employs about 200 people.
Under the Senate bill, most businesses with fewer than 50 workers will be exempt from penalties if they don't offer employee coverage. Larger companies would face fines as high as $750 per worker if even one employee seeks federal help to buy a policy.
Democrats say a package of tax credits within the Senate bill will reduce costs for small businesses. Small businesses that qualify would get a 25% tax credit to help pay for employee coverage. The legislation would also allow small businesses to band together to seek coverage at costs similar to those of much larger companies.
Large companies that fund their own insurance have been relatively positive about the Senate bill, which is much less prescriptive than the House bill and doesn't contain a government-run insurance plan. Still, large companies cite a list of concerns.
A top gripe is that the Senate bill would alter the tax rules that affect big companies providing prescription-drug benefits to their retired workers. Under the law earlier this decade creating a drug benefit in Medicare, companies that continued to provide such benefits qualified for a 28% tax-free subsidy. The Senate bill would tax that subsidy.
A spokesman for Caterpillar said, "The financial impact would be significant for Caterpillar, particularly in the first year."
Martin Reiser, a Washington representative for Xerox and chairman of the National Coalition on Benefits, said another big concern was "whether a lot of the provisions meant to contain [health-care] costs will actually do so. If they don't work -- and we won't know for years -- then the bill is a failure."
—Gary Fields and Ann Zimmerman contributed to this article. Write to Neil King Jr. at neil.king@wsj.com

O Come O Come, Emanuel

2009-12-22T00:21:00.002-04:00

Will Democrats regret Rahm's wager on health care?

By WILLIAM MCGURN

'Twill be the night before Christmas when the Senate delivers the top item on White House Chief of Staff Rahm Emanuel's wish list: a health-care bill. But like the beautifully wrapped gift that looks so wonderful under the tree, this health-care legislation might start to look more like the ghastly sweater from your Aunt Tilly once it comes out of the box.
Give Majority Leader Harry Reid his due. Notwithstanding the grumblings about the way he did it, getting the 60 senators he needed to avoid a Republican filibuster was an achievement. Assuming the House and Senate work out their differences, Mr. Reid's Christmas gift tees up the president for a triumphant State of the Union come January.
Yesterday President Barack Obama gave us a preview when he took a little victory lap amid a jab at critics who are "continually carping" about big spending. The health-care vote, he said, is "a big victory for the American people."

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Chad Crowe

Whether it's a "big victory" for the Democratic Party depends on whether you buy Mr. Emanuel's wager about 1994. The Emanuel Wager goes like this: It was the Democrats' failure in 1994 to pass a health-care bill that ushered in the Gingrich takeover of Congress. In his own meetings with Democrats, former President Bill Clinton has pressed the same line.

This was the message Mr. Emanuel delivered personally to Mr. Reid, when he urged him to cut a deal with holdout Joe Lieberman. This was the message the president echoed two days later in the West Wing, when he told Democrats that no piece of legislation would be perfect. And this appears to be the message embraced by Mr. Reid and House Speaker Nancy Pelosi, given their willingness to accept any amendment to get some health-care bill passed.
So here's the rub: Emanuel's Wager holds only if the merits of the legislation matter not at all.

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Kim Strassel: Democrats on the Health-Care Precipice

That's a cynical view of politics. Of course, if you are Mr. Emanuel and you are looking across the table at senators such as Ben Nelson or Mary Landrieu, you can be forgiven for having your cynicism confirmed. Whether this same cynicism applies to the American people, however, is another question.
Here the signs should be less reassuring to Democrats. As polls have consistently shown, the more Americans learn about Democratic plans for health care, the more the opposition grows. Mr. Reid appreciates this dynamic, which is why he wrote his bill behind closed doors, when only Santa could have any real idea of who's earning a place on the naughty list.
If Mr. Emanuel is right, once health-care legislation is passed and Mr. Obama spins it as a huge victory, the American people will forget their objections and the Democrats will get credit for passing historic reform. If so, that will be some achievement. Because it means building on a health-care package supported by fewer than 38% of Americans (the RealClearPolitics poll average).
If the merits do matter, by contrast, passing this bill could prove more costly than failure. Mr. Obama has been unequivocal in his public statements. In his telling, this legislation will lower costs, reduce the deficit, help small businesses, maintain the status quo on abortion, offer Americans more choices, and so forth.
All these promises may look different when the details emerge, and we learn what change really means. If the president's promises do not hold up, all these Obama statements will be chopped into campaign ads that cut right to his credibility. As for his allies in the Senate, the 60 to 40 party-line vote to close debate means that every Democrat there can be held up as the deciding vote.
It's also unclear whether the traditional standbys for avoiding public accountability—e.g., hiding behind procedural votes—will fly this time. In the last few months, the American people have been watching. And they have learned a great deal about filibusters, manager's amendments, reconciliation, special Medicaid sweeteners for special states, etc.
So they are not likely to be fooled by a senator who tries to have it both ways: by voting to keep this bill alive when his or her vote could have stopped it (Monday morning's cloture vote), and then voting against it (the coming Christmas Eve vote) when passage was assured. Remember how well it worked for John Kerry in the 2004 campaign when his words explaining his votes on a supplemental to fund our troops were thrown back at him. Explained the then-presidential candidate: "I actually did vote for the $87 billion before I voted against it."
Mr. Emanuel was right to tell his fellow Democrats that the price of failure would be to make them all look weak. The question is whether there will be a larger price for looking arrogant.
Write to MainStreet@wsj.com

Sen. Nelson Holds Up Health Bill

2009-12-18T01:06:00.002-04:00

Dispute Over Abortion Threatens Democrats' Christmas Deadline for Passage

By GREG HITT and JANET ADAMY

WASHINGTON -- Senate Democrats' drive to pass health-care legislation by Christmas showed signs of faltering Thursday, amid divisions over abortion and criticism by some Democratic supporters that the bill is unaffordable for lower-to-middle-income families.
In a seesaw day, Sen. Ben Nelson, an antiabortion Nebraskan who is the last Democrat withholding support for the legislation, rejected an overture by party leaders to address his concerns about the bill's handling of abortion. Among other things, Democratic leaders proposed to create a new tax credit that would promote adoptions.
Sen. Nelson said his concerns had "not been fully answered." In an interview with a Nebraska radio station, he suggested it would be difficult to vote on the broader bill by Christmas, as the White House wants.

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"I accept the idea of deadlines and the pressure that that creates," he said. "But a deadline and a timeline that's out there, that is not achievable, isn't helpful." He added, "I do intend to be home for the holidays."
Labor leaders amplified their complaints about the bill. AFL-CIO chief Richard Trumka objected to the bill's proposed tax on high-value insurance plans, and the decision by Senate Democrats to drop a government-run insurance plan. Mr. Trumka said the Senate bill was "too kind to the insurance industry."
Senate Democratic Leader Harry Reid of Nevada continued to work to get 60 votes, the number needed to ensure passage of the legislation, said Reid spokesman Jim Manley. With Mr. Nelson's vote in doubt, President Barack Obama met with Maine Sen. Olympia Snowe, the lone Republican to show interest in supporting the package, to see if she would back the bill. Sen. Snowe is an abortion-rights supporter.
"He'd prefer to get this moving," Sen. Snowe said. She added that she urged the president to postpone action and use "part of January" to deal with her concerns, which include a proposal to establish a new long-term care program. "The time frame is totally unrealistic," she said of the push for a vote by Christmas.
The bill is designed to extend health-insurance coverage to tens of millions of Americans. It includes a mandate on individuals to carry health coverage or pay a fine -- a provision that is raising fresh concerns among some lawmakers who say that even with new tax credits, some people will find coverage unaffordable.
The Senate bill sets some limits on abortion coverage under insurance policies bought in the new national exchange -- or marketplace -- that would be created under the bill. It would still allow women who receive some government subsidies to buy insurance that covers the procedure, though they would have to use their own money to pay for an abortion.
Sen. Nelson is seeking to further tighten the bill's restrictions. He dismissed the latest attempt to find common ground. "As it is right now, without further modifications, it isn't sufficient," he said.

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Associated Press

Nebraska Sen. Ben Nelson, center, flanked by Connecticut Sen. Joe Lieberman, left, and West Virginia Sen. Jay Rockefeller, right, as they prepare to leave after appearing on CBS's 'Face the Nation' Sunday in Washington.

With the holidays looming, some Democrats were beginning to suggest it might be difficult to make the Christmas deadline set by Mr. Reid.

"Obviously, we are going to take the holidays off, and if we haven't done health care, we need to keep going and come back and do it as soon as possible," said Sen. Jack Reed (D., R.I.). Sen. Debbie Stabenow (D., Mich.) added she didn't know when passage of the bill would come, saying it could be "Christmas Eve, or Christmas, or the week after, or the week after that."
Mr. Reid is juggling a number of year-end priorities. He was trying to push the Senate toward a final vote Saturday on a fiscal 2010 defense bill, which also includes provisions extending jobless benefits. Also pending is legislation needed to lift the nation's $12.1 trillion debt ceiling.
"This entire process is essentially a charade," said Senate Minority Leader Mitch McConnell (R., Ky.). Republicans threatened to resist Mr. Reid's efforts to proceed to a vote on the defense bill, in what would be a symbolic protest over the push on health. Mr. McConnell said Democrats were preparing to vote on a health bill "that no one outside of the majority leader's conference room has seen."
The White House brushed off suggestions that momentum may be turning against the health overhaul. "Despite all the cable TV chatter, nothing has happened in recent days that suggests that this bill is any less likely to pass," said White House communications director Dan Pfeiffer.
Democrats fear a delay could cause them to lose traction on the bill. Pushing the Senate vote past Christmas would add to the time it would take to piece together a compromise between the House and Senate, and would tie debate on that final bill more tightly to the 2010 election season. Polls show widening voter discontent with the health initiative.
Write to Greg Hitt at greg.hitt@wsj.com and Janet Adamy at janet.adamy@wsj.com

Democrats on the Health-Care Precipice

2009-12-18T00:56:00.002-04:00

Enacting health-care legislation in the face of overwhelming public disapproval may cost the party its chance of forging a sustainable majority.

Barack Obama emerged from his meeting with Senate Democrats this week to claim Congress was on the "precipice" of something historic. Believe him. The president is demanding his party unilaterally enact one of the most unpopular and complex pieces of social legislation in history. In the process, he may be sacrificing Democrats' chances at creating a sustainable majority.
Slowly, slowly, the Democratic health agenda is turning into a political suicide pact. Congressional members have been dragged along by momentum, by threat, by bribe, but mostly by the White House's siren song that it would be worse to not pass a bill than it would be to pass one. If that ever were true, it is not today.
Public opinion on ObamaCare is at a low ebb. This week's NBC-WSJ poll: A mere 32% of Americans think it a "good" idea. The Washington Post: Only 35% of independents support it—down 10 points in a month. Resurgent Republic recently queried Americans over the age of 55, aka Those Most Likely to Vote In a Midterm Election. Sixty-one percent believe ObamaCare will increase their health costs; 68% believe it will increase the deficit; 76% believe it will raise their taxes.
Democrats also have managed to alienate the liberal base to which they were catering. The death of the public option and Medicare buy-in this week sent Howard Dean to thundering "kill the bill." A week from now, the current polls might look good.
Yet it is in individual states where the disconnect between the White House's soothing words and the ugly political reality is most stark. While Democrats are under fire for the economy and spending, it is health care that has voters thinking it's time for political change.

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Associated Press

North Dakota's Sen. Byron Dorgan

Consider North Dakota. A recent Zogby poll showed 28% (you read that right) of state voters support "reform." A full 40% said they'd be less likely to vote for Democratic Sen. Byron Dorgan next year if he supports a bill. In a theoretical matchup with Republican Gov. John Hoeven (who has yet to announce), Mr. Hoeven wins 55% to 36%. Mr. Dorgan has been in the Senate 17 years; he won his last election with 68% of the vote. This should not be happening.

In Arkansas, 32% support this health-care legislation. Sen. Blanche Lincoln, also running next year, trails challengers by more than 50 points among the 56% of voters who strongly disapprove of the health plan. Senate Majority Leader Harry Reid, the public face of health reform, can barely break 38% approval in Nevada. In Colorado, where 55% of voters oppose a health bill, appointed Democratic Sen. Michael Bennet told CNN he'd vote for a bill even if it "cost him his job." Give the freshman credit for honesty.
Nor is this a red state/swing state phenomenon. In deep-blue Delaware, 46% oppose the health plan. Democrats pounded Delaware GOP Rep. Mike Castle, running for Senate, for voting against the House bill. That vote has in fact kept Mr. Castle leading his expected opponent, Beau Biden, the vice president's son. Chris Dodd helped author the Senate health bill and is up for re-election next year. He is arguably the Senate's most politically vulnerable Democrat.
Don't trust the polls? In the past weeks, four well known House Democrats announced they will not run for re-election. All are longtime incumbents; one, Tennessee's respected John Tanner, co-founded the Blue Dog coalition. These folks have seen the political handwriting on the wall.
Democrats have also been pulled by another White House promise: That once Americans witness reform, they will turn around. Yet even supporters know this ugly bill will not "fix" health care. The problems will remain—with more in addition—and Democrats will own them. Meanwhile, the backlash against the pending health-care legislation is seeping out to hamper Democrats' broader agenda. Pew this week published a poll in which it marveled (fretted?) over the "extent to which the public has moved in a conservative direction on a range of issues" since President Obama took office.
So why the stubborn insistence on passing health reform? Think big. The liberal wing of the party—the Barney Franks, the David Obeys—are focused beyond November 2010, to the long-term political prize. They want a health-care program that inevitably leads to a value-added tax and a permanent welfare state. Big government then becomes fact, and another Ronald Reagan becomes impossible. See Continental Europe.
The entitlement crazes of the 1930s and 1960s also caused a backlash, but liberal Democrats know the programs of those periods survived. They are more than happy to sacrifice a few Blue Dogs, a Blanche Lincoln, a Michael Bennet, if they can expand government so that in the long run it benefits the party of government.
What's extraordinary is that more Democrats have not wised up to the fact that they are being used as pawns in this larger liberal game. Maybe Mr. Obama will see a bump in the polls if health care passes; maybe not. What is certain is that this vote is becoming one that many in his party will not survive.
Write to: kim@wsj.com

ObamaCare and the Liberal Obsession

2009-12-17T00:39:00.002-04:00

Every Democratic president since FDR has failed to pass national health insurance. The current legislation in Congress is likely the last chance to enact it.

If President Obama's health-care initiative fails, there is no longer a rationale for being a liberal in the United States. Everything else on liberalism's to-do list is footnotes.
Passing national health insurance has obsessed every Democratic president since Franklin Roosevelt. Even Harry Truman, for some conservatives a model of "moderate" Democratic politics, wanted it. Looking back, Truman wept and warned: "I've had some bitter disappointments as President, but the one that has troubled me most, in a personal way, has been the failure to defeat the organized opposition to a national compulsory health insurance program. But this opposition has only delayed and cannot stop the adoption of an indispensable federal health insurance plan."

Daniel Henninger discusses how passing health-care reform is a liberal obsession.

No other issue has consumed more political energy in the U.S. than "health-care reform." Congress's half-year preoccupation with health care is only the latest blip in the Democrats' long march to a public option.
As we head to the final act, one element of this history stands out: The liberals' repeated failure to get it done.
The Democratic Mecca—a real national health insurance system available to all—has always encountered stiff resistance in Congress, notably as now from moderate Democrats. In the 1960s, Senate Finance Chairman Russell Long (of Mary Landrieu's Louisiana) railed publicly against Medicare's costs but as now, questions about cost were obliterated.
Frustrated at the failure to pass their "National Health Insurance" bill during the presidency of Dwight Eisenhower, the Democrats ratcheted back from the Euro-style idea of FDR and Truman to a plan that would cover only Social Security beneficiaries, the elderly. This was Medicare.
Medicare failed all its initial votes in 1960. A compromise known as Kerr-Mills, which limited federal coverage to the "indigent" elderly, passed the Senate by a vote of 91-2. Many said then that Kerr-Mills addressed the U.S.'s main problem, which was medicine for the poor. Ronald Reagan supported Kerr-Mills, arguing that people "worth millions of dollars" shouldn't be getting health care paid for by government.
For Democratic liberals, a lot is never enough. With John Kennedy's election, they resubmitted Medicare for the elderly regardless of income.
The Democrats still couldn't pass a health-care entitlement on the scale of Social Security. The politics they threw into the effort was massive. They put 20,000 elderly in Madison Square Garden to hear JFK's oratory. Rallies were held in 45 cities. Organized labor ran campaigns against members of the Ways and Means Committee in their home districts. For all this, in July 1962 the Senate voted 52-48 against Medicare. JFK denounced the vote on TV.

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Corbis

JFK pleads for universal health care in Madison Square Garden in 1962.

It is a familiar story that Lyndon Johnson got Medicare passed as part of the Kennedy legacy. But for LBJ in 1965, the political planets were in perfect alignment. He had an overwhelming victory in the 1964 presidential campaign and huge congressional majorities. He had a robust economy, a gift of the Kennedy tax cut passed in early 1964. Also, no House hearings were held that year on the 296-page bill, which Democratic Sen. Philip Hart of Michigan complained was "one of the most complex set of social security amendments ever brought before this body."

Oh, and let us not overlook the party's concurrent quest for money transfers. In a moment of glee over the 1965 bill, Rep. Phil Burton of California, a member of the liberal pantheon, intoned: "All in all, our fair state and its people in the first year will be favored to the tune of some $550 million, a not modest sum." (Norms of spending "modesty" have changed since.)
The Democrats' persistent problems with this issue, including the Clintons' Health Security Act in 1994, suggests a victory for ObamaCare is no sure thing.
Nearly every defeat of broad public health coverage has come amid some turbulence that scared the public or politicians.
For Truman it was the Korean War. For JFK it was a recession, Vietnam and the Cuban missile crisis. Walter Lippmann wrote of JFK that a too-confident president was exceeding the public's reach. The Social Security Administration's own history of the Kennedy effort notes, "Some experts still had doubts about the reliability of the cost estimates for the bill."
Now Democrats say this vote is about "history." No, it's about their history. As with past failures to federalize health care, the air in 2009 is full of static—high unemployment, Afghanistan, a terrorist prison in Illinois and a petulant White House. The Democrats' familiar problems with the politics of universal health care have turned the bill into one of the most degraded legislative exercises in congressional history. Left-wing Dems like Howard Dean are screaming "kill" the Senate bill, suggesting a progressive Jonestown over it. Public support is below 40%.
This is probably the final death struggle for universal health care. They may let Harry Reid's Senate seat itself go down in the bloodbath over the 70-year obsession. Anyone remotely opposed to this idea had better step forward. History says ObamaCare isn't a done deal til the fat lady votes.
Write to henninger@wsj.com

SEIU Pulls Back on Supporting Bill Amid Concerns Bill Isn't Progressive Enough

2009-12-17T00:21:00.000-04:00

By Jeffrey Young - 12/16/09 12:37 PM ET

The Service Employees International Union (SEIU) backed out of an event with other organizations promoting the Senate healthcare reform bill Wednesday over concerns about changes made to the legislation to accommodate centrist Democrats.

The SEIU had planned to participate in a Capitol Hill press conference along with the AARP, the liberal advocacy group Families USA, Consumers Union and the American Cancer Society Action Network. As recently as Tuesday morning, the organizations distributed an advisory to the news media that included the SEIU.

But the move by Senate Majority Leader Harry Reid (D-Nev.) to excise provisions of the healthcare reform bill to create a government-run public option health insurance program and to allow people between 55 and 64 years old to buy into Medicare gave the labor union pause, spokeswoman Lori Lodes said.

"That decision has to be made by our leaders and our members," Lodes said. The event with the AARP and the other groups was scheduled before Reid made changes to the bill.

The SEIU executive board will hold what Lodes described as an "emergency" meeting Wednesday night to decide how to move forward. "Right now, they don't have the information they need to make this decision," said Lodes, who added that the SEIU informed the other organizations on Tuesday they would not be joining the press conference.

The board meeting likely will not produce a final determination by the union about whether to support advancing the Senate healthcare bill, which not only lacks a public option and the Medicare buy-in but also would levy an excise tax on so-called Cadillac health insurance plans that some union members have, Lodes said.

"We will not have an absolute decision coming," largely because Reid has not released the final language of the healthcare bill, she said.

The Big Scare: President Obama: Federal Government 'Will Go Bankrupt' if Health Care Costs Are Not Reined In

2009-12-17T00:17:00.002-04:00

ABC's Karen Travers reports from Washington:
President Obama told ABC News’ Charles Gibson in an interview that if Congress does not pass health care legislation that will bring down costs, the federal government “will go bankrupt.”
The president laid out a dire scenario of what will happen if his health care reform effort fails.
“If we don't pass it, here's the guarantee….your premiums will go up, your employers are going to load up more costs on you,” he said. “Potentially they're going to drop your coverage, because they just can't afford an increase of 25 percent, 30 percent in terms of the costs of providing health care to employees each and every year. “
The president said that the costs of Medicare and Medicaid are on an “unsustainable” trajectory and if there is no action taken to bring them down, “the federal government will go bankrupt.”
“This actually provides us the best chance of starting to bend the cost curve on the government expenditures in Medicare and Medicaid,” Obama said.
Watch Charlie Gibson’s interview with President Obama tonight on World News and check back on ABCNews.com for the full interview.
Obama told Gibson that anybody who says they are concerned about the rising deficit or worried about tax increases in the future has to support this health care bill.
“Because if we don't do this, nobody argues with the fact that health care costs are going to consume the entire federal budget,” the president said.
Obama is facing an increasingly skeptical American public when it comes to his push for health care reform.
The latest ABC News/Washington Post poll found that support for the health care reform package, while never robust, is now at a low ebb and opposition has been steadily growing stronger in intensity.
For the first time, a majority of those surveyed disapproved of the president’s work on health care (53 percent) and oppose the health care reform package making its way through Congress (51 percent, compared to 44 percent approval).
That seven-point margin for opposition is its most to date -- indeed statistically significant for the first time -- and the differential in intensity of sentiment has grown since September.
More on the ABC News/Washington Post poll HERE.

Nancy Pelosi: No Health Care Deal This Year

2009-12-17T00:05:00.002-04:00

Speaker Nancy Pelosi predicted Wednesday that job creation and deficit reduction will be the central Democratic themes for the coming year – and that public support for health care reform will rebound once a bill has been sent to President Barack Obama.

On the divisive issue of Afghanistan, the California Democrat ducked the question of how she would vote on increased war funding: “Let’s see what they request,” she said. But she has urged her party, including old allies on the anti-war left, to listen and give some “room” to Obama, recognizing that the president had been “dealt a very bad hand because there was no plan in Afghanistan for years.”

Pelosi made her comments at a year-end roundtable with reporters where she described herself as back in full “campaign mode” and confident House Democrats will retain “a strong majority” after the 2010 elections.

“He didn’t give me 72 hours notice,” she joked of Rep. Brian Baird’s surprise decision to not seek re-election in his swing district in Washington state. But Pelosi said her rule of politics was “don’t assume anything” and she wasn’t panicked by the recent spate of retirements in her ranks.

In the case of health care reform, Pelosi credited House Democrats with having saved Obama’s initiative after the onslaught of attacks during the August recess. And if the Senate can complete its bill this month, she will work to try to send a House-Senate compromise to the White House before the State of the Union.

“They will pass a bill and we will have a bill,” the speaker said, and once that happens, she predicted the focus will shift away from the differences among Democrats and more on what is in the package itself.

“We are in a define-or-be-defined occupation,” she said, and her adversaries have had the advantage of picking out single issues, such as abortion or the public option, to characterize the whole.

Matching the House bill against the still-evolving Senate package, she said she saw differences of affordability for families and the revenue-raisers that would have to be negotiated. But she downplayed differences over the public option for coverage, saying the emphasis had always been on giving consumers an insurance option, not that it be public or government run.

“We know that, between the two bills, we have the makings of a big difference for the American people,” Pelosi said. “When we have a bill . . . the discussion is no longer about the bishops or about the public options, and it’s about what’s in the bill for people.”

She plans to travel to Michigan for the Detroit auto show in January and is already pressing the Senate to respond quickly next month to a new job-creation package on the floor Wednesday. When a Michigan reporter asked her response to White House proposals about job-creating investments in environmental technologies, she bridled a bit: “We need no introduction to these subjects, and we’re thrilled that the White House is joining them.”

But in contrast with this past year, dominated by the Democrats aspirations for health care or climate change legislation, she said the grim federal debt now loomed over the agenda.
“There is a very, almost fierce determination to reduce the deficit,” she said, and repeatedly returned to her early years in Congress and budget battles under President Bill Clinton that contributed to the Democrats losing control of Congress in 1994.

“We’ve been here before,” she said. “We had to make very difficult decisions, and as you know, we paid a political price for it but we had to do it.”

Pelosi predicted in January ‘we’ll come to terms on a commission” such as those proposed to make recommendations to Congress on difficult deficit-reduction measures. But without mentioning Senate Budget Committee Chairman Kent Conrad (D-N.D.) by name, she seemed cool still toward his legislation, which would usurp the speaker’s power over legislation and dictate an up-or down-House vote -- without amendments -- on whatever the commission recommends.

“I said pass it in the Senate,” the speaker said. “Send it to me, I’ll have to face it.” But when Senate leaders told her that it was unclear still if the Conrad plan had the 60 votes needed for passage, her answer was: “Then let’s talk about what we can both pass rather than talk about what some people think should happen but doesn’t really have the votes.”

“This is not a completely whole new ball game because we had to do it when President Clinton made the determination that we would go forward,” the speaker said. “We know how to do it -- we’ll do it again.”

: Nancy Pelosi seems determined to get her legislation passed. Photo: AP

The People Lose in Health Care Trainwreck

2009-12-16T01:10:00.003-04:00

WASHINGTON -- This is what happens when the soaring promises of Hope and Change give way to old-style political prostitution on the Potomac.
President Obama won last year vowing to change the way Washington works.
Democrats clung to his coattails and won commanding control of Congress.
In less than 12 months, though, all the Democrats' promises of honesty, openness and common sense have sunken into the same old sordid sewer that has forever defined Washington as the loathsome, dishonest and wasteful place that it is.
The result is the health-care train wreck.

We must lower the skyrocketing costs, Dems said.
Now they are willing to spend any amount of your money it takes to get some kind of health-care legislation passed.
And they don't care how much their own accountants tell them the bill will actually raise the costs of health care.
We will usher in a new era of openness, they vowed.
Not anymore.
Openness and honesty were killing their health-care plans, so Democrats took it entirely behind closed doors.
The only way to provide health care for all Americans, they promised us, was if the government went into the insurance business.
Now they say states can opt out or opt in. Or you can join Medicare. Or, some people can join Medicare.
"Anything!" they are saying. "We just need a victory!"
This is what happens when politicians go from idealism to survivalism.
They no longer care what they promised voters. They don't care what the public wants. And they don't care about what is right.
All they care about is a victory so that they can claim to have accomplished something.
churt@nypost.com

Sources: Medicare buy-in likely to be dropped from health care bill

2009-12-15T01:08:00.000-04:00

Lieberman talks health care

STORY HIGHLIGHTS

Plan to expand Medicare to those 55 and over will be dropped, sources say
Move aims to win back support of Sen. Joe Lieberman, they say
Senate Dems need 60 votes to close debate and bring health care bill to a vote
Lieberman support is key to the 60 votes

Washington (CNN) -- Senate Democrats are preparing to drop a compromise health-care plan that would allow 55- to 64-year-olds to buy into Medicare because of opposition from Connecticut Sen. Joe Lieberman, two senior Democratic sources said Monday.
"It's what the White House wants, and there aren't many other options that allow us to finish by Christmas," said one source.
Lieberman, an independent who caucuses with the Democrats, has emerged as the majority party's main obstacle to its efforts to get a health care bill through the Senate before Christmas. He ratcheted up his public opposition to the bill Sunday by threatening to join a Republican filibuster if the legislation contains either a government-run public health insurance option or a proposed alternative that would expand Medicare to people as young as 55.
"I think the danger always is you try to add too much onto a bill," he told reporters Monday evening. He said he supports the "core" of the bill, including tighter regulations on private insurers, but he wants Democrats to "take off some of this stuff that runs the risk of creating federal debt, and moves toward a government takeover of insurance, which I think would be bad."

Unanimous Republican opposition so far means Senate Democrats need all 60 votes in their caucus to close debate on the sweeping health care bill. Final passage of the bill would then require only a simple majority of 51.
Lieberman supported letting older workers buy into Medicare in 2000, when he was the Democratic vice presidential candidate, and as recently as September in comments to a Connecticut newspaper. But he said Monday that the idea was "no longer necessary," since the Senate bill includes subsidies to help people 55 and older buy insurance coverage before they become eligible for Medicare.
"I was suggesting various ideas for health care reform that did not involve the public option, and that was the focus at that time," he said. "But the important thing is I'm for health care reform, and if we get together, we're going to deliver a health care reform bill that will provide the ability to get health insurance to 30 million people that don't have it now."
Lieberman spokesman Marshall Wittmann said that now, "We have a huge national deficit and a program that analysts indicate is in dire fiscal straits in 2009."
Senate Democrats held an emergency meeting Monday night to discuss the issue, which threatens to derail the Obama administration's push for a sweeping reform of U.S. health insurance. Although a final decision was not made at Monday night's meeting, a second Democratic source said a final decision could be made at a White House meeting Tuesday between the Senate's Democratic majority and President Obama.
"I think there is a fundamental understanding of the direction we're going in," said Sen. John Kerry, D-Massachusetts.
Before the meeting, liberal Democrats Tom Harkin of Iowa and Jay Rockefeller of West Virginia indicated that the Medicare buy-in would likely be dropped. While they didn't like the idea, they suggested they would support a health care bill anyway.
Democrats "may have to do what Mr. Lieberman wants," Harkin said.
The Medicare expansion was part of a package of provisions announced by Reid last week as an alternative to a government-run public health insurance program, which lacked enough support among Democrats to break a filibuster. Negotiated by a team of 10 Democratic senators -- five liberal and five moderate -- the compromise package was hailed by Reid, Obama and others as an important step forward in the health care debate.
The package also would allow private insurers to offer nonprofit health coverage overseen by the government. But many senators have reserved judgment on the compromise proposal until the non-partisan Congressional Budget Office provides its analysis of how much it costs.
Senate Majority Leader Harry Reid would discuss no specifics of a bill after Monday night's caucus, telling reporters he would wait until the CBO finished its estimate of a revised bill's cost. But he said the measure "saves lives, saves money and saves Medicare."
"I am confident that by next week we'll be on our way to forward this bill to the president," he said.
Most Democrats support the public option as a nonprofit competitor to private insurers that would expand coverage and bring down prices. Republicans and some moderate Democrats, along with the health insurance industry -- one of the major employers in Lieberman's home state -- oppose a public option, calling it a first step toward a government takeover of the U.S. health care system.
Lieberman first expressed possible opposition to the health care bill in late October, saying he would join a GOP filibuster if the measure contained the public option. Asked about Lieberman's position then, Reid said: "Joe Lieberman is the least of Harry Reid's problems."
Another potential obstacle for Reid is moderate Democrat Ben Nelson of Nebraska, who said Sunday he cannot support the Senate bill without tighter restrictions on federal funding for abortion. The Senate last week defeated an amendment proposed by Nelson and two other senators that would adopt tougher language on abortion funding contained in the House health care bill.
A compromise on the abortion language is possible, said Nelson, one of 10 Senate Democrats who negotiated in private last week on the public option compromise.
If the Senate eventually passes a health care bill, its version will have to be merged with the version the House of Representatives passed in November, which includes a public health insurance plan. The final bill would then need approval from both chambers before going to Obama to be signed into law.

Obama and Democratic leaders have said they want the bill completed this year. The Senate would need to finish its work this week to leave a realistic chance of meeting that schedule.

Dems against Dems in health care vote struggle

2009-12-15T00:49:00.000-04:00

By DAVID ESPO, AP Special Correspondent David Espo, Ap Special Correspondent – Mon Dec 14, 6:24 pm ET

WASHINGTON – The end game in sight, Senate Democrats coped with stubborn internal differences as well as implacable Republican opposition on Monday in a struggle to pass health care legislation by Christmas.
A liberal-backed call to expand Medicare as part of the legislation drew strong opposition from Sen. Joe Lieberman, I-Conn. and quieter concerns from a dozen Democrats, raising significant doubts about its ability to survive.
Congressional officials said the administration was recommending the provision be jettisoned to clear the way for the most sweeping health care legislation in a half-century. In response, a top presidential aide, Dan Pfeiffer, said, "The White House is not pushing (Senate Majority Leader Harry) Reid in any direction, we are working hand in hand with the Senate leadership to work through the various issues and pass health reform as soon as possible."
Disputes over abortion and the importation of prescription drugs from Canada and other countries also flared.
In an attempt to generate support for the bill, Reid promised late in the day that any final compromise with the House would completely close a gap in Medicare prescription drug coverage generally known as a "doughnut hole." The Senate bill goes only part way toward that goal.
Democrats are "looking for 60 votes," said Dick Durbin of Illinois, the party's second-ranking Senate leader — a statement that has characterized their effort to overcome Republican opposition for months.
President Barack Obama, the fate of his top domestic priority in doubt, invited all Senate Democrats to a meeting at the White House complex on Tuesday — possibly the final day for an agreement if the legislation is to clear the Senate before Christmas.
In the interim, the president's Monday schedule included a meeting with Sen. Bob Casey, D-Pa., who has been trying to negotiate a compromise on the abortion issue with Sen. Ben Nelson of Nebraska. Both senators oppose abortions, but Nelson has been outspoken in demanding changes in the bill before he can vote for it.
The overall measure, costing nearly $1 trillion over a decade, is designed to expand coverage and ban the insurance industry practice of denying coverage on the basis of pre-existing medical conditions. Obama has also urged Congress to slow the rate of growth in health care spending nationally, and several days after Reid submitted a package of revisions, lawmakers awaited final word from the Congressional Budget Office on that point.
Additionally, a top administration economic adviser acknowledged Monday that the Democratic-backed health care measure would raise spending in the short run, but she said it would eventually generate more than enough savings to offset the expense of expanded coverage.
"Our bottom line is that the bills as they are coming through will genuinely slow the growth of health care spending, both public and private, by about 1 percentage point a year for an extended period," said Christina Romer, chair of the Council of Economic Advisers.
Sen. Byron Dorgan, D-N.D., led the effort to lift a long-standing ban on the importation of prescription drugs from Canada and elsewhere. Obama favored the plan as a senator, but the pharmaceutical industry is opposed, and the White House appeared anxious not to jeopardize a months-long alliance with drug makers who have been helpful in trying to pass the overhaul.
But the obstacle that loomed largest was a proposal to permit uninsured men and women to purchase Medicare coverage as early as age 55.
It emerged last week as part of a framework agreement between moderates and liberals struggling to define the role of government in the newly revised health care system. Additionally, the proposal calls for creation of nationwide plans run by private insurance companies under the supervision of the Office of Personnel Management, the agency that oversees the system through which federal employees and lawmakers obtain their own coverage.
The two provisions were seen as a replacement for Reid's initial call for a government-run insurance plan to compete with private industry.
Liberals have long wanted a government-run option, but moderates oppose it as an unwanted intrusion into the health care system. In announcing the agreement last week, Reid told reporters he could finally see the finish line for his effort to pass a health care bill.
Despite that optimism, opposition to the Medicare changes blossomed from doctors and hospitals, who are paid less to treat patients under Medicare than those covered by private insurance companies.
Lieberman announced his opposition over the weekend, but he was not the only critic.
"We appreciate the rationale underlying the proposed Medicare expansion but fear that provider shortages in states with low reimbursement rates such as ours will make such a program ineffective, or even worsen the problems states are experiencing," a dozen Democrats from across the political spectrum wrote Reid.
Democratic officials said late last week that efforts were under way to try and ease the concerns of doctors and hospitals, as well as defray the cost of buy-in coverage for consumers. Under some estimates, the price tag could reach $7,600 annually or more.
Lieberman said on Sunday he was opposed to the Medicare provision, threatening to deny Democrats his vote if it remained in the bill.
That set off an unusual round of finger-pointing, in which Senate aides anonymously accused him of having flip-flopped on the issue after privately indicating to Reid he was in favor of it.
In a pointed rebuttal, Lieberman's spokesman said, the Connecticut lawmaker had told Reid privately on Friday "that he had problems with the Medicare provision." Marshall Wittman, the spokesman, added, "This position was also told to negotiators earlier in the week. Consequently, Senator Lieberman's position came as no surprise to the Democratic leadership. Any contrary charge by aides who cowardly seek to hide under the cloak of anonymity is false and self-serving."
But Lieberman's consistency on the issue came under question within hours, when House Democrats circulated a videotape from September in which he spoke favorably of allowing men and women as young as 55 to purchase coverage under Medicare.
Wittman said those comments were made before the Senate health care bill, which includes health insurance subsidies, was finalized. He said Lieberman believes the government assistance makes a Medicare buy-in program redundant.
One other proposal to emerge from last week's negotiations appeared headed for oblivion.
The Congressional Budget Office said a requirement for insurance companies to spend 90 cents of every premium dollar on medical care would transform the industry into "an essentially governmental program" that would more properly belong in the federal budget.
Reid's bill now includes some limits on insurance company overhead, but Sen. Jay Rockefeller, D-W.Va., and other liberals advocate the 90 percent proposal.