Keeping Real Health Care Reform Off the Table
by Alan Maass / June 19th, 2009 (0)

The health care industry is determined to strangle any proposal in Washington for real reform — and the Democrats are acting as accomplices.

Barack Obama’s administration and party leaders in Congress have given up without a fight on a single-payer system that could actually solve the health care crisis — and they’re allowing the measures they do claim to support to be gutted of anything that might make a difference.

Support for a radical overhaul of the health care system, with a leading role for government-run programs, has never been greater. But with health care legislation expected to take shape over the …

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Health Care Reform
And Carburetor Tweaking

by Paul Dean / June 19th, 2009 (0)

What we call a “health care system” in America is by my standard a strange and almost incomprehensibly corrupt and twisted thing. The continued existence of such a cruel and dysfunctional system requires that a great deal of mind-fogging fairy dust be continually thrown in our faces by the health care industry and the politicians they own. At all costs, they must inoculate us against the possibility that a spontaneous outbreak of common sense might infect the populace. Rest assured that the strategists for the drug and insurance companies understand what they are up against.

They understand that to keep in …

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Whither The Blue (Cross) Dogs Second major poll finds huge support for public plan option. NYT: "72 percent of those questioned supported a government-administered insurance plan - something like Medicare for those under 65 - that would compete for customers with private insurers. Twenty percent said they were opposed ..."; Bloomberg: "President Barack Obama will take his case to the American people this week on a plan to overhaul the U.S. health-care system ... Obama invited the ABC television network to broadcast from the White House on June 24 and will take health-care questions from the public in the East Room."; Leading House Democrats introduce bill with public health plan option. NYT; Change.org's Tim Foley praises House; Sen. Diane Feinstein undercuts President Obama on CNN's State of the Union: "Well to be candid with you, I don't know that he has the votes right now..."; While Sen. Bob Casey backs the president: "I believe one of those choices should be a public option, which, in the paper today, the New York Times survey shows 72 percent of the American people favoring it..."; On ABC's This Week, Sen. Lindsey Graham asserted, "The CBO estimates were a death blow to a government run health care plan," even though the CBO estimate did not address public plan option.; Sen. McCain flunks math on CBS' Face The Nation, disingenuously extrapolating CBO estimate and ignoring ideas like public plan option that would expand coverage while reducing cost; Time raises questions on attempt to derail public plan with series of co-ops; Joe Paduda smacks scaled-back Baucus draft proposal: "The draft of the Baucus bill is a clear indication that some of the Senators ostensibly driving the health reform process have very little appetite for taking on the health care industry; the bill is all about coverage with almost no meaningful effort at controlling cost."; Economist View's Mark Thoma asks: "What's with the Blue-Cross Dogs?"; Big Pharma gives a little, keeps seat at reform table. AP: "[Sen.] Baucus' announcement said drug companies would pay half of the cost of brand-name drugs for seniors in the so-called doughnut hole - a gap in coverage that is a feature of many of the plans providing prescription coverage under Medicare. In addition, the entire cost of the drug would count toward a patient's out-of-pocket costs, meaning their insurance coverage would cover more of their expenses than otherwise."; GoozNews adds more context: "...not much of the money will be available for health care reform. The donut hole is by definition out-of-pocket costs for seniors. Cutting those expenses will not free up money in government budgets for helping the uninsured. That means the Congressional Budget Office will score the offer at much less than the $80 billion."; Beat The Press' Dean Baker skewers W. Post for attacking Obama, praising Big Pharma, on costs; Reuters has the latest data on US health care crisis: "Americans are struggling to pay for healthcare in the ongoing economic recession, with a quarter saying they have had trouble in the past 12 months, according to a survey released on Monday."

PAUL KRUGMAN
Health Care Showdown nytimes.com - The question now is whether we will nonetheless fail to get that change, because a handful of Democratic senators are still determined to party like it's 1993.

IAN WELSH
Senate Democrats Aren't Caving On The Public Option, They Just Don't Belive In Real Universal Health Care huffingtonpost.com - They don't believe in universal health care, and they know that their real constituents aren't the people who vote for them but the people who fund their campaigns and make sure they, their friends and their families are taken care of. And no, they don't think that's you, the voter and taxpayer. Their calculation is that voters are sheep and won't make them pay any real price for killing a good health care plan.

THE NEW YORK TIMES
A Public Health Plan nytimes.com - A robust public health care plan that piggy-backs on the rate setting powers of Medicare would lower costs, save money, and extend health benefits to more Americans.

Palliative care must be part of health reform, CHA official says

By Nancy Frazier O'Brien
Catholic News Service

WASHINGTON (CNS) -- Palliative care that focuses on pain management and attention to the psychological, social and spiritual needs of suffering and dying patients must be part of the nation's health care reform, the new chairwoman of the Catholic Health Association's board of trustees said at a Capitol Hill briefing.

Colleen Scanlon, an attorney who previously worked as a palliative care nurse, said such care can be "a model to improve quality and manage scarce resources" as policymakers debate health care reform.

"By reducing pain and suffering and coordinating care transitions, palliative care reduces emergency room visits, hospital stays and readmissions, and most importantly improves patient and family satisfaction," said Scanlon, senior vice president for advocacy at Catholic Health Initiatives in Denver.

At the June 15 briefing, she represented both CHA and the Supportive Care Coalition: Pursuing Excellence in Palliative Care, a coalition of 19 Catholic health systems.

Scanlon said research shows that in many cases people hospitalized with life-threatening illness "receive expensive, aggressive medical intervention that is often unwanted and that diminishes their quality of life."

Given that the estimated 90 million Americans now living with serious and life-threatening illnesses is expected to double over the next 25 years, "we must find a better way to care for the seriously ill and dying," Scanlon said.

"We have a moral obligation to ensure that the seriously ill receive care that respects their wishes, that protects their dignity and that meets the needs of the whole person -- body, mind and spirit," she added.

Palliative care "is highly coordinated, interdisciplinary, patient- and family-centered care that optimizes quality of life by anticipating, preventing and treating symptoms, as well as facilitating patient autonomy, access to information and treatment choice," Scanlon said.

In addition, she said, it is "provided concurrently with disease-modifying treatment and continues as end-of-life care and hospice care after such treatment is no longer effective, appropriate or desired."

"Palliative care must be integrated into health reform legislation and should be addressed in quality measures, payment reform, comparative effectiveness, health IT (information technology), demonstration programs and workforce issues," Scanlon said.

The briefing was sponsored by CHA, the American Cancer Society Cancer Action Network and two Democratic House members -- Reps. Steve Israel of New York and Lois Capps of California.

Capps is chief sponsor of the National Pain Care Policy Act of 2009, H.R. 756, which would educate doctors and other health care professionals about how to best diagnose and treat pain safely; raise awareness among patients and their families about the need to seek proper pain management; and improve coordination of pain research at the National Institutes of Health.

The legislation passed the House by voice vote March 30 and, as S. 660, is now before the Senate Committee on Health, Education, Labor and Pensions.

END

Americans Demand a Public Option in Health Care -- When Will Politicians Listen?

Robert Parry, Consortium News

Health and Wellness: Even in special-interest-dominated Washington, it's rare for politicians to so blatantly privilege a private industry over the will of the people.

Do Americans Have a Right to Healthcare?

Post by Staff
Health and Wellness: The Nation's Washington editor Chris Hayes debates Reihan Salam of The National Review. More »

• Full Post

Healthcare Reform: A Looming Policy Disaster
Andrew Foy and Brenton Stransky
How to spend much more without improving health outcomes. More

Kucinich and other real democrats have made it clear for a very long time that the only way to get universal
health care in this country is a single payer system and there is a bill pending in the House to put it in operation...
Anything short of this is just more game playing by the powers that be, which always end up saying, "We tried."

DEAN BAKER
Spreading the Wealth Around to the Insurance Industry and Friends truthout.org - The insurance, pharmaceutical and medical supply industries, along with the hospitals and the American Medical Association, structured our health care system so that we pay more than twice as much as other countries, and get worse care. These massive transfers are not the result of the wonders of the free market. These folks are getting money out of our pockets because their friends in Congress have rigged the deck so the money flows from us to them.

ROBERT PARRY
Serving the Medical-Industrial Complex consortiumnews.com - Not only are the Republicans - and some Democrats - standing against the desires for 72 percent of the population but, in effect, they also are trying to lock in 119 million unhappy customers for a profit-making industry, and compel nearly 50 million uninsured to buy insurance under penalty of fines. Even in the sorry history of special-interest-dominated Washington, it is rare for politicians to so blatantly adopt defense of a private industry over the will of the people.

Public Plan Opposition May Be Weakening
Huffington Post's Ryan Grim reports shift from top "co-op" backer: "Sen. Kent Conrad (D-N.D.) moved sharply toward public health care Monday, saying that he could 'absolutely' support major parts of Sen. Chuck Schumer's compromise proposal for a public option after closed-door negotiations ..."; Change.org's Tim Foley doesn't see the common ground: "So Conrad thinks he can reconcile a national health care co-op with state health care co-ops, perhaps in some symbiotic relationship where a state administration can somehow pool its purchasing power nationally. That's basically gobbledy-gook, and gets us no closer to figuring out if this co-op is a single entity or a network of co-ops, or somehow both and neither simultaneously. It might make for intriguing theology, but it makes for poor health reform policy."; Politico headline "Senators try to keep co-op hopes alive"; CQ on timeline for the Senate health committee and new CBO estimates: "The acting chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee is optimistic that the panel may be able to finish work on health care overhaul legislation this week, but Republicans aren't so sure ..."; Wonk Room's Igor Volsky lambastes Republicans for falsely claiming the CBO scored public plan option; 538's Nate Silver finds correlation between special interest dollars andopposition to public plan option; The Plum Line on new Organizing for America push: "Obama's Political Operation To Launch Big Database Of Health Care Stories"; 538's Ed Kilgore on real bipartisanship: "if Barack Obama wants to conduct a bipartisan approach to universal health care, what does that mean in terms of the public option? Killing or watering down the public option in order to (maybe) attract the support of Sen. Chuck Grassley, and not much of anybody else in the congressional Republican ranks? Or maintaining it to appeal to rank-and-file Republicans, who favor it despite the views of their 'leaders' and the polarized atmosphere in Washington?" (via The Treatment)

Public Plan Compromise? Baucus and Conrad telling Bloomberg that WH wants them to compromise with GOP: "White House Chief of Staff Rahm Emanuel met last night at the U.S. Capitol with Senate Democrats and told them Obama is 'open to alternatives' to a new government insurance program in order to get legislation overhauling the health-care system to his desk, said Senator Kent Conrad of North Dakota. "; Jonathan Cohn notes Obama has never made public plan option non-negotiable: "Obama refused--first implicitly and then explicitly--to say he'd veto a bill that lacked a public insurance option. This isn't exactly a break with the past."; Ezra Klein sees positives in Obama's response at press conference: "he defended the plan's substantive merits. His answer was, in other words, an effort at persuasion rather than diversion. The implication was that he, at the least, is genuinely convinced by the case for a public insurer."; Ezra Klein also says a good compromise can be reached: "If you've got [national structure and purchasing power] -- and if Schumer wins on the permanent board -- then you really are in a situation where it doesn't matter if you call this a co-op or a public plan."; Conservatives only want co-ops if they can't do anything. W. Post; Politico adds: "[Sen. Chuck Schumer] has been trying to negotiate a deal on an alternative to the public insurance option ... But Schumer said Republicans haven't been open to making changes to the nonprofit insurance cooperative model, which is considered the last hope to avoiding an impasse."; W. Post offers misleading analysis of own poll about public plan option, reports: "62 percent support the general concept, but when respondents were told that meant some insurers would go out of business, support dropped sharply, to 37 percent." BUT actual poll question hypothesizes more drastic result: "What if having the government create a new health insurance plan made many private health insurers go out of business..."; NYT flags CBPP criticism of Baucus funding proposal; Senate Finance hacking their proposal down to help less people. The Hill; Wonk Room rounds up yesterday's congressional testimony supporting public plan option; Change.org's Tim Foley on testimony from impassioned small businesswoman: "You hear a lot about how small businesses would get crushed by raising taxes on the wealthiest 1%, or how small business will be crushed by excessive regulations, or how small business would be crushed by a carbon tax or cap & trade. But those same people who claim to stand up for small businesses disappear when we're dealing with something that does crush small businesses - the no-win scenario of either letting the employees who feel like your family go without benefits, opting for the 'split the baby'solution of getting a high-deductible or high cost-sharing plan that you know will be insufficient, or subjecting to yourself to the slings and arrows of outrageous insurance monopolies, where the only safe prediction is that your costs will go up."; CQ: "The two Senate committees writing health care overhaul legislation are drawing closer to having mostly complete products ready after the July Fourth recess ... The Health, Education, Labor and Pensions (HELP) Committee is marking up its draft bill this week, but no longer with the intention of finishing before the recess."

JONATHAN WALKER
Public Option Genie Will Soon Be Out of the Bottle Very soon, the Congressional Budget Office will release a score for the House Democrats' draft health care legislation. Their bill contains a relatively strong self-financing public option. My research has led me to conclude that including a strong public option will result in the bill being scored several hundred billion dollars cheaper.

BRIAN DOCKSTADER
Mythbusting An Insurance Lobby Attack Ad This morning my breakfast was ruined, ruined by an anti-health care reform ad on TV.

Prime-Time Public Plan Pitch Health Care '09 rally and lobby day in DC today, organized by Health Care for America Now!; Jonathan Cohn on presidential prime-time health care town hall: "...he used the occasion to hammer away at a key point--one that, I increasingly believe, holds the key to the entire reform debate. On at least three separate occasions, Obama pointed out rising costs--left unchecked--are going to destroy the health care system. You might like your current insurance arrangements, Obama suggested, but there's no reason to think they'll be in place a few years from now. At best, your plan will simply become less comprehensive and/or more expensive. At worst, it will no longer be available to you. Or to put it more simply, change may be scary, but no change is even scarier."; Senate Finance plan will have the employer benefit tax. Bloomberg; CQ reports Senate Finance looking to lower costs by preventing business from dropping coverage; House Dems looks to lower price tag of reform by upping doctor payments. The Hill; NYT reports that "Senators" are worried "that in offering subsidized health insurance to millions of individuals and families, they could inadvertently speed the erosion of employer-provided coverage." BUT NYT only quotes right-leaning Dems, ignores new statement from 120 House and Senate members: "ROBUST PUBLIC OPTION A MUST." Huffington Post's Sam Stein reports MoveOn pressuring Sen. Feinstein to support public plan option. TPMDC finds potentially disingenuous GOP support for "co-op" plan: "Enzi supports the Finance Committee's process, which he said has been more transparent and bipartisan in spirit. He says the co-op proposal sounds promising, but he needs to learn more about it before he offers his full support to the provision ... This is a common position in the GOP, and, frankly, a common legislative tactic in general. It's not necessarily a wink and a nod toward a 'no' vote, but it raises concerns among Democrats--or at least it should--that Republicans might try to weaken the bill only to turn around and vote against it." How's that free market insurance treating ya? W. Post: "Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee."

ZRA KLEIN
The Truth About the Insurance Industry voices.washingtonpost.com - The issue isn't that insurance companies are evil. It's that they need to be profitable. They have a fiduciary responsibility to maximize profit for shareholders. The best way to do that is to cut "medical losses." The best way to cut "medical losses" is to stop insuring sick people.

ROBERT B. REICH
Why We Need a Public Health Care Plan online.wsj.com - Without a public option, the other parties that comprise America's non-system of health care - private insurers, doctors, hospitals, drug companies, and medical suppliers - have little or no incentive to supply high-quality care at a lower cost than they do now. Which is precisely why the public option has become such a lightening rod.

When to Ration Health Care - Michael Kinsley, Washington Post
Public Plan a Critical Part of Reform - Paul Krugman, New York Times
How ObamaCare Threatens Your Health Plan - Rich Lowry, NRO

A Sea Change in Public Opinion on Health Care? - C.R., Economix
Will Americans Go For It? - Jennifer Rubin, Contentions
Health Care Reform: Obama Takes on ABC - McJoan, Daily Kos

• Health Care Battle
  • Clash on How to Pay For It
  • Public Option Issue Not Resolved

Does anyone know why Robert Reich did not get a cabinet appointment? Are small "d" democrats excluded from the Obama Administration?

TERRANCE HEATH
End Health Disparities With Health Care For All The debate over health care reform has taken a particularly worrisome turn. Suddenly we're in a place where passing something kind of like reform may be more important than getting to reform itself. In the name of "compromise" and in interest of getting something passed, we could get bill that helps fewer people, and preserves more of the status quo. For minorities and low-income households that means more of the kind of disparities - in access to care, quality of care, and health outcomes - that are all too common in our present health care system.

Baucus Bill Scales Back Support for Working Families
W. Post on Senate Finance proposals to lower 10-year size to $1T: "Senate Budget Committee Chairman Kent Conrad (D-N.D.) said the Finance Committee had reduced the overall cost of its bill by cutting subsidy levels for uninsured people. He said members had not yet resolved the issue of the 'public option,' a government alternative to private insurance, although he said discussions continued to focus on a member-owned cooperative model ..."; NYT adds: "Assistance would originally have been available to people with incomes up to 400 percent of the poverty level ($88,200 for a family of four). Democrats have lowered the ceiling to 300 percent of the poverty level ($66,150 for a family of four). Senators said the cost of the bill might also be reduced by dropping or scaling back a plan to give tax credits to small businesses, to help them buy insurance.; Sen. Wyden seeks to add new tax deduction to complement reduction of old tax exemption. CQ; EPI: Why a public health insurance option is key to saving costs; Beat The Press' Dean Baker calls out W. Post again for ignoring health costs role in long-term deficits: "The Post (a.k.a. Fox on 15th Street) only told readers the second part of this story. CBO projected that the deficit would exceed 42 percent of GDP in 2080 under its baseline assumptions. This is like telling people what the deficit would be after a nuclear war without calling attention to the fact that the projection assumes a nuclear war. If the health care costs underlying these projections prove accurate, the economy will be so badly wrecked, no one will care about the size of the deficit."; NPR photog snaps crowd at Senate hearing, asks listeners to spot the lobbyists; Sen. Specter indicates new support for public plan option. TPMDC: "Speaking ... to a large and animated crowd of union organizers and health reform advocates in a brewing house just North of the Capitol, Sen. Arlen Specter (D-PA) said he supports a public insurance option. 'Schumer has it right about having a public component,' Specter said ... Before Specter switched parties this spring--and for a brief period afterward--he said he did not support the public option."; OurFuture.org has video from yesterdays' successful Health Care '09 rally of several thousand, featuring Sens. Sherrod Brown, Robert Menendez and Barbara Mikulski.

WH Not Drawing Lines On Health Care
On NBC's Meet The Press and ABC's This Week, WH adviser Axelrod supports public plan option and retaining benefits tax exemption, but leaves door open to compromise; Bloomberg speculates union contracts may retain tax exemption in compromise; Walker Reports sees rejection of false bipartisanship. "On This Week, David Axelrod redefined bipartisanship as simply including Republican ideas in the bill. He only 'hopes it will come with Republican votes.' This is new willingness on the part of the White House to go it alone on health care reform. I suspect what happened is the White House saw just how watered down legislation would need to be to get Republicans' support and was very not happy."; The Treatment's Jonathan Cohn details all the other critical issues to fight for beyond public plan option: "Will there be a maximum on out-of-pocket spending--and, if so, what will that maximum be? Will the government guarantee relatively good benefits for everybody? Or will people still end up taking out insurance that has huge cost-sharing--not to mention skimpy coverage of mental health and other traditionally neglected services? How much funding for reform will come out of the pockets of the health care industry--and how much out of the pockets of individual taxpayers? How aggressively will the government try to change the way medicine is practiced, to improve quality and reduce waste? How slowly will all of these changes be introduced?"

HEALTH CARE -- PODESTA AND DASCHLE PROMOTE PUBLIC PLAN, OUTLINE BUDGET-NEUTRAL PLAN TO PAY FOR REFORM: Yesterday, former Democratic Senate Majority Leader Tom Daschle and Center for American Progress (CAP) President and CEO John Podesta promoted a budget-neutral plan to finance health care reform, advocated for a strong public option as the best way to control health care costs, and urged Democrats to "not hesitate" in using budget reconciliation to push through legislation if Republicans opt to obstruct real reform. Both noted that any discussion of whether the Senate Democrats should use reconciliation or not is premature, but Daschle called reconciliation a "viable fallback option," and Podesta said "there is a point at which you have to move on" with reform. Obstructing reform would make Republicans "less and less relevant," Daschle warned, as Democrats move forward with reconciliation, which "would probably have a pure public option just because most likely it will only involve Democrats deciding what that reconciliation package will be." Responding to President Obama's call that reform should not add to the deficit, Daschle and Podesta endorsed a Center for American Progress report that says "taxing some employer-provided health benefits" should be considered to pay for reform. The report, by CAP fellow Judy Feder and Harvard Economist David Cutler, offers a series of "failsafe" proposals to pay for reform, such as "a 'pay or play' requirement for larger employers to either provide health benefits or pay toward employees' coverage through private plans or from the government" and higher taxes on "tobacco products, alcoholic beverages and sugar-sweetened drinks." Both Podesta and Daschle were optimistic that health care reform will pass this year, with Podesta declaring that a "better than 50-50 chance is maybe even a little bit understated."

PHILLIP CRYAN
No Compromise on the Public Plan!: Why Weakening the Public Option Would Weaken the Party Responsible Why are all the alternatives to a robust public plan now being floated in the health care reform debate - cooperatives, state or regional plans, a "trigger" for the public plan, a public plan prohibited from bargaining with drug companies - such profoundly bad ideas? For one simple reason: they would fail to rein in health care costs' out-of-control growth rate. And the effects of such a failure would very likely include not just unsustainable public budgets and the eventual collapse of universal health coverage but political calamity for the party that made the reform.

ALEXANDER ZAITCHIK
Bogus Think Tank "Third Way" Pops Up to Thwart Health Care Reform alternet.org - Third Way is drenched in corporate money, tangled in ties to big business and bent on Clintonian triangulation. How dare it call itself progressive?

PAUL WALDMAN
The Fretting Over Health Care Reform prospect.org - Is health-care history just repeating itself? Not quite.

RAHUL RAJKUMAR AND HAROLD POLLACK
Getting a Second Opinion on Health Care Reform latimes.com - There are voices besides the AMA. Lawmakers should understand that the group represents an increasingly narrow segment of the medical profession and that other organizations are more in touch with the public.

Senate HELP Draft Has Public Option Politico Pulse gets leak of Senate HELP cmte draft: "THE SENATE HELP COMMITTEE IS ABOUT TO COME OUT WITH A 'LEVEL PLAYING FIELD' OPTION SIMILAR TO WHAT SCHUMER PROPOSED IN MAY ... If HELP does go in this direction, it won't be as liberal as the House, but it will be a strong alternative to the coop plan that is the emerging idea in the Finance Committee, but that progressives hate."; Politico reports Republicans to launch health attack today: "Minority Leader Mitch McConnell (R-Ky.), Sen. John McCain (R-Ariz.) and Sen. John Cornyn (R-Texas) have set up a public discussion at the University of Texas MD Anderson Cancer Center in Houston on Tuesday, hoping to gin up public opposition to the public plan." Sen. Olympia Snowe tells AP she will only back a delayed "trigger" for public plan option: "Snowe said it would be unfair to include a government-run health insurance option that would take effect immediately."; Daschle pushes taxing of employer benefits and delay of public plan option. ABC; FDL's Jane Hamsher rips tax plan: "...taxing the benefits of people who agreed to work for $30,000 a year just so they could get health care coverage is a non-starter. We're well on the path to a 'grand compromise' where the insurance industry gets bailed out and the public gets screwed, because that's what the system is set up to do."; Republicans being threatened/cajoled to join in a compromise. AP: "Mainstream Democrats close to President Obama are warning Republicans about insisting on too many changes to the president's health care overhaul, saying the Democratic-controlled Congress will move ahead without GOP input if they do."; NYT adds: "Whether Mr. Obama can have a more bipartisan outcome with health care remains unclear. He has invested so much political capital in a health care bill that not to have legislation would be politically disastrous for him. If that means passing a bill without Republican support, some Democrats say, Mr. Obama will do it."; CBS poll show urgency for health reform hinges on income; Ezra Klein debunks notion public plan means price controls, pointing to Medicare; TPM's Josh Marshall exposes insurance industry real objective. Zero competition: "the opposition to a so-called 'public option' comes almost entirely from insurance companies who have developed monopolies or near monopolies in particular geographic areas. And they don't want competition."; Health Care for America Now blog reports on pressure being applied to western Senators; American Prospect editors debate public plan option. KevinMD indicates AMA rep has taken a hit; CQ reports CBO won't score savings for prevention.

Health Care Is Not a Right
by Jacob G. Hornberger

Amidst all the health care debate, there is one underlying assumption that hardly anyone challenges: the notion that people have a right to health care. The truth is that it’s a nonsensical notion. People no more have a right to health care than they have a right to education, food, or clothing.

After all, what does a right to health care mean? If I have a right to something, then doesn’t that mean that you have a correlative duty to provide it? If you’re a doctor, then it means that you are required to serve my needs, like it or not. If I need an operation, then you cannot say “no” because that would be denying me my right to health care.

Thus, isn’t the right to health care actually a power to force doctors to provide people with medical services?

Now, the proponent of health care as a right might say, “That’s not what I mean. Why, to force doctors to provide health care services to others would be akin to slavery, especially if it’s for free. I think that doctors deserve to be paid for their services.”

Fair enough. But then doesn’t the right to health care entail the power to force someone else to pay for it? Let’s assume, for example, that I need hip-replacement surgery that will cost $25,000 and that I don’t have the money to pay for it. Since I have a right to health care, that means that I have a right to get the money from you to pay for my operation. It also means that you can’t say no because that would be interfering with my right to health care.

Thus, the right to health care entails the power of everyone to get into the pocketbooks of everyone else. That’s not only a ridiculous notion of rights but also a highly destructive one. Since obviously people can’t go and take the money from others directly, it inevitably entails converting government into an engine of seizure and redistribution. Or to paraphrase Bastiat, such a concept of rights converts government into a fiction by which everyone is doing his best to live at the expense of everyone else.

Meanwhile, while everyone is using government to get into everyone else’s pocketbook to pay for his health care expenses, he is simultaneously doing his best to protect his own income and assets from being plundered by the government to fund everyone else’s health care bills.

Over time, it is easy to see how such a system devolves in everyone’s warring against everyone else. It is also easy to see that such a system obviously does not nurture friendly and harmonious relations between people. This is especially true when these types of “rights” expand to such areas as education, food, clothing, and housing.

The true nature of rights — the type of rights the Founding Fathers believed in — involved the right of people to pursue such things as health care, education, clothing, and food and that government cannot legitimately interfere with their ability to do so.

Thus, the right to life, liberty, and the pursuit of happiness, as described in the Declaration of Independence, doesn’t mean that someone else is forced to provide you with the means to sustain or improve your life. It means that government cannot enact laws, rules, or regulations that interfere with or infringe upon your right to pursue such things.

When Americans began looking upon rights as some sort of positive duty on others to provide them with certain things, that was when the quality of health care in America began plummeting. That was what Medicare and Medicaid were all about — the so-called right of poor people and the elderly to health care. It is not a coincidence that what began has the finest health care system in the world has turned into a system that is now in perpetual crisis.

There is one — and only one — solution to America’s health care woes — and it lies not in a government takeover of health care. In fact, the solution is the exact opposite: It is the end of all government involvement in health care — a total separation of health care and the state. That would entail not a reform or improvement of Medicare and Medicaid but rather their total repeal.

At its core, the solution to America’s health care crisis lies in the abandonment of the notion that health care is a right. Once people reach this fundamental realization, as our American ancestors did, the nation can get back on the road toward to a healthy, prosperous, and harmonious society.

Jacob Hornberger is founder and president of The Future of Freedom Foundation.

HEALTH CARE 7/1 1:10 P.M.
Medical Arrogance
Obama’s desired reforms would reduce the cost of health care? Improve quality? Enable people to keep their current insurance policies and doctors? Wrong on all counts. THE EDITORS

Largest Employer Backs Employer Mandate White House holds health care town hall at 1:15 PM ET; Wal-Mart joins SEIU to back employer mandate to provide insurance. NYT: "But Wal-Mart's embrace of the employer mandate may come at a price. In its letter, the company says that if Congress imposes a requirement that employers offer insurance, it must also offer a guarantee to business that health care costs will in fact be contained, perhaps through a so-called trigger mechanism that would impose reductions if certain spending targets were not met."; The Treatment's Jonathan Cohn says the move has real political impact: " By endorsing the idea of a employer mandate, Wal-Mart has made the idea more difficult to demonize. It has also - and I can't stress this enough - given some political cover to members of Congress who might be sympathetic to the idea of employer mandate but hesitate to take a vote that might be perceived as anti-business. " Wonk Room's Igor Volsky adds: "Wal-Mart's support for an employer mandate is highly significant, but so is its rejection the 'free rider provision' - a likely component of the Senate Finance Committee's bill ..."; Change.org's Tim Foley on the business split: "Clearly the Chamber of Commerce, with a snippy statement denouncing Wal-Mart's move as '[using] the government as a weapon against their competition,' takes this defection seriously."; OURFUTURE.ORG FLASHBACK: "Business Mandate Good For Business" Reactions to Senate HELP Cmte Public Plan Option; AP on Senate HELP cmte draft of public plan option; Health Care for America Now's Jason Rosenbaum approves: "This fulfills the broad requirements for a public option: Available everywhere and on day one, and accountable to Congress and the voters, as well as rate flexibility. Of course, things are still very much in flux and these details could all change, for better or for worse. But so far, so good."; Wonk Room Igor Volsky's agrees the HELP approach would lower costs; GoozNews more skeptical; Walker Reports awaits the CBO score.

Seventy-five percent of Americans who have been "pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured." Many experts say that fixing the health care system won't mean "simply giving everyone an insurance card." Too many Americans "already have coverage so meager that a medical crisis means financial calamity."

Today, the pharmaceutical lobby group PhRMA and the consumer health care advocate group Families USA are launching a "multimillion-dollar national television advertising campaign to urge lawmakers to pass quality, affordable health care reform." Watch the ads here.

Americans like government health care, but are not eager to pay for it Americans overwhelmingly like the idea of a government-run health program — but balk at the idea of paying more than $500 a year for it, a new Quinnipiac University poll found.

The survey of more than 3,000 voters nationwide from June 23 to 29 said that 69 percent thought people should have the "public option" Democrats are seriously considering as they write health care legislation.

But only 49 percent said they would pay more for a health care overhaul — 45 percent said they would not — and 72 percent did not want to pay more than $500 annually. And by a 63 to 30 percent margin, people opposed taxing employer-paid health benefits.

Other findings: Of the 88 percent of insured Americans, 49 percent are very satisfied with their coverage and 36 percent are somewhat satisfied.

"American voters want their fellow countrymen to have the option of a public plan, but don't want a public plan for themselves because they are satisfied personally with their health care," said Peter Brown, assistant director of the Quinnipiac University Polling Institute. "That presents a challenge to those who want Americans to pay more to reform the system."

Read the poll here.

HEALTH CARE -- NEW BUDGET ESTIMATE OF PUBLIC PLAN PROVES IT LOWERS COST AND COVERS MORE AMERICANS: A couple of weeks ago, the Congressional Budget Office (CBO) released a preliminary score of the health care legislation under consideration in the Senate Health, Education, Labor, and Pensions Committee. The bill was estimated to cost $1 trillion over 10 years, while reducing the number of uninsured by "only" one-third. As many informed observers noted at the time, the cost estimate was incomplete because the legislation that the CBO reviewed did not contain language about a public health insurance plan or an employer mandate. Nevertheless, Republicans seized on the opportunity to engage in merciless political attacks, citing the incomplete CBO score as proof that health care reform is not worth doing: Sen. Lindsey Graham (R-SC) said "the CBO estimates were a death blow to a government run health care plan," and Sen. John McCain (R-AZ) said "[the CBO estimate] should be a wake up call for all of us to scrap the current bill and start over in a true bipartisan fashion." But the proposal lacked a public health insurance option or an employer mandate, provisions that would drastically change the size, scope and estimate. Now the HELP committee has submitted a full bill -- and the result is drastically different. The "plan carries a 10-year price tag of slightly over $600 billion, and would lead toward an estimated 97 percent of all Americans having coverage." In addition, "the [employer mandate] provision is also estimated to greatly reduce the number of workers whose employers would drop coverage, thus addressing a major concern noted by CBO when it reviewed the earlier proposals." Additionally, the incoming president of the American Medical Association, Dr. J. James Rohack, said his organization now supports a public plan, after initially indicating its opposition, adding that the AMA supports an "American model" that includes both "a private system and a public system, working together."

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"The Hottest Places in Hell are Reserved for Those Who, in Times of Moral Crisis, Maintain a Neutrality" Tom Bozzo says to watch this video [parts of transcript below]:

Bill Moyers Journal: BILL MOYERS: Wendell Potter ... worked for CIGNA 15 years and left last year. ... why are you speaking out now?

WENDELL POTTER: I didn't intend to, until it became really clear to me that the industry is resorting to the same tactics they've used over the years, and particularly back in the early '90s, when they were leading the effort to kill the Clinton plan. ...

I was beginning to question what I was doing as the industry shifted from selling primarily managed care plans, to what they refer to as consumer-driven plans. And they're really plans that have very high deductibles, meaning that they're shifting a lot of the cost off health care from employers and insurers, insurance companies, to individuals. And a lot of people can't even afford to make their co-payments when they go get care... But it really took a trip back home to Tennessee for me to see exactly what is happening to so many Americans. I ... went home, to visit relatives. And I picked up the local newspaper and I saw that a health care expedition was being held a few miles up the road, in Wise, Virginia. And I was intrigued.

BILL MOYERS: So you drove there?

WENDELL POTTER: I did. ... It was being held at a Wise County Fairground. ... It was a very cloudy, misty day, it was raining that day, and I walked through the fairground gates. And I didn't know what to expect. I just assumed that it would be, you know, like a health-- booths set up and people just getting their blood pressure checked and things like that.

But what I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents, to care for people. I mean, there was no privacy. In some cases-- and I've got some pictures of people being treated on gurneys, on rain-soaked pavement.

And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee-- all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.

There could have been people and probably were people that I had grown up with. ... And that made it real to me. ...

It was absolutely stunning. It was like being hit by lightning. It was almost-- what country am I in? It just didn't seem to be a possibility that I was in the United States. ...

I had been in the industry and I'd risen up in the ranks. And I had a great job. ... I was insulated. I didn't really see what was going on. I saw the data. I knew that 47 million people were uninsured, but I didn't put faces with that number.

Just a few weeks later though, I was back in Philadelphia and I would often fly on a corporate aircraft to go to meetings.

And I just thought that was a great way to travel. ... You're sitting in a luxurious corporate jet, leather seats, very spacious. And I was served my lunch by a flight attendant who brought my lunch on a gold-rimmed plate. And she handed me gold-plated silverware to eat it with. And then I remembered the people that I had seen in Wise County. Undoubtedly, they had no idea that this went on, at the corporate levels of health insurance companies. ...

I didn't know exactly what I should do. You know, I had bills of my own. And it was hard to just figure out. How do I step away from this? What do I do? And this was one of those things that made me decide, "Okay, I can't do this. I can't keep-- I can't." One of the books I read as I was trying to make up my mind here was President Kennedy's "Profiles in Courage."

And in the forward, Robert Kennedy said that one of the president's, one of his favorite quotes was a Dante quote that, "The hottest places in hell are reserved for those who, in times of moral crisis, maintain a neutrality." And when I read that, I said, "Oh, jeez, I-- you know. I'm headed for that hottest place in hell, unless I say something." ...

BILL MOYERS: Your own resume says, and I'm quoting. "With the chief medical officer and his staff, Potter developed rapid response mechanisms for handling media inquiries pertaining to complaints." Direct quote. "This was highly successful in keeping most such inquiries from becoming news stories, at a time when managed care horror stories abounded." I mean, you knew there were horror stories out there.

WENDELL POTTER: I did. I did. ...

BILL MOYERS: You were also involved in the campaign by the industry to discredit Michael Moore and his film "Sicko" in 2007. ...

BILL MOYERS: So what did you think when you saw that film?

WENDELL POTTER: I thought that he hit the nail on the head with his movie. But the industry, from the moment that the industry learned that Michael Moore was taking on the health care industry, it was really concerned. ... They were afraid that people would believe Michael Moore. ...

The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you're heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern. ...

[P]art of the effort to discredit this film was to use lobbyists and their own staff to go onto Capitol Hill and say, "Look, you don't want to believe this movie. You don't want to talk about it. You don't want to endorse it. And if you do, we can make things tough for you." ...

BILL MOYERS: Now, that's exactly what they did, didn't they? They ... radicalized Moore, so that his message was discredited...

WENDELL POTTER: Absolutely. ... It worked beautifully. ... The film was blunted. It--

BILL MOYERS: Was it true? Did you think it contained a great truth?

WENDELL POTTER: Absolutely did.

BILL MOYERS: What was it?

WENDELL POTTER: That we shouldn't fear government involvement in our health care system. That there is an appropriate role for government, and it's been proven in the countries that were in that movie.

You know, we have more people who are uninsured in this country than the entire population of Canada. And that if you include the people who are underinsured, more people than in the United Kingdom. We have huge numbers of people who are also just a lay-off away from joining the ranks of the uninsured, or being purged by their insurance company, and winding up there.

And another thing is that the advocates of reform or the opponents of reform are those who are saying that we need to be careful ... because we don't want the government to take away your choice of a health plan. It's more likely that your employer and your insurer is going to switch you from a plan that you're in now to one that you don't want. You might be in the plan you like now.

But chances are, pretty soon, you're going to be enrolled in one of these high deductible plans in which you're going to find that much more of the cost is being shifted to you than you ever imagined. ...

BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are...

BILL MOYERS: And they do what to make sure that they [remain profitable]?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims...

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here...," Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

They'll resort to things like ... dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes. ...

BILL MOYERS: When a member of Congress asked the three executives who appeared before the committee-- if they would end the practice of canceling policies for sick enrollees, they refused. Why did they refuse?

WENDELL POTTER: Well, they were talking to Wall Street at that moment. ...

BILL MOYERS: This is the key question for me. Can health reform that includes a public plan actually rid our system of the financial incentive on the part of the insurance industry to provide less for more?

WENDELL POTTER: It will help. It would help. Would it rid it? No, I don't think it would, because of the for-profit structure that is now dominant in this country. But the public plan would do a lot to keep them honest...

The Bottom Of The Pyramid If a job’s worth doing, it’s worth doing well. So if you’re going to be a pusher, you may as well do it right:

Drug Firms See Poorer Nations as Sales Cure For the first time in a half-century, sales of prescription drugs are forecast to decline this year in the U.S., historically the industry’s biggest and most profitable market. The Obama administration and Congress’s attempt to pass legislation overhauling the health-care system, including provisions that could lower the cost of medicine, could put drug makers’ U.S. businesses under further pressure.

As a result, developing countries like Venezuela have begun to look more attractive to the industry. Sales of prescription drugs in emerging markets reached $152.7 billion in 2008, up from $67.2 billion in 2003, according to IMS Health, which tracks the industry. IMS forecasts sales will climb to $265 billion by 2013.

It seems that in the prescription drug business, emerging markets are where it’s at. Even in communist/socialist/whatever-it-is-it-doesn’t-matter-because-Hugo-Chavez-is-a-bad-guy-ist Venezuela. If you’re in the pill pushing business, go south.

Our friends at Pfizer understand this, and they’ve unveiled a dynamic new sales strategy to capture the ultimate in emerging markets. They’ve not only gone geographically south, they’re going socio-economically south as well. You could say they’ve hit bottom:

Until recently, drug companies doing business in emerging economies have catered mostly to the wealthy and middle class. Now, Pfizer is turning to what it calls, in internal marketing discussions, the “bottom of the pyramid.” Its program in Venezuela is an exercise in how to reduce prices enough to attract poorer customers while still turning a profit. “There’s an economy in the barrios,” says Rafael Mendoza, the man Pfizer has put in charge of the strategy in Venezuela, as he gestures toward the satellite dishes and air conditioners that dot Petare [a Caracas slum].

Selling drugs in American ghettos has always been profitable, so why not branch out and go global? There’s a lot of sick people at the bottom of the pyramid. If they’ve got cash to spend on satellite dishes and air conditioners, surely they can cough up some dough for Lipitor or Zoloft, or the Little Purple Pill?

…Read on

HEALTH CARE
Health Insurer's Practices Revealed
In an interview with PBS's Bill Moyers last Friday, former health insurance executive Wendell Potter spoke out against the practices of health insurance companies, stating that "it became really clear to me that the industry is resorting to the same tactics they've used over the years, and particularly back in the early '90s, when they were leading the effort to kill the Clinton [health care] plan." Potter said insurers seek to "drive down" costs by refusing to insure "unhealthy people," a tactic borne out by the fact that 47 million Americans currently lack health insurance. The "insurance industry has been one of the most successful, in beating back any kinds of legislation that would hinder or affect the profitability of the companies," said Potter, the former head of Corporate Communications at health insurance giant CIGNA. Last month, Potter told the Senate Committee on Commerce, Science, and Transportation that the industry, which once employed him regularly, drops sick policyholders so they can meet "Wall Street's relentless profit expectations."

BACK TO THE CLINTON PLAYBOOK: In 1993, right-wing pundit Bill Kristol urged Republicans to block any health care proposal in order to prevent the Democrats from being seen as the "generous protector of the middle class." Potter says similar tactics are being used this time around. In the spring, a memo by Republican strategist Frank Luntz outlined the script for opponents of health care reform. Luntz argued that a politician had to first pretend to support it, but should then use phrases like "government takeover," "delayed care is denied care," "consequences of rationing," and "bureaucrats, not doctors prescribing medicine." That jargon is now routinely heard by Republicans arguing against reform. Republican consultant Alex Castellanos recently authored a memo that urged conservatives to co-opt the cause of "bringing down health care cost[s]" in an effort to "slow this sausage-making process down" and "defeat" it. Potter told Moyers that conservative politicians "want to believe that the free market system can and should work in this country, like it does in other industries. ... They parrot those comments, without really realizing what the real situation is."

HOW INSURERS VIEW THE PUBLIC OPTION: Critics have charged that Obama's proposal to enact a new public health insurance plan to compete directly with private insurers would lead to a "government takeover" of the health care system. Progressives have long argued that a public health insurance option is essential to controlling skyrocketing health care costs and achieving affordable coverage for all. Potter agrees, and argued that health care companies' "biggest concern" is that the U.S. might adopt "a broader program like our Medicare program" which "could potentially reduce the profits of these big companies." "The industry doesn't want to have any competitor," said Potter. "They certainly don't want it from a government plan that might be operating more efficiently than they are." He added that "we shouldn't fear government involvement in our health care system. That there is an appropriate role for government, and it's been proven." Potter said that he doesn't expect the public option to rid the health care system of financial incentive, but he does think it would keep insurers "honest" by offering a "standard benefit plan" that provides comprehensive coverage.

SMEARING MICHAEL MOORE: In his documentary SiCKO, filmmaker Michael Moore exposed the deplorable practices of the major health insurance and pharmaceutical companies in working to deny coverage to insured individuals. Armed with the deep pockets of the health care industry, a number of front groups -- like Freedom Works, the Galen Institute, and the Heritage Foundation -- lobbed personal insults against Moore (such as perpetuating the false idea that "healthy individuals" would "wind up subsidizing people like Moore") in an effort to maintain the status quo. During the interview with Moyers, Potter said that health insurance companies developed a concerted strategy to radicalize Moore by labeling him a "Hollywood entertainer" while pushing to discredit SiCKO as pure "fantasy." But Potter said that he thought Moore "hit the nail on the head with his movie," which advocated that the government-run systems of other western democracies produce better health care outcomes. The health insurance companies "don't want you to think that it was a documentary that had some truth," Potter said. To push back on politicians, Potter said the industry routinely worked to defeat anyone who opposed their interests. The strategy included running ads, especially commercials in an elected official's home district, making contributions to a competitor, and using "lobbyists and their own staff to go onto Capitol Hill and say, 'Look, you don't want to believe this movie. You don't want to talk about it. You don't want to endorse it. And if you do, we can make things tough for you." Potter said the plan "worked beautifully" with politicians mouthing the "talking points that had been circulated by the industry."

> HEALTH: DEMOCRATIC HEALTH BILL DETAILS TAX CHANGES
> By Peter Cohn and Anna Edney
>
>
> House Democrats this afternoon unveiled a 1,018-page healthcare > overhaul
> bill, with Ways and Means Chairman Charles Rangel announcing his > committee
> will begin marking up its portion Thursday morning.
>
> The bill would impose a 1 percent surtax on households with modified
> adjusted gross income - or an AGI after deductions for investment > interest
> -- above $350,000, rising to 1.5 percent for joint returns reporting
> modified adjusted gross incomes of $500,000 or more, and then to 5.4
> percent for households with incomes greater than $1 million.
>
> Beginning in 2013, if at least $675 billion in savings are not > identified
> elsewhere in the healthcare system, the first two rates would rise > to 2
> percent and 3 percent, respectively.
>
> If at least $700 billion in savings are found within the health > system,
> then only millionaires would face a surtax, according to a copy of the
> bill.
>
> The bill also contains some revenue-raisers dealing with > international tax
> law and compliance.
>
> It would delay by a decade rules governing multinational firms' > worldwide
> allocation of interest expenses that were scheduled to take effect
> beginning in 2011. House Democrats have proposed a similar tax change
> several times over the last couple of years, arguing businesses > would not
> feel the brunt of ending a tax break that they have not yet enjoyed.
>
> Senate Republicans have opposed the move, arguing that some firms have
> been planning for the tax change since it was enacted in 2004. It also
> could compound the effects of a potential move next year to deny > companies
> deductions for their overseas interest expenses unless they repatriate
> overseas income back to the United States, industry sources argue.
>
> House Democrats also have included a provision, similar to one in > previous
> bills that the Senate has stripped out, limiting tax treaty benefits > for
> deductible payments such as rents and royalties made by U.S. > subsidiaries
> of foreign firms to affiliates in other countries.
>
> A similar proposal, long championed by Rep. Lloyd Doggett, D-Texas, > passed
> the House last year as part of alternative minimum tax relief > legislation
> and would have raised nearly $7 billion.
>
> The aim is to clamp down on "treaty shopping" in which a firm > organizes in
> a country that has a tax treaty with the United States offering > favorable
> withholding rates on deductible payments but with no substantial > business
> activities in that country.
>
> Foreign firms argue the provision is a blunt instrument that would > impact
> good actors along with a few bad ones.
>
> The House bill would also codify the economic substance doctrine,
> requiring firms to prove that a transaction was entered into for a
> substantive purpose other than to obtain a tax benefit. That > provision,
> included in President Obama's budget, was estimated to raise about $7
> billion in June.
>
> Rep. Mike Ross, D-Ark., chairman of the Blue Dog Coalition's Health > Care
> Task Force, said Monday night that Democrats had raised the small-> business
> exemption to the employer mandate to businesses with up to $250,000 in
> payroll from $100,000.
>
> House leaders and Blue Dogs had about a dozen concerns to work out, > and
> Ross anticipated the bill proposed today would need significant > changes to
> gain Blue Dogs' support.
>
> Under the bill, employers with payroll between $250,000 and $400,000 > would
> pay a smaller penalty than larger companies for not providing health
> insurance to their employees, according to a copy of the bill.
>
> Medium- to large-sized businesses must pay an 8 percent payroll tax > as a
> penalty for not providing insurance under the bill. The percentage > of the
> penalty shrinks to 6 percent, 4 percent and 2 percent for companies > with
> payroll between $250,000 and $400,000.

DEM HEALTH RX A POI$ON PILL IN NY

TERRIFYING 57% TAX LOOMS FOR BIGGEST EARNERS

By CHARLES HURT IN DC and DAVID SEIFMAN AND JENNIFER FERMINO IN NY, Post Wire Services

Congressional plans to fund a massive health-care overhaul could have a job-killing effect on New York, creating a tax rate of nearly 60 percent for the state's top earners and possibly pressuring small-business owners to shed workers.

New York's top income bracket could reach as high as 57 percent -- rates not seen in three decades -- to pay for the massive health coverage proposed by House Democrats this week.

OPINION: SLEDGEHAMMER HIT TO CRUMBLING EMPIRE STATE

EDITORIAL: HERE COMES OBAMACARE

OPINION: THESE PLANS WILL REDUCE YOUR CHOICE

The top rate in New York City, home to many of the state's wealthiest people, would be 58.68 percent, the Washington-based Tax Foundation said in a report yesterday.

That means New York's top earners, small-business owners and most dynamic entrepreneurs will be facing new fees and penalties.

The $544 billion tax hike would violate one of President Obama's ironclad campaign promises: No family will pay higher tax rates than they would have paid in the 1990s.

Under the bill, three new tax brackets would be created for high earners, with a top rate of 45 percent for families making more than $1 million. That would be the highest income-tax rate since 1986, when the top rate was 50 percent.

The legislation is especially onerous for business owners, in part because it penalizes employers with a payroll bigger than $400,000 some 8 percent of wages if they don't offer health care.

But the cost of the buy-in to the program may be so prohibitive that it will dissuade owners from growing their businesses -- a scary prospect in the midst of a recession.

Obama took to the airwaves yesterday with ads and TV interviews promoting the need to reform health care.

As a Senate health committee passed a different version of a health-care reform bill - a milestone for the issue - Obama said on NBC, "The American people have to realize that there's no such thing as a free lunch."

And in a Rose Garden speech, he said the "status quo" on health care is "threatening the financial stability of families, of businesses, and of government. It's unsustainable, and it has to change."

Asked if Obama supports the surtax on wealthiest Americans even though it would break a campaign pledge, White House spokesman Robert Gibbs said only, "It's a process that we're watching."

Republicans in Washington and small-business defenders in New York said the House legislation would effectively place a stranglehold on businesses while running off top earners.

A Very Unhealthy Health Bill - Diana Furchtgott-Roth, RealClearMarkets

Health care and national security

A while back I commented on the two imbalances of power that drive American grand strategy. The first is the gap between the United States and the other major powers, which makes Americans think they are responsible for managing much of the world and convinces them that they can do so with near-impunity. The second imbalance is the strength and political clout of a host of different institutions and interest groups whose common agenda is encouraging greater international activism on the part of the United States. In recent decades, the forces in favor of "doing more" have been better-funded and better-organized than those who favor greater restraint, which is one reason why we spend so much on defense and why we find ourselves entangled in intractable conflicts on several continents.

But when I read some early reports about the Obama administration's health care plans, I began to wonder if the various forces that favor global activism are going to face stiffer opposition in the future. We are likely to have a sluggish economy for some time to come and the U.S. population is getting older. Virtually everyone agrees that serious health care reform is badly needed but will cost a lot. Plus, Obama's various economic recovery measures are going to saddle us all with record deficit levels. Us baby boomers are not exactly noted for our altruism, and my generation is going to put a lot of pressure on politicians to deliver the entitlements we've been promised. All of this means that budget dollars are going to be very tight, and the Pentagon is going to face tougher scrutiny when it brings in gold-plated requests. The Nation and Mother Jones may not be all that formidable a political opponent, but what about the AARP?

One of the great triumphs of Reagan-era conservatism was to convince Americans that paying taxes so that the government could spend the money at home was foolish and wrong, but paying taxes so that the government could spend the money defending other people around the world was patriotic. Ever since Reagan, in short, neoconservatives supported paying taxes to promote a U.S.-dominated world order, while denouncing anyone who wanted to spend the money on roads, bridges, schools, parks, and health care for Americans as a "tax and spend liberal." But if I'm right about the emerging fiscal environment, that situation may be about to change.

TIM SLOAN/AFP/Getty Images

Stephen M. Walt

Massachusetts in Suit Over Cost of Universal Care
By ABBY GOODNOUGH Published: July 15, 2009 BOSTON — A hospital that serves thousands of indigent Massachusetts residents sued the state on Wednesday, charging that its costly universal health care law is forcing the hospital to cover too much of the expense of caring for the poor.

The hospital, Boston Medical Center, faces a $38 million deficit for the fiscal year ending in September, its first loss in five years. The suit says the hospital will lose more than $100 million next year because the state has lowered Medicaid reimbursement rates and stopped paying Boston Medical "reasonable costs" for treating other poor patients.

"We filed this suit more in sorrow than in anger," said Elaine Ullian, the hospital's chief executive. "We believe in health care reform to the bottom of our toes, but it was never, ever supposed to be financed on the backs of the poor, and that's what has happened in Massachusetts."

The central charge in the suit is that the state has siphoned money away from Boston Medical to help pay the considerable cost of insuring all but a small percentage of residents. Three years after the law's passage, Massachusetts has the country's lowest percentage of uninsured residents: 2.6 percent, compared with a national average of 15 percent.

Low-income residents, who have benefited most from expanded access to health care, receive state-subsidized insurance, one of the most expensive aspects of the state plan. But rapidly rising costs and the battered economy have caused more problems than the state and supporters of the 2006 law — including Boston Medical — anticipated.

According to the suit, Massachusetts is now reimbursing Boston Medical only 64 cents for every dollar it spends treating the poor. About 10 percent of the hospital's patients are uninsured — down from about 20 percent before the law's passage in 2006. But many more are on Medicaid or Commonwealth Care, the state-subsidized insurance program for low-income residents.

One of the state's reimbursement rates to Boston Medical, dropped from $12, 476 in 2008 to $9,323 by 2009, the suit says.

Wendy E. Parmet, a professor at the Northeastern University School of Law, said the suit was "a step in a wider minuet" as state lawmakers, health care providers and other stakeholders try to figure out how to make the new law work in the long term.

"I think it's going to be a very hard lawsuit for them to prevail on," Professor Parmet said of the hospital. "I think they're trying to bring another weapon into what is essentially, in many ways, a political and economic battle going on in the state about how to pay for health care, and making sure their voice gets heard."

The suit comes as Congress looks to Massachusetts as a potential model for overhauling the nation's health care system. Even before the suit, the state's fiscal crisis had cast doubts on the law's sustainability.

To help close a growing deficit, the Democratic-controlled Legislature eliminated coverage for some 30,000 legal immigrants in the new state budget. Gov. Deval Patrick, a Democrat, is seeking to restore about half of the $130 million cut, but lawmakers have expressed reluctance, saying that doing so would require cuts to other important programs.

State officials expressed surprise at the lawsuit, saying that Boston Medical received $1.5 billion in state funds in the past year and should not be seeking more in the midst of a fiscal crisis.

"At a time when everyone funded and served by state government is being asked to do more with less, B.M.C. has been treated no differently," said Dr. JudyAnn Bigby, the state secretary of health and human services, in a prepared statement. "We are confident that the administration's actions in this area comply with all applicable law and will be upheld."

State officials have suggested that Boston Medical could reduce costs by operating more efficiently. The state has also pointed out that the hospital has reserves of about $190 million, but Tom Traylor, the hospital's vice president of federal and state programs, said the reserves could only sustain the hospital for about a year.

"The magnitude of the loss here can't be solved on the program-cutting or expense-cutting side," Mr. Traylor said. Professor Parmet said the hospital's dissatisfaction with the new law should be a warning to Congress that "insurance alone doesn't solve the problems" of the health care system. In fact, she said, it might exacerbate the financial problems of safety-net hospitals in the short term.

Katie Zezima contributed reporting

http://www.nytimes.com/2009/07/16/us/16hospital.html?_r=1

Why We Must Ration Health Care
http://www.nytimes.com/2009/07/19/magazine...wanted=1&em

• Healthcare Reform
  • Senate Panel Approves Overhaul
  • Relies on Taxing the Wealthy
  • Sebelius: Healthcare Can't Wait
  • Dems Surtax Is Disastrous

• Healthcare Reform
  • CBO Questions Health Costs
  • White House Looks to GOP
  • House Dems Push Ahead
  • Relies on Taxing the Wealthy
  • Sebelius: Healthcare Can't Wait

• Health Care Battle
  • Obama Tries to Regain Momentum, Urges Speedy Action on Reform
  • CBO: House Bill Adds to Deficit
  • Obama: No Deficit Increases

http://www.ibdeditorials.com/IBDArticles.a...332548165656854

It's Not An Option
By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 15, 2009 4:20 PM PT

Congress: It didn't take long to run into an "uh-oh" moment when reading the House's "health care for all Americans" bill. Right there on Page 16 is a provision making individual private medical insurance illegal.

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

From the beginning, opponents of the public option plan have warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither. Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington's coverage.

The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, "fizzle out altogether."

What wasn't known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law.

The legislation is also likely to finish off health savings accounts, a goal that Democrats have had for years. They want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs.

With HSAs out of the way, a key obstacle to the left's expansion of the welfare state will be removed.

The public option won't be an option for many, but rather a mandate for buying government care. A free people should be outraged at this advance of soft tyranny.

Washington does not have the constitutional or moral authority to outlaw private markets in which parties voluntarily participate. It shouldn't be killing business opportunities, or limiting choices, or legislating major changes in Americans' lives.

It took just 16 pages of reading to find this naked attempt by the political powers to increase their reach. It's scary to think how many more breaches of liberty we'll come across in the final 1,002.