Republicans' attacks on the Senate Democrats' health bill kicked off with criticism about process as much as substance.
Senate Minority Leader Mitch McConnell at an October press conference in Washington. ( John Moore/Getty Images)
Majority Leader Harry Reid, D-Nev., spent weeks forging the bill "behind closed doors," charged the Republican leader Mitch McConnell, of Kentucky and his deputy, Jon Kyl, of Arizona, in statements right after the bill became public.
What about it? Squawking aside, secretive legislative engineering is business as usual for the Senate, say open-government advocates and former congressional aides, including one Republican. While the legislative process is often opaque (smoke-filled rooms, anyone?) nothing Reid did while combining bills from two Senate committees is beyond the pale, these Senate-watchers told us .
Senate Democrats' plan to overhaul health came in longer but cheaper than many people expected Wednesday. Still, with a cost of $849 billion and 2,074 pages of legalese, it's a bear of a bill to digest.
Sen. Harry Reid unveils his plan for health overhaul. ( Win McNamee/Getty Images)
Senate Majority Leader Harry Reid, principal architect of the legislation that melds the work of two Senate committees, got creative to pay for the proposed expansion of health coverage, estimated to reduce the ranks of the uninsured by 31 million over a decade.
Here are some of the ways he plans to raise the dough:
A "botax": Brace yourselves, denizens of Hollywood, Miami and Park Avenue, for a 5 percent tax on elective cosmetic procedures and surgery. Doesn't matter if you pay out of pocket or have insurance coverage, the tax applies across the board. Details start on page 2045 of the bill. Could raise$5.8 billion over a decade.
Some Republican lawmakers say the Democrats' health overhaul could land uninsured people behind bars, but it's a claim rooted in a rigid reading of the law around tax evasion that seems quite a stretch.
Rep. Peter Roskam of Illinois waves handcuffs during a floor speech. (YouTube)
The Wall Street Journalreports that House conservatives are saying "people who refuse to buy health insurance could spend five years in prison," an overhaul critique that has also cropped up in the Senate on the eve of its own floor debate. Like an earlier accusation that reform would create government "death panels," the claim doesn't stand up to scrutiny.
During the House debate early this month, Rep. Peter Roskam, R-Ill., said the individual mandate to buy health insurance in the Democrats' plan could mean jail time: "I'm not talking about figurative handcuffs," he added, waving a pair of shiny, police-style manacles as he spoke. "I'm talking about criminal penalties."
If Senate Majority Leader Harry Reid succeeds in moving a health bill onto the Senate floor, Republican Tom Coburn of Oklahoma has threatened to make the clerk read the whole thing aloud before debate can begin. Yikes!
Even if the Senate Democrats' bill comes in quite a bit slimmer than then nearly 2,000-page House version, the task could take days. So wouldn't it be nice to have a showbiz pro do the reading job?
We got to thinking about the possibilities after reading some fairly inspired suggestions put forth on Twitter. It's hard to top @pourmecoffee's idea of William Shatner, but @ezraklein gave it a go with Christopher Walken. Nice!
After kicking around some other names, we offer this slate for your vote.
The rumors are flying fast and furious that Senate Majority Leader Harry Reid will soon unveil to the world the health overhaul bill he's been working on for months after one last effort to rally the recalcitrant troops behind closed doors at 5 p.m. today.
Health overhaul poses a leadership challenge for Sen. Harry Reid. ( Brendan Hoffman/Getty Images)
Reid hopes to bring the bill--ostensibly a combination of the bills approved by two different Senate committees earlier this year--to the full Senate to begin debate as early as this weekend.
He's fighting not only the calendar -- Republicans have vowed to prolong debate for at least several weeks, probably pushing a final vote right up to the Christmas holidays -- but also his own caucus.
Dr. Nancy Nielsen, the immediate past president of the American Medical Association, urged lawmakers Tuesday to do away with once and for all looming cuts to Medicare's physician payments -- something her organization has demanded for years.
At issue is a 12-year-old formula--passed as part of a broader bill by a GOP Congress and signed into law by President Bill Clinton--that requires Medicare to squeeze physician payments when they outpace broader economic growth, which they have since 2003.
Congress has intervened to block such cuts to doctors' pay in each of the last seven years. But, those Band-Aids, as Nielsen calls them, are temporary. New cuts always loom in the next year.
Any day now, the Senate will start debating a health overhaul bill, opening the next big chapter in the administration's push to remake the nation's health-care system.
Next stop for health overhaul: the Senate. (Alex Wong/Getty Images)
Time hasn't been kind to the Democrats, though. Delays during the summer led to frothy town hall meetings and a general backlash against President Obama's plans. And despite the recent House passage of the Democrats' unified health bill, Americans remain "deeply divided" on health care, the Washington Postreports.
The latest Washington Post-ABC News national poll shows public opinion has hardened and remains "deeply divided" on the issue of health overhaul.
So far, the fight over the abortion ban language attached to the House health overhaul bill has mostly centered around "what ifs." But now the complex stories of federal workers affected by a similar ban implemented by Republicans over a decade ago are surfacing.
Take D.J. Feldman, a 41-year-old federal employee from around Washington, DC. She became pregnant in 2008 with a baby she very much wanted. But three months later, her fetus was diagnosed with anencephaly, essentially a lack of most of the brain, skull, or scalp. Such profound defects prevent the affected babies from ever attaining consciousness; most are stillborn.
Feldman's doctor told her she needed to end the pregnancy. "There was no doubt in her mind that this was medically necessary," Feldman said of her doctor's advice. So Feldman went to a local hospital and had the abortion.
A law to remake health care in this country doesn't have to be perfect, but it does have to get passed to make a difference, former President Bill Clinton told Senate Democrats Tuesday.
Former President Bill Clinton is mobbed by reporters after talking about health care during the Democrats' weekly caucus inside the Capitol Tuesday. (Tim Sloan/AFP/Getty Images)
"I think it is good politics to pass it and pass it as soon as they can," he said to reporters who packed a Capitol hallway to get his take on the current health debate. "The worst thing to do is nothing."
Mindful of Clinton's failure to enact sweeping health-care legislation during his presidency, President Obama and Democrats hope this time is different. While House Democrats passed their measure late Saturday, it's unclear when the Senate will begin debate.
On Saturday night, before approving its landmark health bill, the House adopted an amendment offered by Rep. Bart Stupak, D-Mich., to tighten restrictions on abortion funding in the bill.
That much everyone agrees on. And that's about all everyone agrees on.
Supporters say it merely continues a long history of prohibiting federal funding of abortion. "Let us stand together on principle. No public funding for abortion, no public funding for insurance policies that pay for abortion," said Stupak on the floor.
But abortion-rights backers are calling it the biggest rollback of abortion rights in a generation.
One reason it's been hard for some conservative pundits to know exactly what to make of Rep. Anh "Joseph" Cao's vote for the Democrats' health overhaul over the weekend is that he's only been a declared Republican for a couple of years.
Rep. Anh "Joseph" Cao smiles at an election victory party in New Orleans in 2008. (Alex Brandon/AP)
But, as New Orleans native and American Spectator senior editor Quin Hillyer put it, "The man never claimed to be a fully committed economic conservative."
In fact, Cao's Republican affiliation is still in its infancy. He joined the party Dec. 6, 2007, exactly one year before being elected to Congress on the GOP ticket, a spokesman for the Louisiana Secretary of State told us. Cao had been registered as an unaffiliated voter at his current address since September 2000. (Older records weren't available through the state office).
It was early summer. A senior federal health official wrote a memo suggesting that living wills -- documents that can convey patients' wishes about when to end life support -- could help curb health-care costs.
The memo leaked to the media. By August, a New York Times' column said the official "likes euthanasia."
Sound like this year's angry August? Well, this story unfolded in 1977, and the official in question was Robert Derzon, the first administrator of the Health Care Financing Administration, now the Centers for Medicare and Medicaid Services.
The loneliest Republican in Washington today is Rep. Anh "Joseph" Cao, the only member of the GOP to vote for the health overhaul bill put together by the Democrats in the House.
Republican Rep. Joseph Cao and his daughter listen to President Obama at a town hall meeting about the Gulf Coast recovery on October 15, 2009, in New Orleans. (Chris Graythen/Getty)
Sure, Cao's got a lot of new Democratic pals, including President Obama, but we're not sure we'd want to be him at his next meeting with Republican leaders.
The Stupak amendment to the House bill, restricting abortion coverage, removed a big hurdle for Cao, a devout Catholic, to vote yes. Wooing by Obama didn't hurt.
As the House heads for a showdown vote this weekend on its huge health overhaul bill, it remains unclear whether Democrats have the 218 votes they need to pass their measure. And abortion is a big reason why.
Abortion protesters gave Congress an eyeful and an earful this week. (Chip Somodevilla/Getty)
There have long been so-called "pro-life" Democrats; otherwise liberal members who are also strongly anti-abortion. Many of them are also strongly pro-health overhaul, but they want very much to write strict limits on federal funding of abortion into the bill. Such limits are strongly opposed by a majority in their party, but at the moment, there just may be enough of those anti-abortion Democratic votes to threaten the bill's passage.
The closeness of the vote has abortion foes from outside Washington feeling emboldened. But the vehemence of the anti-abortion demonstrators last week as House Democrats' unveiled their health overhaul bill even took some hardened reporters aback.
A little-noticed provision tucked into the House's nearly 2,000 page bill would require chain restaurants and operators of vending machines to post calorie counts for the food they sell. Don't feel bad if you missed it, it's stuck down in Section 2572, starting on page 1,510.
Will calorie counts like these keep consumers from buying the burger? (Chris Hondros/Getty)
New York already requires chain restaurants to post calories. And California isn't far behind. But the House bill would take the concept national, make calorie counts prominent, and also require the display of suggested daily calorie intake. Maybe then Americans could make a more considered decision about the Big Mac (540 calories) or Premium Southwest Salad without chicken (140 calories), please, they're about to scarf?
The move is being lauded by supporters, such as Rep. John Larson a Democrat from Connecticut, who said in a statement that the menu changes would empower Americans "to make their own health care choices." Empowering, perhaps, but the changes sound like a fair amount of work for those in the restaurant biz. Nevertheless, the National Restaurant Association "strongly supports" the provision, a spokesman for the trade group told us.
Here comes the AARP to endorse Democrats' health legislation, just in time for big votes on the House floor that could come as soon as Saturday.
President Obama speaks about health care during a meeting at the AARP's headquarters in Washington. At left is AARP President Jennie Chin Hansen. (Saul Loeb/AFP/Getty Images)
The Associated Press reports the influential group representing retirees and older people will publicly back the unified health legislation in the House. The AARP Web site promises "a major health reform announcement" at 11:30 EST today.
AARP's support would give House Democrats a big boost. Half of Americans over 50 belong to the organization, AARP's lobbying director David Certner told NPR's Peter Overby.
The Congressional Budget Office did its number-crunching magic on the House Republicans' health proposal and found that the bill wouldn't cost much--or put much of a dent in the ranks of the uninsured.
House Minority Leader John Boehner offers a "Republican Solution" to health overhaul. (Harry Hamburg/AP)
Assuming the Republicans prevail and their bill became law before the end of this year, the CBO figures about 3 million more people would have health coverage a decade from now. That would leave about 52 million nonelderly people in this country uninsured in 2019.
The bottom line, from CBO Director Doug Elmendorf's blog, "The share of legal nonelderly residents with insurance coverage in 2019--83 percent--would be roughly in line with the current share."
Extending insurance coverage to tens of millions of people who don't have it is one thing. Slowing the rise of health spending is another, and a lot harder task at that.
Do the plans for overhaul offer more than a Band-Aid for health costs? (iStockphoto.com)
Critics of Democrats' plans to overhaul the nation's health system say the proposals to date skirt the fundamental cost problem of American health care.
"The bills are directionally correct, but they're not going far enough," George Halvorson, CEO of Kaiser Permanente, tells the Washington Post.
Some versions of the healthcare overhaul bill would require health plans to cover "religious or spiritual health care." It may not be quite as hot a button as abortion coverage, but the amendment has Congressional tempers flaring.
Should prayer be considered health care? (iStockphoto)
The Los Angeles Times reported on the topic today, pointing to the version of the bill passed by the Senate health committee that includes coverage for prayer and other religious "health care." Sen. Majority Leader Harry Reid is still deciding whether or not to cut the provision from the consolidated bill that will go to the Senate floor, the paper said.
In the House, two committees voted to include spiritual coverage. But after some members argued the church-state co-mingling was unconstitutional, House Speaker Nancy Pelosi nixed it from the consolidated health bill unveiled last Thursday.
Even though Halloween is safely past, the health bill House Republicans plan to offer as an alternative to the Democrats' proposal is creeping up on us with a strong feeling of deja vu.
That's because the 230-page draft contains a laundry list of material the GOP has trotted out for years but has never quite gotten through Congress. (To see a PDF of the bill, click here.)
For instance, Association Health Plans--a way for small businesses to join forces to offer insurance--are in here, although they've been shot down many times before over concerns that they would have lax oversight compared to their competitors.
The bill also would free insurance companies to sell across state lines -- an idea popularized in recent weeks by Rush Limbaugh.
House Minority Leader John Boehner speaks behind a copy of the Democrat's version of the health care bill during a news conference on Capitol Hill in Washington, Thursday, Oct. 29, 2009.
(Harry Hamburg/AP)
The aim of the Republican bill? To "make the current system work better," Minority Leader John Boehner said over the weekend.
He announced the change in the Saturday Republican video address, and ex veep candidate Sarah Palin plugged it on her popular Facebook page, calling it a "game changer."
Allah Pundit of the major conservative opinion site Hot Air says that's an unusual endorsement from Palin -- she's usually critical of party leaders.
If you had any doubt about the challenge of buying health insurance on the individual market, just ask Doug Holtz-Eakin. Remember him?
Doug Holtz-Eakin listens to questions about preexisting conditions during a forum hosted by Congressional Republicans last week. (Chip Somodevilla/Getty Images)
Holtz-Eakin, a 51-year-old policy wonk, is still unemployed a year after his gig as Sen. John McCain's top health guru dried up along with the Arizona Republican's bid for the presidency.
Now, the Washington Postreports, Holtz-Eakin's coverage under COBRA is about to run out and his outlook for an individual policy is grim.
When it comes to revamping the nation's health system, President Obama drew a $900 billion budget line in the sand for getting the job done.
A billion here and a billion there starts to add up. (iStockphoto.com)
The unified bill from House Democrats walks right up to the line but doesn't cross it, with a net cost of $894 billion over 10 years, the Congressional Budget Office estimates. It may also seem pretty close to the $829 billion Sen. Max Baucus' bill would add to the federal tab.
But with all that money riding, we figured it was worth taking another look. First off, there's just no doubt that insuring more people will cost a lot of money. The net spending exceeds more than $1 trillion over a decade.
If the 1,990-page health bill trotted out Thursday isn't hefty enough for you, just wait a little while. There's more material on the way.
House Minority Whip Roy Blunt warns there could be surprises in an amendment to the House health bill. (Brendan Smialowski/Getty Images)
Up next is a "manager's amendment" from House Democratic leaders that could run 800 pages or more and contain all sorts of surprises that nobody will know about until shortly before lawmakers have to vote on it, Rep. Roy Blunt, a Missouri Republican, warned Thursday.
"This won't be the bill that comes to the floor," Blunt said at news conference where a copy of the House Democrats' plan was piled on the podium. At the session, Republicans said the measure would raise taxes, cost jobs and deepen the federal deficit, charges House Speaker Nancy Pelosi of California and her Democratic colleagues dispute.
The notion that Americans spend $700 billion a year on health care that doesn't leave them healthier is Exhibit A in the Obama team's case that health costs can be cut without rationing.
Budget director Orszag testifies at a June hearing. (Mark Wilson/Getty Images)
White House budget director Peter Orszag often plays first fiddle in the efficiency ditty, writing in his blog last spring that such spending "subjects you and me to tests and procedures that aren't necessary and are potentially harmful -- not to mention wasteful."
Now an independent report by a unit of Thomson Reuters appears to back that up. A white paper, released this week, estimates that the nation wastes between $600 billion and $850 billion a year. It fingers specific categories of waste, such as administrative inefficiencies ($100 billion to $150 billion), unneeded medical services ($250 billion to $325 billion), fraud and abuse ($125 billion to $175 billion), and others. The paper had no outside sponsors.
Down in Florida this week, visiting with seniors in a place called Sunrise, House Speaker Nancy Pelosi adopted a shiny new name for the "public option" -- the issue on which hangs the fate of the health care overhaul.
She called it "a consumer option," adding that her moniker was more accurate because "public" implied it would be taxpayer-paid. "Which it is not," she added. But the new lingo will get a lot of use now that the Democrats have unveiled the House's new health bill. (See all 1,990 pages of the bill here.)
But will the new name stick? Not if history has much to say about it.
Today is the day House Speaker Nancy Pelosi is set to unveil the Democrats' unified bill to overhaul health care.
What's in the proposal, which melds the work of three different House committees over the summer? Some form of public option and an expansion of Medicaid for the working poor, allowing people making up to 150 percent of the poverty level to qualify for it, the Washington Postreports.
How much will it cost? The Post writes the House legislation would run up a tab just shy of $900 billion over a decade. It's not expected to add to the federal budget deficit over at least 20 years thanks to some Medicare cuts and new taxes, for what that's worth.
NPR's Julie Rovner says the biggest issue for House Democrats wrangling votes is the flavor of public option to include.
Another reason to start saving your money, or at least consider spending your Golden Years on the Great Plains, is the rising cost of long-term care.
A fresh survey from the health insurance industry shows the cost of all sorts of care--from nursing homes to assisted living communities--continues to climb. Care in some states costs a lot more than others, too.
(iStockphoto.com)
The Mature Market Institute, the research arm of insurer MetLife, just released a survey that shows North Dakota's assisted living costs are the lowest in the nation -- about $2,000 a month, in 2009. The same care in Wilmington, Delaware, where our grandmother lives, averages $5,219 a month. Ouch. We have some questions for the Veep.
Senate Majority Leader Harry Reid says he's always looking for Republicans to support his party's policy initiatives but they're hard to find. Yet the move he made Monday may chase away Sen. Olympia Snowe, the only Republican who has so far supported Democrats' efforts to overhaul the nation's health care system.
Sen. Max Baucus talks health care with Sen. Olympia Snowe earlier this month. (Alex Wong/Getty Images)
Reid, who has been trying to merge two Senate committees' health overhaul plans, said he intends to include a version of the "public insurance option" that would allow states to opt out by 2014 if they don't like the program.
But Snowe, the senior senator from Maine, says a public option should kick in only if affordable coverage proved unavailable to 95 percent of residents in any state. She voted earlier this month with Senate Finance Committee Democrats to support chairman Max Baucus's health care legislation, but she said that was not guarantee of her future support.
Well, the public option just got another lease on life.
Sen. Harry Reid of Nevada says the public option is back on. (Chip Somodevilla/Getty Images)
Senate Majority Leader Harry Reid of Nevada has now confirmed publicly what's been flying around as rumor for a few hours. A unified Senate bill to overhaul the nation's health system will include a government-sponsored program in the insurance market. In a nod to critics, states that don't want to go that route can opt out.
Reid said a public option is "an important way to ensure competition" and polls show Americans support the approach. Within a few hours the proposal will go to the Congressional Budget Office for the verdict on cost, and we could see the details in a day or two.
Importantly, Reid said he had the support of Montana Democrat Max Baucus and the White House in making the change, signaling the Democrats may now calculate they have a better chance of getting 60 votes in the Senate with the public option than without it.
We're new here in Washington, so most of the political folkways are lost on us. Much of what happens seems like "dynamic equilibrium," one of the few things we remember from high school chemistry class. Lots of little things change, canceling each other out, so nothing big seems to budge.
House Speaker Nancy Pelosi continues to push for a public option.(Lauren Victoria Burke/AP)
So, we wonder, is there really progress on adding a "robust public option" to health overhaul, after a key Senate committee seemed to send the idea to its doom? During the day yesterday, it sure seemed like it, with House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid talking it up.
Today? Not so clear. As Politico's Mike Allen writes today, Pelosi isn't so sure she can get the votes for the government-sponsored alternative she prefers.
How would doctors across the country actually like an overhaul that brought health coverage to the uninsured? Pretty well, if it rolls out anything like the one in Massachusetts.
Three years after the state enacted a law mandating health coverage for just about everyone, less than 3 percent of people there are uninsured.
So far, so good, doctors say. Seventy percent of more than 2,100 Massachusetts physicians polled recently gave the reform law a thumbs-up. Just 13 percent opposed it; 16 percent didn't know or wouldn't answer the question.
Yes, we know the numbers add up to 99 percent, but that's because of rounding, the pollsters at Harvard School of Public Health say. The results just went up on the Web site of the New England Journal of Medicine.
The government isn't going to kill your Grandma in the new health overhaul bill, but if she's rich, she better get ready to pay more for her Medicare.
Some Medicare beneficiaries may be on the hook higher premiums. (iStockphoto.com)
That's the word that came out, very quietly, from officials at the Centers for Medicare and Medicaid on Friday. Buried in a Federal Register notice (and in a press release that somehow didn't get posted to the agency's website until this morning) is the official news that premiums for Medicare Part B (the coverage for outpatient and physician services) are rising to $110.50 per month next year, up from this year's $96.40.
Now the vast majority--73 percent--of Medicare beneficiaries won't face higher bills. That's because Social Security isn't granting a cost-of-living increase next year, for the first time in more than three decades. The two are connected because the vast majority of Medicare enrollees have their Medicare premiums deducted from their Social Security checks, and, by law, Medicare increases can't result in a net deduction in the amount of that check.
Sometimes how journalists cover a story becomes part of the story.
Click on the image for an interactive map from NPR showing the uninsured by state and congressional district.
Recently, NPR health editor Joe Neel, who sits just down the way from us, put together an email that went to member stations with some guidance on how best to characterize the number of uninsured in this country.
The email spread and led to a fair amount of chatter on Twitter and a piece by the Business & Media Institute.
So in case you're interested, we figured we'd give you the full text to chew on. The bottom line: about 46 million in the country are uninsured , but about 16 million aren't citizens.
There's nothing quite like a landmark Senate vote to focus the minds of folks worried about how changes to the nation's health system could hurt their livelihoods.
Karen Ignagni, president of America's Health Insurance Plans, says current plans for health overhaul would raise insurance premiums. (J. Scott Applewhite/AP)
Leaders of the attack pack: insurance companies. And the administration, which this summer cast overhaul largely as insurance reform, has been fighting back pretty hard. The Washington Postsays, "What was a tenuous truce has turned quickly into an all-out battle, with both sides ratcheting up the hostilities."
We're not against any overhaul--just this overhaul, the insurers say. Karen Ignagni, president of the trade group America's Health Insurance Plans, stopped by NPR's All Things Considered Tuesday to defend a controversial report commissioned by the industry that said premiums for just about everyone will go up, if final legislation looks like the version just passed by the Senate Finance Committee.
Maine Republican Olympia Snowe ended the suspense and said she would vote yes on the Senate Finance Committee's health bill.
Sen. Olympia Snowe (R, Maine) beams after saying she would vote for the Senate Finance Committee's bill to overhaul health care. (Charles Dharapak/AP)
She made Sen. Max Baucus's day, and maybe his summer and fall, too. The Finance chairman finally has a Republican vote to show for his deliberate and compromise-laden approach to remaking the health system. "When history calls, history calls," she said.
But don't get carried away, Snowe warned. She could change her mind and vote nay down the road, if health legislation takes a different shape. "My vote today is my vote today," she said.
Just about everybody, including us, is pretty sure the Democrats on the Senate Finance Committee will all vote to move along the health bill championed by Chairman Max Baucus. That should get the procedural job done.
Sen. Max Baucus talks health care with Sen. Olympia Snowe. (Alex Wong/Getty Images)
But what about the fig leaf of bipartisanship? Baucus labored long and hard to get at least one Republican on board. His last shot is Maine's Olympia Snowe.
She's sympathetic to Baucus's aim to extend health care to the uninsured. Bloomberg weighs in with a profile of Snowe, orphaned at 9 and long known for her independent streak.
Many people thought this day would never come. And despite duelingstudies about the impact released over the weekend, the Senate Finance Committee votes on a bill to revamp the nation's health system.
The Senate Finance Committee gets down to the numbers that matter most--votes. (iStockphoto.com)
So we've assembled a few fun numbers to help you wrap your heads around the progression of events.
Eleven months ago, Senate Finance Committee Chairman Max Baucus unveiled his "white paper," outlining his vision of an overhauled health-care system.
Five months ago, Baucus went behind closed doors with a core groups of three Republicans and two fellow Democrats -- the infamous Gang of Six -- to see if he could craft the only bipartisan health bill in Congress.
Three weeks ago, he acknowledged that significant bipartisan agreement on this issue was not gonna happen and brought a more Democratic measure to the committee.
While Congress haggles over the details of a massive health-care overhaul, at least a few people will no longer have to worry about losing their health insurance if they get sick: college students who are still covered under their parents' health plans.
Standing behind a picture of her daughter Michelle, AnnMarie Morse talks about Michelle's Law with U.S. Rep. Paul Hodes, D-NH. (Jim Cole/AP)
Today a law Congress passed last year becomes effective. It's known as Michelle's law, after Michelle Morse, a New Hampshire college student who was diagnosed with colon cancer in 2004.
After her diagnosis, the Morse family discovered something sad and tragic about most health insurance policies -- young adults over 18 usually can't stay on their parents' plans unless they're full-time students. But if they develop a serious illness and drop out of school, they probably can't get their own health insurance, either.
Now we have the official number for how much reforming the nation's medical malpractice system could save: $11 billion this year.
Is 0.5% of health spending a lot or a little? (iStockphoto.com)
How you see the estimate, just issued by the Congressional Budget Office, is something altogether different.
Aha! say the advocates of caps on malpractice and other measures to rein in suits against doctors. That $11 billion is real money. And there's the $59 billion in deficit reduction over a decade, the CBO estimates."That's not chump change," Republican Sen. Chuck Grassley of Iowa said in a statement. "It's a no-brainer to include tort reform in any health care reform legislation."
As Washington wrangles over how to expand health coverage, some folks are taking direct action to help the uninsured right now.
People wait to be screened for a chance at free surgery in Pueblo, Colo. (Cameron Allen)
This Saturday in Pueblo, Colorado, more than 40 people are expected to have surgery free of charge for everything from bad gallbladders to balky knees. There will even be a few vasectomies and tubal ligations.
It's another charity treatment marathon on US soil involving groups that used to think more about helping impoverished people overseas. Similar though much larger events in Los Angeles and Virginia have shined a light on the plight of the uninsured.
So Sen. Max Baucus and the Democrats on the Senate Finance Committee are feeling pretty good about cobbling together an overhaul bill that came in at a relatively affordable $829 billion over 10 years.
Will the young and healthy jump into an overhauled insurance pool? (iStockphoto.com)
But some of the compromises to pull that off are drawing fire now. Namely, slim subsidies for the middle class and a last-minute pullback on penalties for folks who skip buying insurance.
"You need everybody in the insurance pool to make sure that premiums are affordable," Alissa Fox, a senior vice president with the Blue Cross and Blue Shield Association, told NPR. "And lowering the penalty will mean that people will find it more advantageous to pay a very small penalty than to buy insurance."
Nobody will make much progress in taming health-care spending in this country without getting doctors on board.
A medical mystery unraveled in Lewiston, Maine. (NPR/John W. Poole)
In the first installment of a series on escalating health costs, NPR's Alix Spiegel takes a look at the curious case of Lewiston, Maine, where back in the 1970s so many women were getting hysterectomies that 70 percent of female residents were likely to have had one by the time they reached 70. In a nearby town the hysterectomy rate was more like 25 percent.
How come? The big difference wasn't the patients, it was the doctors. The ones in Lewiston recommended hysterectomies far more often than their peers elsewhere.
In the end, all health care is local. Where you live continues to makes a big difference in your health status, access to care and how much that care costs.
Click on the image for an interactive map. (Commonwealth Fund)
In a state-by-state scorecard put together by the nonprofit Commonwealth Fund, Vermont comes out at the top of the heap. The Green Mountain state was the only one to score in the top quartile on five key measures: access to care, prevention and treatment, avoidable hospital use and cost, fairness, and health status.
Bottom of the list? Mississippi, which scored in the lowest quartiles across the board.
The most anticipated numbers since the tally of votes in this year's "American Idol" are out: the Congressional Budget Office score of the Senate Finance Committee's health overhaul bill.
And the news for Chairman Max Baucus (D, Mont.) is mostly good. CBO says his revised overhaul plan would cost a total of $829 billion over 10 years, well under the $900 billion goal set by President Obama. (See the CBO blog here for more info and read the letter here.)
Even better, the CBO figures the Baucus plan would reduce the federal deficit by $81 billion over the next decade. Although CBO isn't really supposed to make projections longer than 10 years into the future, the number-crunchers expect the bill would probably reduce federal deficits beyond 2019, too. All that bodes well for a committee vote by the end of the week to send the bill to the Senate floor for debate.
Depending on where you work, your weight could be an important preexisting condition that determines how much you'll have to kick in for health coverage.
(iStockphoto.com)
More and more bosses are tying employees' share of insurance costs to their BMIs. That's Body Mass Index, a number calculated by comparing your height to your weight. Experts consider a BMI of 30 or greater to qualify a person as obese. Around 19-25 is considered normal, and less than 18.5 is underweight.
NPR's Morning Edition reported Tuesday about grocery chain Safeway charging employees about $318 more a year for health coverage if their BMI scores are above 30. Alabama has already adopted a similar approach for state employees, where workers with BMIs of 35 or more face surcharges of $25 per month. North Carolina is headed down the same road.
Rate this! Consumers Union, the nonprofit publisher of Consumer Reports, is throwing its weight behind a health overhaul.
How come? Well, take a look at the results of a national poll by CU that found 51 percent of Americans have had to make a tough choice regarding their health and cost in the past year. Those choices were such things as not going to the doctor when they should, skipping out on medical bills, or deciding not to take needed medicine because of the expense.
To make its stance clear, CU, which has an active consumer advocacy arm, is launching a TV ad in support of health reform. That's a first for a policy issue in the organization's 73-year history.
"Many Americans are one pink slip--or one major illness away--from losing their health coverage," says Consumers Union President Jim Guest in the TV spot. "Washington, the time for health care reform is now."
On a Kimmel dare, the musician T-Pain used his eponymous iPhone app "I Am T-Pain" to remix highlights from President Obama's speech to a joint session of Congress and some other clips for musical comic effect. Maybe the president should have thought of this himself.
Now we can show you the little helpers Senate Finance Committee Chairman Max Baucus has leaned on during the mind-numbing mark up of his bill to overhaul health care.
As NPR's Julie Rovner wrote yesterday, the Montana Democrat has kept his bearings the last couple of weeks with two cheat sheets--one to keep him smiling and the other a reminder to beware of Republican blandishments.
Sen. Max Baucus reveals his secret cheat sheets. (Evan Vucci/AP)
If you have trouble reading them, the sheet on the left has a smiley face with a curlicue of hair and the one on the left bears the message, "Do Not Take The BAIT!!"
Finally, a health bill looks ready to head to the Senate floor from the Finance Committee, last of the five congressional panels crafting a plan to overhaul the nation's health system.
Sen. Max Baucus talks health care with Sen. Olympia Snowe. (Alex Wong/Getty Images)
Yeah, we know the Congressional Budget Office still has to crunch the figures and a final vote won't come until next week. But, the two-week markup, called a "death march" by one reporter who gets out undying respect for sitting through it all, ended a little after 2am Friday morning in Washington.
The Democrats, with a 13-10 majority on the committee, can pass the bill on no matter what the Republicans have to say about it. Soon we'll get the big-time debate of the full Senate. What will they chew over?
We've been wondering if the Senate Finance Committee will ever finish putting Chairman Max Baucus's health bill through the wringer.
Why is Sen. Baucus smiling? (Win McNamee/Getty Images)
The debate may end today or tomorrow, we learned a little while ago, with a vote sometime next week after the Congressional Budget Office slices and dices the numbers on the revised bill.
So how is Baucus, a marathoner, dealing with the longest markup by the committee in 15 years? He gets help from a couple of cheat sheets he keeps in front of him on the dais.
One has a little smiley face on it, with a single curly piece of hair sticking out. He says it reminds him to "keep smiling."
As the debate over health overhaul plods along in the Senate, what are the odds something will actually get done?
(iStockphoto.com)
Some point to Massachusetts, a trailblazer that legislated universal coverage three years ago, as an example of what can be done. But Kaiser Health News' Jordan Rau reminds us not to forget California, where Republican Gov. Arnold Schwarzenegger tried mightily and futilely to cover the uninsured.
What went wrong? Proponents of change failed to do enough soon enough to win support from Republicans. The left wasn't on board either, arguing Schwarzenegger's proposals weren't adequate. Then there were the budget problems--California's budget woes led to tension over how much to subsidize coverage for less-well-off folks.
No one has ever accused the Senate of doing anything quickly. And so it is with the Senate Finance Committee's consideration of Chairman Max Baucus's health overhaul measure.
Wednesday marked the sixth day of deliberations on the bill, which Baucus noted was the longest the panel has spent on a single measure in more than a decade and a half.
But as the amendments continue to pile up, it's becoming more and more clear that the measure is heading towards ultimate approval, if not by the end of this week, then next week for sure.
In just the past 24 hours, members managed to fend off changes to the bill equally sought by the left and the right -- all of which would upset the delicate balance Baucus has been trying to maintain to gain the elusive 60 votes needed to choke off that talk-a-thon in the Senate known as a filibuster.
Maybe President Obama should stick to photo ops with first dog Bo if he wants to get a health care bill passed. That's one of the messages from the public opinion poll out today by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health.
Public to Obama: more Bo and nurses, fewer men in suits. (Ron Edmonds/AP)
No, the poll didn't actually ask about Bo. But it did ask about the public's view of interest groups involved in the health overhaul debate. And the public had a decided preference for some groups over others.
Groups the public had the most confidence "to recommend the right thing for the country when it comes to health care" included those representing nurses, patients and doctors, in that order. Groups in which they had the least confidence included health insurance companies, major corporations and pharmaceutical companies.
So what does this have to do with President Obama and photo ops? A lot, says Harvard polling expert Robert Blendon.
So you think you're having a hard time understanding how the American health care system work? Well, so does your doctor.
A study of graduating medical students finds that less than half say they have a good sense of how to navigate health care systems or the economics of practicing medicine.
The new doctors say they feel their medical schools did not prepare them to understand the mind-numbing mess of American health care. Only 40 to 50 percent of medical students, polled between 2003 and 2007, said they felt confident they were leaving medical school with appropriate training in the practice of medicine.
The problem with this, of course, is that patients expect their doctors to guide them through the health care system.
"Patients look to their doctors for this kind of guidance," says study co-author Dr. Matthew Davis, an associate professor at the University of Michigan Medical School. "If we're graduating students from our medical schools in the U.S. who have coin-flip odds of being confident of knowing the U.S. health care system, then are we really preparing them to be the best source of information for their patients?"
President Obama (aka "our scientist-in-chief," according to National Institutes of Health director Francis Collins) stopped by the NIH today and took the opportunity to note that a previous presidential visitor had also been accused of trying to socialize medicine, nearly 70 years before.
Channeling FDR at NIH. (Gerald Herbert/AP)
Obama noted that when President Franklin D. Roosevelt spoke at the dedication of the NIH, he said, "Neither the American people nor their government intends to socialize medical practice any more than they plan to socialize industry."
"FDR was being accused of a government takeover of health care. But he thought NIH was a pretty good idea," said Obama.
Maybe it's time for Congress to get its ears checked.
A new poll released this morning by NPR, the Kaiser Family Foundation and the Harvard School of Public Health shows that 71 percent of the public thinks Congress is paying too little attention to what people like them are saying about changes in the health care system.
Congress is instead listening to the "lobbyists and people that'll get them re-elected," says Nancy Turtenwald, a petite, middle-aged woman from Milwaukee we stopped in the Capitol Visitor's Center yesterday.
Despite the big bats of Sen. Jay Rockefeller (D-W.Va.) and Sen. Charles Schumer (D-NY), each of whom took a crack at tacking on the so-called public option, they both struck out today as the committee entered its second week of debate on a health overhaul bill.
The count: 15-8 in Rockefeller's case, 13-10 in Schumer's slightly watered-down version.
As August heated up, opposition to a health-care overhaul hit the boiling point. But a September poll taking the public's temperature on the administration's plan to remake the health system show tempers may be cooling and that support for action is on the rise.
How do you feel about health overhaul? (iStockphoto.com)
The Kaiser Family Foundation, a nonpartisan health research group, has surveyed a nationally representative random sampling of Americans six times since February on healthcare issues. The latest results, from polling during the week ended Sept. 18, show President Obama's luck may be turning.
One feeling that has eased for Republicans is the belief that their families would be "worse off if the president and Congress passed health care reform," Kaiser said. The September poll shows about half of Republicans feel this way, that's down from 61 percent in August. Overall, only 23 percent of respondents believe they would be worse off --down from 31 percent in August.
To find the fault lines in America's health-care map, just follow the money.
Where do the health-cost increases end? (iStockphoto.com)
For starters, the insurance status quo isn't exactly static. Costs keep climbing. Premiums and out-of-pocket expenses for workers who get insurance on the job will rise 10 percent next year, the Chicago Tribunereports. All told, the average insured Joe is looking at direct health costs of $4,023 in 2010, according to data from HR consultants Hewitt Associates.
So if the country agrees to change things, who pays? An op-ed in the Wall Street Journal co-authored by ex-Health and Human Services chief Michael Leavitt and two economists says young people will foot a bigger part of the bill than they may have realized.
The discussion about how to remake health care often gets boiled down to a debate over expanding coverage to the tens of millions of people who don't have any.
But what about the 25 million Americans who have insurance that's just not very good? These are the underinsured, people who pay more than 10 percent of their income on out-of-pocket expenses or 5 percent on deductibles.
NPR's Richard Knox takes us inside the Maine home of the Martins, who spent 45 percent of their household income last year on insurance and uncovered medical care. "That's just crazy," says mother Martha, 52, who works three part-time jobs and is facing another year of big medical expenses. "I don't pay that much in taxes."
The pharmaceutical industry's controversial deal with the administration on health overhaul held up in its first public test yesterday.
( iStockphoto.com )
The Senate Finance Committee defeated an amendment to Sen. Max Baucus's bill that would have sought more than $100 billion in rebates from drugmakers over 10 years. Previously, the industry pledged $80 billion in cuts to President Obama in return for companies' support of an overhaul.
The Republicans voted as a bloc against an amendment, proposed by Democratic Senator Bill Nelson of Florida, that would have tapped Big Pharma for more money to close the doughnut hole of the Medicare drug benefit.
We watched the Senate Finance Committee's jawboning on the Baucus health bill yesterday, but have to admit that our usual media multitasking meant we mostly heard five-minute snippets here and there.
Sen. Max Baucus, flanked by senators from both parties, leads the discussion of his health overhaul proposal. (Chip Somodevilla/Getty Images)
NPR's David Welna has a longer attention span and filed a report for All Things Considered late Tuesday that helped us catch up on what we missed. First, the Republicans didn't surprise anyone by rushing to get on board.
Despite months of courting by Chairman Max Baucus and a reduction in the bill's expense, Republican Sen. Chuck Grassley of Iowa blasted the legislation as too costly, "There's no plausible rationale for imposing all these new taxes and big spending on top of an economy that's doing its best right now to recover."
For a fight over something that's being called a "gag order," there's sure a lot of jawing going on.
The fight went public Monday, when Medicare officials revealed they had warned Humana that a missive sent to some members of its Medicare Advantage health plans could be "misleading and confusing." The government agency ordered Humana -- and other private companies that serve Medicare -- not to offer "misleading and/or confusing opinion and conjecture by the plan about the effect of health care reform legislation."
Republicans (read our earlier post) immediately jumped in to defend the rights of insurance companies to warn Medicare members, in essence, that Congressional Democrats were considering cuts to the insurance companies' bottom lines, and possibly those members' additional Medicare benefits.
When Humana, one of the biggest private insurers offering plusher Medicare plans to seniors, warned some customers a health overhaul could eliminate benefits they like, the feds told the company to knock it off.
At issue is a mailing sent by Humana to some patients enrolled in its Medicare Advantage plans. Those are the private options that replace standard Medicare for about one in five beneficiaries who chose the option. (The Huffington Post got a copy of a Humana mailing you can read here.)
Medicare Advantage costs the government more and is a prime target for cuts by Democrats as part of a health overhaul. Analysts say the plans, on average, get paid about 14 percent more than it costs to provide benefits to patients.
The health-care sausage-making goes public today as the Senate Finance Committee meets to mark up the overhaul bill put together by Chairman Max Baucus, the Montana Democrat.
Sen. Max Baucus will lead Finance Committee in mark up of his health bill starting today. (Mark Wilson/Getty Images)
Republicans Grassley, Enzi and Snow will be there. They and the rest of the 23 members of the committee are expected to make the most of the national speechifying moment with individual opening statements that could take hours.
Expect more theater than policy, the New York Times's Prescriptions blog says, suggesting a few senators to pay some attention to. Topping the list: Arizona's Jon Kyl, the Republican's "muscle man" an West Virginia's John D. Rockefeller IV, the "Democrats' liberal conscience."
The Mayo Clinic keeps popping up as a model for how Americans should get their care. There's hardly a better brand-name around, but could the Mayo approach, melding lower-than-average cost and better-than-average quality, really work everywhere?
The Mayo Brothers, founders of the eponymous clinic, insisted on salaries for doctors. (Mayo Clinic)
NPR's Linda Wertheimer asks Mayo Clinic President and CEO Denis Cortese on Tuesday's Morning Edition. Yes, he says, the Mayo model "is transportable--with difficulty." The key ingredient is instilling a culture among physicians that puts the needs of patients first, he says.
We thought the Hippocratic Oath was supposed to cover that, but evidently even the modernized version used in many med schools isn't up to the task.
You'll learn about people in nine different situations, ranging from the uninsured to folks with top-shelf coverage. Even the insurance haves, like federal worker Rhonda Dorsey profiled by NPR's Joe Shapiro on Monday's Morning Edition, face limits.
If you saw one appearance by President Obama over the weekend, you might as well have seen them all. He put on his salesman-in-chief hat again and flogged a well-honed set of talking points, as the debate over plans for a health overhaul intensifies.
NPR's All Things Considered weekend host Guy Raz boiled down the president's interviews on five Sunday yak shows to about 2 1/2 minutes, if you want a recap.
If you're really lazy, allow us to summarize the summary for you: Eighty percent of what Obama wants in a health overhaul is in the bills already kicking around Capitol Hill; health premiums went up 5 1/2 percent last year, so we better do something--and fast; and, fear of change--not race--is fueling resistance to the plan.
How much is health insurance worth? Not enough for one 53-year-old freelance writer to pay for it out of his own pocket.
Freelance writer Duncan Moore is an unlikely insurance daredevil. (Duncan Moore)
Duncan Moore, a reporter who has covered the ups and downs of health care for years, explains his surprising decision in the Los Angeles Times. "I'm the last person I would have imagined living without a safety net between me and the medical risks of early middle age," he writes.
But after Moore left his last full-time job and no longer qualified to continue his coverage by paying $447.12 a month, he figured he was better off taking his chances.
When we need answers about what's going on with the health overhaul, we run over to the cube of NPR's Julie Rovner and grab her before she runs off to the studio or up to Capitol Hill.
On Thursday's All Things Considered, you get your chance, as Rovner tackles questions from listeners. We got a preview and share a few highlights.
A listener in Ohio wants to know how the government would enforce a mandate that everyone in the country have health coverage? Some people would be exempt, mainly on grounds of economic hardship, but the rest of us who could afford health coverage and don't get it would be dunned through the tax system.
President Obama keeps saying under his plan for health overhaul, you can keep your insurance if you like it. But what if you don't care for the coverage you get on the job? Can you easily get something better?
Sen. Wyden says give choice a chance. (Rick Bowmer/Associated Press)
Probably not. And the options for most people wouldn't change much under the leading overhaul proposals on Capitol Hill. Sure, new state marketplaces, or exchanges, would offer a range of insurance choices. But, as it looks now, only the uninsured and people working for small companies would be able shop there.
An absence of insurance choice is a mistake, Sen. Ron Wyden (D-Ore.) argues in today's New York Times. And he offers up an idea to expand options while taking care not to undermine employer-based health coverage.
It's going to take a while for people to make their way through the details of the Baucus health bill. We've only scratched the surface ourselves. But the most important review--the price tag calculated by the Congressional Budget Office--is already in.
Sen. Max Baucus briefs the press Wednesday on his health bill. (Mark Wilson/Getty Images)
Yesterday afternoon the CBO bean counters tallied up the numbers in the Baucus proposal and worked a little arithmetical magic to put the cost at $774 billion over 10 years, 9.6 percent less than the Montana senator's own estimate of $856 billion.
Who's right? "CBO is the official scorekeeper for Congress, so what it says pretty much goes," NPR's health-policy guru Julie Rovner notes. Still, the Finance Committee fired off a memo late yesterday, saying both numbers are right, with an explanation of the differences here.
If you make it to the end of the Baucus overhaul bill, starting around page 213 you'll find a bunch of new taxes, er, fees that will be levied on various sectors of the health-care economy to fund expansion of coverage.
Probably tax-free under Baucus plan. (iStockphoto.com)
Though the figures had been telegraphed before the release of the bill, it's still something to see the annual amounts in black and white: $750 million from clinical labs, $2.3 billion from Big Pharma, and $6 billion for health insurers.
Then there's the medical device industry, which gets socked with $4 billion in annual taxes, though its domestic sales are a fraction of the drug industry's. The trade group AdvaMed called the bill's tax on devices "unfair and counterproductive."
What's included and what's out of Senator Max Baucus's bill?
Senator Max Baucus. (Getty Images)
Well, you won't find any public option. President Obama may be disappointed but probably won't be surprised. In the public option's stead as a choice in state insurance exchanges are the health co-ops we've been hearing were a favorite in the Senate.
The bill would make available $6 billion in loans and grants to get co-ops rolling. They're more concept than reality in most parts of the country as it stands now.
Just to be crystal clear these co-ops wouldn't be a stealthy government-run alternative, the language stipulates the non-profit co-ops can't be "sponsored by a state, county, or local government, or any government instrumentality." [Our emphasis added.]
Please join us in perusing the proposal. Even though it's long, it's a so-called chairman's mark, meaning it's written in something approaching regular English instead of hardcore legislativese.
Baucus, chairman of the Senate Finance Committee, is supposed to brief reporters in a couple of hours on the plan.
He's been the focus of plenty of attention from the administration, the media and, of course, interest groups that have a lot at stake in how a health overhaul shakes out.
So would you be surprised to learn that Baucus has received $3.9 million in contributions from the health industry over the last two decades? The Associated Press reports that figure and says Baucus has gotten more money from health interests than any other elected federal official except President Obama and three other senators.
Who needs health insurance? Not me. (iStockphoto.com)
Health coverage under the overhaul plan would be mandatory, with a few exemptions, and those who don't get coverage through their jobs or a government plan like Medicaid would face a penalty if they don't buy insurance themselves.
That's where subsidies are supposed to make a difference, but healthy young people who've long gambled they can get by without coverage and working folks who are just eking out a living may balk anyway. Subsidies may not help them much, if at all, so an insurance mandate could cost these people a pretty penny.
A municipal public option takes hold in San Francisco. (Justin Sullivan/Getty Images)
Take a look at San Francisco for a clue. An experiment there in universal coverage is bearing fruit, KQED's Sarah Varney reports on Tuesday's Morning Edition.
Called Healthy San Francisco, the program for the uninsured isn't health insurance but instead offers care in clinics and covers admissions to hospitals located in the city.
After months of delays, the slowpokes on the Senate Finance Committee are finally set to release a draft overhaul bill, perhaps as soon as today.
Sen. Max Baucus says his committee's health bill is almost ready. (Evan Vucci/Associated Press)
Chairman Max Baucus (D-Mont.) said Monday that his committee had reached agreement on almost every aspect of a health revamp, but we'll believe it when we see it.
A few things seem clear, though. The chatter about illegal immigrants somehow having a loophole through which they could get subsidized health benefits would be closed with some specifics on verification of immigration status.
Doctors surveyed for their views on health care and how it might be overhauled are more receptive to change than you may have figured.
(iStockphoto.com)
When it comes to expanding coverage to the uninsured, guess what? A majority of doctors--62.9 percent--prefer a mix of private and public options, according to more than 2,100 responses from a national sample of nearly 5,200 docs.
What sort of public option do they like? Well, for the near-elderly--folks between 55 and 64 years old--some 58.3 of the respondents support an expansion of Medicare, an idea contemplated by the Senate Finance Committee.
Will it stay or will it go? The prospect of a government-run insurance alternative continues to dominate the debate over health overhaul, sharpening questions about whether President Obama's package for change can make it through Congress if the public option is included.
(iStockphoto.com)
On one hand, the administration says it will consider other methods to assure competition and choice in the insurance marketplace, yet it hasn't pulled the divisive proposal off the table. Obama "prefers the public option," but would contemplate alternatives, his press secretary, Robert Gibbs, said on CNN's State of the Union over the weekend.
The public option two-step isn't cutting it with some moderates, including Maine Republican Senator Olympia Snowe, who called the administration's continued jawboning in favor of a public option "unfortunate" on Face the Nation just a few minutes after Axelrod supported it.
Set aside the debate for just a moment over how big a factor medical malpractice really is in rising health-care spending.
(iStockphoto.com)
If not convinced it's a problem, President Obama at least entertained the notion of malpractice reform in his big health speech, saying "defensive medicine may be contributing to unnecessary costs." And, he said, Health and Human Services would move ahead quickly with some test projects contemplated by the Bush administration.
As the Wall Street Journal reports, those include early disclosure of errors and apologies for them, and screening of potential lawsuits by doctors to weed out frivolous claims.
Did Obama get the job done? His speech to rouse action on health legislation was more specific, yet easier to follow than past Obama talks.
Was President Obama's pitch on Capitol Hill enough? (Alex Wong/Getty Images)
He hammered away on the need for an overhaul now, citing unsustainably high costs, the ranks of the uninsured, the unique and embarrassing status of America among rich countries for not guaranteeing health coverage for it citizens and the fragility of coverage even for those who think they're in good shape.
He challenged critics, defused some myths and even threw a few bones to the Republicans, including jump-starting projects that could be a prelude to malpractice reform and embracing a John McCain proposal to offer low-cost insurance to people unable to get coverage because of preexisting conditions.
He even put a number--$900 billion over a decade--on what the White House thinks the health overhaul will cost as he outlined details, such as individual insurance mandate.
Just hours before President Obama is set to address Congress and the nation on his plans for a health overhaul, the New England Journal of Medicine pulls out the smelling salts.
(iStockphoto.com)
A pair of bracing commentaries published online says the time for change has come, so don't blow it, politicians.
In one of the pieces, two defenders of Britain's National Health Service concede its flaws, but say the jewel in its crown is "the strength of its primary care and its general practitioners," something the US would do well to emulate. Primary care doctors cost less and spend less than specialists, which the US has oodles of. So learn from the NHS, they say, and beef up primary care while pruning specialty care.
Senators Dodd and Harkin talk health care in June.(Robert Giroux / Getty Images)
Before long we're expecting to find out officially that Connecticut Senator Christopher Dodd won't take the job as chair of the Senate health committee, succeeding his old friend Edward Kennedy.
There are quite a few reports out already saying Dodd has made up his mind to stick with his job running the Senate banking committee. If so, then next in line as chairman of the Health, Education, Labor and Pensions Committee would be Iowa Democrat Tom Harkin.
That's a big job--especially now, with health overhaul dominating Capitol Hill.
How could we not watch President Obama's health pitch to Congress tonight? We'll be parked in front of the flat screen in the family room, explaining the finer points of insurance rescission, the Gang of Six and health co-ops to a couple of toddlers.
(iStockphoto.com)
But what about you? If you're like most Americans, you'll probably tune in, too. Some 56 percent plan to watch Obama's speech tonight, according to polling data just out from the Pew Research Center for the People & the Press.
Democrats are making it must-see TV, with 72 percent expecting to watch, compared with 41 percent of Republicans and 52 percent of Independents.
What will President Obama say tonight in his speech before a joint session of Congress? And will it matter?
We're certain to be reminded of the necessity for changing the health system, as the president sees it, to cover more people and to restrain spending. That's the foundation for the admittedly complex and evolving plan he'd like to see implemented.
There are lots of reports Obama will stand behind a government-run, or public, insurance option as a competitive check on private insurance. The Washington Postreports House Speaker Nancy Pelosi expects Obama to affirm his support for a public option and challenge doubters who think they have a better idea to "put it on the table."
We doubt President Obama will be turning to Republican Newt Gingrich for political advice anytime soon.
Newt Gingrich argues for incremental health change. (Chip Somodevilla/Getty Images)
But if Obama listens in to NPR's Renee Montagne chat with the former House Speaker on Wednesday's Morning Edition, he'll get a prescription for legislative incrementalism when it comes to health care.
"I don't believe it's intellectually possible to take 18 percent of the economy of the largest economy in the world--life and death for every individual--and in one sweeping bill change all of it," Gingrich says.
People aren't smart enough to write a bill that does everything at once, he says, and a huge piece of legislation (1,300 pages or more) will be larded with "bizarre" goodies that may attract supporters now but cause problems down the road.
Back to school. Back to work on a health overhaul.
A man with a health-care plan seeks action. (Mark Lyons / Getty Images)
Lawmakers return to Washington today, and President Obama, after stumping for health overhaul on Labor Day, is prepping for a stem-winder before a joint session of Congress Wednesday night that could be his last best chance to gain support for his plans.
In case you were too busy grilling over the long weekend, the pick lines from Obama's speech before a union crowd in Cincinnati Monday went like this:
I've got a question for all these folks who say, you know, we're going to pull the plug on Grandma and this is all about illegal immigrants -- you've heard all the lies. I've got a question for all those folks: What are you going to do? What's your answer? What's your solution? And you know what? They don't have one. Their answer is to do nothing.
Will fiery rhetoric be enough to get Congress moving Obama's way? Not by itself, but The New Republic's Jonathan Cohn writes the situation isn't as bleak as it could be, considering the "train wreck of a month" the administration had in August.
For all the criticism lately that a health overhaul might go too far and cost too much, a close look at some of the legislation in the works shows it might not fulfill the promises of affordable coverage for plenty of Americans either.
Our pal Jordan Rau at Kaiser Health News takes a look at some families that are already having trouble paying for insurance out of their modest incomes and finds they could still be left behind.
"Under the House proposal, people receiving government subsidies could still end up spending 20 percent or more of their annual incomes on premiums, deductibles and co-insurance," Rau writes, citing estimates from the House Committee on Ways and Means obtained by Kaiser.
Nobody in La Crosse, Wisconsin, ever thought the local hospital's initiative to help people prepare for the inevitable end of life would become a talking point in the national debate on health overhaul.
(iStockphoto.com)
But that's what happened to Gundersen Lutheran, the flagship hospital of a health system serving three Midwestern states, after a House health bill included a provision this spring to allow Medicare to pay for end-of-life counseling, the Washington Postreports. Gundersen Lutheran had pushed for Medicare to pay for the work.
It didn't take long for opponents of the administration's plans to remake health care to label these counseling sessions "death panels" and hold them up as Exhibit A for the government's intrusion into the most personal of health decisions. No matter that the characterization has been pretty much debunked. If there's one part of overhaul plans most likely to be dropped, it's government payment for end-of-life counseling, now a political "third rail."
NPR's Ari Shapiro asksDr. Atul Gawande, a surgeon and writer for the New Yorker, to explain how decisions about care get made. Gawande says the simplest sort of rationing based on a "fixed allowance of care" may be scary but won't ever be reality in this country.
He argues in favor of rational care, basing decisions on the best evidence. If implemented systematically that approach would help eliminate plenty of ill-advised procedures.
If now isn't the last chapter in the administration's plan to overhaul health care, it's certainly the end of the beginning.
President Obama heads to Capitol Hill next week to sell health-care plan. (Alex Wong/Getty Images)
President Obama is heading to Capitol Hill next week to press Congress to buck up and pass something. He's also expected to be more direct about what he wants to see.
NPR's Mara Liasson reports the president aims to clear up confusion about how the health system he has in mind would work, particularly for Americans with health insurance. He's expected to offer some info on how the changes would cut costs.
Still, comments by David Axelrod, Obama's top political guru, leave us a wee bit more confused. "All the ideas are on the table now, we're well down the road, 90 yards down the field," Axelrod told Liasson. "And now we have to go the last 10 yards together and the best way to start that is for the president to address this issue with force and clarity and that's what he's going to do Wednesday night."
No conversation about overhauling health care can get very far before a doctor, just about any doctor, says lawyers and malpractice suits are big reasons health costs are so high. Republicans, even the ones who aren't doctors, generally agree.
Malpractice caps fire up doctors and the GOP. (iStockphoto.com)
On NPR's Morning Edition, Scott Horsley reports on "that old Republican chestnut: cutting down on frivolous lawsuits." Would caps on malpractice make a big difference in costs? Or, perhaps more significantly at the moment, would Democrats attract Republican support for health legislation by adding provisions to limit the liability of doctors?
Bill Bradley, the silky basketball shooter and deal-making New Jersey senator back in the day, suggested a political play to fellow Democrats in a New York Timesopinion piece over the weekend: "Combine universal coverage with malpractice tort reform in health care."
What exactly is so wrong with the American system of health care? It just costs too much.
Shifting health costs is a Band-Aid. (iStockphoto.com)
Aside from issues of quality and coverage, the price paid per capita for U.S. health care is more than $8,000 compared with about $5,500 in the next most expensive country (probably Switzerland) and the $4,500 paid in other developed countries, writes Stanford health economist Victor Fuchs in the current issue of JAMA.
So no wonder that every plan to overhaul health care aims to reduce costs. But Fuchs warns that some of the proposals might just shift the pain, not cure it.
Now more than ever people are arguing about the cost and payback on investments for prevention.
Is an apple a day cost-effective? (iStockphoto.com)
As the green-eye-shade-wearing Douglas Elmendorf, director of the Congressional Budget Office wrote last month:
Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.
So the idea that lots of prevention is somehow going to save, rather than cost money, under a health overhaul looks all wet.
Well, a paper just published online by the wonky journal Health Affairs suggests that looking at the costs and benefits of prevention over a really long time, say 25 years, might give a fuller picture than the 10-year period that's traditionally used in calculations for government budgeting.
It's time for President Obama to reveal his health cards, say some longtime supporters and even a few Republicans.
Obama returns from vacation to find health-care overhaul stalled. (Mandel Ngan/Getty Images)
A key Senate committee's failure to produce a health bill before the August recess, an onslaught of criticism at town hall meetings and slipping poll numbers have put in peril the president's goal of remaking the nation's health-care system.
What's a president to do? Propose his own legislation instead of standing back and cheering on Democratic proxies. "Obama's approval numbers would jump 10 points if Americans knew he was fully in charge," writes Bob Dole, retired Republican senator, in the Washington Post. If Obama introduces an explicit proposal of his own, Dole expects a few Republicans might even support planks of the plan.
A creepy crawley critter in your basement or proposals to overhaul health care can be downright frightening.
Joseph LeDoux (left) and the Amygdaloids.(William Chang)
And as NPR's Julie Rovner reports, opponents have been using scare tactics to fight changes to the American health-care system for just about as long as people have been trying to give it a makeover.
It turns out the foes of change are pretty smart because fear works. "Once fear is aroused and in your brain, it tends to take over and dominate," explains Joseph LeDoux, a New York University neuroscientist. It's also contagious.
But LeDoux, who's written tons of academic papers and several books on how the brain works, has his own viral way of spreading the science of the brain: rock music. He leads a band called the Amygdaloids, named for the almond-shaped region of the brain instrumental in the fear response.
The group of New York University researchers specializes in a genre they've dubbed "Heavy Mental," and has even played Madison Square Garden. OK, so it was for an NYU graduation ceremony. Still, pretty impressive.
A key concession made by House negotiators to persuade conservative Democrats to support a public option as part of health overhaul is in jeopardy.
Sometimes mistaken for a health co-op. (iStockphoto.com)
Rep. Pete Stark (D-Calif.) wants the government to use Medicare rates to pay doctors and hospitals under a government-sponsored insurance alternative. That could scotch an agreement with so-called Blue Dog Democrats, who pushed for the feds to negotiate how much health-care providers would be paid by a public plan.
"I think most of us agree that we pay too much to providers now," Stark told reporters on a conference call, according to a report by Modern Healthcare. Doctors and hospitals probably wouldn't, having argued for a long time that Medicare is too stingy.
Sen. Edward M. Kennedy of Massachusetts succumbed to brain cancer Tuesday night.
Click on the image for a timeline of Kennedy's life. (Saul Loeb / Getty Images)
The 77-year-old legislative giant died just as his great hope for an expansion of health care to serve all Americans is as close to being realized as at any point in his long life.
Kennedy called universal, decent-quality health care for Americans "the cause of my life." Just a month ago, writing inNewsweek, he affirmed his belief that "quality care shouldn't depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to."
In the demimonde of health wonks, there's a special place for Paul Starr, the Princeton academic whose history of the American health system more than 25 years ago still seems fresh today.
Is health overhaul a "gateway drug" to government domination? (/kallu/Flickr)
Over the weekend, Starr brought some historical perspective to the current debate over health overhaul to NPR's On The Media. Opposition to some form of universal health coverage for American is as old as efforts to make it happen.
Around World War I, the plans foundered as opponents murmuring about an association with Germany, Starr tells On The Media co-host Bob Garfield. FDR chose to skip universal coverage as part of the package that created Social Security rather than do battle with the American Medical Association.
Take a look way back in the corner of a town hall meeting on health overhaul and you might just find someone who works for an insurance company.
Pick me. (iStockphoto.com)
Thousands of insurance workers, some armed with tips from a trade group, have been trooping to the meetings to politely make the case for their beleaguered industry.
Maybe that's why we hadn't noticed them until the Wall Street Journalwrote about them today.
Take Lary Loew of Wheeling, W.Va., who turned out for Rep. Alan Mollohan's (D., W.Va.) meeting there a little over a week ago. Loew runs an employee benefits company in town and told the Journal he showed up because "my whole industry is being threatened."
We remember lo those many years ago when a New England governor, who was also a doctor, started making noise about running for president and improving health care.
Howard Dean has high hopes for health care. (Win McNamee/Getty Images )
Howard Dean made it the top of the Democratic Party, though he never got to live at 1600 Pennsylvania Avenue. Still, the former Vermont governor can't stop talking about health care. He's even got a book out on the subject.
Why does the country need a public alternative? "The fact is that only Medicare has controlled costs better than the private sector," Dean tells All Things Considered's Robert Siegel on Friday. "Now Medicare doesn't do a terribly great job of controlling costs, but they do a much better job than private health insurance does."
The insurance industry has become the beleaguered bogeyman of health overhaul. But would the changes proposed so far be so bad for the companies?
WellPoint CEO Angela Braly (WellPoint)
Sure, insurers have resisted a government-sponsored health option that the Obama administration has advanced as a way to keep costs down and competition up. Karen Ignagni, head of the trade group America's Health Insurance Plans, toldAll Things Considered's Robert Siegel the other day that a government plan could become just another way to shift costs to those with private insurance.
Sounds like good business, right? That's what Morning Edition co-host Steve Inskeep asks Angela Braly, CEO of WellPoint, the largest private insurer as measured by the number of people it covers. Actually, in search of an answer, he puts the question to her again and again.
Sen. Ted Kennedy makes plans for a successor. (Saul Loeb/Getty Images)
For President Obama to pull off a health overhaul, he's going to need every vote he can get in the Senate. And no vote would mean more than one cast by Ted Kennedy, the Massachusetts Democrat who has been the acknowledged master of health policy in the august chamber for decades.
Kennedy, ailing with brain cancer, is trying to make sure that if he's not around to vote for Obama's plan someone else will be.
The Boston Globereports Kennedy sent a letter to Massachusetts Governor Deval Patrick and leaders of the state legislature asking them to change a 2004 law that would leave the seat empty, in the event of his death, until a special election can be held.
We may have a new benchmark for raucousness at congressional town hall meetings.
Rep. Frank faces tough town hall. (Associated Press)
Rep. Barney Frank, the loquacious Massachusetts Democrat, faced a very tough crowd at a senior center in the coastal town of Dartmouth Tuesday.
A flash point came when some in the crowd compared President Obama's plans for health overhaul to something from the Nazi era, complete with posters showing President Obama with a Hitler-style mustache.
"On what planet do you spend most of your time?" Frank asked a woman, who wanted Frank to explain his support for what she called a Nazi policy, the Associated Press reported. "Ma'am, trying to have a conversation with you would be like trying to argue with a dining room table. I have no interest in doing it."
We haven't had a discussion with our family doctor about end-of-life planning. But if he were half as soothing as David Casarett, a palliative medicine specialist who talked Tuesday with All Things Considered's Melissa Block, maybe we wouldn't mind.
Dr. David Casarett
How does one of these chats get started? No scary death panel to confront. "Usually I try to begin these conversations by talking about patients' hopes and fears," Casarett explains. "What's important to people? What they would like their future to look like? What they're afraid of? What they'd like to avoid?"
So what about all this death panel talk and the notion that health overhaul would put the government into the euthanasia business? Casarett says he's "still mystified" that allowing Medicare to pay for end-of-life counseling somehow got twisted into death panels deciding when to pull the plug.
If you think health-care overhaul is hopelessly complicated, maybe a flowchart will help.
A blueprint for what the proposed changes to the health system would mean for you was laid out by The Nation's Washington editor Chris Hayes during a Q&A session at a recent Netroots Nation conference.
Then Nicholas Beaudrot, blogging at Donkeylicious, turned Hayes's rat-tat-tat breakdown into a graphic. Click on the snapshot image or here to see an enlarged version that you can actually read.
A picture of health--overhauled. (niq77174/Flickr)
If you were thinking about writing the White House to report some cockamamie criticism of Obama's plans for health overhaul, you may need to update your address book.
(iStockphoto.com)
The Wall Street Journalreports the administration deep-sixed a controversial email account to collect tips on disinformation about health reform.
In a blog post early this month, the White House said the mailbox was established because it just couldn't keep track of all the rumors. "If you get an email or see something on the web about health insurance reform that seems fishy, send it to flag@whitehouse.gov," the post advised.
Washington isn't a swamp. It's a schoolyard. And the House GOP leader is accusing another powerful Republican of cutting a deal with a schoolyard bully.
In this case, the bully is President Obama and the powerful Republican is Billy Tauzin, former chairman of one of the key House committees that oversees health care and now the head of the Pharmaceutical Research and Manufacturers of America.
"The simple truth is, two wrongs don't make a right," House GOP leader John Boehner writes in a scathing letter to Tauzin, obtained by NPR. "When a bully asks for your lunch money," Boehner continues, "you may have no choice but to fork it over."
"But cutting a deal with the bully is a different story, particularly if the 'deal' means helping him steal others' money as the price of protecting your own," Boehner writes.
And that was just how the letter opened. Full text here
The National Health Service in the U.K. has become a punching bag for some critics of proposals to remake the U.S. health-care system.
(iStockphoto.com)
Among the inflammatory charges, Sen. Edward Kennedy wouldn't have received state-of-the-art care for his brain tumor in a place like Great Britain because health overseers would have found extending the life of the 77-year-old unworthy of the expense.
"Well, I'm sorry to say that's the most ludicrous thing that I've heard," Ara Darzi, a surgeon and former minister of health, tells Steve Inskeep on Tuesday's Morning Edition. It's an example, Darzi says, of the "lies that have been used to set fear against reform."
The only co-op we have any experience with is the New York variety for apartment living. Even in the little Brooklyn building where we used to kick back, the vetting process for prospective shareholders was daunting, including in our case a separate interview of our dog. She passed.
A pediatrician from Group Health Cooperative checks a patient.
(Stephen Brashear/GroupHealth)
She took a look at HealthPartners, a Minnesota-based co-op with 1.25 million members. The folks insured by HealthPartners also own the non-profit company. Any money left over each year gets plowed back into care.
We always thought the Senate was the place for civil discourse on the issues of the day. Maybe it still is. But when senators start arguing about health care and death panels on Twitter, all bets are off.
Death panel became the shorthand for claims by opponents of health overhaul that a provision in a House bill on end-of-life counseling would lead to government-ordered euthanasia.
Senator Chuck Grassley, an Iowa Republican, is clearly ticked off at the recently ex-GOPer Arlen Specter, the senior senator from Pennsylvania. Just a little while ago Grassley fired this salvo Specter's way:
If you want to take the temperature of health overhaul, check out the polls.
Time to see the polling doctor. (iStockphoto.com)
The Marist Poll is out with numbers this morning that show President Obama has a lot of work left to do if he hopes to remake the country's health-care system.
Forty-five percent of American voters disapprove of how Obama is handling health care, compared with 43 percent who give him a thumbs-up. That's a dead heat, considering the +/- 3.5 percent margin of error in the poll.
Grand Junction, Colo., a cost-quality leader. (Eleaf/Flickr)
Let's call them the Four Horsemen of Health Care Improvement:
Atul Gawande, the surgeon and embarrassingly talented journalist; Donald Berwick, an indefatigable campaigner for better health quality; Elliott Fisher, a bigwig with the indispensable Dartmouth Atlas; and,Mark McClellan, the doctor-economist who oversaw the addition of a drug benefit to Medicare.
Forget the naysayers who proclaim that it's impossible to remake our health system to deliver better care at a lower cost, these four doctors write in the New York Times. It's happening already.
In 74 places (hospital referral regions, for the wonks out there) around the country, per capita Medicare costs are low or declining and the quality of care is above average.
Dental patients at a free health clinic at the Forum arena in Inglewood, Calif. (John Moore/Getty Images)
As the debate over the administration's plan to remake health care rages on, some folks are taking direct action to bring medical help to the uninsured.
Hundreds of people started lining up Monday for a chance to get their teeth fixed, eyes checked and various other maladies cared for at the clinic, which opened Tuesday.
How hard will it be to reconcile the proposals kicking around Capitol Hill to remake health care?
At least for three House bills, the content is about 85% the same, Nancy-Ann DeParle, head of the White House Office of Health Reform, tells Melissa Block, co-host of All Things Considered. "The bills do follow the basic blueprint that the president put forth from his campaign," DeParle says.
In the Wednesday interview, DeParle acknowledges that the 15% of the legislation that's different will take some work to reconcile. Issue No. 1: the fate of the public plan.
She tells Block she's not sure whether a co-op, an alternative getting support in the Senate, would be acceptable to President Obama. We're also not likely to find out the details of what provisions the president supports or rejects until a bill surfaces in conference.
The Commander In Chief will try his hand at selling the administration's plans for remaking the health-care system at a town hall meeting in Portsmouth, N.H., this afternoon.
We'll monitor what President Obama has to say and how the crowd behaves, after so many of these meetings have turned ugly.
Click the "play" button below and our live updates about the event should scroll automatically.
Health and taxes aren't the usual combo of life's inevitabilities.
The loafers lobbyists made famous. (DavidAll06s/Flickr)
But as NPR's Linda Wertheimer reports, the remaking of the federal tax code against long odds in the '80s may tell us something about the prospects for an overhaul of health care.
Two decades ago, Republicans and Democrats each had their reasons for wanting to transform the tax system. President Reagan made lowering taxes his top domestic priority. Democrats, who controlled the House at the time, wanted to close loopholes that favored the wealthy and corporations.
Bill Bradley, then a senator from New Jersey, says that proved a winning formula:
It just made a lot of sense to cut tax rates, who's not for that, and to pay for it by eliminating loopholes that allowed different people making the same income to pay different taxes.
Would changes being proposed for our health-care system actually lead to government-sponsored euthanasia?
(iStockphoto.com)
Some critics come pretty close to saying so, and comments on the subject by Sarah Palin on Facebook late last week got a lot of folks fired up:
The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care.
To set matters straight, the Washington Post's Ezra Klein chatted with Sen. Johnny Isakson, a Georgia Republican who has worked to expand coverage of end-of-life planning. In particular, he supports a voluntary, Medicare-covered counseling session for people with their doctors to discuss end-of-life options. The idea is to make it easier to decide in advance what sorts of care people want and don't want when facing death.
Before we go any further, can we do a smidge of reality-checking of our own? There's a lot more at stake in the proposals to overhaul health care than just reforming the insurance system. Sure, we know the Dems' talking points emphasize hammering on the insurance industry. Just ask insurance-industry lobbyist Karen Ignagni, as Kaiser Health News did the other day.
But ask doctors, hospitals and drugmakers how much money they might gain or lose under various plans for a taste of the topics beyond strict insurance reform.
Coming soon to a TV near you: a wave of ads bankrolled by drug companies in support of health overhaul.
Don't adjust your set--those ads are from the drug industry. (iStockphoto.com)
The drug industry, already a big spender on commercials for its medicines, is a seemingly unlikely patron for the planned ad blitz, which could cost $150 million or more, the Associated Press reported over the weekend.
The ads would bolster the administration's plans to remake health care and expand insurance coverage to nearly 50 million people.
To put the size of the ad campaign in perspective, the New York Timespoints out that Sen. John McCain spent $126 million on ads in his bid for the presidency. In the end, the drug industry ad spending could wind up within spitting distance of the $236 million shelled out for campaign ads by Team Obama.
Republican Senator Judd Gregg of New Hampshire figures some sort of health overhaul is inevitable. He just doesn't know if he'll like it.
Sen. Gregg bets overhaul is coming. (Getty Images)
"I'm presuming something will pass," Gregg tells NPR's Linda Wertheimer in an interview for Friday's Morning Edition. The president has invested his "status on public policy" in getting legislation through, Gregg explains, "and he has supermajorities in the House and the Senate" to get the job done.
But Gregg, who's not running for reelection, says he's a little worried the plans advancing already are "very far on the liberal side of the agenda" and would eventually lead to a system with the government as the primary insurer.
A promise by the pharmaceutical industry to save the nation $80 billion over a decade in exchange for protection from further givebacks under an overhaul of health care just got validated by the White House.
( iStockphoto.com )
The New York Times reports that pharmaceutical companies got spooked by action in the House that would give the feds negotiating authority for drug prices and bigger rebates from the industry.
So the industry got an explicit affirmation of protection from deeper cuts, according to the Times.
Billy Tauzin, head of the trade group PhRMA and the industry's lobbyist-in-chief, explained the quid pro quo -- drugmakers stepped up first with a cost-saving pledge, and, in return, got "a rock-solid deal." A White House official confirmed Tauzin's account to the Times.
Despite the public rancor over a potential health overhaul, a bipartisan agreement on how to remake the system may not be dead yet. The Washington Postreports that Senate negotiators are making progress on a compromise that would cut about $100 billion from the price tag for expanding health coverage while still getting 94 percent of Americans on insurance rolls.
The Post, citing "participants in the talks," says the latest and still fragile proposal would ditch the public insurance option that the administration has made a top priority and, in a first, "tax health-care benefits under the most generous plans."
Six senators, three Dems and three from the GOP, are supposed to brief President Obama on the state of talks later today, the Post reports.
Well, this didn't take long. The Democratic National Committee has trotted out a Web ad to get the party's supporters to tell Republicans to lay off the public meetings on health-care overhaul.
The ad reprises snippets from some recent confrontations, including a quick shot of protesters at a Philadelphia meeting last weekend that featured some testy exchanges between the audience and Sen. Arlen Specter (D-Penn.) and HHS Secretary Kathleen Sebelius. There's also a cameo appearance by a memo on disruption tactics.
You can find some more details on the Democrats' beefs with the "angry mobs" on the DNC blog here.
But the basic message, as you might expect, is: GOP, call off the dogs. To that end, the spot concludes with the telephone number for the Republican National Committee.
We gave it a try just to see what the RNC had to say and got an automated phone directory. Conveniently enough, the recorded voice prompted us to press 1, if we were calling about the recent DNC ad. Okee dokee. We did, and a few seconds later found ourselves talking with a receptionist at the DNC, who said she's been getting a lot of calls like ours today.
Update: The DNC's Brad Woodhouse said in an email that the call-forwarding option is "a neat trick." But it also shows, he wrote, that "Republicans don't want to have a discussion about the future of health care reform."
The RNC said they'd have something to tell us about this later today.
You may be on summer vacation, but the interest groups looking to make their mark on legislation to overhaul health care are working harder than ever.
No rest for the weary lobbyists. ( Alykat / via Flickr)
The Wall Street Journalreports that delays on Capitol Hill make this month the key time to "snare one-on-one meetings with lawmakers back in their home districts."
Take Tim Trysla, a lobbyist at Alston + Bird. Makers of diagnostic imaging equipment are among his clients. "If you're looking for savings, don't come at us," says Trysla, who has called on 120 legislators, sometimes taking General Electric execs along to make the case for protecting payment for medical scans. (Check out a nifty WSJ interactive graphic on lobbying spending here.)
What did Health and Human Services Secretary Kathleen Sebelius make of the free-for-all that erupted during a Philadelphia town hall meeting about health care over the weekend?
HHS's Secretary Kathleen Sebelius talks insurance. ( Mark Wilson / Getty Images )
"Democracy is alive and well in Philadelphia," she told All Things Considered co-host Melissa Block this afternoon.
These sorts of meeting have been marked by protests all around the country. Sebelius said she knew this one might have some "interesting dialog" when the audience booed during introductions by the director of the National Constitution Center.
There were many people at the meeting who aimed to "disrupt and and have the opportunity to disengage folks from a conversation about health reform," she said. Take a listen to the interview:
Still, public concerns about a health overhaul aren't just orchestrated, Sebelius acknowledged, telling Block, "I don't think there's any more personal issue to the American people than health care."
Forget Norman Rockwell. The town hall meetings that many representatives and senators are holding back in their districts to make the case for a health care overhaul are turning into knockdown-dragouts.
A conservative group in Connecticut called Right Principles laid out how it "conducted an action" at a town hall meeting of Rep. Jim Himes (D-Conn.) in late May, even calling it a "potential playbook" for others who want to do the same.
Some of the tips: be organized; be prepared with detailed questions (including some that cite the legislator's voting record); try to sit in the front of the room; leave the protest signs outside the hall.
The group posted a video from the event, which you can watch below.
As senators prepare to head home for the dog days of August, the dog fight over remaking health care shows no sign of abating.
Sen. Kyl says it's time to hit the road. ( Terry Ketron / AP)
The latest round features a little legislative rope-a-dope from Republicans who don't like much about the proposals kicking around Washington so far.
Sen. Jon Kyl (R-Ariz.) tells NPR's Linda Wertheimer in an interview set to air on Morning Edition Tuesday that he'd rather see no health overhaul than adoption of the approaches on the table right now.
Would a cool name change improve public relations for the public option? Senator Jay Rockefeller (D-W.Va.), thinks so.
Rockefeller tells All Things Considered's Robert Siegel in an interview to air Friday night: "I don't think people like the name."
The public option -- the government-created, non-profit health insurance program being proposed to compete with private insurance -- gets high marks from some, but others fear it means the government will take over health care.
How about the ice cream option, says Sen. Rockefeller (Susan Walsh / AP(c) 2009)
"I wish we could call it the ice cream option... because it's the free market system. If people don't want anything to do with the public plan, they keep what [insurance] they have... it's optional, optional, optional," he says.
The fact that Medicare got one year older during a historic struggle for comprehensive healthcare reform is something akin to being born on Christmas: Everyone's partying, but you're not sure it's really about you.
NPR's Joanne Silberner points out that Medicare today is
a lot bigger than President Lyndon Johnson thought it was going to be when he signed the legislation providing money for doctor and hospital care for seniors. Medicare now includes home health care, hospice, and kidney dialysis, and covers people with disabilities.
That growth has a price, Silberner notes. "Medicare represented 3.5 percent of the federal budget in 1970 and 15 percent of the budget in 2008."
Meanwhile, House Speaker Nancy Pelosi sent special cards out today, too, though not exactly birthday cards.
(More after the Jump on how Speaker Pelosi is arming House Dems for "Battlefield August")
While it's no surprise that the pharmaceutial industry is spending lots of money to lobby Congress on health care this year, what are they getting in return?
That's $40 million in the last three months -- far ahead of other health care lobbying expenditures, as reported so far.
But it's more than the dough, it's what that money bought: an army of lobbyists to swarm Capitol Hill, and possibly the strength to keep a few key issues they don't like off the table, like government price controls and re-importation of drugs from Canada.
Check out the interactive graphic illustrating the firms the drug industry trade group alone spent.
Three years after instituting a plan that subsidizes health care for many of its residents, Massachusetts now has the lowest uninsured rate in the U.S. -- 2.6 percent, compared to the U.S. average of 15 percent. But the nation's leading experiment in near-universal health care is also straining at the seams, with revenues yanked down and costs pushed up by a continuing recession.
So yesterday an influential state commission with representatives from the state legislature, insurers, hospitals and doctors voted unanimously for a radical solution: Within the next five years, upturn the way doctors and hospitals are paid.
Instead of paying providers for each office visit, lab test, or procedure, the state would pay networks of doctors and hospitals a flat monthly or annual fee for each patient they care for.
(But wouldn't providers be tempted to dump the sickest, most expensive patients? Read past the jump to see why the commission thinks not)
The flurry of news about Alzheimer's disease this week and the blizzard of health legislation news blowing down from Capitol Hill should prompt the same reaction in careful readers. First: Read between the lines. And second: Hold your applause until the end.
For example, on the health care front, Senators Christopher Dodd and Orrin Hatch toldMorning Edition's Steve Inskeep that they're committed to working together on health care legislation, though their vote on the bill coming out of their committee yesterday was strictly partisan. This wrestling match is far from over.
As for Alzheimer's:
More than 3,000 brain researchers are gathered in Vienna this week to mull over the latest in Alzheimer's research, and the association sponsoring the meeting has been churning out press releases, which is largely why there's been daily news. One study getting a lot of press suggested that moderate drinking could curb one's risk of getting the illness; another said having combat-related PTSD could increase the risk.
It's been known for years that people who have inherited two copies of a particular variant of a gene linked to cholesterol metabolism -- ApoE -e4 -- are much more likely to getting Alzheimer's dementia. But doctors have just as long discouraged people from getting the test because a) it's not a perfect predictor and b) there's no preventive treatment for the disorder. Getting tested under such conditions, doctors thought, could prematurely devastate perfectly healthy people who got bad genetic news.
The ornate Beaux-Arts style Russell Caucus Room, where the Senate Health, Education, Labor and Pensions Committee meets, has witnessed its share of historic events. The Watergate hearings, the McCarthy hearings, the Iran contra hearings, and today, committee passage of a health overhaul bill all took place there.
But HELP Acting Chairman Chris Dodd (D-CT) may have gone too far when he waxed poetic on one infamous set of hearings, says NPR's Julie Rovner, who was on the scene.
"There were many important events that occurred in this room over the years. In fact, the hearings on the examination on what happened to the Titanic..." Dodd said.
But he caught himself: "...Which is not maybe the best example to use considering the effort we are undertaking," Dodd added hastily.
Really, we don't want to see you again any time soon istockphoto.com
If you get out of the hospital after heart surgery and you have to go right back because you have pnemonia, it might mean the hospital didn't address your health problems properly.
It costs the health system billions to readmit patients, and it happens a lot -- one out of five Medicare patients are readmitted within 30 days, says CMS.
Hospital Compare, the government website that tracks hospital quality, yesterday added new data that will make it easier for the public to compare hospital recidivism rates over the last three years.
If you've ever wondered how much pay it takes to play in Washington's health care debate, check out the Center for Responsive Politics post today on how much the pharmaceutical, insurance and health professional lobbying groups have paid.
Some eye-opening excerpts:
The Pharmaceutical Research and Manufacturers of America, which represents the drug industry, has spent $27.2 million since last year on lobbying.
The senior citizen advocacy group AARP? They've spent $31 million on lobbyists.
And the American Medical Association has spent $24.9 million, followed closely by the American Hospital Association at $23.8 million.
That's a lot of loafers.
So what are they getting in return? Check out NPR's series called Dollar Politics, which follows the money and influence trail, and our coverage here on what the dealmaking means to you.
Thanks to NPR's Power, Money and Influence Correspondent (his real title!) Peter Overby for the tip.
The business community is reeling following Wal-Mart's surprising announcement that it would join a major union to support a controversial proposal to require employers to either provide health insurance to employees or pay into a government fund.
The ever-colorful Neil Trautwein, vice president of the National Retail Federation, tells Fox News yesterday in this video that if Wal-Mart made some sort of back door deal, it may come back to bite the company. Literally.
"If you offer an alligator an arm, chances are it's going to come back for the other arm and both legs, so I just don't think it's a success strategy," he says.
I'll admit it. When I walk by the board room after a meeting, I snarf up a leftover muffin. And I hunch over my computer desk to eat a quick sandwich rather than walk out of the building to get a salad and some fresh air. I don't micro exercise, because I just found out what it is.
But I know I am not alone.
Not only is this behavior undermining our diet and exercise plans, it may end up costing big health care bucks. Medical costs for obese workers are between 29 and 117 percent greater than those for workers with normal weight, CDC says. We're talking about greater risks for diabetes, stroke, heart disease and more.
Today the CDC announced LEAN Works!, a website designed to help your company set up a fitness and nutrition program from start to finish. They also offer this handy but slightly terrifying obesity cost calculator so you can compute your specific risks.
As Congress looks for ways to save money on health care, we call all save a little money ourselves, starting by taking the stairs and putting down the donuts.
Tim Grizzard writes that every time he's dealt with a severe illness,
it is like no one has ownership of the problem. In the hospital, treatment is so disjointed from one shift to the next and from one doctor to the next.
Dr. Samuel J. Williams, a semi-retired surgeon in Virginia, says he's "learned the hard way" that patients and families need advocates to help them understand what's happening and make informed decisions.
"I believe that such professionals will become more necessary, not less," Williams writes. He's interested in starting such a service in southwest Virginia, and suggests churches might test the idea of a "parish doctor" or "parish nurse."
A number of others around the nation (I've posted their links at the bottom) tell us they're already doing patient advocacy -- either on a volunteer or paid basis.
Pollster Stan Greenberg channels famed N.Y. Yankees Coach Yogi Berra Ron Frehm/AP
Yogi Berra's famous tagline sums up how former President Clinton pollster Stanley Greenberg sees the state-of-play on health care this year: "Deja vu all over again."
"People want change, but they know if it's not done right they will pay the price," Greenberg tells NPR's Melissa Block in an interview today.
Greenberg, who recently polled the public on the very same questions that he did back in 1993, just before Bill Clinton's big health care overhaul push, got back many of the very same answers. The American people, he said, are dissatisfied with the health care system. Yet, three-quarters are satisfied with their own care.
President Obama patiently explains his support for the public health option /istockphoto.com
With the tone of a patient but firm elementary school teacher, President Obama today poked critics who fear that the "public option" -- the creation of a government-run health plan that would compete with private health plans for beneficiaries -- would kill the private insurance system.
"If private insurers say that marketplace provides the best quality health care, then why is it that the government, which they say can't run anything, is suddenly going to drive them out of business? That's not logic," Obama said.
You could almost hear the ruler being raised gently up and down, calmly but slightly threateningly, in his palm as he spoke.
Sen. Chris Dodd (D-CT) is, by severalaccounts, facing the politicalfight of his life as he bids to keep his Senate seat in 2010. He has been unable to distance himself from the awarding of insurance executive bonuses that caused so much populist outrage earlier this year and he trails three Republican challengers in the polls.
Now, his long-time friend and colleague, the ailing Sen. Edward Kennedy (D-MA), has either thrown him a lifeline or an anchor -- he's appointed Dodd the captain on health care for the Health, Education, Labor and Pensions Committee this year. Dodd is attempting to steer Kennedy's bill through committee as we speak.
Check out the new campaign video above in which Kennedy calls Dodd his "closest ally" in the fight for health care rights for all.
Facing a long hot summer drafting a health overhaul bill, those working on the issue had only one desire when the opening bell rang today in the Senate: Find the perfect soundbite that will make it into the papers.
In the interest of fairness, we bring you both contenders, and a Star Wars Lego video we like (above.)
Sen. Judd Gregg (R-N.H.) expressing his party's general disdain for the version of the bill put before the panel:
Rep. Jan Schakowsky, before she broke her foot. Charles Rex Arbogast/AP
What's with all the crutches in Congress?
First there was Supreme Court nominee Sonia Sotomayor, who limped to a hearing after tripping over a curb. And this week Rep. Jan Schakowsky (D-IL), just back from a Congressional trip to Guantanamo Bay, shows up to a subcommittee meeting with a bad limp.
"I wish there was a dramatic story," she told her fellow committee members yesterday. "I went to Guantanamo and fell, and broke my foot in two places."
But it wasn't her own pain she was feeling in that committee hearing, Schakowsky told me later. Instead she had pangs of sympathy (and anger) listening to the stories of three people who thought they had health insurance -- until they got sick.
President Obama waves from the stage before speaking to the American Medical Association on Monday Pablo Martinez Monsivais/AP
Thanks for watching our first live-blogging effort yesterday. And thanks for your comments on our coverage of President Obama's speech to the American Medical Association. I'll respond here to a few.
To Dr. Kahn, who says:
"I dont think there is any thing wrong with govt. backed health insurance plan. After all medicare is a govt [plan] and my patients love it."
Yes, that's the paradox. Medicare is government-funded and government-run and generally patients love it, but doctors not so much -- because Medicare limits how much they can charge.
Dr. Atul Gawande's commencement address this morning to graduating medical students at the University of Chicago reminds me of my favorite fortune-cookie saying: "All is not yet lost."
The Boston surgeon has been cited lately by everybody up to President Obama for his New Yorker article that pulled back the curtain on why doctors in McAllen, Texas, practice one of the most expensive styles of medicine in America.
It's because patients in McAllen get more "stuff," Gawande says. More tests, more procedures, more specialist visits, more hospital admissions. "But not necessarily more of what they need."
McAllen is far from alone. And health "reform" ain't gonna work if American docs keep doing that, Gawande told the newly minted physicians.
Max Baucus, Democrat from Montana and chairman of the Senate Finance Committee overseeing the health care overhaul this year, seems to have gone a little bit mob boss this week in his quest to control the debate.
Roll Call reports that his top aides met with prominent Democratic lobbyists, warning them not to meet with Republicans on health care matters or it would be viewed as a "hostile act."
Yikes. Wonder if they were packing.
Baucus told reporters he was unaware of the threats.
Good morning. Lots of health news to dissect today.
New FDA Commissioner Peggy Hamburg says she wants to take on tobacco, and it looks like she's going to get her wish.
NPR's Joanne Silberner reports that after a decade-long effort, the power to regulate cigarette content and advertising is about to fall into the agency's hands. They'll get a whole lot of new money to do it, too.
NPR's Richard Knox warns that the WHO is FINALLY about to declare its equivalent of DefCon FIve on the new H1N1 flu virus, stay tuned for details on what that really means.
I know the information's around here somewhere... /istockphoto.com
It seems that turning Obama volunteers into lobbyists takes more than a name change.
I took a very unscientific look for All Things Considered yesterday at one of the many meetings sponsored around the nation this weekend by Organizing for America -- formerly Obama for America.
One thing was clear: Volunteers need more information if they are going to press Obama's health care overhaul plan.
Egypt, the country that slaughtered its entire pig population in April to ward off swine flu, now has a handful of confirmed H1N1 flu cases.
Gulf News reports that a Cairo doctor is on a campaign to stop the region's traditional kiss-kiss-kiss greetings in favor of dry versions, like handshakes.
Health care moves to a tweet, tweet beat wonderferret/Flickr
Good Morning. The business of overhauling health care, or at least talking about it, moves up to warp speed. A European-touring President Obama gets an earful of tweets from the ranking Republican on the Senate Finance Committee.
Sunday morning, Sen. Charles Grassley (R-IA) let it be known, from his Blackberry in shorthand to the world via Twitter, that he was none too pleased with the President's tone in his weekly radio address:
Pres Obama while u sightseeing in Paris u said 'time to delivr on healthcare' When you are a 'hammer' u think evrything is NAIL I'm no NAIL
It's going to be a long, hot, summer of late night health negotiations.takomabibelot/flickr
President Obama wants a health care overhaul bill ready to sign by October. That's a tall order for a bill that affects one-sixth of our economy, so we're expecting a summer full of late nights and political fistfights.
The basement rooms of the Capitol will hum with the sounds of negotiations over buzzwords like tax increase, subsidies, exemptions, carveouts, employer mandate, public plans and private competition, but we want to know, how's it going to go?
Brand-spanking new Kaiser Health News has a roundup of the opinions of Washington's health experts, predicting the shape of the debate to come. Check it out here.
Having a computer is not enough to get patients to make healthier choices southerntabitha/Flickr
Would you like to receive e-mails from your health insurer, reminding you to exercise more and eat right? How about a text message promoting free blood pressure checks at the local hospital?
Apparently, most of us want such communications, but insurers and doctors are not yet taking advantage of these proactive technologies.
A new survey by Microsoft released today says most consumers want their doctors and health insurers to use technology reminders to help them live a healthy lifestyle, but nearly half say their health plans support them only when they are already sick.
As part of its efforts to give the public a window into the complexities FDA faces when regulating food, drugs and medical devices, the agency announced the formation of a task force on transparency yesterday.
Releasing more information about products under agency review won't be easy, former general counsel to the agency Peter Barton Hutt tells The New York Times:
Still, the goal is to open up a system in which the agency failed to inform the public that a widely prescribed heartburn drug was especially toxic to babies; that a diabetes medicine and a painkiller increased heart attack risks; and that antidepressants increased suicidal thoughts and behavior in children and teenagers.
Sen. Max Baucus sustained a gruesome eye injury during the 2003 JFK 50-miler, but he has recovered and runs on Anna Bradford/Washington Running Report
It's become almost a habit for Senate Finance Committee Chairman Max Baucus to talk about how much he's enjoying the task of trying to negotiate a huge health care overhaul bill.
He did it again at the White House this morning, at a news conference to officially unveil a study arguing that fixing what ails the health care system would also boost the nation's economy.
"This is a lot of fun working on all this," said Baucus, "because you talk to all these groups and man, they want to be part of the solution."
The Family Van might teach us a thing or two about the price of preventive care. Courtesy of President and Fellows of Harvard College
What's an ounce of prevention worth? That's a timely question as Congress gets down to the serious business of overhauling the health care system.
Harvard has figured out the true value of preventive care. At least for a mobile clinic that roams the streets of Boston.
It costs around $566,000 a year to run The Family Van, as the clinic-on-wheels is called. Its staff has nearly 5,000 patient encounters annually. Harvard researchers figure that 80 percent of these patients would have gone to a hospital emergency room if the van hadn't been around.
A visit to the Van costs the program $117, but its free for patients. The emergency room costs more than $900 for a non-emergency visit. The prevention payoff is pretty clear here.
UPDATE 4:53 pm: Sen. Charles Grassley is already squinting at the fine print:
"I'm skeptical that these proposals will add up to anywhere near $2 trillion. In the legislative process, proposals rise or fall based on what CBO says about them, and the same will be true here."
Today's 28-page letter from the health care industry and labor's top brass confirms that the health care industry and labor groups really, really want to be at the table when Congress takes up a health care overhaul.
They've pledged to "do their part" to create health savings, and offer some concrete suggestions for where to look for these savings.
AHIP, the health insurance trade group, calls for standardizing and automating a bunch of basic insurance functions, including "claims submissions, eligibility, claims status, payment, and remittance."
The AMA points to measures it is working on that could control overuse of certain medical procedures, including surgery for back pain, diagnostic imaging and stenting for stable coronary disease.
SEIU, a union that includes many health-care workers, argues for shifting funding to allow more patients to be cared for at home rather than in nursing homes.
While none of these suggestions are shocking or particularly new, having something in writing might make it easier for Congress to pin the interest groups down and hold them at their word.
Health care costs continue to rise, everyone has ideas on how to curb them AMagill/Flickr
Earlier today we brought you data on the cost of doing nothing to curb health care costs. Now we bring you ideas on how to reign in health care costs.
Two nuggets to put in the hopper today:
Much to the consternation of medical device and drug companies, HHS is proposing to consider the cost of care as part of its definition of comparative effectiveness research.
Health care costs may break the bank, whether we address them or not istockphoto.com
How to pay the eye-popping cost of a major health overhaul bill is Topic A around Washington these days. Taxes on sugary soft drinks, on health insurance premiums, and on beer and wine are all under consideration.
But there is an equally alarming cost to consider: The cost of not doing anything at all.
One study from researchers at the University of California, San Diego, and published in an online version of the policy journal Health Affairs today looks at what might happen to the number of uninsured Americans if Congress does not address it this year.
Philadelphia Phillies relief pitcher Clay Condrey, Carlos Ruiz, and Shane Victorino celebrate after the Phillies defeated the Yankees 4-3 in New York on Sunday, May 24, 2009. Kathy Willens/AP
We're not talking about the Yankees v. Phillies games last weekend, we're talking about Michigan Attorney General Mike Cox's latest quest to stop insurance companies from raising rates.
According to the Detroit Free Press, Blue Cross of Michigan is seeking 56 percent rate increase for non-elderly people buying their own insurance; 42 percent for group conversion policyholders who purchase coverage they once had at work, and a 31 percent increase for seniors with supplemental Medicare policies.
"Blue Cross should stop putting profits over people and focus on its mission as the insurer of last resort," Cox says.
That was one of my mother's favorite lines, which she exclaimed with glee whenever she figured out one of her kids' crazy schemes before it could be executed.
Dueling pistols for Washington health overhaul message gurus istockphoto.com
The line might be from the mid-1960s cartoon, "Quick Draw McGraw" about a lovable, goofy mustang who was the sherriff of a lawless Western town. Or it could have come from a similarly-themed competitor, "Deputy Dawg," but in any case, it spoofed the Wild West obsessions of a previous generation.
As the Senate Finance Committee heads for a make-or-break attempt at a health overhaul bill next month, Democratic Chairman Max Baucus of Montana likes to repeat his mantra that "everything's on the table" for discussion.
But pressed by a reporter at a breakfast session Thursday, Baucus conceded that there's at least one major proposal that's not: Single-payer, which involves having the government pay all health bills, eliminating the role of private insurance.
"That's the only thing that's not," Baucus said, "because it cannot pass. And I don't know two or three members of Congress who privately, honestly tell you that it can pass."
But Baucus, who directed Capitol Police to arrest single-payer supporters who launched loud protests at his last two public hearings on a health overhaul, didn't want that to be his last word on the subject.
Finally, along with the azaleas, health care overhaul bills are starting to sprout on Capitol Hill.
But they're not the bills most people have been waiting for -- the ones from Senators Ted Kennedy (D-MA)or Max Baucus (D-MT), chairs of the committees that will make or break the president's top priority.
Still, the new bills are notable because they're coming from some of the naysayers in the process -- Republicans who have been complaining that the proposals being espoused by President Obama and his followers are too expensive and too bureaucratic.
The big bill of the day comes from Sens. Tom Coburn (OK), and Richard Burr (NC), and Reps. Paul Ryan (WI) and Devin Nunes (CA). The "Patients' Choice Act" raises no new taxes, creates no new government-run health program, and, in fact, would turn back much of the Medicaid program for the poor to the states.
They are billing it as an alternative to "Obamacare."
"We are showing that America can have a system of universal health care access without the government running it," said Ryan.
This puppy looks like he's reading. He may even be reading a new study on health insurance mergers. istockphotos.com
In many parts of the country, only one or two health insurers control the market, health insurance premiums are rising faster than inflation, and many insurers don't follow the rules.
This is according to a new report issued by Health Care for America Now, a grassroots group pushing for major health reform this year.
NPR's Julie Rovner got a sneak peak at it last night and says the report is likely to spark debate as Congress crafts legislation to overhaul the nation's health system, even if the information in it has been publicized before.
She notes HCAN's savvy strategy:
"If you want to make an important point in an ongoing debate, it helps to have a new study. Even if that study says something most of the in-the-know people already know."
Many Republicans and Democrats want to tax your health benefits to help pay for a health overhaul, but not everyone's sold on the plan, namely, the President.
And what does taxing your health benefits mean, exactly? It means changing the tax code, which currently makes employer-sponsored health care tax free for employees.
End it, says Douglas Holtz-Eakin, former health care guru to former Republican presidential candidate Sen. John McCain.
The current tax treatment of health benefits is unfair because it goes only to those who receive their insurance from their employer, not those who purchase their own health insurance, Holtz-Eakin says. He adds:
"Moreover, the subsidy is of greater value to the more affluent (who have a higher tax rate and thus avoid more taxes) than to the less affluent. It also distorts decisions about health insurance and, by implication, health care."
Holtz-Eakin suggests replacing the tax-free health benefit law with a phased-in credit of $4,500 for those who have private health insurance, plus the very non-conventionally-Republican idea of expanding Medicaid and federal subsidies to states who address a significant portion of their uninsured.
Furthermore, the exclusion is counterproductive: tax-free health benefits encourage employers to provide more compensation in the form of health insurance and encourage insured individuals to use more health care than they would if they had to pay with after-tax dollars. The result is higher health-care costs.
Health industry CEO future fashion statement?Rob Lee/Flickr
If health plans and drug makers are looking for ways to control costs as they prepare to make a deal with Congress on a major health overhaul this year, they might start with what they're paying their CEOs.
FierceHealthcare reports on health plans' CEO compensation based on data gathered from the SEC.
Aetna's Ron Williams takes the top spot. His compensation package of $24.3 million is double that of his closest competitor, Cigna's H. Edward Hanway, who takes in $12.2 million.
Three, four and five, respectively, are Angela Braly of WellPoint at $9.8 million; Dale Wolf of Coventry Health Care at $9 million, and Michael Neidorff at Centene, who got $8.8 million in compensation last year.
Yet the health plan CEO compensation packages practically pales in comparison to pharmaceutical industry executive pay.
Health Futures Inc. President Jeff Goldsmith has some controversial views on the biggest sticking point in President Obama's health care overhaul plan. Namely, he says dump the whole public plan idea.
In a Health Affairs blog post today, Goldsmith suggests that Obama give up the idea of creating a new Medicare-like public health insurance plan to compete with private plans if he wants to get a bill passed this year. He says:
"...the Obama team and congressional leadership will have to forswear the potential for an ideologically polarizing fight with a fragmented industry. That fight might please a resurgent Democratic base, but it could also galvanize providers and insurers, as well as risk-averse consumers, and lead health reform back to gridlock."
Instead, he says, leverage the State Childrens' Health Insurance Program and expand Medicare to more of the uninsured, accept health industry concessions, and implement the new technologies that will streamline the medical system.
Does an appeal to a sense of collective equity matter when it comes to raising taxes?
When President Obama proposed in February to limit the rate at which families making more than $250,000 a year can take itemized deductions on their taxes as a major means to pay for a health care overhaul, the squawking began immediately around the country's dinner tables.
Members of my family, most of whom don't make the $250,000 per year salary at which the new rate would kick in, and don't itemize many deductions, complained bitterly about "paying more taxes."
Congress isn't sold either, and charitable organizations are steamed.
But Budget Whiz Kid Peter Orszag is trying a new approach -- fairness, and an explanation that doesn't require a tax law degree.
In a blog post Saturday (yes, the Office of Management and Budget has a blog), he explains it this way:
If you're a teacher making $50,000 a year and decide to donate $1,000 to the Red Cross or United Way, you enjoy a tax break of $150. If you are Warren Buffet or Bill Gates and make that same donation, you currently get a $350 deduction--more than twice the break as the teacher. Limiting itemized deductions for high-income Americans would help restore balance to the tax code, and any effect on charitable giving is likely to be swamped by other Administration policies.
After meeting with President Obama at the White House this morning, House Speaker Nancy Pelosi told reporters she is "quite certain" that there will be a health care overhaul bill on the floor by the end of July, before Congress departs for their August recess.
"We've got to get it done this year," the president urged. "And we don't have any excuses. The stars are aligned." Obama met with a group of Democratic House leaders this morning to discuss health care legislation, the third straight day his agenda has included some health care-related event.
Obama said any plan to overhaul the health care system should address three things: lowering costs; allowing patients choices on picking their doctors and health plans; and providing access to quality and affordable care.
Increasing taxes on alcohol, tobacco and even soft drinks might not be the most popular ways for Congress to finance efforts to overhaul the nation's health care system and such measures would make a small dent in the price tag, according to most estimates. But such taxes could be more politically palatable than another idea floating around the debate -- limiting the tax deductions for employer-provided health care benefits.
Senate Finance Chairman Max Baucus has indicated that he would be open to changing the rules on how benefits are taxed as a way to help pay for an overhaul estimated to cost $1.5 trillion over ten years. Updated 3:10: NPR's Julie Rovner reports on the discussion over taxing health care benefits at the Finance Committee hearing, listen to it here:
As has been pointed out several times this week, it's an idea that was proposed by Sen. John McCain during last year's presidential race -- and one attacked heartily by President Obama's campaign.
The AP reports that White House aides now say the president is "open to suggestions from Congress," on how to finance the plan. As this idea continues to percolate, expect Obama's campaign opposition to be a part of the discussion. And, you might be seeing this ad a lot more often:
Stop shaking this, and you could save the country money on health careL. Marie/Flickr
When Max Baucus, the chairman of the Senate Finance Committee, gathered some of the nation's top economists to talk about how to raise the funds to pay for a health care overhaul, he thought knew what to expect.
Most of the suggestions were ones that have been around for a while: Start taxing employees' health insurance and pay health care providers based on quality, not quantity.
Then came Michael Jacobson. The longtime head of the Center for Science in the Public Interest had a very different list, including "lowering the sodium levels in food."
Too much salt causes or exacerbates a long list of medical ailments, he said, and curbing it could reduce medical spending by some $20 billion dollars a year. While Congress is at it, he said, it could curb trans fats in food and tax sugared soft drinks.
Replied Baucus after Jacobson was finished -- apparently without irony -- "parts of the calculus here are what's politically palatable."
If you understand the difference between percent and percentage points, give your math teacher an apple today Sister72/Flickr
A coalition of health care industry leaders have promised President Obama that they'll hold health care costs down.
Great. We can all use a break.
But how much of a break might we be getting? The numbers have been very confusing.
Consider the following descriptions:
"The industry says it can shave 1.5 percent off the annual rate of growth through voluntary efforts." (New York Times, 5/12/09)
"President Barack Obama, however, praised the promise to slow spending 1.5 percent a year, for $2 trillion of savings over 10 years, as a 'watershed event' in health-care reform efforts." (Hartford Courant, 5/12/09)
"In short, the coalition has agreed to reduce the annual health care spending growth rate by 1.5 percentage points for the next 10 years" (5/11/09 posting on the White House Blog)
Percent and percentage points -- They're NOT the same thing. You can skip the rest of this post if you're getting the heebie jeebies, but if you're still with me, I'm going to make up some numbers to illustrate the difference between percent and percentage points.
The ups and downs of health care cost controls Altman/Health Affairs
In case you think we're alone out here, questioning the ability of policymakers to significantly save money while overhauling the health system, we offer you this prescient paragraph:
The problem of rising health care costs is reemerging as a national issue. Unfortunately, costs are rising as the economy sputters, the federal surplus dwindles, and the nation is focused on the war against terrorism and its ripple effects here at home. It will now be much harder to make much progress on big-ticket health problems such as expanding health coverage for the uninsured and providing drug coverage for seniors.
That was none other than health experts Drew Altman and Larry Levitt, in an article they wrote for Health Affairs published on January 23, 2002.
The article is pessimistically titled: "The Sad History Of Health Care Cost Containment As Told In One Chart".
The above graph is Exhibit 1, showing health spending's ups and downs as Medicare and Medicaid passed in the mid-1960s, wage and price controls of the 1970s, the last "Voluntary Effort" of the health industry in the late 1970s, and the impact of managed care in the 1990s.
Altman and Levitt go on:
What the analysis of private health spending reported in Exhibit 1 shows is that no approach our nation has tried, over the past thirty-five years, to control health costs has had a lasting impact.
President Obama strides purposefully past reporters after a White House meeting on health reform todayCharles Dharapak/AP
There was a lot of buzz at the White House today when President Barack Obama met with health care providers to discuss ways in which they could help reduce health care costs and help -- rather than thwart -- reform efforts.
Here's what the President said after the meeting:
...what's brought us all together today is a recognition that we can't continue down the same dangerous road we've been traveling for so many years; that costs are out of control; and that reform is not a luxury that can be postponed, but a necessity that cannot wait. It's a recognition that the fictional television couple, Harry and Louise, who became the iconic faces of those who opposed health care reform in the '90s, desperately need health care reform in 2009. And so does America.
And in its letter to the President, the industry groups commit to changing their ways, including:
Reducing the cost of doing business by addressing cost drivers in each sector and through common sense improvements in care delivery models, health information technology, workforce deplyoment and development, and regulatory reforms.
But just in case you were starting to inhale, remember the Congressional Budget Office assessment from December, which is sure to punch a little hole in your balloon: These things will definitely help make health care better, but they won't likely save the federal government money.
If trying to rescue the banks, save the American auto industry, stimulate the economy via a $787 billion stimulus package, managing a troop increase in Afghanistan and facing off with pirates and swine flu seemed time consuming, wait until President Obama really gets going on health care.
President Obama and HHS Sec. Sebelius gear up for health care push. Brendan Smialowski/Bloomberg News
The president has said he wants something done on "comprehensive health reform" this year but appears happy to set broad parameters for the moment, leaving the details for Congress to work out. But that doesn't mean the administration is taking a passive approach by any means and this week provided a glimpse of the push that's already begun.
The president's budget set the marker for health care as a top priority for the year, setting aside about $600 billion in spending over the next ten years as a down-payment for an overhaul of the system. That's about half of what the experts say it will cost.
And there were signals all around that the administration is pushing to shape the debate to come. In her first appearance in front of Congress since being confirmed as Health and Human Services Secretary, Kathleen Sebelius Wednesday said that the president isn't looking for a government takeover of the health care system but does support a publicly financed component. "Dismantling the private market and having an entirely public option ... I think is not something that the president supports."
