Crist Stumbles on Healthcare

Over the last couple months, the Florida Senate race has been a battle of messages between Charlie Crist and Marco Rubio. Both have been very effective and thus the race has been tight with each having their share of polls showing them leading.

Rubio has continued to ride his message of American exceptionalism, small government and free markets. Meanwhile, Charlie Crist has ridden a message of the independent politician not beholden to either party.

Both would have been perfectly happy staying on this message until November. Recently, however, Governor Crist has stumbled in trying to explain his position on Obamacare.

Florida Gov. Charlie Crist (I) is walking back comments he made in an interview earlier today about the recently enacted healthcare law.

Crist is mounting an independent bid for Senate against Republican Marco Rubio and Democratic Rep. Kendrick Meek.

Crist told a local TV station Friday that he would have voted in favor of President Obama's healthcare proposal were he in the Senate. That was a reversal of his previous position against the healthcare law.

"I would have voted for it," Crist said in the interview. "But I think it can be done better, I really do."

Crist has said just about everything on Obamacare recently. He's said he would have voted for it and against it. He's said he'd repeal it and he'd just improve it. He's been taken totally off message. Meanwhile, Rubio carries the Republican Party line of repeal and replace and so he stays on message and attacks Crist as a flip flopper.

This race will be very tight and it will come down to exactly these sorts of errors. Rubio has won this round. If he's flawless going forward, victory is in hand.

Obamacare Chickens Coming Home To Roost

The themes from this recent O'Reilly Factor Talking Points Memo are not likely to go away. Health insurance rates are on the rise. The health insurance companies are blaming Obamacare for the rise in costs. This part in particular will prove politically deadly for President Obama.

As we stated Wednesday night, American health insurance companies are building in the anticipated costs of Obamacare. For the next four years until the Obamacare program completely kicks in in 2014, all Americans are going to be hammered as the insurance companies try to make as much money as they can before the federal rules are imposed.

I don't know about you, but I never heard this part of Obamacare. I was never told that my insurance rates were going to run wild.

Were you told that? Did President Obama mention that? I don't believe he did.

If you believe Dick Morris, the President wants rates to go up so that he can institute single payer in 2014. Of course, he won't be around in 2014 because his policies are all a colossal failure and we are seeing the beginning of that abject failure in real terms with Obamacare right now.

The fact is that Obama claimed that Obamacare would bend the cost curve downward and instead rates are skyrocketing up and the insurance companies are blaming Obama. So, the economy is horrible. Unemployment is near ten percent. The border is a mess. Afghanistan is a mess. Now, health insurance premiums are skyrocketing as a result of the very policies that Obama claimed would make them come down. To add to that, both Charlie Rangel and Maxine Waters may have their congressional trials in September. That's an unmitigated Democratic disaster. ob

Missouri Invalidates Health Care Mandate

Yet another state sent Obamacare a message.

Missouri voters on Tuesday easily approved a measure aimed at nullifying the new federal health care law, becoming the first state in the nation where ordinary people made known their dismay over the issue at the ballot box.

The measure was intended to invalidate a crucial element of President Obama’s health care law — namely, that most people be required to get health insurance or pay a tax penalty. Supporters of the measure said it would send a firm signal to Washington about how this state, often a bellwether in presidential elections, felt about such a law.

“My constituents told me they felt like their voices had been ignored and they wanted Washington to hear them,” Jane Cunningham, a state senator and Republican who had pressed for a vote, said Tuesday night. “It looks to me like they just picked up a megaphone.”

The legalities of all this are murky. The politics couldn't be clearer. The administration is on a collision course with dozens of states on this mandate and it will end up in the Supreme Court. It will pit individual states against the federal government. While this is happening, the Obama administration is on a separate collision course with Arizona and other states vis a vis illegal immigration.

This Chart Says it All

Welcome to the world of Obamacare.

My colleague Soccer Dad has more.

Real Clear Politics and Health Care Reform

Today's health care section of Real Clear Politics is a microcosm of the problems that the administration faces on health care reform. Today, it links to three different stories and each is a problem for the Democrats. The first story is about how health insurers are pushing for plans that will limit the choices patients will have in choosing their doctors from the New York Times.

As the Obama administration begins to enact the new national health care law, the country’s biggest insurers are promoting affordable plans with reduced premiums that require participants to use a narrower selection of doctors or hospitals.

The plans, being tested in places like San Diego, New York and Chicago, are likely to appeal especially to small businesses that already provide insurance to their employees, but are concerned about the ever-spiraling cost of coverage

But large employers, as well, are starting to show some interest, and insurers and consultants expect that, over time, businesses of all sizes will gravitate toward these plans in an effort to cut costs.

The tradeoff, they say, is that more Americans will be asked to pay higher prices for the privilege of choosing or keeping their own doctors if they are outside the new networks. That could come as a surprise to many who remember the repeated assurances from President Obama and other officials that consumers would retain a variety of health-care choices.

Of course, President Obama billed health care reform as a way to cut costs and expand choice. The reality is of course very different.

The second story, also from the New York Times, is about how the Obama administration has taken to calling the mandates a tax.

When Congress required most Americans to obtain health insurance or pay a penalty, Democrats denied that they were creating a new tax. But in court, the Obama administration and its allies now defend the requirement as an exercise of the government’s “power to lay and collect taxes.”

And that power, they say, is even more sweeping than the federal power to regulate interstate commerce.

Administration officials say the tax argument is a linchpin of their legal case in defense of the health care overhaul and its individual mandate, now being challenged in court by more than 20 states and several private organizations.

It's true that the power to tax is a constitutional mandate of the federal government. The problem is that if this mandate is a tax, then that's a tax on everyone. Yet, President Obama so famously promised that 95% of the country wouldn't be taxed under his administration.

If this mandate is a tax, then it also means that everyone's taxes are going up.

Finally, there's this story from Politico in which both the left and right are pushing back against his abortion policy in health care reform.

The key lines are these: "The Obama administration has decided that no woman in the new high-risk insurance pools will be allowed to obtain abortion coverage beyond limited cases (rape, incest, endangering the life of the woman). Not even if she pays for that coverage with her own money...

"...The president committed his administration to preventing any federal funds from being spent on abortion care. But the fact is, this announcement from HHS goes well beyond that. Nothing in the new health care reform law requires a ban on abortion coverage in the high-risk pools. No law passed by Congress forced this decision. The Obama administration has chosen to place a new burden on ill and medically vulnerable women seeking abortion coverage."

...

Talk dominated conservative news outlets over the last few days that New Mexico and Pennsylvania were going to allow elective abortions as part of their applications for access to the new federal insurance pools. Among the sparks for that round of stories was an AP report in which New Mexico officials initially said elective abortion would be covered under its policies, then started walking that back.

But the National Right to Life Committee sparked an uproar by claiming a similar issue was arising in Pennsylvania. Pennsylvania officials strenuously denied that and Democrats accused the NRLC of creating an issue out of whole cloth aimed at testing an executive order President Obama signed last March.

It still remains unclear if the new health care reform will use federal tax dollars to fund abortions. The president said no and even signed an executive order to stop it. We don't live in a dictatorship and so an executive order is largely useless.

Keep Your Health Insurance: Not So Says IBD

President Obama famously often said

if you like your health insurance, you'll keep it

Not so says an Investor's Business Daily study.

internal White House documents reveal that 51% of employers may have to relinquish their current health care coverage by 2013 due to ObamaCare. That numbers soars to 66% for small-business employers.

The documents — product of a joint project of the Labor Department, the Health and Human Services Department and the IRS — examine the effects new regulations would have on existing, or “grandfathered,” employer-based health care plans.

Draft copies of the documents were reportedly leaked to House Republicans earlier in the week. Rep. Bill Posey, R-Fla., posted them on his Web site Friday afternoon. (View the full report here.)

In fact, I made a similar assertion when I analyzed the House version of the bill last summer.

The nexis, if you will, of government control starts on page 72 and page 84. Those two pages establish the government health exchange, define the government's role in it, and define what providers must enroll in it. The health care exchange will be administered by a new bureaucracy, the Health Choices Administration. Any insurer, health practitioner, or hospital in the health care exchange will be subject to the regulations of the exchange as laid out by the Health Choices Administration.

Who needs to be in the exchange? Any health care provider that provides health care that is paid in whole or in part by a third party must be in the exchange. In other words, any hospital that accepts insurance must be part of the exchange. All insurance companies must be part of the exchange. Chiropractors, laser surgeries, and other procedures that don't accept insurance would not be part of this exchange. As such, almost the entire health care industry would fall under the control of the health care exchange. The health care exchange would now be regulated by the Health Choices Administration.

As such, it is totally misleading to say that if you like your health care it won't change. That's only if your current health care plan conforms to whatever regulations are created by the Health Choices Administration.

That's the critical point. There will be well over 100 new regulators and bureaucracies created by the bill. There will also be a new government run exchange. In both cases, the government will decide what is and isn't appropriate as far as health insurance. With all of these new government controls, it's impossible to know what will and won't be appropriate and so this new study is not altogether surprising.

Fiscal Conservatism is the New Populism

The most famous populist is probably William Jennings Bryan. He rode a wave of man of the people appeal and almost won the presidency before the age of forty on a third party ticket.

The interesting thing about populism is that it doesn't fit into any traditional ideology. Anyone can be a populist because all it really means is a politician that is in touch with the thoughts and beliefs of the people. The "folks" is what Bill O'Reilly calls them as he applies his own brand of populism on his show.

Only three or four years ago, populism was associated with such concepts as universal health care, protecting U.S. jobs, and tax increases on the wealthy. That's why it's none too ironic that fiscal conservatism is the new populism.

That's the greatest accomplishment of the Tea Parties. They were the greatest visual evidence that the folks care about government spending, out of control government, and deficits. It was cool to be fiscally conservative.

This isn't only ironic but natural. It was populist to be for universal health care when that was merely a concept. When the folks got the bill for universal health care, the folks wanted someone that could spend their tax money wisely. Now, if you want to be a populist, you have to get your fiscal conservative bonafides.

A Rose By Any Other Name...

...Is still a public option.

With health care reform now flailing the President is weighing his options. There are those that say that he may give up the public option for an alternative. We'll all wait and see, but, make no mistake, any government involvement is still a public option, and all public options will lead to single payer health care.

There are two options that are most prominent. The first is the so called non profit co op option. This is of course a totally absurd alternative. There are already dozens of co ops, non profit and for profit. There needs to be no new law to create co ops. So, this co op won't be like all co ops. This one will be started by the federal government. As such, it will have the full weight and power of the federal government behind it.

The problem with any public option is that an option with the government's backing is wholly unfair. The government can print money, raise taxes, or borrow with no end. Private insurance companies can't do that. So, whether you call it a public option or a co op started and run by the government, it has the same very corrosive characteristic that will help lead us to single payer. The co op is no different that the public option. It's just dressing the public option, which has become poisonous, and calling it something else.

The other potential option is a public option with a so called trigger. By this, there will be a trigger if insurance rates go too high. Think about this. The new bill will have all sorts of new mandates for insurance companies like forcing people to take on those with pre existing conditions. So, insurance companies will be forced to take on all sorts of new people that they will need to insurance. Most of these will present a much larger insurance risk. Then, there will also be a so called "trigger" for the public option. So, after they take on more risk, if they also raise their rates, then there will be a public option. Doesn't that sound like the insurance companies are set up to fail?

Of course, the so called trigger will really come down to the cliche, the devil is in the detail. For instance, will it account for inflation? If it doesn't, the trigger will be hit eventually. Really, it will come down to who is designing the trigger. If the trigger is designed by someone who's agenda is to make sure that insurance companies simply don't go out of control then that's one thing. If, on the other hand, it's designed simply to trigger the public option, then that's quite another. Who do we think will design it? It won't be Senator Jim DeMint that's for sure. It will be a Democratic leader. It will be Nancy Pelosi, Harry Reid, or Barney Frank. So, what sort of a trigger will we have?

It's pretty simple. Either we have a private market, or a public market. There's never been a successful hybrid. Those either get perverted like Fannie/Freddie, or they will just turn public. Call a public option what you want. Ultimately, it's still the same thing...a trojan horse for single payer.

Some Perspective On Universal Health Care and the Founding Fathers

How many times have you heard a Democratic politician or pundit say something like this?

Among the OECD's 30 members -- which include Australia, Austria, Belgium,Canada, the Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, South Korea, Luxembourg, the Netherlands, New Zealand, Norway, Poland, Portugal, the Slovak Republic, Spain, Sweden, Switzerland, and the United Kingdom -- there are only three lacking universal health coverage. The other two happen to be Mexico and Turkey, which have the excuse of being poorer than the rest (and until the onset of the world economic crisis, Mexico was on the way to providing healthcare to all of its citizens). The third, of course, is us."

(Here is the actual report from the OECD web site)

"The story gets worse as the details emerge. Although the public share of health expenditure in the United States is much lower than any other OECD country except Mexico, the public expenditure on healthcare is much higher per capita than in most OECD countries. So we pay a lot more in taxes devoted to medical care -- not including insurance premiums, co-payments, fees, and other health costs -- than taxpayers in those 27 countries that have universal coverage. Our public expenditure provides coverage only for the elderly and some of the poor (through Medicaid and the SCHIP program for children) while other countries provide universal coverage while spending less."

Let's think about this for a minute. The U.S. doesn't have universal health insurance coverage and many pundits and Democratic politicians think this is bad. Isn't having health insurance a choice? If it's a choice what does it say about all those nations that have universal coverage. It means that there is no choice.

This country was founded on liberty. It was founded on the principle that the government would leave the citizenry alone and only performing the basic functions of protecting the citizens. Now, we bemoan the fact that the U.S. is the only industrialized nation in the world that doesn't have universal coverage. Of course, universal coverage means forced coverage.

What would the founding fathers think of someone proclaiming that the lack of "universal health care" in the U.S. is a bad thing? Health insurance wasn't even a creation when the Revolutionary War was fought. Now, some politician thinks that it should not only be a right but a demand of the citizens. In fact, anyone that views our nation as the only industrialized without universal coverage as a bad thing knows very little about the principles that this nation was founded on.

This nation was founded on the principle of liberty. Health insurance should be as available and cheap as possible. It should not be mandated. It should NOT be paid for by the taxes of someone else. That infringes on the liberty of those being taxed. Anyone that looks at our place in the world, as the only industrialized nation without universal health care, and thinks that's a bad thing simply has no idea what this country was founded on.

The White House Vs. Drudge

This morning, the Drudge Report lead with a You Tube video in which an older clip, from 2003, of then State Senator Barack Obama supporting single payer. Here's the clip.



Drudge is one of the most visited political sites on the web and so I can only assume that word got back to the White House. That's because one of his communications' folks, Linda Douglass, created her own You Tube video.


Douglass called the initial video "unfair", "out of context", and had a few clips of her own. She had clips of Obama saying clearly that people won't lose their health insurance and that he only wants the public option to create competition. Now, because one of the charges was that President Obama was taken "out of context", Drudge later posted the full video of the event that he posted earlier. Here is that video.





Now, with every passing day, it becomes more and more clear that the White House couldn't try and screw up the legislation, selling, and politics of health care reform and screw it up any worse than they are . This is the latest reincarnation of a White House that simply doesn't know what they are doing.



Once again the White House has picked a fight with an individual news site. They've picked fights with Fox News, Rush Limbaugh, Sean Hannity, Jim Cramer, and Rick Santelli. Now, they're taking on Drudge. Even worse here, all Drudge did was link to a You Tube video. Drudge gets plenty of views on its own but there's no doubt that by drawing attention to this the White House only made even more people watch the video.



The White House defense is absurd. The full video shows that nothing is out of context. It shouldn't surprise anyone that Obama is really for single payer. That's what most true blue liberals are for. It's what Barney Frank says he wants and so to Jan Schakowski. Furthermore, that he has said something totally different to a different audience only means he's just like all politicians who tells everyone what they want to hear. The video the White House produced stinks of not only desperation but to quote Shakespeare, "thou dost protest a bit too much".

This is the latest misstep on health care in a series of missteps that characterize a White House that simply doesn't know what it's doing on health care. First, it set an artificial deadline of August to pass health care reform. That was simply absurd. If this passes, it will be the most complicated piece of legislation in generations. Yet, the president presumed to finish it entirely in seven months? Then, he allowed Congress to write the bill in its entirety. This naturally lead to a public battle between its liberal and moderate wing. The president did little to pipe down the intra party confrontation. As such, Democratic Reps and Senators were forced to go on television to voice their opposition to the legislation. The press conference was a disaster. His explanations on health care were inexplicable. Then, he stepped into by commenting on the arrest of Professor Gates. Now, he's taken on a website and turned a cult video into a video that is the subject of news stories and controversies.

The Democrats Health Insurance Competition Gambit

The Democrats have continuously defended their idea for a public option of health insurance by proclaiming that insurance companies take advantage of the system and a public option is necessary to provide competition. This has always been a totally illogical and absurd claim. There are over 1000 different companies that provide health insurance in this country. Yet, they are convinced that one more is what is necessary to create real competition.

At the same time, Republicans like Senator Jim DeMint and Congressman John Shadegg have gotten behind ideas to allow health insurance to cross state lines. Right now, health insurance works as regional monopolies. This is something I have spoken of on more than one occasion. One reasonis that insurance companies long ago were able to carve out an exemption in Sherman Anti Trust that would allow for such regional monopolies. Furthermore, it is now illegal for health insurance to cross state lines. As such, a health insurance company located in Pennsylvania can't provide insurance to a patient in New York.

If Democrats were honest about what was providing a lack of competition in health insurance, they would start and end there. If health insurance companies competed in all fifty states, that would immediately create all sorts of new competition and bring costs down.

Yet, the Democrats don't want any of that type of reform to health insurance. They claim that state laws and regulations keep such competition from being possible. Yet, somehow car, home, fire, and life insurance can all cross state lines. In fact, I know of no other insurance but health insurance that doesn't cross state lines. Remarkably, the only health insurance that is so expensive that its causing a crisis is health insurance.

Instead, Democrats want to create one health insurance company, and one only, that will be able to cross statelines. That's the new health insurance provided by the federal government. The only health insurance provided by the federal government. It will still need the help of medical billing employees to run properly. The only health insurance provider that will be able to compete with every health insurance company in every state will be the new health insurance provider that will be created by the federal government. (that's along with Medicare, Medicaid, and VA which are also government run)

Now, if Democrats are so keen on creating competition, one must ask why they are so resistent to allowing health insurance to cross state lines. This week Barney Frank admitted to Single Payer Network that a strong public option would lead to single payer.



The same happens in this Jan Schakowski clip.



The drive toward "competition" is nothing more than a trojan horse. If competition was their main priority, then the plan would allow for insurance to cross state lines along with the public option. It isn't. Instead, the only thing that will provide "competition" is the public option. Remember, it is the far left wing of the Democratic party that is most in favor of the public option. They were the ones that revolted when the Blue Dogs weakened the public option last week.

Any robust public option, like the one favored by Schakowsky and Frank, would eventually lead to single payer whether its supporters know it or admit it or not. That's because the public option has the benefit of the unlimited power of the Treasury and taxes. Their costs will always be lower than a private insurance company's costs. Though, often that cost is made up in printing money and in higher taxes. Competition can be created by opening up the market to interstate competition. The public option is nothing more than a trojan horse toward single payer.

Seniors Are Scared of Obamacare...and They Should Be

I first heard Dick Morris make this point. The main reason, electorally, that Obamacare is falling apart is that the elderly are rejecting in great numbers. Morris cites a poll in which elderly reject the plan by about 16 points. This is a massive political problem because folks over 65 have about a 70% voting attendance. About 30% of all health care expenses are spent on the last year of someone's life. So, it is the elderly that are the most affected by any health care reform idea. Frankly, the elderly are rejecting Obamacare with good reason.

First, President Obama has proposed, along with the Democrats in Congress, have proposed to pay for some of the health care reform with cuts in Medicare.

Nobody is talking about reducing Medicare benefits," Obama said. "Medicare benefits are there because people contributed into a system. It works. We don't want to change it. What we do want is to eliminate some of the waste that is being paid for out of the Medicare trust fund that could be used more effectively to cover more people and to strengthen the system."

Such assurances haven't stopped Republicans from stepping up their criticism.

"Using massive cuts to Medicare as a way to pay for more government-run health care isn't the kind of change Americans are looking for," Senate Republican leader Mitch McConnell of Kentucky said Thursday in a speech on the Senate floor. "Americans want savings from Medicare to be used to strengthen Medicare, not to create a system that would ... lead to a government takeover of health care."

While the President continues to insist that Medicare cuts won't lead to cuts in Medicare benefits, it's hard to see what else that would lead to. By cutting the fees paid to doctors for Medicare patients, that will eventually lead to less doctors accepting Medicare. The elderly should be worried that cuts in Medicare will lead to cuts in Medicare benefits because there's really nothing else that could happen.

Of course, the fear only starts in the cuts in Medicare. Pages 425-430 mandates advanced care planning for seniors. This will mandate that seniors meet regularly with a counselor to plan for their treatment as they near death. On page 429, the Advance Care Planning Consultant will be used to dictate treatment as patient's health deteriorates. On page 430,the government will decide what level of treatments you may have at end-of-life. This is mandated so this is no option. This is a requirement. Since most health care costs come at the end of life, they will be the first to be rationed.

Pages 272-274 analyzes and studies the treatment of cancer. Within this section, the bill mandates this...

The Secretary shall conduct a study to determine if costs incurred by hospitals exceed costs incurred by other hospitals

It's followed by a section on AUTHORIZATION OF ADJUSTMENT. As such, this section will lead to the rationing of cancer care.

On page 268 the bill even regulates the sale and rental of electric wheel chairs.

The reality is that elderly are very worried about what effect this bill will have on them, and they should be. This bill will ration care and since an enormous amount of care happens at the end of life it will be that care that will be rationed first. The bill will cut Medicare costs and that means cuts in Medicare benefits. It will force seniors to see advance care consultants and it will even have government bureaucrats make decisions for end of life. It even regulates electric wheel chairs.

Why Employer Funded Health Insurance is So Corrosive

In an earlier post, I gave my policy ideas for fixing our health care system. In my hypothesis, I made the point that the nexis of many of our structural problems in health lie in the fact that employers are the ones that overwhelmingly provide health insurance. I think it's important to expand on what exactly is so corrosive with having a system in which employers provide health insurance for their employees.

First, we've all likely heard politicians bemoan the fact that someone can't "take their health insurance with them" when they leave their job. Of course when someone bemoans this problem, they are bemoaning the wrong problem. After all, the reason that employees can't "take their health insurance with them" when they leave their job is because their employer is the one that negotiated the insurance deal. The insurance plan is the property of the company not the employee. Of course, the employee can't take their plans with them since the plan isn't their property. So, the problem isn't that employees can't take their insurance with them, but that we have employers provide insurance for their employees. The second reality causes the first problem.

Then, we've all heard of the so called gold plated insurance plans. These add hundreds of billions in medical costs yearly because they cover just about any medical procedure including regular check ups. Imagine how large automotive costs would be if everyone had car insurance that included oil changes, tire reallignments, and new windshield wipers. One of the reasons that health care costs are so expensive is that the patient is rarely a consumer. That's because most patients have nearly all hospital visits covered entirely by someone else. Patients never question the costs of tests, procedures, and everything else related to their visit. That's because they don't pay for it anyway. If car insurance covered oil changes, oil changes would become exponentially more expensive. That's because no one would ever question the cost of the oil change.

So, why are so called gold plated insurance plans so prevalent? They are provided by employers. In fact, they are often used as part of the selling point to recruit potential employees. Since health insurance isn't taxed, the employee has absolutely no motivation to get anything but a gold plated health insurance plan. Since employers provide most health insurance plans, gold plated plans become the standard. By doing so though, we also create a system in which costs are simply unsustainable.

Finally, employer funded health insurance also contributes to the enormous power of the insurance companies. That's because the patients become by standards in the health process. The insurance is provided by someone else. As such, the one in a position to control the insurance companies, the patient, has little power to control them. The patient can't leave the insurance company if they are unhappy. It wasn't their choice to use the company in the first place. It was the choice of their employer. I have documented several cases of corruption by the insurance companies against doctors. In fact, an insurance company insider once admitted that it's standard practice to shred doctor's bills. That's because they've found that only 80% of doctors notice that they haven't been paid. (likely because doctors are so busy that they don't always keep good track of their bills) The check against waste and corruption is the patient. If an insurance company mistreats your doctor, the patient leaves and finds another insurance company. Of course, if the insurance company is chosen for you, then you can't leave. The system of employer funded health insurance encourages more power in the hands of the insurance companies and less power in the hands of the doctors, and that's what leads to this waste and corruption.

So, it is for these reasons that I believe that our health care system won't be fixed until we find a way to lessen the influence of employer funded health insurance. Once again, here are my recommendations.

Energy Committee Secures Health Care Deal

Henry Waxman was able to pull Blue Dogs and liberals together to cut a deal to secure passage of the health care bill out of his Energy Committee just a couple hours ago.

Liberals and a small core of conservative Democrats set aside long-standing ideological differences early Friday to cut a deal that should allow the House Energy and Commerce Committee to approve a sweeping health care bill, breaking a two-week deadlock that threatened President Barack Obama’s top domestic priority.

Blue Dog Democrats on the committee, who are the linchpin in the House health care debate, agreed to allow their liberal colleagues to cut billions from existing government-funded health care programs in order to restore some $50 billion to $65 billion in subsidies set aside in the bill to help middle-income families purchase coverage.

This final agreement should clear the way for committee passage later today. Energy and Commerce is the last of the three House committees to consider the bill, so passage will put the package in the hands of party leaders for a titanic fight when Congress returns in the fall over the government's role in health care.

In the meantime, Waxman also lost one moderate Blue Dog out of his coalition, Rep. Zach Space. That means only three of the seven Blue Dogs on the committee have signed on. Despite this agreement, I am still of the opinion that the bill, in its current form, has little to no chance of becoming law.

The bill will have now passed out of three House committees. The Blue Dogs are still not all on board. If the Energy Committee is an indication, slightly more than half are still voting against the bill. The liberal wing is also not that happy with the new bill. It's unclear how many of the full chamber will be lost when it comes to a full vote. You're probably looking at between 25-30 Blue Dogs that will vote against this bill. Only 39 Democrats can vote against the bill and still have it pass. (if the Republicans vote in unison against it) So, passage out of the House is by no means a certainty.

Things are even more murky in the Senate. There, there isn't even a bill yet. Right now the bill has to walk a very tight rope between the liberal and moderate wing of the party. It has barely enough support to pass out of the House. Democrats can only hope for that kind of "success" in the Senate. Then, it still has to be reconciled and maintain that support.

I haven't even started talking about the month break yet. Now, lawmakers will go back to their districts and hear from their constituents. The bill is a lot less popular in the country than it is in the Democratic caucus. Furthermore, we'll have two more jobs numbers before there is a vote. If we're still losing 400,000 or more for the month of August (numbers that would come out the first Friday of September), then, in my opinion, all hope for passage of health care reform this year would be lost. The economy would be judged to still be in free fall and there'd be no confidence in any of the president's agenda at that point.

Support for both the president and this bill is falling and the momentum is against it. It's months before it winds up being law at best. So, between now and then, something must change to turn around the momentum. So, the message will need to be recalibrated, if you will, or the economy will have to show a remarkable turnaround. If not, the bill, as it stands now, will still not pass.

Health Care Reform is Still on the Ropes

Just as Henry Waxman seemed to appease the center with a deal with the Blue Dogs, that same deal has a potential of a "rebellion" from the left.

House Speaker Nancy Pelosi spent half of Wednesday finalizing a deal with the Blue Dogs — and the other half quelling a brewing rebellion among progressives who think conservatives have hijacked health care reform.

Liberals, Hispanics and African-American members — Pelosi’s most loyal base of support — are feeling betrayed after House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) reached an agreement with four of seven Blue Dogs on his committee who had been bottling up the bill over concerns
about cost.

The compromise, which still must be reconciled with competing House and Senate versions, would significantly weaken the public option favored by liberals by delinking reimbursement rates to Medicare.

One of the concessions that the Blue Dogs were able to negotiate was a weakening of the "public option". This is a cause celebre among those on the left, and certainly the far left. With it weakened, it's unclear how many of them will vote for the deal, and there's a lot more liberals in the caucus than there are Blue Dogs. So, it appears to coax the middle, Waxman, Pelosi, et al may have lost the left.

Furthermore, the deal in the Energy Committee was cut with only four of the seven Blue Dogs on the committee. That's enough, if Dems hold everyone else, to pass it out of the Energy Committee. It's still unclear how many of the full 52 Blue Dogs are on board with this deal. It's even less clear just how many liberals will be held with this deal.

So, ironically enough, this deal might wind up meaning less votes in the Democratic caucus. It points out two significant problems. The first is structural. This shows again the problem that Dick Morris pointed out first. The Democrats are a collection of factions and it's nearly impossible to craft legislation that will appease them all. (or at least enough of them to get a majority) Between the Congressional Black Caucus, the Congressional Hispanic Caucus, the Blue Dogs, and the liberals that's a lot of people to keep happy. It turns out that it's too many people to keep happy and the Democrats simply can't find a majority on any piece of legislation.

Even more troubling for those in charge, it appears that there is no leadership. How in the world did Waxman secure this deal without making sure the liberal wing would be on board? Furthermore, if the public option is a deal breaker why is Baucus negotiating a coop in the Senate? Even if Baucus figures out how to make a deal with his committee and gets it passed out of his committee, the liberals clearly wouldn't be on board. It looks as though the Democrats aren't talking to each other. People are making deals without knowing the numbers. That's chaos and a total failure of leadership.

Earlier, I said that this deal got them some momentum back. I'm changing my analysis. This deal is symptomatic of the total chaos that the Democrats are governing with.

Some Quick Early Thoughts on the House Health Care Agreement

So far, we know a lot less about the reported compromise between Blue Dogs and the Dem leadership on health care bill in the Energy Committee. We know that the Blue Dogs on this committee have announced that a deal has been cut. We know that under this deal the price tag of the bill will get cut by $100 billion over the next ten years. We know that there will be more emphasis on hospitals in rural areas. We also know that companies with payrolls of $500,000 and less will be exempt from being mandated to provide insurance. There will also be some changes to the public option though those changes aren't clear.



Here's what we still don't know. We don't know when any health care bill will be voted on the full House. The Blue Dogs have gained a commitment not to have a full vote before the break. The current plan is to vote on it in September after the House comes back from break. Of course, in political terms a month and a half is an eternity and anything can happen prior to that. We also don't know the details of the bill that will come out of the Energy committee. Most importantly, we don't know what if anything will come out of the Senate.



The only bill that has been released in detail is this House bill. The only full released bill is nothing short of a monstrosity. It includes at least ten new government regulators. It creates a health care exchange that will be regulated by one of these regulators. All health care providers will be forced to be part of this exchange if they use or provide insurance in their business. As such, almost the entire health care field will now be regulated by a yet created new government regulator. It includes regulation and rationing of cancer care, end of life care, and even electric wheelchairs. It forces audits on any company or individual that self insures. It mandates the government to see patient records, bank statements, and tax records. It even sets salaries for doctors. These are just a few of the "highlights" of this monstrosity of a bill.



So, if what comes out of the Energy Committee is largely a mirror of what is now the only full bill, with the changes mentioned earlier, the Blue Dogs will have betrayed the principles they have professed to believe in. They will have been exposed as much more Democrats than fiscal conservatives. The current bill is not fiscally conservative. The changes made will not make it fiscally conservative. For instance, the Blue Dogs screamed that they wanted to see more in the bill to "control costs". Yet, there's ZERO in the House bill, so far, to deal with tort reform. The hundreds of billion spent in unnecessary tests to protect doctors against potential lawsuits are NOT currently addressed. If the Blue Dogs sign onto a bill without tort reform, they will have betrayed their fiscally conservative principles.



Politically this is a small victory for the President but it is still very small. No bill will be voted on in either chamber before the August break. That means that at least two more sets of jobs numbers will come out before the vote, and the legislators will go home to hear from their constituents before voting on any final bill. If the bill doesn't change markedly from the current version, they will get an earful. The rationing, government control, and ACORN giveaways are only now being analyzed. The changes that the Blue Dogs received will be marginal outliers if the final bill continues to include the basic tenets of the current House bill.



So, the Democrats and the President have extracted a change in momentum but I still believe it is short term and temporary. The trend continues to be against health care reform. It doesn't appear as though the Democrats have any desire to really moderate health care. Until and unless they do, health care reform will not happen. It remains to be seen if what comes out of the Energy Committee will be real moderation or merely window dressing. That will determine just how close we are to passing health care reform.

The Definitive Dossier on the House Health Care Bill (Pages 1-500) Part III

I'm going to combine two parts into one post because they are both small enough. So, for the third part, I will analyze the new taxes in the bill as well as community group benefits.

Now, specific tax increases are NOT in this bill. Those still haven't been finalized. What's in this bill are requirements of both employers and employees that amount to either extra costs or penalties. The end result is the same. This can be found on pages 149-170. It starts with the section entitled "employer contribution in lieu of coverage".

The taxes are levied both on small businesses and on individuals. All businesses with revenues of $250,000 and more would now be required to provide health insurance for their employees. These insurance plans would then have to meet the standards set out by government bureaucrats. Any business that makes $400,000 and more in revenues will be penalized an extra 8% payroll tax if they don't comply with this new regulation. Any business with revenues of $250,000-$400,000 would be levied a payroll tax of 2-6% on a sliding scale if they don't comply with the new regulation. Meanwhile, individuals that don't get insurance that meets the criteria of the government will be levied a 2.5% pay roll tax. Finally, on page 170, all resident aliens are exempt from everything I just listed.

Also in this bill are references to "community group benefits". For instanc, on page 472, the bill says "payment to community based organizations". On page 469, payments are earmarked for "community based home medical care." On page 95, the bill authorizes the Secretary of Health and Human Services to conduct community outreach to sign up folks in underserved areas. Of course, community based groups will be contracted out to sign up all these folks. On page 321, the bill mandates that hospital expansion face "community input". Now, "community based" is a broad term and is really not very defined in the bill. I believe that most conservatives will see "community based" as a code word for ACORN and other such groups.

Here are the analyses for parts I and part II.

Current Health Care Reform is a Political Cancer

There are all sorts of things that one can learn by having a statcounter on their web site. For instance, after I published this piece in which I listed the page numbers along with some of the most insidious portions of the House health care bill, I received an interesting set of hits from google searches. Almost immediately, I got an enormous amount of hits with the search term (page 425 health care bill). Page 425 creates "advanced care planning consultation" and thereby sets regulations for treating those near death. In other words, it rations the care of those near death. Then, there's page 268 where the government regulates the purchase and rental of electric wheel chairs. Page 272 is where care for cancer patients is rationed. These are just a handful of over 1000 pages in this bill.

I bring this up because most people still don't know what is specifically in the bill but they are starting to find out. Imagine the uproar when the media starts to actually do a few reports on pages 425-430 of this bill. The bill is being rejected by the public and they still haven't heard details about it. The details are worse, much worse, than even the summaries and analysis so far.

Already, the only thing that has really happened in the debate over health care is to put on display the massive schism that exists in the Democratic party. Does anyone really believe that having Blue Dogs come on television to trash their leadership's legislation while proclaiming they haven't been treated honestly helps the party? Does anyone really believe that Nancy Pelosi and Henry Waxman threatening to by pass committees helps anyone in the Democratic party?

The latest dust up involves Pete Orszag proclaiming that the CBO wasn't measuring the bill in a holistic way when they determined that IMAC (the Independent Medical Advisory Council). Now, is it really a wise political strategy for the White House' top accountant to take on the top accountant in the nation?

Worse yet for the White House, as things have fallen apart, the president has only doubled down on the health care bill. He has been talking about it non stop for almost two weeks. (with a small break to handle his gaffe about Professor Gates) He's doubled down on a bill no one likes and has no hope of passing.

Again, keep in mind that the analysis of what's actually in the bill has only just started. Soon, we'll stop talking about rationing as a theoretical concept and point to page 425 where health care for the elderly is actually rationed.

If you were to draw up a political disaster, you really couldn't draw it up any better, or worse depending on your perspective. The party is fighting itself. They are fighting independent auditors that have reputations far better than them. The public doesn't like the bill. The bill is awful, and sunshine is only just beginning to be lit. Yet, the once popular president has decided to expend the maximum amount of political capital on this dying and very unpopular bill.

In the next couple weeks, we're going to stop analyzing just how bad this bill is because it will soon be overkill. Then, we'll analyze just how bad the damage is to the Democratic party. It's nothing short of a political cancer. Nancy Pelosi, Harry Reid, President Obama, Henry Waxman, and Max Baucus have all had their political reputations tarnished significantly and permanently by this whole fiasco. The party is fighting itself. They are trying to steamroll a bad bill no one likes on their caucus and the country. Worse yet, even though they are determined to use every underhanded and dirty trick they can think of, they will FAIL. They are all staking their political reputations behind a bad bill, a bill everyone hates, and a bill that won't pass.

I surmised about a week ago that the president should scrap this effort and start anew. Instead, he is determined to move forward full steam ahead. That's simply the equivalent of staying on the beach even after you experience sun burn. There is no good that can come of this. He can only continue to damage his reputation, lose credibility, lose favorability, and lose precious political capital he'll need for the next fight.

The Definitive Dossier on the House Health Care Bill (Pages 1-500) Part II

In the first part, I analyzed the new government controls of the House health care bill. In this part, I will analyze the ways in which the plan will ration health care.

The nexus, so to speak, of rationing in health care starts at the bottom of page 27 and goes through page 30. That section is entitled, essential benefit package defined. This describes all those health procedures which will be deemed "essential". In the next section starting on page 30 entitled, Health Benefits Advisory Committee, this creates yet another bureaucracy that will deem which procedures are in fact "essential". in the previous part, I also mentioned page 335. On this page, there is the establishment of the "Outcome Based Measures". This will be a quantitative analysis of all procedures to measure their cost effectiveness. In other words, if there are two procedures to combat the same malady and one costs $10000 and the other costs $5000 and they both save lives at the same rate, the "Outcome Based Measures" will deem the second more cost effective. This same committee will then outlaw the first procedure. So, if a procedure is not deemed "essential" and is not deemed cost effective, it will be eliminated.

Keep in mind just how corrosive this can be. As procedures evolve they get better. Some new heart transplant might initially not see good results. Yet, as doctors perform it, study it, and trade information back and forth, it gets perfected. In the system dreamed up by the Congress, that won't happen. That's because the committee will render it obsolete before any such procedure has a chance to evolve.

The most insidious portion of this bill is found on pages 425-430. I mentioned it in the section on government control. This portion of the bill regulates the manner in which those near death will get treatment. Combine this with the "Outcome Base Measures" and this is where you will find the nightmare scenarios of the 80 year old not getting their hip replacement. Since that is likely to not be "cost effective" and "essential", it will likely be made obsolete.

Pages 272-274 deal with studying and analyzing care for cancer patients. There are several frightening parts of this section but here's the most frightening.

The Secretary shall conduct a study to determine if costs incurred by hospitals exceed costs incurred by other hospitals

The next section after this quotation is entitled, AUTHORIZATION OF ADJUSTMENT. As such, first the HHS Secretary will study if hospital patient care is cost effective and then the HHS Secretary will be given authority to adjust the cost structure of all hospital deemed not cost effective. As such, if your cancer treatment center is deemed not cost effective, the HHS Secretary will have power to adjust its cost structure and that means to decide which procedures can continue and which can't.

To understand just how intrusive this rationing gets, on page 268 the government is give authority to regulate the rental and purchase of power driven wheel chairs. In other words, even power driven wheel chairs will be rationed.

Finally, on page 241 (also mentioned in the previous part) the government sets rates that doctors can make. According to the language, there will be little difference among specialties. As such, neurosurgeons won't be able to make much more than other specialties. Because some specialties like neurosurgeons require significantly more schooling, new potential doctors will have less motivation to go into those fields. By creating a disincentive for many specialties, we'll have less of those specialists. With the power to regulate "essential" and "cost effective", the government will be forced to cut many procedures in those specialties because there will simply not be enough doctors to perform them.

Here is the previous part again. In part III, I will analyze the new tax outlays on individuals and small business owners that will be created by this plan.

The Definitive Dossier on the House Health Care Bill (Pages 1-500) Part I

Introduction: Trying to analyze a one thousand page plan is difficult enough. As such, I will take the first 500 pages first. Even then, it would be way too long a post to analyze all five hundred pages all at once. There are four major points of emphasis: government control, rationing, taxes, and community group benefits that I will analyze. I will take those in four parts. First, let's talk about government control. Also, I will reference pages in the bill which you can find at this link.

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The president has proclaimed on numerous occasions that if you like your health care plan, you need not worry because it WON'T change. Is this true? A thorough analysis of the bill leaves a lot of doubt.

The nexis, if you will, of government control starts on page 72 and page 84. Those two pages establish the government health exchange, define the government's role in it, and define what providers must enroll in it. The health care exchange will be administered by a new bureaucracy, the Health Choices Administration. Any insurer, health practitioner, or hospital in the health care exchange will be subject to the regulations of the exchange as laid out by the Health Choices Administration.

Who needs to be in the exchange? Any health care provider that provides health care that is paid in whole or in part by a third party must be in the exchange. In other words, any hospital that accepts insurance must be part of the exchange. All insurance companies must be part of the exchange. Chiropractors, laser surgeries, and other procedures that don't accept insurance would not be part of this exchange. As such, almost the entire health care industry would fall under the control of the health care exchange. The health care exchange would now be regulated by the Health Choices Administration.

As such, it is totally misleading to say that if you like your health care it won't change. That's only if your current health care plan conforms to whatever regulations are created by the Health Choices Administration.

The control only begins there. A lot of businesses and organizations are self insured. For instance, IBM has created its own insurance company for its employees. Several other companies as well as other groups like churches have also created an insurance company for their members or employees. Since they are self insured, they are not subject to this health care exchange. Remember, the exchange is only for those that have third party costs. Now, the hospitals that IBM employees go to would almost certainly be part of the exchange but that's another story. For those types of companies and groups, on page 22. Those employers, and other organizations that self insure, will then be mandated to a government audit. These audits will measure: financial solvency, their ability to pay the premiums, the extent to which ratings rules will cause adverse selections of their groups in the market. In other words, the government will audit all self insured organizations to make sure their health insurance plan is up to par as the government measures par.

Then, there is the introduction of an alphabet soup of new government bureaucracies to regulate health care. These new bureaucracies include: the Telehealth Advisory Committee, the aforementioned Health Choice Administration, the Independent Medical Avisory Council, the the Office of Civil Rights, the Office of Minority Health, the Public Health Investment Fund, and the Health Affordibility Administration. All of these new bureaucracies will have new regulatory authority over the administration of health care. In all, the bill creates 53 new bureaucracies.

The most insidious government control comes in pages 425-430. Here, the government will regulate "advanced care planning consultation". In layman's terms, the government will regulate how older folks will be treated and by so doing, just how much treatment will be provided to them. (I'll get more into this in the rationing portion but in here is language that will mandate that health care be provided if it isn't cost effective)

On page 335, there is the "Outcomes Based Measures". This will measure the cost effectiveness of all procedures done in the country. (this will also be revisited in the rationing portion) In other words, the government will do sort of health care polling of all procedures to determine if they are worth the cost. Of course, in order to do that, the government has to have access to the medical records of all procedures. This pages creates this"outcomes based measures" and by so doing, gives the government that access.

On pages 57-59, there is the establishment of the standardization of electronic administration. This will provide such things as real time determination of an individual's financial responsibility at the point of service, harmonize all common data points across administrative and clinical transactions, and describe all data points in unambiguous terms. On page 58, a National Health Care ID card is created. This card will be used by the government to create the ability to make real time financial determinations of a patient. As such, this will give the government real time access to bank statements, investment accounts and anything else necessary to make this decision. Thus, we finish off the Orwellian takeover of health care by the government.

On page 195, the Health Choice Administration is given access to the tax records of all Americans in the health care exchange. Here is the relevant text

The Health Choice Act of 2009, shall disclose to officers and employees of the Health Choice Administration, or such state based health insurance exchange, as the case may be, return information of any tax payer whose income is relevant

Finally, on page 241, government bureaucracies will set salaries for doctors. Here is the relevant portion.

...Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.

Here is the second part on rationing.