Liability Reform and Reconciliation

The President just pointed out that a Republican Congress and Republican President were not able to enact reasonable medical liability reform.  The reason for that is simple: Republicans did not jam through liability reform under a partisan, 51-vote reconciliation process.  Contrast that approach with Speaker Pelosi’s chief health care advisor, who publicly bragged about being able to devise a “trick” to pass this unpopular bill through the reconciliation process.

Of course, when he was a Senator, Barack Obama said he opposed jamming provisions through the Senate on a 51-vote margin: “What I worry about would be you essentially still have two chambers – the House and the Senate – but you have simply majoritarian, absolute power on either side.  And that’s just not what the Founders intended.”  Now, not so much…

About Those “Drastic Cuts” to Medicare, Mr. President…

Speaker Pelosi just responded that there would be no cuts to Medicare benefits in the Democrat proposals.  However, in an October 2008 speech, then-Senator Obama attacked his presidential opponent by stating that “Senator McCain would pay for part of his [health care] plan by making drastic cuts in Medicare…even though Medicare is already facing a looming shortfall.”  How exactly are the Medicare proposals the President is now endorsing – which Speaker Pelosi said would not impact beneficiaries – different from the “drastic cuts in Medicare” the President opposed during the campaign?

Coverage Through Medicaid?

President Obama just alleged that individuals in Medicaid have access to coverage when they get sick.  Perhaps he should actually talk to some Medicaid recipients, one of whom took a view far from the President’s in a Wall Street Journal piece: “You feel so helpless thinking, something’s wrong with this child and I can’t even get her into a doctor….When we had real insurance, we would call and come in at the drop of a hat.”  And even a Consumers Union spokesman, formerly the head of a state Medicaid program, recently called a Medicaid card a “hunting license” to try and find a doctor that would see them.  Not “real insurance” and a “hunting license” to try and find a doctor – this is the basis for the President’s health “reform…”

Republicans vs. Democrats on Health Insurance Coverage

A few final thoughts for this fourth and final segment:

  • In a January 2008 debate, Senator Obama asked what then-Senator Clinton what would happen if people cannot afford insurance: “What are you going to do about it?…Are you going to garnish people’s wages?”  Yet that is what the House and Senate bills would do—sic the IRS on people who do not buy “government-approved” insurance.  Many may argue these provisions violate the President’s campaign promise not to raise taxes on individuals with incomes under $250,000—“not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”
  • According to CBO, nearly half the total reduction in the number of uninsured comes from an expansion of Medicaid, which pays physicians 40 percent below private insurance plans.  As a result, doctors accepting Medicaid are so hard to find that a Consumers Union spokesman recently called a Medicaid card a “hunting license” to try and find a doctor that would see them.  How is giving 15 million low-income people a “hunting license” to try and find a doctor who will see them “reform?”
  • Governors in both parties that cannot afford their current Medicaid programs have already voiced significant concerns about what Tennessee Democratic Gov. Phil Bredesen termed “the mother of all unfunded mandates” being imposed upon states in the form of 15 million new Medicaid enrollees.   As a result of the added restrictions in Democrats’ proposals, the head of Washington state’s Medicaid program believes that states facing severe financial distress may say, “I have to get out of the Medicaid program altogether.”  How does encouraging states to drop out of Medicare constitute “reform?”
  • During his presidential campaign, Senator Obama promised that “you will not have to change plans” under his platform, and that “for those who have insurance now, nothing will change…except you will pay less.”  However, the Congressional Budget Office has stated that enrollment in Medicare Advantage will decline by millions under Democrats’ proposed more than $120 billion in cuts, and millions more will only be able to keep their current coverage by paying more in premiums and co-pays.  So in other words, seniors who like their current plan won’t be able to keep it—and those who are “permitted” by the Obama Administration to keep their current coverage will be forced to pay more.
  • Republicans have long argued that the key to expanding insurance coverage is reducing costs, which is why incremental measures like liability reform and insurance reforms allowing broader choice of plans will bring down the long-term trend of cost growth and have beneficial effects on coverage.  Independent experts at the Congressional Budget Office agree on both counts.
  • Republicans also believe in allowing portability and choice in insurance plans, which is why many believe in premium assistance options for programs like Medicaid that according to CBO would reduce the deficit by billions of dollars, even while giving more individuals a choice of private plan options rather than a one-size-fits-all government-run plan.
  • Even some leading Democrats have argued that the party’s fixation on expanded insurance coverage is potentially damaging.  In an interview last spring, former House Majority Leader Dick Gephardt (D-MO)—who led his party during the time of the last national health care debate—told the New York Times that “the way to get to [universal coverage] is to show that we can deal with some of these [cost] problems first.”  Republicans couldn’t agree more with those sentiments, which is why Republican efforts have focused like a laser beam on cutting costs, not creating trillion-dollar schemes creating massive dislocation within the health care system.

Let Americans Sue Their Doctor — But NOT Their Government…

Senator Durbin is speaking now about the need for “accountability” against doctors and hospitals by allowing lawsuits.  Yet the bill Senator Durbin supports allows no such “accountability” against government bureaucrats for arbitrary and capricious decisions denying patients coverage.  The language below, from the section on the Senate bill’s new Independent Payment Advisory Board (pages 1013), shows how Washington bureaucrats would have virtually carte blanche authority to re-write Medicare law and regulations – without any redress for patients harmed by their actions.  If Democrats love allowing lawsuits so much, why won’t they let individuals sue the new government bureaucracies created in their bill?

 

‘‘(5) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the implementation by the Secretary under this subsection of the recommendations contained in a proposal.

Does the President Want to Drink Some “Gator Aid?”

The President is arguing about the Medicare Advantage program right now, and asking Republicans if it’s working right now. Of course, at least one Democrat Senator thinks it’s working right now – which is why page 878 (Section 3201(g)) of the Senate bill provides a special backroom deal for Florida beneficiaries, because of one Democrat Senator’s political influence…

Bernie Madoff Accounting

Congressman Ryan, in talking about the budgetary gimmicks in the bill, cited a CBO letter that stated that using money from the Medicare program not to save Medicare, but to fund new entitlements, “would not enhance the ability of the government to pay for future Medicare benefits.”  This “Madoff-esque” accounting—where the Administration argues the same money is being used both to save Medicare and reduce the deficit—is nothing like “reform.”  In fact, if a private sector firm tried to use this type of double-entry accounting under the Democrat plan, it would likely end up in the same place Bernie Madoff is now—in jail…

Vice President Biden and “Humility”

The Vice President just emphasized the need to be “humble” in attempting to divine the wishes of the American people.  The tone is interesting, as here is what Senator Biden said in 2005 about jamming provisions through the Senate on a partisan, 51-vote margin: “…Ultimately an example of the arrogance of power.  It is a fundamental power grab….I pray God when the Democrats take back control we don’t make the kind of naked power grab you are doing.”  Yet reports even going into the summit have outlined how the majority will soon take steps to jam a health bill through under the reconciliation process.  So much for “humility” on the part of Democrats…

President Advocates for “Garnishing People’s Wages”

In talking about the need to “broaden the insurance pool,” the President is advocating forcing individuals to buy “government-approved” coverage.  Of course, in a January 2008 debate, Senator Obama asked what then-Senator Clinton what would happen if people cannot afford insurance: “What are you going to do about it?…Are you going to garnish people’s wages?”  Yet that is what the House and Senate bills would do—sic the IRS on people who do not buy “government-approved” insurance.  Many may argue these provisions violate the President’s campaign promise not to raise taxes on individuals with incomes under $250,000—“not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”

Republicans vs. Democrats on Reducing the Deficit

A few nuggets for this afternoon’s debate on deficit reduction:

  • The Obama campaign platform asserted that “the additional revenue needed to…help people who cannot afford health insurance is more than covered by allowing the Bush tax cuts to expire for people making more than $250,000 per year.”  Therefore, the $518.5 billion in tax increases included in the Senate bill—including tax increases on medical industries that “would be largely passed through to consumers in the form of higher premiums for private coverage”—should not be necessary.
  • In an October 2008 speech, then-Senator Obama attacked his presidential opponent by stating that “Senator McCain would pay for part of his [health care] plan by making drastic cuts in Medicare…even though Medicare is already facing a looming shortfall.”  How are the Medicare proposals the President is now endorsing different from the “drastic cuts in Medicare” he opposed during the campaign?
  • Again, it’s important to recall that his health care campaign platform stated that “The Obama plan will cost between $50-65 billion a year when fully phased in.”  However, CBO scored the Obama/Senate plan as spending $199 billion on insurance subsidies in 2019 – and this total is BEFORE the increased spending in the proposals the White House unveiled earlier this week (and which have yet to be fully scored) are included.  If the cost of the Obama health plan has more than tripled in the 18 months between his presidential campaign and today, how much more will federal costs explode if and when the bill is actually enacted?
  • What do Democrats plan to do about the Medicare physician payment “doc fix?”  The White House’s budget proposed not paying for the $371 billion cost to provide a permanent “doc fix” change.  This unpaid-for spending would more than eradicate all the bill’s deficit reductions in the first ten years—and according to a Heritage Foundation analysis would cost more than $1 trillion in the longer term.  In addition to imposing new burdens on America’s children and grandchildren, why should senior citizens be forced to pay one-quarter of this $371 billion cost—nearly $100 billion—in higher Part B premiums because Democrats in Congress and the Administration refuse to pay for this new spending?
  • The Congressional Budget Office has raised significant doubts about whether the bill’s purported deficit reduction can in fact be achieved.  CBO noted that the Medicare savings provisions “might be difficult to sustain over a long period of time” and that “it is unclear whether such a reduction in the [Medicare] growth rate could be achieved, and if so, whether it would be accomplished through greater efficiencies…or would reduce access to care.”  Even if the rosy assumptions in the legislation prove accurate, CBO notes that the Senate bill’s cumulative deficit reduction “would represent a small share of the [federal government’s] total deficits” under current law.
  • Likewise, the Administration’s own actuaries believe that the bill’s deficit savings “may be unrealistic,” asserting that 20 percent of hospital providers would become unprofitable within the bill’s first 10 years and questioning whether these providers “might end their participation in the [Medicare] program, possibly jeopardizing access to care for beneficiaries.”
  • CBO has also confirmed that the federal budgetary commitment to health care would RISE by about $200 billion in the Senate bill’s first decade.
  • In 2005, Republicans proposed reducing Medicare’s projected growth in spending by about $22 billion as part of a Deficit Reduction Act intended to reduce budgetary shortfalls.  Not a single Democrat in either chamber, including then-Senator Obama, voted for the legislation—and many Democrats called the Medicare proposals “immoral.”  How do the Medicare savings proposals in this year’s legislation—which would reduce program spending by hundreds of billions of dollars, instead of the “mere” $22 billion in the 2005 measure, differ from the “immoral” cuts to Medicare Democrats previously criticized?