How Elizabeth Warren “Swift Boated” Herself on Health Care

Every four years, political analysts and commentators compare current presidential candidates to events from campaigns past. She may not want to admit it, but Sen. Elizabeth Warren’s actions on health care the past several weeks, culminating in the release of her second health plan on Friday, echo the 2004 presidential campaign of her Massachusetts colleague, former Sen. John Kerry.

During his campaign for the Democratic nomination, Kerry played up his military service at every opportunity. Howard Dean’s strident opposition to the Iraq War, coupled with his infamous on-camera implosion after the Iowa caucuses, gave Kerry an opening that he parlayed into the Democratic nomination. At the party’s convention in Boston, Kerry famously started his acceptance speech with a military salute: “I’m John Kerry, and I’m reporting for duty.”

The Swift Boat Veterans for Truth ads that ran after the Democratic convention attempted to turn Kerry’s biggest strength—his military service—into a weakness. The ads sparked controversy, and no small amount of political attention, by raising questions about Kerry’s service in Vietnam, and his activities protesting the Vietnam War following his return.

Likewise, the past several weeks have seen Warren turn her biggest strength—her wonky, “I’ve got a plan for that” persona—into a weakness. On November 1, she released her first health-care plan, replete with multiple documents highlighting supposed savings under a single-payer health-care system, and her plan for raising revenue to pay for such a system without raising taxes on the middle class.

Warren’s first plan drew mockery from her fellow Democratic candidates and conservative commentators alike for its unrealistic gimmicks and assumptions. Most notably, Warren’s plan failed to concede what one of her own advisors implicitly admitted: That an $8.8 trillion “employer contribution” would ultimately come out of the pockets of the middle class. Meanwhile, her opponents continued to hammer Warren for wanting to strip away the existing insurance of millions of Americans, including union workers who negotiated their health coverage at the bargaining table.

Her initial plan failed so badly that exactly two weeks later, Warren felt the need to reboot. She released another health plan, this one highlighting a supposed “transition period,” to get ahead of criticism from her fellow Democrats in the upcoming presidential debate.

This plan pledged that, within her first 100 days in office, Warren would work to enact “a true Medicare for All option”—one that people could select if they chose, but would not require individuals to give up their existing coverage. Only later, “no later than my third year in office,” would Warren “fight to pass legislation that would complete the transition” to a full single-payer system.

The second plan seems like a deliberate dodge, an attempt for Warren to have her cake and eat it too. The single-payer bill introduced by Sen. Bernie Sanders (I-VT)—which Warren has co-sponsored—contains a four-year transition plan in Title X of the underlying legislation. The single-payer bill introduced in the House by Rep. Pramila Jayapal (D-WA) also includes a transition, which would take place over a two-year period. Warren’s claim that Congress should pass not one but two major bills to enact her health-care agenda sounds like an excuse for her to walk away from her commitment to single payer.

On that count, who can blame her? Evidence from the midterm elections shows that support for full-on socialized medicine cost the average Democrat in a competitive district nearly 5 percentage points of support. No wonder that even Barack Obama conceded on Friday that “the average American doesn’t think we have to completely tear down the system” and cautioned Democrats against proposing “crazy stuff,” in a not-so-subtle warning about proposals by Warren and Sanders.

But Warren now remains firmly mired in a mess of her own making. Her “I’ve got a plan for that” mantra meant she had to release a detailed health care proposal at a time political expediency might have suggested vagueness. Her Democratic rivals, to say nothing of President Trump’s re-election, can now pick apart those details over many months.

And to think those details won’t matter to the American people, or lead to additional controversy, belies past experience. When House Speaker Nancy Pelosi admitted in 2010 that “We have to pass [Obamacare] so that you can find out what’s in it,” she conceded that the legislative details matter to millions of Americans—and that such public scrutiny put Democrats in political peril.

Hours before she released her first health-care platform, an article on the issue correctly claimed that “Warren did not have a plan for this.” Her initial lack of a plan, followed by her willingness to spell out in minute relief the details of her socialized medicine plan, could prove her undoing.

This post was originally published at The Federalist.

Howard Dean’s Dirty Little Secret on Medicaid

Appearing on Meet the Press yesterday, former Vermont Governor Howard Dean was asked about the possibility that, given the Supreme Court’s ruling on Obamacare last Thursday, states could choose to opt out of the law’s new Medicaid expansion.  He gave an interesting response: “I think this stuff about not accepting Medicaid and not accepting Exchanges is crazy.”

Which is ironic, because a May 1998 front-page article from the Rutland Herald profiled how Judith Steinberg, a physician based in Shelburne, had written to her patients that she was no longer accepting individuals insured by the state’s largest Medicaid managed care organization:

Dr. Judith Steinberg told her patients in a letter that Community Health Plan/Kaiser Permanente has cut payments to her practice while raising rates to its insured.  The decision by Steinberg’s group means several hundred patients in CHP’s commercial and its “Access Plus” Medicaid plan will be obliged to either switch doctors or switch insurers.  The practice is the only CHP primary care provider in Shelburne….CHP serves about 30,000 of the 51,000 Medicaid clients who are in HMOs in Vermont.

Why is all of this relevant?  Because Dr. Judith Steinberg just so happens to be Howard Dean’s wife.

Put it another way: Howard Dean’s wife dropped out of that state’s largest Medicaid plan – while Dean was governor – due to low reimbursement rates and onerous bureaucratic regulations the Governor himself imposed.  So if Dean wants to go and publicly argue that “not accepting Medicaid…is crazy” – either for individual physicians, or for states looking to avoid Obamacare’s new unfunded mandates – he might want to chat with Mrs. Dean first.

Obamacare Strikes Out with Voters — Again

Last night, voters in the critical bellwether state of Ohio sent a clear message to the Administration regarding Obamacare.  Voters in the state approved a constitutional amendment designed to allow individuals to choose their own health care without being subjected to diktats from bureaucrats, in Washington or elsewhere.  This amendment against Obamacare’s individual mandate passed overwhelmingly – at press time, the amendment had nearly 66% support, and more than 2.1 million votes in favor. (Final results will be available here.)

While clearly decisive, the Ohio result was entirely unsurprising.  A ballot initiative in Missouri (another swing state) last year passed with an even higher 71% margin, and received significant Democrat support in the process.  And even former Democratic National Committee Chairman Howard Dean has admitted that “the American people aren’t going to put up with a mandate.”

The Ohio results come as polling shows that approval ratings surrounding the law – never popular with a majority of voters – has fallen even further, to an all-time low.  When it comes to the entire 2700-page law, or its unprecedented and constitutionally dubious mandate for all individuals to purchase health coverage, Tuesday’s result further illustrates that the only thing bipartisan about Obamacare has been the opposition to it.

Howard Dean Encourages Employers to Drop Coverage: “A Very, Very Good Thing”

Appearing on Morning Joe today, Howard Dean once again expressed support for the idea of employers dropping coverage, calling the recent findings from McKinsey that up to half of all employers could drop coverage “a good thing.”  (Makes you wonder why Democrats sent McKinsey nasty letters attacking their study as biased.)  Dean specifically said about Obamacare:

The fact is, it’s very good for small business.  It’s incredibly good for small businesses.  The McKinsey study, which the Democrats [in Congress] don’t like, but I do, and I think it’s true.  Most small businesses are not going to be in the health insurance business any more after this thing goes into effect….I think Obamacare is a huge help to small business.

Former New York Governor George Pataki, also on the show, chimed in: “The only way it’s a help [to small business] is if they dump coverage,” and Dean promptly agreed: “That’s right – and that’s what they should do.”  Dean said that contrary to the President’s promise that individuals would be able to keep their own coverage, “It is going to happen – and I think it’s a very, very good thing.”

However, employers’ financial gain will be the taxpayers’ loss: Former Congressional Budget Office Director Doug Holtz-Eakin’s analysis confirmed that, because many more firms than originally projected will have a rational economic basis for dropping their plans come 2014, the federal government will incur in up to $1 trillion more in new federal spending on insurance subsidies than official estimates.

In other words, employers are going to drop coverage in New Hampshire.  And they’re going to drop coverage in South Carolina and Oklahoma.  And they’re going to drop coverage in Arizona and North Dakota and New Mexico.  They’re going to drop coverage in California and Texas and New York.  And they’re going to drop coverage in South Dakota and Oregon and Washington and Michigan.  And the exploding federal subsidies on Obamacare won’t send anyone to the White House – they’ll send our nation to the poor house.  Byah!

Howard Dean Supports Dumping Workers in Obamacare Exchanges

In a debate on the health care law this afternoon, former Vermont Governor Howard Dean expressed support for the idea of employers dropping coverage, calling the recent findings from McKinsey that up to half of all employers could drop coverage “a good thing.”  (Makes you wonder why Democrats are sending McKinsey nasty letters.)  Dean went on:

The biggest thing we can do for small businesses is get them out of the healthcare business….If this bill does that, and all these small businesses dump their people into the exchanges, we will finally have broken the link between the employer and health insurance in this country.

In other words, employers are going to drop coverage in New Hampshire.  And they’re going to drop coverage in South Carolina and Oklahoma.  And they’re going to drop coverage in Arizona and North Dakota and New Mexico.  They’re going to drop coverage in California and Texas and New York.  And they’re going to drop coverage in South Dakota and Oregon and Washington and Michigan.  And the exploding federal subsidies on Obamacare won’t send anyone to the White House – they’ll send our nation to the poor house.

Peter Orszag on Access to Treatments and Malpractice Reform

On a New York Times blog yesterday, former OMB head Peter Orszag writes in support of a David Leonhardt column about ways to reduce Medicare spending, specifically by limiting access to new, costly treatments.  Both Orszag and Leonhardt discuss an article (subscription required) in this month’s issue of Health Affairs, which proposes a reimbursement regime whereby Medicare would pay for new treatments for three years, at which point a given drug or therapy would have to prove its worth relative to other, cheaper alternatives in order to justify higher payments from Medicare.   Orszag approvingly notes that “the newly created Independent Payment Advisory Board could propose this type of payment change in order to help reduce costs and improve quality in Medicare.  The change would then take effect by default – if Congress ignored the board’s proposals, if one house voted them down, or even if both houses voted them down and then the President vetoed that legislation.”

Given the approval of Dr. Orszag – who was intimately involved in health care reform from the first days he joined the Administration – to this approach restricting access to treatments, and Medicare Administrator Donald Berwick’s prior support for “rationing with our eyes open,” it’s worth asking: Does the Obama Administration support these types of proposals to have unelected bureaucrats on a federal board withholding access to important but costly treatments – and are these types of access-limiting initiatives the kind we can expect from the Independent Payment Advisory Board created by the law?

Separately, Dr. Orszag used his regular column in the Times yesterday to point out what Republicans have long known: namely, that the health care law “does almost nothing to reform medical malpractice laws.”  Orszag dismisses the idea of caps on non-economic damages – which many Republicans advocate – but he does support “provid[ing] safe harbor to doctors who follow evidence-based guidelines.”  This is a curious statement, as Republicans offered multiple amendments to enact exactly the types of liability reforms that Dr. Orszag – at the time one of the most influential experts on health care within the Administration – supports, yet none of them made it into the legislation.  Former Vermont Governor Howard Dean previously provided one possible explanation as to the omission: “The reason that tort reform [was] not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everyone else they were taking on.  And that is the plain and simple truth.”

The “Professional Left’s” Health Care Damage Control

Per my article last night, Politico is up with an expanded story on the Powerpoint presentation by Families USA, the AFL-CIO, the SEIU, and AARP – aka the “professional left” – attempting damage control over the “astonishing shortcoming[s] in the White House’s all-out communications effort” surrounding the unpopular health care law.  “The presentation also concedes that the fiscal and economic arguments that were the White House’s first and most aggressive sales pitch have essentially failed.”

Further evidence of that failure comes in this morning’s CNN poll, which found that only 40% support the health care law, while a majority – 56% – oppose the measure.  In addition, Americans oppose the individual mandate to purchase health insurance by a 56-44% margin.  Most surprisingly, Americans across every income group – and across every age group – oppose the health care law’s individual mandate.  The results only confirm what former DNC Chairman Howard Dean admitted a fortnight ago – that “the American people aren’t going to put up with a mandate” to purchase health insurance.  That advice from an erstwhile Obama ally will likely prove cold comfort to Democrats seeking a way out of the unpopular law they passed.

Howard Dean: “The American People Aren’t Going to Put Up with a Mandate”

Former Vermont Governor and Democratic National Committee Chairman Howard Dean was on MSNBC this morning.  Asked about Tuesday’s resounding victory for Missouri’s Proposition C, whereby 71% of voters expressed their opposition to the health care law’s individual mandate, Gov. Dean said that the American people would not stand for such an imposition on their rights – “people don’t like to be told what to do” – that the mandate could well be ruled unconstitutional, and that it would be stripped from the legislation eventually regardless.

Video of the Governor’s comments can be found here (relevant excerpts start at 3:45) – it’s well worth watching.

A Reading Guide to Obamacare’s Backroom Deals

“I think the health care debate as it unfolded legitimately raised concerns not just among my opponents, but also amongst supporters that we just don’t know what’s going on. And it’s an ugly process and it looks like there are a bunch of back room deals.”

— President Obama, interview with ABC’s Diane Sawyer, January 25, 2010[i]

 

The White House recently enacted its health “reform” agenda by signing the 2,733 page legislation (H.R. 3590) that passed the Senate in December.[ii] While the Administration touts its removal of the “Nebraska FMAP provision” that saw 49 other states funding Nebraska’s Medicaid largesse (known as the “Cornhusker Kickback”), it did not address other deals negotiated by Democrats in the Senate legislation. Many other backroom agreements are included in the legislation the President has now enacted into law:

Page 428—Section 2006, known as the “Louisiana Purchase,” provides an extra $300 million in Medicaid funding to Louisiana.[iii]

Page 2132—Section 10201(e)(1) provides an increase in Medicaid Disproportionate Share Hospital (DSH) payments for Hawaii, meaning 49 other states will pay more in taxes so that Hawaii can receive this special benefit.

Page 2203—Section 10317 amends provisions in Medicare so that hospitals in Michigan and Connecticut can receive higher payments.

Page 2222—Section 10323 makes certain individuals exposed to environmental hazards eligible for Medicare coverage. The definition used in the bill ensures the only individuals eligible will be those living in Libby, Montana.

Page 2237—Section 10324 increases Medicare payments by $2 billion in “frontier states.”[iv]

Page 2354— Section 10502 spends $100 million on “debt service of, or direct construction of, a health care facility,” language which the sponsors intended to benefit Connecticut.[v]

Page 2395—Section 10905(d) exempts Medigap supplemental insurance plans from the new tax on health insurance companies; press reports indicate this provision was inserted to benefit an insurer headquartered in Nebraska.[vi]

Even after the public outrage from the “Cornhusker Kickback,” Democrats used separate legislation designed to “fix” this particular provision (H.R. 4872) to add yet more deals behind closed doors.[vii] For instance, page 71 (Section 1203(b)) of the “fixer” bill provided an increase in Medicaid disproportionate share hospital payments just for Tennessee. And Section 2213 (page 145) of the original version of the “fixer” bill[viii] included a sweetheart deal making the Bank of North Dakota the only financial facility in the country exempted from Democrats’ government takeover of student loans—a backroom deal so egregious that it was removed within hours once the bill was finally revealed to the American public.[ix]

These specific agreements and provisions also do not display the full scope of the White House’s legislative deal-making. For instance, the head of the pharmaceutical industry said the Administration approached him to negotiate a deal with his industry: “We were assured, ‘We need somebody to come in first.  If you come in first, you will have a rock-solid deal.’”[x] And former Democratic National Committee Chairman Howard Dean publicly admitted at a town hall forum that “The reason that tort reform is not in the [health care] bill is because the [Democrat Members] who wrote it did not want to take on the trial lawyers.”[xi]

The many pages of backroom deals included in the health care takeover legislation raise several questions: If the bill itself was so compelling, why did Democrats need billions of dollars in “sweeteners” negotiated in secret in order to vote for it? If President Obama was so concerned about the public perceptions created by the backroom dealing, why did he not propose to strike all the special agreements? Does he believe that this pork-barrel spending is the only reason why Democrats voted to pass his government takeover of health care in the first place?

 

[i] Full interview transcript available at http://abcnews.go.com/print?id=9659064.

[ii] Senate-passed bill text available at http://www.opencongress.org/bill/111-h3590/text.

[iii] “Dems Protect Backroom Deals,” Politico February 4, 2010, http://www.politico.com/news/stories/0210/32499.html.

[iv] Congressional Budget Office, score of H.R. 3590 including Manager’s Amendment, December 19, 2009, http://cbo.gov/ftpdocs/108xx/doc10868/12-19-Reid_Letter_Managers_Correction_Noted.pdf.

[v] “Dodd Primes Pump in Bid to Survive,” Politico December 22, 2009, http://www.politico.com/news/stories/1209/30881.html.

[vi] “How Nebraska’s Insurance Companies Stand to Profit from Ben Nelson’s Compromises in Health Care Bill,” Huffington Post 21 December 2009, http://www.huffingtonpost.com/2009/12/21/how-nebraskas-insurance-c_n_400080.html.

[vii] Senate-passed bill (H.R. 3590) text available at http://www.opencongress.org/bill/111-h3590/text; reconciliation bill (H.R. 4872) text available at http://www.opencongress.org/bill/111-h4872/text.

[viii] House Rules Committee amendment in the nature of a substitute, http://docs.house.gov/rules/hr4872/111_hr4872_amndsub.pdf.

[ix] “Conrad Wants Controversial Carve-Out Axed,” Roll Call March 18, 2010, http://www.rollcall.com/news/44368-1.html. The provision was stripped by the Rules Committee prior to full House consideration of H.R. 4872.

[x] Quoted in “White House Affirms Deal on Drug Cost,” New York Times August 5, 2009, http://www.nytimes.com/2009/08/06/health/policy/06insure.html?_r=3&scp=8&sq=kirkpatrick&st=cse.

[xi] Exchange at Town Hall forum in Reston, VA, August 25, 2009, available online at http://www.youtube.com/watch?v=IdpVY-cONnM.

A Reading Guide to the Senate Bill’s Backroom Deals

“I think the health care debate as it unfolded legitimately raised concerns not just among my opponents, but also amongst supporters that we just don’t know what’s going on. And it’s an ugly process and it looks like there are a bunch of back room deals.”

— President Obama, interview with ABC’s Diane Sawyer, January 25, 2010[i]

 

The White House recently released its own health care proposal[ii] in the form of changes to the 2,733 page legislation (H.R. 3590) that passed the Senate in December.[iii] While the proposal purports to remove the “Nebraska FMAP provision” that saw 49 other states funding Nebraska’s Medicaid largesse (known as the “Cornhusker Kickback”), it does not address other deals negotiated by Democrats in the Senate legislation. Many other backroom agreements are included in the Senate bill, which the White House has now endorsed as the platform for Democrats to enact “health reform” into law:

Page 428—Section 2006, known as the “Louisiana Purchase,” provides an extra $300 million in Medicaid funding to Louisiana.[iv]

Page 878—Section 3201(g), known as the “Gator Aid” provision, shields certain Florida residents from Medicare Advantage cuts. In December, 57 Senate Democrats voted not to extend this special deal to all Medicare beneficiaries.[v]

Page 2132—Section 10201(e)(1) provides an increase in Medicaid Disproportionate Share Hospital (DSH) payments for Hawaii, meaning 49 other states will pay more in taxes so that Hawaii can receive this special benefit.

Page 2222—Section 10323 makes certain individuals exposed to environmental hazards eligible for Medicare coverage. The definition used in the bill ensures the only individuals eligible will be those living in Libby, Montana.

Page 2237—Section 10324 increases Medicare payments by $2 billion in “frontier states.”[vi]

Page 2354— Section 10502 spends $100 million on “debt service of, or direct construction of, a health care facility,” language which the sponsors intended to benefit Connecticut.[vii]

Page 2394—Section 10905(c) includes language exempting Nebraska Blue Cross/Blue Shield and Michigan Blue Cross/Blue Shield from the new tax on health insurance companies, despite an Administration report calling Michigan Blue Cross/Blue Shield’s rate increases “disturbing.”[viii]

Page 2395—Section 10905(d) exempts Medigap supplemental insurance plans from the new tax on health insurance companies; press reports indicate this provision was inserted to benefit an insurer headquartered in Nebraska.[ix]

These specific agreements and provisions also do not display the full scope of the White House’s legislative deal-making. For instance, the head of the pharmaceutical industry said the Administration approached him to negotiate a secret arrangement with his industry: “We were assured, ‘We need somebody to come in first.  If you come in first, you will have a rock-solid deal.’”[x] And former Democratic National Committee Chairman Howard Dean publicly admitted at a town hall forum that “The reason that tort reform is not in the [health care] bill is because the [Democrat Members] who wrote it did not want to take on the trial lawyers.”[xi]

The many pages of backroom deals included in the Senate legislation raises several questions: If the bill itself is so compelling, why did Senate Democrats need billions of dollars in “sweeteners” negotiated in secret in order to vote for it? If President Obama is so concerned about the public perceptions created by the backroom dealing, why did he not propose to strike all the special agreements? Is he worried that this pork-barrel spending is the only reason why Democrats would vote to pass his government takeover of health care in the first place?

 

[i] Full interview transcript available at http://abcnews.go.com/print?id=9659064.

[ii] White House plan available at http://www.whitehouse.gov/sites/default/files/summary-presidents-proposal.pdf

[iii] Senate-passed bill text available at http://www.opencongress.org/bill/111-h3590/text.

[iv] “Dems Protect Backroom Deals,” Politico February 4, 2010, http://www.politico.com/news/stories/0210/32499.html.

[v] Senate Record Vote 370 on McCain motion to commit, http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=111&session=1&vote=00370.

[vi] Congressional Budget Office, score of H.R. 3590 including Manager’s Amendment, December 19, 2009, http://cbo.gov/ftpdocs/108xx/doc10868/12-19-Reid_Letter_Managers_Correction_Noted.pdf.

[vii] “Dodd Primes Pump in Bid to Survive,” Politico December 22, 2009, http://www.politico.com/news/stories/1209/30881.html.

[viii] White House Office of Health Reform, report on insurance company practices, February 2010, http://www.healthreform.gov/reports/insuranceprospers/insuranceprofits.pdf.

[ix] “How Nebraska’s Insurance Companies Stand to Profit from Ben Nelson’s Compromises in Health Care Bill,” Huffington Post 21 December 2009, http://www.huffingtonpost.com/2009/12/21/how-nebraskas-insurance-c_n_400080.html.

[x] Quoted in “White House Affirms Deal on Drug Cost,” New York Times August 5, 2009, http://www.nytimes.com/2009/08/06/health/policy/06insure.html?_r=3&scp=8&sq=kirkpatrick&st=cse.

[xi] Exchange at Town Hall forum in Reston, VA, August 25, 2009, available online at http://www.youtube.com/watch?v=IdpVY-cONnM.