In the face of widespread suspicion that health care reform is stalled indefinitely, House Speaker Nancy Pelosi (D-Calif.) told reporters this afternoon that Democrats will succeed in passing the party’s top domestic priority, adding that “we are very close to doing that in a comprehensive way.” How? Well, it won’t happen by the House simply taking up the Senate bill. “Our members will not support the Senate bill,” Pelosi said. “Take that as a fact.” Instead, she wants both the House and Senate to pass an amending bill through the budget reconciliation process, which requires only 51 votes in the Senate. “Don’t even ask us to consider passing the Senate bill,” she warned, until after that amending proposal clears both chambers. In the meantime, Pelosi said, the House will strip out several provisions of the larger reform proposal — provisions that aren’t permitted to move via reconciliation — in hopes of passing them as stand-alone bills. Next week, for example, House leaders will consider a proposal to repeal the anti-trust exemption enjoyed by health insurers for over 60 years. “Just because we reach a bump in the road doesn’t meant that we turn back,” Pelosi said. “We will get the job done.”

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Pelosi: ‘We Are Very Close’ to Passing Health Care Reform

Perhaps the strangest element of Capitol Hill’s months-long health reform debate has been that Democrats — proposing to cover tens of millions of uninsured Americans while banning the worst abuses of the insurance industry — have been branded a public enemy, while Republicans — hell bent on killing the reforms — have somehow been cast as populist heroes. Continuing that theme, Rep. Dave Camp (R-Mich.), senior Republican on the powerful Ways and Means Committee, told reporters today that GOP leaders have no interest in getting health coverage for everyone, Merrill Goozner reports . His idea of reform? Allowing insurance companies to sell across state lines; limiting medical malpractice awards (”enough to pay for reform,” he said); creating high-deductible, high-co-pay plans for the uninsured (”we’re not trying to get to universal coverage”); and setting up special pools to make insurance more affordable for small business. If that sounds familiar, it should because it is essentially the same plan that was offered by Sen. John McCain and rejected by voters just 14 months ago. Surprising? Not in a town where tax cuts for the wealthiest Americans are also celebrated as a victory for the middle class.

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GOP Congressman: ‘We’re Not Trying to Get Universal Coverage’

Scott Brown, the Republican newly elected to replace the late Sen. Edward Kennedy (D-Mass.), has been surprisingly forthcoming about his vote in favor of the health reforms adopted by Massachusetts a few years back — reforms that include the same individual coverage mandate that many Republicans on Capitol Hill have declared unconstitutional. And while many Republicans are spinning Brown’s victory as an indictment of the Democrats’ health reform push, The Washington Post’s Alec MacGillis today  points out the inaccuracy of that argument. Brown, he writes, “rode to victory on a message more nuanced than flat-out resistance to universal health coverage: Massachusetts residents, he said, already had insurance and should not have to pay for it elsewhere.” “We have insurance here in Massachusetts,” he said in a campaign debate. “I’m not going to be subsidizing for the next three, five years, pick a number, subsidizing what other states have failed to do.” What Brown failed to mention is the inconvenient fact that the Massachusetts reform plan (1) focused on coverage, not cost containment (not exactly an approach championed by the fiscally conservative), and (2) relies heavily on federal subsidies to fund an expansion of the state’s Medicaid and CHIP programs, among others. In October, the New England Journal of Medicine, using state data, reported that the federal government dedicated $688 million to Massachusetts health care in 2006, before the reforms took effect. In 2007, after the reforms were in place, that number jumped to $816 million. In 2008, it was $888 million. Last year, it was projected to approach $1.3 billion. So while Brown says he’s not going to subsidize what other states failed to do, other states are busy subsidizing what Massachusetts has done. He should at least acknowledge that fact as he continues to oppose the Democrats’ proposals.

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The Irony of Scott Brown’s Opposition to Health Care Reform

House Speaker Nancy Pelosi’s (D-Calif.) press conference at the Capitol this morning is churning dramatic headlines about how health reform is dead. But she really doesn’t say that. In fact, she says just the opposite. “We have to get a bill passed — we know that,” she said . “That’s a predicate that we all subscribe to.” She added: “I don’t see the votes for it at this time. … In every meeting that we have had, there would be nothing to give me any thought that that bill could pass right now the way that it is.” [Emphasis mine.] And that may be true. But remember that the same could have been said at almost any point during both the House and Senate debates last year. It required all kinds of concessions and back-room deals to get Democrats on board, which is exactly how these things work. Don’t think for a second that similar negotiations aren’t happening right now to get reluctant House Democrats behind the Senate bill, which remains the quickest way for party leaders to pass their top domestic priority and move on to the economy , which needs some addressing if they want to fare better in November than they did this week in Massachusetts. The health care bill, under this scenario, couldn’t be altered. But there’s nothing to prevent the persuasive sweeteners from showing up in some other must-pass bill further on down the line.

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Pelosi: House Can’t Pass Senate Health Bill ‘At This Time’

BOSTON — The Republican National Committee’s well-timed poll of what Massachusetts voters want after the ballots are counted tonight provides a roadmap to the party’s strategy if Scott Brown wins tonight. The key bit: Should the winner of this special election be seated in the U.S. Senate immediately or should the Democrat leaders in Washington be allowed to delay seating the winner until after the health care reform bill has been voted on? 79%     Seated Immediately 10%     Allow Democrat Leaders To Delay Seating 9%       DK/Refused Wording aside, there are the seeds of an aggressive campaign to make any delay in a Brown seating politically impossible. Past examples to look at–scandalized Sen. Roland Burris’s (D-Ill.) rain-soaked trip to the Senate to demand that he be seated, and the series of anti-health care reform rallies outside of Congress, put together on incredibly short notice. RNC MA Statewide Pre-Election Survey 1-10 – Final With Results

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MA-Sen: The RNC’s Scene-Setting Memo

Sen. Joe Lieberman (I-Conn.), who’s done plenty in recent months to alienate Democrats, won’t improve his standing with his comments today to Fox News. Asked by Neil Cavuto if he would switch to the Republican Party if the GOP somehow took over the Senate in this year’s elections, Lieberman declared that he has “no idea.” “That’s a big hypothetical a long away from now,” he said. “I was elected as an Independent but I remained a registered Democrat, so I’m with the Democratic Caucus.” Today’s tight Senate contest in Massachusetts, Lieberman added, is indication that Capitol Hill has grown too partisan — and voters are fed up. “The independents are speaking loudly around the country today and they’re telling us, one, to get together here in Washington,” he said. “The second thing really is to do something about the economy and move to the center and worry about things that [independents] are worried about.” That’s no music to the ears of liberals who were hoping that the pendulum swing away from the Bush administration might arc longer than just a year.

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Lieberman Calls for ‘Move to the Center,’ Doesn’t Rule Out Switch to GOP

From a rental car in Massachusetts, TWI’s intrepid David Weigel sat down with The Washington Post’s Ezra Klein yesterday for a Bloggingheads.tv session to talk about — what else? — the Senate special election in the Bay State and its potential implications for health care reform. Watch after the jump.

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David Weigel vs. Ezra Klein on Bloggingheads.tv

With all eyes on the outcome of today’s shockingly close special Senate election in Massachusetts, Washington’s prognosticators are wondering what the Democrats will do on health care reform should GOP candidate Scott Brown steal the seat. House Majority Leader Steny Hoyer (D-Md.) offered two possibilities today, telling reporters that if Brown wins, Democrats could still get the bill to the White House before he’s sworn in — in which case Senate Democrats would still control the 60 seats needed to defeat a GOP filibuster. If that plan falls through, Hoyer added, House leaders are ready to rally the lower-chamber Democrats behind the Senate bill, which passed on Christmas Eve. “The Senate bill,” Hoyer said, “clearly is better than nothing.”

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Hoyer: Senate Health Bill Is ‘Clearly Better Than Nothing’

The Club for Growth is hustling to put up the signatories of its pledge to repeal whatever health care reform bill gets through Congress. The big names among the (so far) 21 candidates: Kentucky’s Rand Paul and Florida’s Marco Rubio, Republicans who have stunned the establishment GOP by becoming serious contenders for Senate seats. Patrick Hughes, who’s having somewhat less success challenging Rep. Mark Kirk (R-Ill.) in Illinois, is also on board, as are two of the Republican candidates for Senate Majority Leader Harry Reid’s (D-Nev.)  seat.

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Marco Rubio, Rand Paul Sign Health Care Reform ‘Repeal’ Pledge

Here’s a tale that could only have happened in this era when rampant A.D.D. has shrunk the news cycle to four minutes. Earlier this week, reports emerged indicating that Senate Majority Leader Harry Reid (D-Nev.), frustrated that Sen. Joe Lieberman (D-Conn.) had decided to oppose a Democratic proposal to expand Medicare coverage to younger folks, later told The New York Times Magazine that Lieberman “double-crossed” him. (The story won’t be published until Jan. 24, but a preview containing the quote ran in The Times on Tuesday.) This isn’t a big story, but in the homecoming-queen world of Washington, where personalities are considered more intriguing than legislating, it caught fire nonetheless. To such an extent that Reid just issued a short statement in an attempt to clear the air. “Senator Lieberman and I have a very open and honest working relationship,” Reid said. “On issues ranging from foreign policy to health care, even when we disagree, he has always been straight forward with me.” OK. Fences mended. Now make it stop.

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Reid: Lieberman ‘Has Always Been Straight Forward With Me’

At a luncheon hosted by The American Spectator and Americans for Tax Reform, South Carolina Attorney General Henry McMaster, a Republican, laid out the strategy and risks of his push – backed by 12 other attorneys general — for a constitutional challenge to the health care bill being debated by Congress. McMaster was alternately vague (no naming names on other AGs who might support him) and blunt about his chance of success. “I think that the courts will be deferential to the Congress on any of these questions, no matter what approach is taken,” said McMaster. “That makes it an uphill battle, but that doesn’t mean that it shouldn’t be fought, and it doesn’t mean that it can’t be won.” McMaster declined to talk much about the “travails” of Gov. Mark Sanford (R-S.C.), but he did must that “on the issues he’s promoted, he’s been dead-on”–a nice boost on the day that Sanford was officially censured by the South Carolina House of Representatives. And McMaster, who’s running to replace Sanford, brushed aside the suggestion that his campaign could help him in the four-way GOP primary. “It could be a campaign issue,” said McMaster, “but right now it is not.”

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GOP AG Suing to Stop Health Care Reform: We’ll Probably Lose

We’ve been writing for months that a major hurdle facing Democratic leaders as they merge the House and Senate heath reform proposals is what to do with the Children’s Health Insurance Program, or CHIP. The House has proposed to terminate CHIP at the end of 2013, citing the ease of enrollment if kids were covered in the same plan as their parents. The Senate, on the other hand,  funds CHIP through 2015. Supporters of the Senate provision warn that moving youngsters to exchange plans will increase costs to low-income families, many of which would respond by not buying coverage for their kids at all. Each side has been adamant in defense of its approach. Until now. CQ reported over the weekend that Rep. Henry Waxman (D-Calif.), chairman of the Energy & Commerce Committee and a supporter of the House CHIP repeal, “may not insist” on the House provision. In a separate interview, Waxman signaled that while he strongly favors his approach, he may not insist on it. “I’m not drawing lines in the sand on anything,” he said. Lawmakers in both chambers “want to make sure we protect children’s access to health care.” It’s worth mentioning that advocates of keeping CHIP around aren’t entirely pleased with the current program, which has a funding cap and therefore threatens to drop kids during budget squeezes. They merely worry that the switch to the exchanges would reduce the number of insured kids in the name of expanding coverage. Also worth noting, the CHIP program, while funded by the government, is run through private insurance companies. That means that Waxman and other supporters of terminating CHIP are up against, not only children’s welfare advocates, but the insurance lobby as well. “Many analysts expect that some version of the Senate language will prevail in the final bill,” CQ writes. “Lobbyists for America’s Health Insurance Plans, an industry trade group, say that shifting people into different programs could be disruptive and confusing, which could lead to some children ending up uninsured.” And AHIP is a group that knows how to get what it wants from Congress.

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Waxman Not Married to CHIP Repeal

This is a starling quote from the omnipresent Larry Sabato, who tells the Boston Herald that Democratic Senate candidate Martha Coakley’s “light schedule of campaign events” is evidence of a lazy campaign that’s wasted a big lead in the Massachusetts special election. That’s not the money quote; this is. In a competitive state, Coakley would be well on her way to losing. If the Democrats lose, they deserve to have health care go down. That’s right–Coakley’s losing ground not because of health care, but because she’s running a lazy campaign. And if she loses, the Democrats “deserve” to have the health care bill fail. That’s some serious spin — it makes a wintry special election more important than the presidential election, 435 House races, and 34 Senate races that produced the current executive and legislative branches. And expect to hear more of that. The Herald piece also gets into spin I’m hearing from a lot of Republicans — that, in the words of John Feehery, interim Sen. Paul Kirk (D-Mass.) “should’ve just shut up” instead of telling a reporter he’d vote for the health care bill no matter who won the special election. That doesn’t quite wash — Kirk would have caused a firestorm among liberals if he suggested that he’d vote against Ted Kennedy’s life’s work depending on who turned out in a January special election. But it’s become a rallying point for conservatives who, in the face of a less lazy Coakley campaign, are trying to keep up a push against her “arrogance.”

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Tomorrow’s Conventional Wisdom, Today!

Defending the special Medicaid deal that Democratic leaders gave to Nebraska to entice Sen. Ben Nelson’s (D-Neb.) support for health care reform, Nelson has said that he pushed for that perk on behalf of the state’s governor, Republican Dave Heineman, who was concerned about the increased pressure that a Medicaid expansion would have on Nebraska’s budget. But don’t tell that to Heineman, who appeared on Fox News this morning to dispute Nelson’s claim that the deal was the governor’s bidding. “We didn’t want a special deal,” Heineman said. Nebraskans are opposed to this special deal. I’m opposed to it. … All states ought to be treated fairly and equally, particularly when you’re talking about a federal program like Medicaid. In fact, Heineman said his concern was with unfunded mandates in general, “whether it’s Medicaid or education or whatever.” The deal has haunted Nelson since it was struck last month, sending his approval ratings south ever since. In light of the embarrassment the agreement has brought to the state, the Nebraska moderate might not insist that the provision remain.

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Nebraska Governor: ‘We Didn’t Want a Special Deal’

Just when you thought breast cancer screening couldn’t get any more confusing, two national medical groups issued new mammogram guidelines Monday recommending that women begin routine screenings at age 40. Issued by the Society of Breast Imaging and the American College of Radiology, the guidelines contradict controversial recommendations released in November by the U.S. Preventive Services Task Force, which suggested that routine screenings shouldn’t begin until age 50. “The significant decrease in breast cancer mortality, which amounts to nearly 30 percent since 1990, is a major medical success and is due largely to earlier detection of breast cancer through mammography screening,” lead researcher Carol H. Lee, a radiologist at the New York-based Memorial Sloan-Kettering Cancer Center, said in a statement. ”It should be remembered that mammography is the only imaging modality that has been proven to decrease mortality from breast cancer. However major efforts continue to build on this success by developing additional methods to screen for early breast cancer.” The Task Force guidelines stirred a storm amidst the congressional debate over the Democrats’ health reform bills, not least because those proposals would  use some of those recommendations in setting coverage floors for insurance plans operating on exchanges.

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New Mammogram Guidelines Contradict Controversial Task Force Recommendations

Among the chief discrepancies between the House and Senate health reform proposals is a provision of the House bill that would allow states to negotiate directly with pharmaceutical companies for lower drug prices on behalf of their lowest income seniors — those eligible for both Medicare and Medicaid. House leaders, behind Energy and Commerce Chairman Henry Waxman (D-Calif.), have proposed to use the resulting savings to close the coverage gap in Medicare’s prescription drug benefit. Trouble is, Democrats in the Senate and the White House promised earlier in the year not to support such price haggling as part of an $80 billion deal cut with the drug lobby to secure its support for the underlying bill. Waxman, though, wasn’t a part of those negotiations and has said that he doesn’t feel obliged to honor a deal to which he never agreed. His latest comments, via FireDogLake , came yesterday: “The President and the Senate made very poor deals with PhRMA,” Waxman said, explaining the deal whereby the drug industry offered $80 billion dollars in givebacks in exchange for their support for the overall bill. “Rahm (Emanuel) said that’s OK,” Waxman said, but he noted that under the deal, the industry would get millions of new customers and Americans would still pay far more than the rest of the industrialized world for prescription drugs. “I have said that I am not bound by that agreement,” Waxman said, noting all the provisions in the House bill which go further than the PhRMA deal. … Waxman said that in the conference, where he expected the President to sit down personally, “I’m going to say, ‘Are we interested in protecting the profits of the drug companies or protecting seniors?’” Although the House does not reconvene until Jan. 12, and the Senate is out until the Jan. 19, leaders from both chambers have returned to Washington this week to begin ironing out the differences between the chambers’ health reform bills, of which Waxman’s drug provision is just one.

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Waxman: Still Not Feeling Bound to That $80 Billion PhRMA Deal

Earlier this week, it was Sen. Russ Feingold (D-Wis.) being targeted by the Progressive Change Campaign Committee, which is hoping that some liberal lawmaker will stand up to insist that the public insurance option be included as part of the Democrats’ final health reform bill. Today, the group launched the next wave of its campaign, announcing plans to target Sen. Bernie Sanders (I-Vt.) with online ads and thousands of daily robocalls to Vermont voters. “The congratulations that Democrats are giving themselves in Washington DC are not shared by voters across the country who overwhelmingly want a public option and oppose being required to buy insurance from companies that put profit ahead of people’s health,” said Adam Green, PCCC co-founder, in a written statement. “Bernie Sanders can be a hero at this historic moment by declaring that any final bill must have a public option to win his support.” Both Sanders and Feingold are adamant supporters of the public option, though both also voted last week in favor of the Senate bill, which doesn’t include such a plan. (The House bill does.) House and Senate leaders are hoping to merge the two bills and have the final product on the president’s desk sometime next month.

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More Pressure From the Left on the Public Option

Informal, behind-the-scenes negotiations began this week to merge the House and Senate health care reform bills, Roll Call reported Monday. But there’s still been no public decision about whether representatives of each chamber will meet later in a formal conference committee, or if the final bill will be the product of more casual closed-door talks between chamber leaders. It remains unclear whether a formal conference committee will be held to resolve those differences. With heavy input from Senate Majority Leader Harry Reid (D-Nev.), Speaker Nancy Pelosi (D-Calif.) and the White House expected regardless, another option is to conduct the negotiations strictly at the leadership level. As we’ve pointed out , there’s no lack of disparities between the bills that need ironing out — including differences in each chamber’s approach to a public insurance option and abortion coverage. The decision about the conference negotiations, Roll Call reports, will be made early next month.

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Still No Word on a Formal Health Reform Conference

Nowhere in the Constitution is Congress empowered to require Americans to buy health insurance, Sen. John Ensign (R-Nev.) charged today. “I am seriously concerned that the Democrats’ health reform bill violates the Constitution of the United States of America,” Ensign said in a statement. “Is it really constitutional for this body to tell all Americans that they MUST buy health insurance coverage?” Two thoughts: First, whatever Congress is empowered to do is not, ultimately, for Congress to decide — that’s a job for the courts. (And you can bet that there will be no absence of lawsuits if the individual mandate survives the process to become law.) And second, why should Congress tolerate a system under which folks without insurance can still receive emergency care on everyone else’s dime? Indeed, even former Senate Majority Leader Bill Frist (R-Tenn.), a thoracic surgeon, has said that requiring everyone to buy into coverage pools is “about the only way” to fix the nation’s dysfunctional health care system. “We have 46 million people who don’t have insurance out there,” Frist told the Fox Business Network in September. “Somebody’s going to have to pay for that. If they can pay for it, they should be responsible to paying for it. And, if not, there are going to be taxes, excise taxes, user taxes on companies like Aetna, on individuals. “And I’m hard-core Republican,” Frist added.

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Ensign: Health Reform Is Unconstitutional

The American Medical Association, the nation’s largest doctors lobby, today put its weight behind the health reform bill likely to pass the Senate this week. But in its letter to Senate Majority Leader Harry Reid (D-Nev.), the group also warns that reform will be incomplete until Congress addresses the flawed funding formula that dictates Medicare payments to physicians. The AMA firmly supports critical aspects of the bill that expand access to health insurance coverage, reform insurer practices, implement administrative simplifications, and promote wellness and prevention. … However, there is still work to be done. [B]efore any health reform effort, including this one, will prove successful, Congress must address Medicare’s fatally flawed physician reimbursement formula, the Sustainable Growth Rate (SGR). This bill relies heavily on the Medicare program to drive changes in provider and patient behavior in the health care system as a whole. However, delivery reforms and incentive policies will not effectively function while the SGR is still in place. This is a stronger endorsement than the one AMA gave to the House bill earlier in the year, when the group hinged its support for health reform on an accompanying elimination of the SGR formula. That proposal passed the House last month, but Senate lawmakers killed a similar measure a month earlier because the $245 billion cost wasn’t paid for. Recognizing that a permanent doc-fix isn’t happening this year, AMA decided not to attach the same condition to its endorsement of the Senate bill. Instead, it attached a warning: Congress — which recently approved a 60-day patch preventing Medicare payment cuts to docs as part of its defense spending bill — must return early next year with plans to provide a permanent solution to the perennial problem. Physicians, and increasingly patients, are rapidly losing faith in the ability of Congress to address this critical issue. It is for that reason that the AMA will oppose efforts to apply temporary band-aids beyond the 60-day extension included in the FY 2010 Defense appropriations bill. Congress must replace the SGR early next year in order to achieve the access, payment and delivery reform goals envisioned by H.R. 3590. We will not support a final Conference Report without a clear pathway for passage of a permanent repeal of the SGR formula early next year. The doc-fix issue leaves Democrats in the awkward position of having to return to health care next year just a few weeks after they’re likely to enact the most expansive health reforms in 44 years.

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Docs Endorse Senate Health Care Bill, With a Warning

As part of a defense spending bill passed yesterday in the House, Democratic leaders included funding to prevent a 21-percent cut in Medicare payments to doctors, which was scheduled to hit Jan. 1. But the relief doesn’t last long. Instead, Democrats delayed the cuts just two months, meaning that Congress will be forced to come back to the issue early next year in search of a longer-term solution. Not only will that not be cheap ( failed legislation providing a permanent fix scored near $250 billion), but it also puts Democrats in the awkward position of taking up an urgent health care bill just weeks after they’re likely to enact the most sweeping health care reforms in decades. That the enormous reform bill doesn’t tackle the so-called doc-fix — one of the thorniest and most expensive problems facing the nation’s health care system — will surely leave some voters scratching their heads.

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House Punts Doc-Fix Problem to March

At TWI’s sister site The Iowa Independent, Lynda Waddington relays the thoughts of Sen. Tom Harkin (D-Iowa), chairman of the Senate health committee, who told reporters today that the health care reform bill moving through the Senate is far from a liberal’s dream, but nonetheless represents a good first step toward bolder reforms down the line. “What we are buying here is a modest home, not a mansion. What we are getting here is a starter home. It’s got a good foundation: 30 million Americans are covered. It’s got a good roof: A lot of protections from abuses by insurance companies. It’s got a lot of nice stuff in there for prevention and wellness. But, we can build additions as we go along in the future. It is a starter home. Think about it in that way,” Harkin said by telephone Thursday morning. Democrats have been on the defensive this week after bowing to the demands of Sen. Joe Lieberman (I-Conn.), who insisted over the weekend that plans to expand Medicare be dropped from the compromise bill. Lieberman has also demanded that the bill contain no public insurance option — in any form. Seeing Lieberman’s support as the only way to get the underlying bill through the Senate, Democratic leaders have given the Connecticut Independent everything he’s asked for — and stirred a backlash from liberals, most notably Howard Dean, the former head of the Democratic National Committee, who is calling for the bill to be scrapped altogether. Harkin said Dean’s frustration is understandable, Waddington writes, but it’s no reason to drop the reform bill and start over. “I think [Dean] is speaking to the frustration of many of the progressives in this country who recognize what I think is sort of the common sense approach of having at least one public option out there,” Harkin said. “I think there is a lot of frustration out there — I have it myself. But you can’t let frustration turn into defeat.”

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Harkin: Health Reform Bill Just a Foundation

Guess that historic first vote on single-payer health coverage won’t happen this year after all. Sen. Bernie Sanders (I-Vt.) today withdrew his Medicare-for-all amendment after Sen. Tom Coburn (R-Okla.) launched a procedural move forcing a Senate clerk to read the entire 767-page text. The Hill has the rest: “The day will come, although I recognize it’s not today, when the U.S. Congress will have to vote to stand up to … all those who profit every single year off of human sickness,” Sanders said. “That day will come.” Senate aides estimated that the bill reading would have taken eight to 10 hours, which would have sidelined the healthcare debate as Democratic leaders are attempting to pass the overhaul by Christmas.

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Sanders Withdraws Single-Payer Amendment

Here are more photos ( see round one here ) from the “Code Red” rally against health care reform that shook the upper Senate Park this afternoon.

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Photos From the ‘Code Red’ Rally

Despite all the setbacks, the Democrats are hoping to pass their enormous health-care reform bill before the December holidays. Today, Sen. Jon Kyl (R-Ariz.) predicted that it’ll never happen. “I guarantee you,” Kyl told Fox News, “it’s not going to be done before Christmas. There is not time, even writing this bill behind closed doors instead of in front of the cameras, as the president promised, to get this done and to get it done right before Christmas.” Kyl has ample experience at stalling legislation, as evidenced by the drawn-out debate over an extension of unemployment benefits. And that was a bill that Republicans supported.

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Kyl: No Way the Senate Health Bill Passes by Christmas

Speaking to reporters at the Capitol moments ago, Sen. Joe Lieberman (I-Conn.) seemed surprised by his own endorsement three months ago of a Medicare buy-in proposal he now opposes — saying that he finally saw the video “last night,” as if it were someone else who granted the now-infamous interview to The Connecticut Post in September. Stuck in a corner, he offered two explanations. (1) He first said that it appeared like his September comments referred back to his endorsement of the Medicare buy-in 2000, when he was running as the vice-presidential candidate on the Al Gore ticket. (Nevermind that the Post interview was conducted clearly in the context of the current health-care debate.)  And (2) he argued that the comments were made before the Senate Finance Committee had introduced its reform bill, which grants generous insurance subsidies to folks aged 55 to 64. (Nevermind that the Senate HELP bill, which passed earlier in the summer, contained similar subsidies and everyone knew that the Finance bill would follow suit.) He didn’t seem to mind that the explanations were contradictory.

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Lieberman: I Finally Watched the Interview I Gave Three Months Ago

Unhappy with all the recent tweaks to the Senate’s health care reform legislation, three top Republicans are asking the Congressional Budget Office to re-score the entire bill. In a Monday letter to CBO, Sens. Charles Grassley (R-Iowa), Michael Enzi (R-Wyo.) and Judd Gregg (R-N.H.) argue that “CBO’s complete analysis of the perfecting amendment needs to be made available to Senators well before a vote on the amendment occurs.” Accordingly, CBO’s analysis must be completed quickly to provide for sufficient time for review … so that the Senators and the public are fully informed about the implications of the latest version of the plan on the federal budget and the health care system. The Democrats obliged similar requests before voting on health care reform in the Finance Committee, and again before the merged bill was brought to the Senate floor. With a self-imposed voting deadline just 10 days away, though, time is hardly on their side.

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Republicans Request New CBO Score of Health Bill

It’s looking that way. Sen. Bernie Sanders (I-Vt.), the only member of the upper chamber to endorse single-payer health coverage , said Monday that he plans to introduce an amendment to the Democrats’ health reform legislation that would establish a Medicare-for-all insurance system. We have got to understand that one of the reasons that our current health care system is so expensive, so wasteful, so bureaucratic, so inefficient,  is that it is heavily dominated by private health insurance companies whose only goal in life is to make as much money as they can. The result is [that] we are wasting about $400 billion a year on administrative costs, profiteering, high CEO compensation packages, advertising and all the other stuff which goes with the goal of private insurance companies to make as much money as [they] can. Michael Briggs, spokesman for Sanders, said Monday that Democratic leaders have indicated that Sanders’ single-payer proposal could be fourth in line among the amendments to get a vote on the Senate floor — the first vote of its kind in the history of the upper chamber. That the provision is certain not to pass hasn’t discouraged the Vermont Independent. “I am not naive. I know that we will lose that vote,” Sanders said. “But … at the end of the day — not this year, not next year, but sometime in the future — this country will understand that if we’re going to provide comprehensive, quality care to all of our people, the only way we will do that is through a Medicare-for-all, single-payer system.”

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A Senate Vote on Medicare-for-All?

Via USA Today , White House spokesman Dan Pfeiffer has denied that the administration is pressuring Senate Democrats to forge a deal with Sen. Joe Lieberman (I-Conn.) on health care reform, as Politico reported earlier today. “The report is inaccurate,” he said in an email. “The White House is not pushing Sen. Reid in any direction. We are working hand in hand with the Senate leadership to work through the various issues and pass health reform as soon as possible.” Senate Democrats have called an emergency meeting at 5:30 this evening to brainstorm ways around the Lieberman hurdle.

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White House Denies Pushing Deal With Lieberman

In June, the White House issued a report making the case that health reform — well beyond a moral and social imperative — is also vital to the economic health of the country. Today, administration officials were at it again. A new report from the Council of Economic Advisers finds that the health bills moving through the Senate would slow the growth rate of health care spending by 1 percent per year into the indefinite future — a trend that would reduce budget deficits, help small businesses, and even lower premiums for Medicare patients. White House senior economist Christina Romer told reporters Monday that those arguing against the Senate bill ”have not looked at the numbers.” “We are headed for a train wreck,” she said. This is hardly a new argument, and certain members of Congress have been screaming for years about the unsustainability of the country’s health care spending. Still, in the middle of a fierce health reform debate — in which scare tactics and political messaging have long-trumped the nuances of the policy — it’s worth reminding voters that leaving the health care system in its current form is no option.

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The Economic Case for Health Reform, Part II

Matthew Yglesias, making another version of his argument that the multiple veto points in the legislative branch overly empower the minority and make America “ungovernable,” drew a quip from Glenn “Instapundit” Reynolds : “Funny, that dumb cowboy Bush seemed to get a lot done with fewer votes in Congress.” Yglesias clarifies: “I meant to convey the fact that the political system seems incapable of addressing large-scale objective problems.” I think if Reynolds were to revisit his quip, he’d have to agree with Yglesias. What, after all, did Bush “get done” on domestic policy? As a libertarian like Reynolds knows, his biggest policy achievements made the government bigger, kicking costs down the road for someone else to pay. In 2001 he made an alliance with liberals and got the No Child Left Behind Act passed. In 2003 he made an alliance with liberals and got Medicare Part D passed. When Bush put his weight behind the sort of reforms that Reynolds likes, and that his base wanted — Social Security reform, for example — it died in Congress. The big exception to all of this, of course, was tax policy. Bush got enormous supply-side tax cuts through Congress. But as Reynolds must know, those tax cuts didn’t need 60 votes to get through the Senate; they went through the budget process and needed 51 votes. I don’t think anyone would make the argument that tax cuts should have to pass a supermajority threshold. I know very few conservatives who are glad that Democratic filibusters, when the party was at an ebb of 45 Senate seats, could kill entitlement reform. But in our current system, cost-shifting policy like that is easy to pass and large-scale policies are tough to pass — note that “deficit hawks” like Sen. Kent Conrad (D-N.D.) are not proposing actual entitlement reforms, but toothless “commissions” to look at those reforms.

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‘That Dumb Cowboy Bush’

Here, via Jim Newell , is a striking example of the Tea Party movement grabbing and appropriating a tactic of the anti-war movement: On Tuesday, December 15 at 8:45 AM thousands of us will meet in Washington, DC at the fountain in Upper Senate Park. From there we will march to the Senate offices, go inside, and demonstrate our opposition to the government takeover of health care. We call this plan “Government Waiting Rooms”. The intention is to go inside the Senate offices and hallways, and play out the role of patients waiting for treatment in government controlled medical facilities. As the day goes on some of us will pretend to die from our untreated illnesses and collapse on the floor.

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‘Some Of Us Will Pretend to Die From Our Untreated Illnesses’

Brian Beutler gets his hands on a Democratic graphic meant to encapsulate the Republican position on Medicare. After months of appealing to seniors — who, according to polls, are the toughest critics of health care reform — over theoretical cuts to Medicare, the GOP is in the position of campaigning against an expansion of Medicare. The graphic: This is mostly a message problem for Republicans, but it’s one that’s been a long time coming. Much of the conservative movement has honed in on “Medicare cuts” as a killer argument against health care reform. This led to even the 60 Plus Association, a conservative group more or less founded to campaign for the privatization of entitlements, running TV ads to demand that seniors get all the Medicare benefits they were promised. It was not hard to find Republicans who’d admit that a spirited defense of Medicare was not in their long-term interests — Rep. Mike Pence (R-Ind.) told me as much — but they expected immediate short-term benefits.

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We Have to Save Medicare in Order to Destroy It

Last week, former Senate Majority Leader Bob Dole (R-Kans.) urged GOP leaders — namely Senate Minority Leader Mitch McConnell (R-Ky.) — not to resist health reform simply for the sake of resisting health reform. “I don’t want the Republicans putting up a ‘no’ sign and saying, ‘We’re not open for business,’” Dole said, according to the Kansas City Star . Today, in the wake of the Senate Finance Committee’s passage of a $829 billion health reform bill, McConnell heeded not a word of Dole’s advice. “This proposal will never come before the Senate,” McConnell chided in a statement. But what we do know is that the bill written behind closed doors here in the Capitol will be another 1,000-page, trillion-dollar Washington takeover. We know it will slash a half-trillion dollars from seniors’ Medicare, add new taxes and raise premiums. That’s not reform.

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McConnell Not Quite Heeding Bob Dole

There’s a great deal of focus on Sen. Olympia Snowe this week as the Finance Committee inches its way closer to a vote on health reform legislation, but the Maine Republican gave no clues in this morning’s opening statement about whether she’ll support the proposal. Instead, Snowe used her initial five minutes to voice concerns about the potentially changing costs of the bill as the actual legislative language is drafted from the current conceptual language. The Congressional Budget Office last week estimated that the bill would reduce federal deficits by $81 billion over the next decade. “If there are significant departures,” Snowe warned, “obviously that could drive up the price.” Snowe is the only upper-chamber Republican who’s shown a bit of willingness to support the legislation, and Democrats have been courting her in order to lend at least a tinge of bipartisanship to the legislation. We’ll know later today if they’ve succeeded.

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Snowe Lends No Hints of Support for Health Bill

Enacting a comprehensive set of medical malpractice reforms would reduce nationwide health care spending by 0.2 percent, according to a report released today by the Congressional Budget Office. Over 10 years, the changes would reduce federal deficits by $54 billion. Estimating that providers will spend about $35 billion this year in liability costs — including insurance premiums, settlements and administrative expenses — CBO found that tort reform would cut that figure by 10 percent. The estimate “reflects the fact that many states have already enacted at least some of the proposed reforms,” CBO said. For example, about one-third of the states have implemented caps on noneconomic damages, and about two-thirds have reformed their rules regarding joint-and-several liability. The estimate is based on changes “similar” to the following taking hold: – A cap of $250,000 on awards for noneconomic damages; – A cap on awards for punitive damages of $500,000 or two times the award for economic damages, whichever is greater; – Modification of the “collateral source” rule to allow evidence of income from such sources as health and life insurance, workers’ compensation, and automobile insurance to be introduced at trials or to require that such income be subtracted from awards decided by juries; – A statute of limitations—one year for adults and three years for children—from the date of discovery of an injury; and – Replacement of joint-and-several liability with a fair-share rule, under which a defendant in a lawsuit would be liable only for the percentage of the final award that was equal to his or her share of responsibility for the injury. Those reforms would reduce federal spending by $41 billion over 10 years, CBO estimated, while increasing revenues an additional $13 billion. Those figures drew immediate praise from Republicans, who have pushed for years to rein in malpractice lawsuits. Sen. Orrin Hatch (R-Utah), who requested the CBO study, issued a statement arguing that the findings “show that this problem deserves more than lip service from policy-makers.” Unfortunately, up to now, that has been all the President and his Democratic allies in Congress have been willing to provide on these issues. Sen. Charles Grassley (R-Iowa), the ranking member of the Senate Finance Committee, also weighed in, saying that “it makes no sense that congressional Democrats have taken malpractice reform off the table.” CBO says comprehensive medical liability reform would reduce federal budget deficits by roughly $54 billion over the next 10 years. That’s not chump change.  It’s a no-brainer to include tort reform in any health care reform legislation.

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CBO: Tort Reform Would Cut Health Spending by 0.2%

Henry Blodget at Clusterstock points out that Coke CEO Muhtar Kent penned a Wall Street Journal editorial that suggests people are fat and lazy all on their own, and not because of his company’s product. Kent wrote his pithy observations Wednesday to protest a possible soda tax to pay for health care reform. From the Journal: While it is true that since the 1970s Americans have increased their average caloric intake by 12%, they also have become more sedentary. According to the National Center for Health Statistics 2008 Chartbook, 39% of adults in the U.S. are not engaging in leisure physical activity. The Centers for Disease Control and Prevention has found that 60% of Americans are not regularly active and 25% of Americans are not active at all. The average American spends the equivalent of 60 days a year in front of a television, according to a 2008 A.C. Nielsen study. This same research data show that the average time spent playing video games in the U.S. went up by 25% during the last four years. If we’re genuinely interested in curbing obesity, we need to take a hard look in the mirror and acknowledge that it’s not just about calories in. It’s also about calories out. Or we could take a hard look in the mirror and say that people who drink too many sugary sodas end up with health problems that cost all of us, and that the companies that market those drinks, especially to kids, should face the consequences of a tax on their product to pay for it all. It’s easier, as Kent demonstrates, to spout off about Americans being lazy. But you’d think a company like Coke would have the kind of public relations department that might frown on insulting people to make your point. Maybe next the people who make Ho Hos and Sno Balls should write scolding op-eds telling people to make sure they renew their gym memberships.

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Coke CEO: If You’re Fat, Blame Yourself, Not Us

The American Association for Justice — the trial lawyers’ lobby group — has just released an astounding statistic:  medical malpractice insurance companies’ average profits are higher than those of 99 percent of Fortune 500 companies. As the nation remains mired in a debate over health care reform and how to keep down the costs of expanding coverage, AAJ is trying to point out that Republicans claims that medical malpractice lawsuits are one of the big cost drivers is completely misleading. In fact, though malpractice claims and so-called “defensive medicine” does account for a small percentage of unnecessary costs , medical errors and the astronomical profits of malpractice insurers appear to be a bigger part of the problem. AAJ’s report released today finds that the average profit of medical malpractice insurance companies is higher than 99 percent of all Fortune 500 companies and 35 times higher than the Fortune 500 average for the same time period; and malpractice insurers have seen their profit margins range from 5.9 percent to 74.8 percent, with an average of 31.2 percent. The report also finds that malpractice insurers have publicly overestimated their losses and underestimated their profits in an attempt to suggest the insurance business and medical practice in general faces a crisis that must be resolved by so-called “tort reform” — i.e., making it harder for patients to sue and to collect damages for their injuries. “Insurance companies are gouging doctors on their premiums to mislead lawmakers,” said American Association for Justice President Anthony Tarricone, managing partner at Kreindler & Kreindler LLP, in a statement released with the report. “And today, injured patients are often left with no avenue to pursue justice, while health care costs continue to skyrocket.”

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Medical Malpractice Insurers’ Profits Higher Than Nearly All Fortune 500 Companies

So says The Associated Press, reporting this afternoon that the absence of an estimated cost from the Congressional Budget Office means that the Senate Finance Committee won’t get around to voting on its health care reform bill until Wednesday at the earliest. Last week, Republicans on the panel, notably Sen. Olympia Snowe (R-Maine), had urged Chairman Max Baucus (D-Mont.) to wait at least 72 hours after receiving the CBO score to stage the vote. Baucus, though, declined to commit to any timelines, saying only that he would leave “a reasonable time” for lawmakers to study the bill with the cost estimates attached.

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Finance Panel Delays Health Reform Vote

During the two-week debate over health care reform in the Senate Finance Committee, it was a Republican — Sen. Jon Kyl (Ariz.) — who pushed back most vocally against a proposal from Chairman Max Baucus (D-Mont.) to save $4 billion a year by charging fees to medical device makers. But some Democrats are none too happy with the proposal either. California Democratic Sens. Dianne Feinstein and Barbara Boxer last Friday sent a letter to Democratic leaders claiming the fees would kill jobs in their state. California is home to more medical device workers and companies than any other state. Our state is home to 1,300 medical technology firms, which create more than 112,000 related jobs. These California firms represent about 20 percent of total United States medical device sales and approximately one-third of the industry’s jobs. The showdown highlights the primary struggle facing Democratic leaders trying to rein in medical spending to keep care affordable and federal programs sustainable. That is, the medical industrial complex has evolved into a $2.3 trillion-per-year colossus, and any proposed cuts are sure to get blasted by lawmakers trying to protect regional interests — even when those regional interests run counter to national interests. Last week, the Finance Committee defeated Kyl’s amendment to eliminate the medical device fees altogether. But the saga is far from over. Indeed, Dow Jones is reporting today that the Advanced Medical Technology Association, the nation’s leading device lobbyist group, is in discussions with Baucus’s office about reducing the fees from $40 billion to $15 billion over 10 years. “A deal might come within days,” Dow Jones says, citing unnamed industry sources.

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Dems Push to Preserve Medical Device Jobs

Deep into the Senate Finance Committee’s marathon debate over health care reform, Democrats Thursday night killed a GOP proposal that would have forced legal immigrants to wait five years before getting federal subsidies on the proposed state insurance exchanges. Sen. Jon Kyl (R-Ariz.), sponsor of the amendment, said it would simply align exchange policies with those of Medicaid, which requires the five-year waiting period for legal immigrants. “I would like to preserve the law as it is,” he said. But Democrats were having none of it. Sen. Robert Menendez (D-N.J.) said the Kyl proposal, aside from treating legal residents like second-class citizens, would also put those folks in the tough position of being forced to buy insurance without lending the means to do so. “That clearly is a Catch 22,” he said. As Daphne pointed out recently, Republicans have exploited the hot-button immigration issue so successfully in the health reform debate that Finance Committee Democrats have gone so far as to exclude illegal immigrants from buying even un subsidized insurance on the exchange. It’s purely a political move, for no one — on Capitol Hill or off — has offered a good explanation for how allowing folks to buy insurance coverage from private companies using U.S. dollars could harm the country. Indeed, it would likely keep those people out of emergency rooms, saving taxpayer dollars. The debate has grown so absurd that it feels, at times, like some voices don’t care to distinguish between legal immigrants and illegal immigrants. As Menendez said, under Kyl’s waiting-period amendment, “legal permanent residents” would be prevented from availing a benefit “that they helped to fund.” The Kyl amendment fell by a count of 10 to 13, along strict party lines.

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Finance Panel Shoots Down GOP Amendment to Keep Legal Residents From Getting Care

Earlier today, we previewed an effort by Sen. Jay Rockefeller (D-W.Va.) to require insurance companies to dedicate a minimum share of premium revenues to health care delivery, as opposed to administrative costs, profits and executive pay. Moments ago, the West Virginia Democrat made his case for the amendment, then withdrew it. The Congressional Budget Office, he said, hasn’t scored it yet. It wouldn’t have passed anyway. Aside from Republican opposition, which would almost certainly be unanimous, Sen. Jeff Bingaman (D-N.M.) said he wouldn’t support the measure either. The underlying bill, Bingaman argued, already addresses the most egregious industry abuses.

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Rockefeller Withdraws Amendment to Force Insurers to Spend More on Care

The Senate Finance Committee on Thursday approved legislation empowering states to create public insurance plans that would negotiate rates on behalf of some of their poorest residents. The proposal, sponsored by Sen. Maria Cantwell (D-Wash.), would allow states to create “basic health plans” catering to those earning between 133 percent and 200 percent of poverty. The bill is designed to ease the budget squeeze on some states with generous Medicaid programs, which would otherwise be forced to pay a portion of the Medicaid costs for the same people. Importantly, the bill would also empower states to negotiate with physicians, hospitals and other providers in search of affordable care. “It is a public plan, but negotiated with the private sector,” Cantwell said. The new plan would be optional, Cantwell emphasized, with states participating only at their own discretion. “The state is in the driver’s seat,” she said. Republicans weren’t convinced. They blasted a stipulation that those qualifying for the new plan wouldn’t be eligible for federal subsidies to buy different insurance coverage on the state exchange. “There is no choice for people if a state decides to do this,” said Sen. Jon Kyl (R-Ariz.). There were additional concerns. Kyl and Sen. John Cornyn (R-Texas) both worried that, by draining the exchange of a chunk of beneficiaries, the risk pool would shrink, thereby raising premiums on everyone else. “This seems to me to be moving in the wrong direction,” Cornyn said. Supporters of the Cantwell proposal hope it will solve a dilemma facing states under the health reform proposal moving through the Finance Committee. That bill hikes minimum Medicaid eligibility to 133 percent of poverty, but also requires states to maintain their current eligibility levels even if they’re well above 133 percent. Some states are concerned that, with Medicaid enrollment rising amid the recession, the mandate to keep eligibility steady will break their already bursting budgets. The Cantwell amendment will shift a percentage of those states’ Medicaid populations into a separate plan funded with federal subsidies. The Congressional Budget Office has yet to estimate the cost of Cantwell’s proposal — a situation prompting Republicans to claim that it shouldn’t get a vote. Sen. Jim Bunning (R-Ky.) called on Baucus to rule the amendment out of order until the CBO score is known. Baucus refused. “This amendment is structured in a way to save money,” he said. “Therefore it is in order.” “We don’t know that,” Bunning snapped. The vote was 12 to 11. Sen. Blanche Lincoln (D-Ark.) was the only member to cross party lines, joining all Republicans in opposing the bill.

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Finance Panel Moves to Create State-Based Public Plans

Dave has been following the saga of Rep. Alan Grayson (D-Fla.), who incited a GOP uproar this week after charging that the Republicans’ health reform strategy is to let the sick “die quickly.” The comment caused GOP leaders to threaten an anti-Grayson resolution, to be introduced if Grayson failed to apologize for his remarks. Roll Call has the tale of the apology, delivered Wednesday afternoon on the House floor: After speaking extensively to the press, Grayson came to the floor with an apology, but not for the Republican Party. “I would like to apologize,” he said. “I would like to apologize to the dead.” No word yet of the GOP response. – You can follow TWI on Twitter and Facebook .

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Grayson Apologizes

The Senate finance panel just shot down an amendment to the committee’s health reform bill that would have required beneficiaries of Medicaid and the Children’s Health Insurance Program to show a photo ID in order to enroll. Sen. Charles Grassley (Iowa), the senior Republican on the Finance Committee and sponsor of the proposal, said the new ID requirement is necessary to prevent identity theft. Democrats disagreed, arguing that it would create an additional barrier preventing the nation’s poorest citizens from accessing care. Sen. Jeff Bingaman (D-N.M.) characterized the Grassley proposal as “a solution in search of a problem.” Similar requirements, he said, have kept citizens from getting Medicaid coverage for years, particularly on Indian reservations where the poverty is endemic and ID documents scarce. The fraud in Medicaid is not patient fraud, but provider fraud, added Bingaman, a former attorney general who claimed to have plenty of experience tackling the problem. Sen. Robert Menendez (D-N.J.) echoed those concerns, wondering aloud how many kids have photo IDs? “This puts children at risk,” he concluded. There is good reason for the Democrats’ concerns. A 2005 law created strict new proof-of citizenship requirements for Medicaid eligibility, forcing potential beneficiaries to produce original-copy citizenship and identification documents. Sponsors said the change was designed to protect taxpayers by preventing illegal aliens from accessing the federal-state program. But Medicaid directors nationwide have said the hurdles have kept many more citizens than illegals from receiving coverage . The committee vote to kill the Grassley amendment was 1o to 13, strictly along party lines.

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Finance Panel Fends Off New Photo ID Requirement in Medicaid and CHIP

Even as the Senate Finance Committee just shot down a long-debated proposal to create a public insurance plan, Sen. Tom Harkin (D-Iowa), chairman of the Senate Health, Education, Labor and Pensions Committee, is predicting a victory for the proposal on the Senate floor, according to The Iowa Independent , TWI’s sister site. “Why shouldn’t we have a public option,” Harkin said during an interview on “The Bill Press Radio Show.” “We have the votes.” Harkin’s reasoning seems to be that, with polls showing rising support for the public option, it’ll be politically tough for lawmakers — particularly conservative-leaning Democrats — to vote against it. “Those in the minority can offer amendments to take it out, and then we’ll see where the votes are,” Harkin said.

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Harkin: Public Option Can Pass Senate

Citing the unlikeliness that the public option could pass on the Senate floor,  Senate Finance Committee Chairman Max Baucus (D-Mont.) just announced that he’ll vote against an amendment to create a public plan. “I can count, and no one has shown me how we can get 60 votes with a public option in the bill,” Baucus said. The Montana Democrat said there’s little doubt that the public option would pressure private insurers to become more affordable, “but my first job is to get this bill across the finish line.” Amendment sponsor Jay Rockefeller (D-W.Va.), though, isn’t buying the argument. Rockefeller, who chairs the Finance Committee’s health subpanel, said Democrats shouldn’t support a bill just for the sake of passing something. “I don’t like that philosophy,” he said.

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Citing Pragmatism, Baucus Will Vote Against Public Option

Medicare is often described as a fee-for-service program, meaning exactly what it sounds like: physicians and hospitals bill the government for each individual service they provide to Medicare beneficiaries, and Washington writes them a check in return. The more services rendered, the more providers are paid — a system that’s fine when those services are necessary, but also creates a perverse incentive for doctors and hospitals to conduct more tests and procedures than might be necessary. Indeed, the fee-for-service model is commonly criticized as a large reason that Medicare spending is rising unsustainably . Democrats are trying to move away from fee-for-service Medicare, aiming instead to create a system that pays for the quality and outcomes of health services, rather than the mere volume of them. This week those lawmakers got a little push. The Government Accountability Office on Monday issued a report finding that over-prescription of some medical procedures are inexplicably endemic to certain regions of the country, suggesting that care regimens are influenced by a nebulous medical culture that differs from place to place. “[C]ertain types of physician services, such as advanced imaging and minor procedures, are performed more frequently in potentially overserved areas relative to other areas, suggesting differences in physician practice patterns,” GAO found. [P]otentially overserved areas had 44 percent more minor procedures — which include services such as ambulatory procedures, eye procedure treatments, and colonoscopies — per 1,000 beneficiaries than other areas. Potentially overserved areas also had 29 percent more laboratory tests and 19 percent more imaging services per 1,000 beneficiaries than other areas. The agency defined “potentially overserved areas” as those “in the top half in both the level and growth in utilization of physician services.” Importantly, increasing the number of procedures doesn’t produce tangible health benefits for the patients on the receiving end, GAO found. The findings weren’t lost on Sen. Max Baucus (D-Mont). The Senate Finance Committee chairman is leading the effort to transition Medicare’s payment system away from fee for service. In a statement issued Monday, Baucus said the GAO report is just further evidence that that transition is necessary. This report makes clear that serious work remains in determining why the use of certain services under Medicare – like imaging and minor procedures – is much higher in certain parts of the country than others, irrespective of a patient’s real need, health status or the availability of doctors. Moreover, the potential abuse and excessive spending revealed in this report is further evidence the status quo of rising health care costs is unacceptable for America’s seniors and the long-term fiscal health of the Medicare program. Baucus’s health reform bill attempts to tie more physician and hospital payments to performance surrounding a number of quality measures.

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GAO Bolsters Case for Medicare Payment Reform

As the health care debate slogs on, Republicans are using the town-hall forums of August as proof that Americans oppose the Democrats’ health reform plans, while Democrats are pointing to various polls as evidence that the Republicans are wrong. Just in time to confuse the issue further, another poll this week indicates that both sides are right (or wrong), depending on how you approach. For example, the poll, conducted by researchers at Franklin and Marshall College in Lancaster, Pa., found that roughly one-third (36 percent) of Americans think the U.S. health care system is better than that in other industrial countries; roughly one-third (29 percent) feel the system is average; and the final third (30 percent) say it’s below average. On the issue of insurance reform, the numbers are similarly all over the board. About 75 percent of respondents with insurance, for example, rate their plans “good” or “very good.” Yet nearly one-fourth of respondents said they’ve skipped a treatment due to cost, while another fourth claim to have missed a prescription fill for the same reason. Of those without insurance, researchers found, 80 percent either applied for coverage and had it turned down, or they simply can’t afford it. The numbers are based on responses this month from 1,046 adults, 900 of them registered voters. If there are any clear conclusions here, they seem to be (1) that Americans’ views on health reform extend little further than their personal experiences, and (2) any argument you want to make about the nature of the country’s health care system can be supported by one of these numbers. Of course, it’s no news that all politics is personal.

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Poll: Americans Don’t Know What They Think

Medicare Advantage is at the forefront of congressional bickering. Again. Indeed, a large chunk of yesterday’s health reform debate in the Senate Finance Committee revolved around the contentious MA program. And the debate is continuing straight into this morning. But to understand the controversy, it’s important to understand what Medicare Advantage is. And despite the misleading name, MA isn’t Medicare. It’s a system, created by Republicans in 2003, under which the government pays private insurers to cover Medicare patients. That is, it allows seniors to opt into taxpayer-funded HMOs in lieu of the traditional fee-for-service program. It’s not Medicare; it’s Medicare’s competitor. Trouble is, it also costs taxpayers about 14 percent more, on average, to cover MA patients than traditional Medicare patients. And many plans cost much more than that. The Congressional Budget Office estimates that capping MA rates at 150 percent of Medicare would still save the government money. That means some plans are charging much more than 114 percent of Medicare — money subsidized not only by taxpayers, but also by seniors in the traditional program, who pay higher premiums to cover the difference. Senate Budget Committee Chairman Kent Conrad (D-N.D.) warned this week that those extra costs — combined with the growing popularity of MA, which now covers 25 percent of seniors — are largely the reason that Medicare spending will swamp the nation’s entire economy in just a few short decades unless Congress reins it in. “We have a runaway train,” Conrad said Thursday. Recognizing low-hanging fruit when he sees it, Senate Finance Committee Chairman Max Baucus (D-Mont.) has proposed to slash MA payments by $123 billion over the next 10 years. But there’s a great deal of dispute about where the extra money goes. In many cases, MA plans are using the subsidies to fund services not covered by the traditional program, things like eye care, dental services, and even gym memberships to encourage fitness. Rural communities, where medical care is often lacking, also benefit tremendously from the subsidies, which encourage HMOs to move into those under-served areas. “We did this because it was necessary,” Sen. Orrin Hatch (R-Utah) said Thursday of MA’s creation. “We couldn’t get the care in the rural communities.” It’s not simply a partisan issue. Sen. Ron Wyden, a Democratic who represents largely rural Oregon, argued yesterday that, although there are certainly abuses among MA plans, not all of those plans are made alike. Those operating in Oregon, Wyden said, are not only working well, but they’re vital to the state. Yet there’s also truth in the argument, popular among many liberal Democrats, that a large chunk of MA subsidies go, not to cover patient benefits, but to pay administrative costs and pad profit margins. What happened, these critics ask, to the efficiencies the private insurers had promised when the program was launched? Bolstering their argument, officials at the federal agency that runs Medicare estimate that seniors in traditional Medicare pay an additional $3.60 per month to subsidize the extra benefits going to MA patients (and the extra profits going to the insurance industry.) Both sides appear to have valid arguments. Some plans seem to be providing valuable care to underserved folks; others are clearly gaming the system. The pickle for Congress is to separate those plans that charge taxpayers more because they have to , and those that charge more because they can . Considering the number of plans out there, just be happy that isn’t your job.

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Controversy Swirls (Again) Over Medicare Advantage