The good news for Senator Ben Nelson is that he doesn’t have to face Nebraska voters until 2012.
If Governor Dave Heineman challenges Nelson for the Senate job, a new Rasmussen Reports telephone survey shows the Republican would get 61% of the vote while Nelson would get just 30%. Nelson was reelected to a second Senate term in 2006 with 64% of the vote.
Nelson’s health care vote is clearly dragging his numbers down. Just 17% of Nebraska voters approve of the deal their senator made on Medicaid in exchange for his vote in support of the plan. Overall, 64% oppose the health care legislation, including 53% who are Strongly Opposed.
At 7:16 a.m., the Senate passed on a 60-39 party line vote a sweeping health care bill that will tighten insurance regulations, provide insurance for 31 million more Americans and cost $871 billion over the next decade.
“This is for my friend Ted Kennedy, aye,” said Sen. Robert Byrd as he cast his vote.
Clearly exhausted, Senate Majority Leader Harry Reid mistakenly voted no before changing his vote to yes, which got a laugh in the chamber, especially from Senate Republican Leader Mitch McConnell.
After the vote, Reid joked, “I spent a very restless night last night trying to figure out how I could show some bipartisanship and I think I was able to accomplish that for a few minutes.”
Senate Republican Jim Bunning was absent for the vote.
With Vice President Joe Biden presiding over the session, Democrats gathered in the chamber before sunrise on the day before Christmas to cast a vote long in coming but in the end, hardly a surprise, a 60-39 tally that was the fourth time in as many days that Democrats proved they could muster the winning margin.
Reid opened the Senate floor at 7 a.m. and channeled Ted Kennedy: “The work goes on. The cause endures… and yet here we are, minutes away from doing what others have tried but none have achieved.”
Republican leader Mitch McConnell responded: “This fight isn’t over. My colleagues and I will work to stop this bill from becoming law. That’s the clear will of the American people — and we’re going to continue to fight on their behalf.”
Senator Tom Harkin on three separate occassions in the course of a single week basically admits the current health care ‘reform’ bill is nothing more than a stepping stone towards a government takeover of the health care industry.
Health and Human Services Secretary Kathleen Sebelius confirms that the Senate health ‘reform’ bill will require everyone to pay for abortion coverage.
Meanwhile, CNS reports that the White House and the Democratic leadership in the House of Representatives have been pressuring Rep. Stupak not to speak out on the “compromise” abortion language in the Senate version of the health care bill.
“They think I shouldn’t be expressing my views on this bill until they get a chance to try to sell me the language,” Stupak told CNSNews.com in an interview on Tuesday. “Well, I don’t need anyone to sell me the language. I can read it. I’ve seen it. I’ve worked with it. I know what it says. I don’t need to have a conference with the White House. I have the legislation in front of me here.”
The Michigan Democrat succeeded last month in getting 64 House Democrats to join him in attaching his pro-life amendment to the House version of the health-care bill. The “Stupak amendment,” as the provision is known, would prohibit the federal government from allocating taxpayer money to pay for any part of any health insurance plan that covers abortion except in cases of rape, incest, or when the life of the mother is in danger.
Stupak had contact with the White House last weekend, when the Senate voted 60 to 40 in the wee hours of Monday morning to shut off debate on the Senate version of the bill.
The current version of the Senate bill contains so-called “compromise” language crafted by Sen. Ben Nelson (D-Neb.). This language does not bar taxpayer funding of health plans that cover abortion, but does create a firewall to supposedly keep federal money from being used to pay for abortions. Over the weekend, Stupak issued a statement calling the proposed Senate language “unacceptable.”
Here is the contact information for the so-called ‘pro-life’ Senators who voted FOR cloture on the bill. Final vote is scheduled for December 24 at 8:00AM, so call IMMEDIATELY:
Since when has Nebraska become synonymous for cynical “what’s in it for me”-type politics?
The term “Cornhusker kickback,” is already a favorite of television’s talking heads.
That’s how the rest of the country sees the deal that was the price for Sen. Ben Nelson’s support for the Democrats’ health reform plan.
Under its provisions, the federal government would pay all additional Medicaid costs for Nebraska “in perpetuity.” The Congressional Budget Office has estimated the deal may be worth $100 million over 10 years.
The deal is the embodiment of what is wrong with Washington.
Instead of thoughtful, careful work on real problems, Washington lawmakers cobble together special deals, dubious financial accounting and experimentation on a grandiose scale.
Nelson wasn’t the first to make a special deal. Sen. Mary Landrieu, D-La., secured the “Louisiana purchase” – as much as $300 million in additional federal funds for Medicaid. Florida, New York and Pennsylvania would be allowed to retain Medicare Advantage. The list goes on.
It’s time to push the reset button on health reform.
The effort has gone awry. As pointed out by Sen. Mike Johanns, actuaries in the U.S. Department of Health and Human Services estimated that costs of medical care in the country will actually be higher after reform than if nothing is done.
Promises that reform under the Senate bill will reduce the federal deficit are largely dependent on cuts to Medicaid that many observers think will be so politically unpopular that they will never happen.
There’s little doubt that the nation’s health care system has deep problems. Millions of Americans are unable to find affordable health insurance. Costs of medical care continue to outpace the overall rate of inflation.
The Senate plan and the House plan address some of these ills. Notably, however, they make little attempt to combat the root causes of rising health care costs.
As lawmakers in Washington spent months locked in partisan battle over health reform, the public has grown increasingly suspicious.
An ABC News/Washington Post poll released Dec. 16 showed that only 37 percent of respondents think that health care would be better after reform, compared with 50 percent who believe it will be better if nothing is done.
Nelson has pointed out that in coming days there will be other occasions on which Democrats will need 60 votes to muscle their plan through the Senate.
Nelson ought to use those opportunities to force Washington to start over on health care reform. Nebraska might have a sweeter deal than other states under the Senate plan, but Congress needs to do better for the overall good of the country.
Sen. DeMint Exposes Draconian Measure in Health Care Bill
Senator Reid Proposes Restrictions on Self-Governance
Senator Harry Reid has slipped language into the heath care bill, via an amendment that would tie the hands of future Congresses with regard to repealing or amending it. The amendment makes substantial changes to the standing rules of the Senate, a move that normally requires a super-majority vote of at least 67 Senators. When questioned about this by Senator DeMint, The Senate president ruled that the bill changes Senate procedure, but not Senate rules, so the 67 vote threshold did not apply. The unasked question that begs to follow is, “what establishes Senate procedures?” Answer: The rules.
Section 3403 of Senator Harry Reid’s amendment (page 1020) states that “it shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report that would repeal or otherwise change this subsection.” The subsection pertains to regulations imposed by the Medicare Advisory Board. The amendment goes on to require a vote of 3/5 the Senate (60 votes) to waive the paragraph.
This posturing, setting some provisions of the law above others, so as to make them untouchable sets a dangerous precedent. It is the Constitution that is established as the supreme law of the land. The threshold for changing it was set high by the founders. Senator Reid and his cohorts are now attempting to enshrine provisions of their health care bill as above normal laws, and not subject to the normal democratic processes to change or repeal them.
DeMint observed, “I don’t see why the majority party wouldn’t put this into every bill.”
Ed Morisey made the point well in his article: “The elected representatives of today should not have greater authority than those who will follow them. Any attempt to pass this into legislation aggrandizes the power of this Congress at the expense of those that follow.”
The proposed language of this health care amendment would, by simple majority vote, establish a requirement for a super majority to alter or repeal it. If this anti-democracy measure is allowed to stand, the implications for this and all future legislation are dire. Hundreds of years of established Congressional process will be subverted, the future will of the people, expressed by the election of their representatives, thwarted by unreasonable and unprecedented obstacles to our right of self-governance.
And tidings of comfort and joy from Harry Reid too. The Senate Majority Leader has decided that the last few days before Christmas are the opportune moment for a narrow majority of Democrats to stuff ObamaCare through the Senate to meet an arbitrary White House deadline. Barring some extraordinary reversal, it now seems as if they have the 60 votes they need to jump off this cliff, with one-seventh of the economy in tow.
Mr. Obama promised a new era of transparent good government, yet on Saturday morning Mr. Reid threw out the 2,100-page bill that the world’s greatest deliberative body spent just 17 days debating and replaced it with a new “manager’s amendment” that was stapled together in covert partisan negotiations. Democrats are barely even bothering to pretend to care what’s in it, not that any Senator had the chance to digest it in the 38 hours before the first cloture vote at 1 a.m. this morning. After procedural motions that allow for no amendments, the final vote could come at 9 p.m. on December 24.
Even in World War I there was a Christmas truce.
The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that “reform” has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state. An increasing roll of leaders in health care and business are looking on aghast at a bill that is so large and convoluted that no one can truly understand it, as Finance Chairman Max Baucus admitted on the floor last week. The only goal is to ram it into law while the political window is still open, and clean up the mess later.
***
• Health costs. From the outset, the White House’s core claim was that reform would reduce health costs for individuals and businesses, and they’re sticking to that story. “Anyone who says otherwise simply hasn’t read the bills,” Mr. Obama said over the weekend. This is so utterly disingenuous that we doubt the President really believes it.
The best and most rigorous cost analysis was recently released by the insurer WellPoint, which mined its actuarial data in various regional markets to model the Senate bill. WellPoint found that a healthy 25-year-old in Milwaukee buying coverage on the individual market will see his costs rise by 178%. A small business based in Richmond with eight employees in average health will see a 23% increase. Insurance costs for a 40-year-old family with two kids living in Indianapolis will pay 106% more. And on and on.
These increases are solely the result of ObamaCare—above and far beyond the status quo—because its strict restrictions on underwriting and risk-pooling would distort insurance markets. All but a handful of states have rejected regulations like “community rating” because they encourage younger and healthier buyers to wait until they need expensive care, increasing costs for everyone. Benefits and pricing will now be determined by politics.
As for the White House’s line about cutting costs by eliminating supposed “waste,” even Victor Fuchs, an eminent economist generally supportive of ObamaCare, warned last week that these political theories are overly simplistic. “The oft-heard promise ‘we will find out what works and what does not’ scarcely does justice to the complexity of medical practice,” the Stanford professor wrote.
• Steep declines in choice and quality. This is all of a piece with the hubris of an Administration that thinks it can substitute government planning for market forces in determining where the $33 trillion the U.S. will spend on medicine over the next decade should go.
This centralized system means above all fewer choices; what works for the political class must work for everyone. With formerly private insurers converted into public utilities, for instance, they’ll inevitably be banned from selling products like health savings accounts that encourage more cost-conscious decisions.
Unnoticed by the press corps, the Congressional Budget Office argued recently that the Senate bill would so “substantially reduce flexibility in terms of the types, prices, and number of private sellers of health insurance” that companies like WellPoint might need to “be considered part of the federal budget.”
With so large a chunk of the economy and medical practice itself in Washington’s hands, quality will decline. Ultimately, “our capacity to innovate and develop new therapies would suffer most of all,” as Harvard Medical School Dean Jeffrey Flier recently wrote in our pages. Take the $2 billion annual tax—rising to $3 billion in 2018—that will be leveled against medical device makers, among the most innovative U.S. industries. Democrats believe that more advanced health technologies like MRI machines and drug-coated stents are driving costs too high, though patients and their physicians might disagree.
“The Senate isn’t hearing those of us who are closest to the patient and work in the system every day,” Brent Eastman, the chairman of the American College of Surgeons, said in a statement for his organization and 18 other speciality societies opposing ObamaCare. For no other reason than ideological animus, doctor-owned hospitals will face harsh new limits on their growth and who they’re allowed to treat. Physician Hospitals of America says that ObamaCare will “destroy over 200 of America’s best and safest hospitals.”
• Blowing up the federal fisc. Even though Medicare’s unfunded liabilities are already about 2.6 times larger than the entire U.S. economy in 2008, Democrats are crowing that ObamaCare will cost “only” $871 billion over the next decade while fantastically reducing the deficit by $132 billion, according to CBO.
Yet some 98% of the total cost comes after 2014—remind us why there must absolutely be a vote this week—and most of the taxes start in 2010. That includes the payroll tax increase for individuals earning more than $200,000 that rose to 0.9 from 0.5 percentage points in Mr. Reid’s final machinations. Job creation, here we come.
Other deceptions include a new entitlement for long-term care that starts collecting premiums tomorrow but doesn’t start paying benefits until late in the decade. But the worst is not accounting for a formula that automatically slashes Medicare payments to doctors by 21.5% next year and deeper after that. Everyone knows the payment cuts won’t happen but they remain in the bill to make the cost look lower. The American Medical Association’s priority was eliminating this “sustainable growth rate” but all they got in return for their year of ObamaCare cheerleading was a two-month patch snuck into the defense bill that passed over the weekend.
The truth is that no one really knows how much ObamaCare will cost because its assumptions on paper are so unrealistic. To hide the cost increases created by other parts of the bill and transfer them onto the federal balance sheet, the Senate sets up government-run “exchanges” that will subsidize insurance for those earning up to 400% of the poverty level, or $96,000 for a family of four in 2016. Supposedly they would only be offered to those whose employers don’t provide insurance or work for small businesses.
As Eugene Steuerle of the left-leaning Urban Institute points out, this system would treat two workers with the same total compensation—whatever the mix of cash wages and benefits—very differently. Under the Senate bill, someone who earned $42,000 would get $5,749 from the current tax exclusion for employer-sponsored coverage but $12,750 in the exchange. A worker making $60,000 would get $8,310 in the exchanges but only $3,758 in the current system.
For this reason Mr. Steuerle concludes that the Senate bill is not just a new health system but also “a new welfare and tax system” that will warp the labor market. Given the incentives of these two-tier subsidies, employers with large numbers of lower-wage workers like Wal-Mart may well convert them into “contractors” or do more outsourcing. As more and more people flood into “free” health care, taxpayer costs will explode.
• Political intimidation. The experts who have pointed out such complications have been ignored or dismissed as “ideologues” by the White House. Those parts of the health-care industry that couldn’t be bribed outright, like Big Pharma, were coerced into acceding to this agenda. The White House was able to, er, persuade the likes of the AMA and the hospital lobbies because the federal government will control 55% of total U.S. health spending under ObamaCare, according to the Administration’s own Medicare actuaries.
Others got hush money, namely Nebraska’s Ben Nelson. Even liberal Governors have been howling for months about ObamaCare’s unfunded spending mandates: Other budget priorities like education will be crowded out when about 21% of the U.S. population is on Medicaid, the joint state-federal program intended for the poor. Nebraska Governor Dave Heineman calculates that ObamaCare will result in $2.5 billion in new costs for his state that “will be passed on to citizens through direct or indirect taxes and fees,” as he put it in a letter to his state’s junior Senator.
So in addition to abortion restrictions, Mr. Nelson won the concession that Congress will pay for 100% of Nebraska Medicaid expansions into perpetuity. His capitulation ought to cost him his political career, but more to the point, what about the other states that don’t have a Senator who’s the 60th vote for ObamaCare?
Your excellent editorial “The ‘Cost Control’ Bill of Goods” (Dec. 14) doesn’t emphasize a potential stealth cost-control aspect proposed in the bill. It will start pilot programs that would transfer the gatekeeper role to doctors at the bedside, a role currently held by “payers” (HMOs and government-agency insurers, including Medicare and Medicaid).
The transfer will be via capitation fee payments, making clinics “responsible” for the cost of care of “insured lives” for one year. Like the more powerful payers, such clinics must restrict orders for care—or go broke. The clinicians’ other choice is to be left out of the income stream, if they are not incorporated in a comprehensive “provider accountable care organization.” These will bid for capitation fee rates at payer population auctions of the insured lives to be serviced.
The illusion of many pundits and policy makers is that mini provider gatekeepers can control costs after the very powerful payer gatekeepers have failed for decades. The problem for patients is the dilemma of all managed-care gatekeepers: cost, quality, access; pick any two. It is not pleasant to think that one’s gatekeeper doctor will have to decide whether to order surgery for your painful hip or only to increase the dose of Ibuprofen—a choice that patients won’t know about, since managed-care corporations and capitated doctors rationing care are carefully hidden behind the Orwellian double-speak of “pay for quality, not quantity,” “well care, not sick care,” “responsibility,” “accountability,” “pay for outcomes,” and other artful illusions.
The economic reality is that no rationing of care supply will ever control costs, when the problem is demand inflation driven by popular insurance tax subsidies too sacred to repeal. Consider that when federal fiscal “necessity” overwhelms empty slogans, scores of new bureaucracies created in ObamaCare would be able to implement Draconian rationing in collusion with subservient insurance and “provider” corporations. The high costs, as well as the rationing powers included in the more than 2,000 pages of the Obama Care Senate legislation are very real.
After a long day of acid, partisan debate, Senate Democrats held ranks early Monday in a dead-of-night procedural vote that proved they had locked in the decisive margin needed to pass a far-reaching overhaul of the nation’s health care system.
The roll was called shortly after 1 a.m., with Washington still snowbound after a weekend blizzard, and the Senate voted on party lines to cut off a Republican filibuster of a package of changes to the health care bill by the majority leader, Harry Reid of Nevada.
The vote was 60 to 40 — a tally that is expected to be repeated four times as further procedural hurdles are cleared in the days ahead, and then once more in a dramatic, if predictable, finale tentatively scheduled for 7 p.m. on Christmas Eve.
Both parties hailed the vote as seismic.
Democrats said it showed them poised to reshape the health system after decades of failed attempts.
“Health care in America ought to be a right, not a privilege,” said Senator Christopher J. Dodd, Democrat of Connecticut. “Since the time of Harry Truman, every Congress, Republican and Democrat, every president, Democrat and Republican, have at least thought about doing this. Some actually tried.”
Republicans said that the bill was fatally flawed and that voters would retaliate against Democrats at the polls in November.
“It’s obvious why the majority has cooked up this amendment in secret, has introduced it in the middle of a snowstorm, has scheduled the Senate to come in session at midnight, has scheduled a vote for 1 a.m., is insisting that it be passed before Christmas — because they don’t want the American people to know what’s in it,” said Senator Lamar Alexander, Republican of Tennessee.
Mr. Alexander added, “Our friends on the Democratic side seem determined to pursue a political kamikaze mission toward a historic mistake.”
Each side blamed the other for the extraordinary series of votes — at dawn Saturday, after midnight Monday, at dawn again on Tuesday, at 1 p.m. on Wednesday and finally on Christmas Eve, when most Americans will be sequestered for the holiday.
The Democrats charged the Republicans with obstinately throwing every procedural obstacle in their way, including filibusters and the full 30 hours of debate allowed under the rules after each filibuster is broken by a vote of 60 senators.
The Republicans charged the Democrats with recklessly rushing to adopt a dizzyingly complex 2,700-page bill that would affect virtually every American, and would reshape one-sixth of the nation’s economy at a cost of $871 billion over 10 years.
“If the Republicans want to exercise every single right they have under the rules, they can keep us here until Christmas Eve, no doubt about it,” said Senator Tom Harkin, Democrat of Iowa. “But to what end, I ask? To what end? We’re going to have the vote at 1 a.m. that requires 60 votes, and then why stay here until Christmas Eve to do what they know we’re going to do?”
Senator John Cornyn, Republican of Texas, said he and his colleagues had a duty to fight until the last minute.
“There is nothing inevitable about this,” Mr. Cornyn said. “The only thing I think inevitable about it is in the light of the unpopularity of what is being jammed down the throats of the American people, there will be a day of accounting. We don’t know when that day of accounting will be. Perhaps the first day of accounting will be Election Day 2010.”
Adoption of the legislation is not a certainty.
The Senate bill, once completed, must be reconciled with the bill adopted by the House last month, and there are substantial differences between the two. The House measure, for instance, includes a government-run health insurance plan, or public option, that was dropped from the Senate bill.
The House speaker, Nancy Pelosi, has said the House would not just accept the Senate bill. And some Senate Democrats have warned that they could turn against the bill if changes made during negotiations with the House are not to their liking.
What started as Sen. Ben Nelson’s personal stand against covering abortion with taxpayer money translated, somehow, into millions of dollars in federal aid for his home state — drawing criticism that his vote was bought.
From Fox News
What started as Sen. Ben Nelson’s personal stand against covering abortion with taxpayer money translated, somehow, into millions of dollars in federal aid for his home state.
The Nebraska Democrat, following weeks of negotiations with his caucus, finally agreed to back the Senate’s health care reform bill this weekend after Democratic leaders made a series of concessions. Nelson’s support gives Democrats the 60 votes they need to overcome a filibuster, barring any last-minute defections.
But critics by Sunday were heavily questioning Nelson’s motivations, given that the abortion restrictions he sought and won did not satisfy several major anti-abortion lawmakers and groups and that it took a major federal payoff to his state to seal the deal.
Critics were calling it the “cornhusker kickback” and the “Nebraska windfall,” lobbing accusations of political deal-making at Nelson.
“It’s pretty obvious that votes have been bought,” Sen. Saxby Chambliss, R-Ga., said.
Nelson did win restrictions on abortion coverage, which is what he sought for weeks. Under the compromise, states would be permitted to ban insurance coverage of abortions in policies sold in the exchanges, except in cases of rape, incest or when the life of the mother is in jeopardy. In states where such coverage is permitted, consumers must notify their insurance company they want it, and pay for it separately.
That didn’t do much to please some anti-abortion lawmakers. But Nelson also won several other concessions, most notably a commitment from the federal government to fully fund his state’s expanded Medicaid population. All states get full federal assistance for the first three years of the bill — but Nebraska would be the only state getting full assistance afterward. One Democratic official put the cost to the federal government at $45 million over a decade.
Democratic senators defended the Nebraska deal. Sen. Kent Conrad, D-N.D., said all states get a lot of federal aid for Medicaid anyway, and that special treatment is hardly unique to Nebraska.
“Personally, every state gets some kind of differential treatment based on their situation,” he told “Fox News Sunday.”
“People fight for their own states. That’s the nature of a democracy,” said Sen. Amy Klobuchar, D-Minn.
But Sen. John McCain, R-Ariz., said Nelson’s victory came at the expense of the other 49 states.
“That puts an added burden on all the other states, including mine,” he said on “Fox News Sunday.”
The concessions didn’t end there. Nelson also got an exemption from a fee on non-profit health insurers — the language was written in a way that only applies to Nebraska and Michigan.
WASHINGTON – With a self-imposed Christmas deadline at stake, Senate Majority Leader Harry Reid engineered a last-minute compromise in the health care debate that has won the support of the lone Democratic holdout and clinched the required 60 votes to pass a sweeping overhaul of the U.S. health care system.
Marathon negotiations among the White House, Senate Democratic leaders and Sen. Ben Nelson, a conservative Democrat from Nebraska, produced fresh concessions that will mean additional abortion restrictions in the legislation and funding to cover poor people for Nelson’s state and more.
“I know this is hard for some of my colleagues to accept and I appreciate their right to disagree. But I would not have voted for this bill without these provisions,” Nelson said at a news conference in the Capitol.
Democratic leaders offered Nelson a deal similar to the $300 million in Medicaid assistance Sen. Mary Landrieu of Louisiana got for her support, numerous sources told Fox News.
When asked about this, Sen. Kent Conrad, a key Democratic leader involved in the negotiations with Nelson, said, “Oh, it’ll be much more.”
Obama devoted his weekend radio and Internet address to the issue he campaigned on in 2008.
“Now — for the first time — there is a clear majority in the Senate that’s willing to stand up to the insurance lobby and embrace lasting health insurance reforms that have eluded us for generations,” Obama said. “Let’s bring this long and vigorous debate to an end.”
Forget the public option, abortion and all the other divisive questions in the health-care debate: The most important issue for patients and their doctors is the transfer of decision-making power from bedside to the federal government.
The bill that Sen. Harry Reid aims to pass in the Senate would mandate that every American enroll in a “qualified” insurance plan. And page 149 states that “qualified” health plans can do business only with a doctor who “implements such mechanisms to improve health-care quality as the secretary [of Health and Human Services] may by regulation require.”
But “mechanisms to improve health-care quality” covers everything in medicine.
Never before has the federal government intruded into medical decisions made by doctors for privately insured patients, except on such narrow issues as drug safety. Now, in the name of quality, the secretary of Health and Human Services would be empowered to regulate your MD’s decisions on everything from cardiac and cancer care to childbirth.
The delegation of power is so broad, it’s conceivable that Washington will be telling your cardiologist when it’s appropriate to use stents or imaging tests — and directing your gynecologist about the use of pelvic sonograms.
What makes this especially troubling is that government will be imposing its regulations with an eye on reducing the cost of your care, even if you’re paying for it yourself: The explicit purpose of “reform” is to reduce what everyone consumes and to discourage some from getting more care than others.
That’s one reason the Senate bill puts a 40 percent tax on “Cadillac” plans — a category that will cover the top 20 percent of plans, according to the Congressional Budget Office. In its Nov. 30 report, the CBO predicts that many employers will downgrade what they provide their workforce to avoid the tax, while others will pass the cost along in the form of lower take-home pay. If you think this bill won’t hurt you because your employer provides a generous health plan, think again.
Despite President Obama’s promises, the Senate bill expressly reduces the care under Medicare. Baby boomers retiring soon will get less than seniors get now. Page 1189 gives the secretary of Health and Human Services “authority to modify or eliminate coverage of certain preventive services,” based on what the US Preventive Services Task Force recommends. This is the same group that just called for cutting back on mammograms.
Whatever your age, and whether you’re in a public program or the richest “Cadillac” plan, you’ll also lose out if you need to be hospitalized — you’ll find fewer nurses on the floor, less diagnostic equipment, longer waits for tests and an overall environment of scarcity.
Why? Because the Reid bill forces hospitals into financial distress.
If — and it is still a big “if — Democrats pass a health bill, that bill will owe as much to former Massachusetts governor Mitt Romney as to Nancy Pelosi and Harry Reid. In fact, with the so-called “public option” out of the Senate health bill, the final product increasingly looks like the failed Massachusetts experiment. Consider that the final bill will likely include:
An individual mandate
A weak employer-mandate
An Exchange (Connector)
Middle-class subsidies
Insurance regulation (already in place in Massachusetts before Romney’s reforms)
As to why this will be a disaster for American taxpayers, workers, and patients, I’ve written about it here, and my colleague Michael Cannon has covered it here and here.
According to the health care reform bill being debated in the U.S. Senate, there’s an easy way to solve the problem of the uninsured in this country:
1. Force Americans to buy health insurance just like we do with auto insurance.
2. Make insurance companies accept everyone who applies, including those who buy insurance only when they’re sick.
3. Don’t let insurance companies sell plans that don’t cover everything.
These three forms of health insurance regulation-individual mandates, guaranteed issue and coverage mandates-have been attempted in a number of states, including California, Massachusetts, New Jersey, New York and Washington. The results are described below.
Individual mandates: “You’ll buy it or else.”
A popular theme in the healthcare reform debate is “shared responsibility.” Attempting to increase individual responsibility, a number of states have enacted a mandate that all citizens must purchase health insurance.
The theory behind individual mandates is that insurance becomes more affordable when purchased by a larger, healthier group of applicants. Adding individuals to the risk pool who are less expensive to insure (and currently the least likely to buy it) would theoretically lower the cost for all those insured.
But in practice, individual mandates have had a different effect on what people pay for health insurance. The impact of mandates on insurance premiums is in large part a consequence of “Guaranteed Issue” described below.
Part of the problem with individual mandates is enforcement. Voters have consistently rejected mandates that would use the tax code or wage garnishment to ensure compliance.
Without “teeth,” mandates provide no compelling reason to purchase expensive, unwanted insurance policies before an individual becomes ill. And even harsh penalties would miss the unemployed and non-citizens, who represent a large percentage of the growth in the uninsured.
This has the effect of driving up costs as less-healthy individuals requiring expensive treatment expand the insurance pool, while healthy individuals avoid buying policies.
Some proponents of individual mandates try to make an analogy to the auto insurance industry. But this is not a logical comparison:
Auto insurance is mandated only for those who drive, a far smaller pool than those who would be mandated to buy health insurance.
Consumers shopping for auto insurance have competition on their side; policies can be purchased from insurance companies offered in other states, driving down premiums as agencies try to compete with other carriers. Inexpensive policies are available across state lines, unlike health insurance plans sold only within a single state. Bostonians are prohibited from buying North Dakota health plans that cost 60% less than those sold in Massachusetts.
Limited coverage auto insurance policies can be purchased, offering only the liability coverage required by law rather than more expensive comprehensive plans. Under California’s Low Cost Auto Insurance Program, premiums can be less than $25 per month. State regulations bar the health insurance industry from offering low-cost plans with limited coverage even when the consumer wants that choice.
Despite the fact that all 50 states mandate auto insurance coverage for drivers, up to 25% of state residents remain uninsured. Even with far simpler opportunities available for enforcing the auto insurance mandate (e.g., requiring proof of coverage before obtaining a driver’s license and registration), the California Department of Insurance estimated in 2003 that 14.3% of all registered vehicles were uninsured. This does not account for unregistered vehicles or those with expired registrations, of particular importance in parts of the state with a high percentage of undocumented immigrants on the road.
Governor Mitt Romney succeeded in imposing an individual government mandate on the citizens of Massachusetts. Taxpayers in that state now fund subsidies for insurance premiums that have risen more than 30% since the Governor’s plan was enacted.
Individual mandates, though popular in political rhetoric, do not address the fundamental problem people face when buying health insurance: it is expensive.
Government guidelines would likely have forbidden the test I used to discover my wife’s cancer.
By SENATOR TOM COBURN – I recently suggested that seniors will die sooner if Congress actually implements the Medicare cuts in the health-care bill put forward by Senate Majority Leader Harry Reid. My colleagues who defend the bill—none of whom have practiced medicine—predictably dismissed my concern as a scare tactic. They are wrong. Every American, not just seniors, should know that the rationing provisions in the Reid bill will not only reduce their quality of life, but their life spans as well.
My 25 years as a practicing physician have shown me what happens when government attempts to practice medicine: Doctors respond to government coercion instead of patient cues, and patients die prematurely. Even if the public option is eliminated from the bill, these onerous rationing provisions will remain intact.
For instance, the Reid bill (in sections 3403 and 2021) explicitly empowers Medicare to deny treatment based on cost. An Independent Medicare Advisory Board created by the bill—composed of permanent, unelected and, therefore, unaccountable members—will greatly expand the rationing practices that already occur in the program. Medicare, for example, has limited cancer patients’ access to Epogen, a costly but vital drug that stimulates red blood cell production. It has limited the use of virtual, and safer, colonoscopies due to cost concerns. And Medicare refuses medical claims at twice the rate of the largest private insurers.
Section 6301 of the Reid bill creates new comparative effectiveness research (CER) programs. CER panels have been used as rationing commissions in other countries such as the U.K., where 15,000 cancer patients die prematurely every year according to the National Cancer Intelligence Network. CER panels here could effectively dictate coverage options and ration care for plans that participate in the state insurance exchanges created by the bill.
Additionally, the Reid bill depends on the recommendations of the U.S. Preventive Services Task Force in no fewer than 14 places. This task force was responsible for advising women under 50 to not undergo annual mammograms. The administration claims the task force recommendations do not carry the force of law, but the Reid bill itself contradicts them in section 2713. The bill explicitly states, on page 17, that health insurance plans “shall provide coverage for” services approved by the task force. This chilling provision represents the government stepping between doctors and patients. When the government asserts the power to provide care, it also asserts the power to deny care.
Health Care Vote Puts Nelson 30 Points Down in Reelection Bid
At 7:16 a.m., the Senate passed on a 60-39 party line vote a sweeping health care bill that will tighten insurance regulations, provide insurance for 31 million more Americans and cost $871 billion over the next decade.
From the 
And tidings of comfort and joy from Harry Reid too. The Senate Majority Leader has decided that the last few days before Christmas are the opportune moment for a narrow majority of Democrats to stuff ObamaCare through the Senate to meet an arbitrary White House deadline. Barring some extraordinary reversal, it now seems as if they have the 60 votes they need to jump off this cliff, with one-seventh of the economy in tow.
Your excellent editorial “
By David M. Herszenhorn and Robert Pear
From 
By BETSY MCCAUGHEY
By 
By SENATOR TOM COBURN – I recently suggested that seniors will die sooner if Congress actually implements the Medicare cuts in the health-care bill put forward by Senate Majority Leader Harry Reid. My colleagues who defend the bill—none of whom have practiced medicine—predictably dismissed my concern as a scare tactic. They are wrong. Every American, not just seniors, should know that the rationing provisions in the Reid bill will not only reduce their quality of life, but their life spans as well.
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