WASHINGTON (MarketWatch) -- Members of the Senate Finance Committee on Tuesday rejected a second amendment to a health-care reform bill that would have created a government-run health-care plan option. The vote was 13 to 10. Sponsors Sens. Charles Schumer, D-N.Y., and Maria Cantwell, D-Wash., said the amendment would hold down rising health-care costs. Senators rejected a similar amendment earlier Tuesday.
(http://bit.ly/Am3Bg)
Wednesday, September 30, 2009
Tuesday, July 28, 2009
Cliff Asness on Health Care
Hedge-fund manager Clifford Asness, writing at Stumblingontruth.com:
Myth #1 Health Care Costs Are Soaring:
No, they are not. The amount we spend on health care has indeed risen, in absolute terms, after inflation, and as a percentage of our incomes and GDP. That does not mean costs are soaring.
You cannot judge the “cost” of something by simply what you spend. You must also judge what you get. I’m reasonably certain the cost of 1950s level health care has dropped in real terms over the last 60 years (and you can probably have a barber from the year 1500 bleed you for almost nothing nowadays). Of course, with 1950s health care, lots of things will kill you that 2009 health care would prevent. Also, your quality of life, in many instances, would be far worse, but you will have a little bit more change in your pocket as the price will be lower. Want to take the deal? In fact, nobody in the US really wants 1950s health care (or even 1990s health care). They just want to pay 1950 prices for 2009 health care. They want the latest pills, techniques, therapies, general genius discoveries, and highly skilled labor that would make today’s health care seem like science fiction a few years ago. But alas, successful science fiction is expensive. . . .
Health care today is a combination of stuff that has existed for a while and a set of entirely new things that look like (and really are) miracles from the lens of even a few years ago. We spend more on health care because it’s better. Say it with me again, slowly—this is a good thing, not a bad thing. . . .
In summary, if one more person cites soaring health care costs as an indictment of the free market, when it is in fact a staggering achievement of the free market, I’m going to rupture their appendix and send them to a queue in the U.K. to get it fixed. Last we’ll see of them.
Myth #1 Health Care Costs Are Soaring:
No, they are not. The amount we spend on health care has indeed risen, in absolute terms, after inflation, and as a percentage of our incomes and GDP. That does not mean costs are soaring.
You cannot judge the “cost” of something by simply what you spend. You must also judge what you get. I’m reasonably certain the cost of 1950s level health care has dropped in real terms over the last 60 years (and you can probably have a barber from the year 1500 bleed you for almost nothing nowadays). Of course, with 1950s health care, lots of things will kill you that 2009 health care would prevent. Also, your quality of life, in many instances, would be far worse, but you will have a little bit more change in your pocket as the price will be lower. Want to take the deal? In fact, nobody in the US really wants 1950s health care (or even 1990s health care). They just want to pay 1950 prices for 2009 health care. They want the latest pills, techniques, therapies, general genius discoveries, and highly skilled labor that would make today’s health care seem like science fiction a few years ago. But alas, successful science fiction is expensive. . . .
Health care today is a combination of stuff that has existed for a while and a set of entirely new things that look like (and really are) miracles from the lens of even a few years ago. We spend more on health care because it’s better. Say it with me again, slowly—this is a good thing, not a bad thing. . . .
In summary, if one more person cites soaring health care costs as an indictment of the free market, when it is in fact a staggering achievement of the free market, I’m going to rupture their appendix and send them to a queue in the U.K. to get it fixed. Last we’ll see of them.
Thursday, July 23, 2009
Obama Moves to Reclaim the Debate on Health Care
WASHINGTON — President Obama tried on Wednesday to rally public support for overhauling the nation’s health care system and said for the first time that he would be willing to help pay for the plan by raising income taxes on families earning more than $1 million a year.
“If I see a proposal that is primarily funded through taxing middle-class families, I’m going to be opposed to that,” Mr. Obama said in a prime-time news conference in the East Room of the White House. A surcharge on the highest-income Americans, under consideration in the House, “meets my principle,” he said.
On a day when the leader of fiscally conservative Democrats said a deal was a long way off and House Speaker Nancy Pelosi insisted that she had the votes to push a bill through, Mr. Obama used the news conference to take his message over the heads of lawmakers and straight to the public. Conceding that “folks are skeptical,” he sought to convince Americans that overhauling the nation’s health care system would benefit them and strengthen the economy.
“If somebody told you that there is a plan out there that is guaranteed to double your health-care costs over the next 10 years,” he said, “that’s guaranteed to result in more Americans losing their health care, and that is by far the biggest contributor to our federal deficit, I think most people would be opposed to that,”
“That’s what we have right now,” he said. “So if we don’t change, we can’t expect a different result.”
While Mr. Obama declared, “it’s my job, I’m the president,” he did not use the appearance at the White House to make any fresh demands on Congress, which is struggling to meet his timetable for both chambers to pass legislation before members break for August recess. Mr. Obama did not repeat that demand Wednesday night.
Instead, he sounded cerebral as he delved into policy specifics for nearly an hour and tried to link them to the concerns of ordinary Americans.
As he sought to reassure the public that a new health care system would be an improvement, he also acknowledged that there would be changes that could be unsettling, a point that is often raised by critics of overhauling the health care system.
“Can I guarantee that there are going to be no changes in the health-care delivery system? No,” Mr. Obama said. “The whole point of this is to try to encourage changes that work for the American people and make them healthier.”
Health legislation is Mr. Obama’s highest legislative priority, and his success or failure could shape the rest of his presidency. But while he is under increasing pressure from leading Democrats to delve more deeply into the negotiations by taking positions on specific policy issues, he largely resisted doing so Wednesday night.
But the president did weigh in how the government might pay for the plan.
In addition to saying he would be open to taxing those households earning more than $1 million — a scaled-back version of an earlier proposal that would have imposed a surcharge on households earning $350,000 or more — he signaled that he was also receptive to another idea under consideration in the Senate: taxing employer-provided health benefits, as long as the tax did not fall on the middle class.
On Capitol Hill, Ms. Pelosi said Democrats remained on track to reach a deal on major health care legislation. But she acknowledged that the process had slowed in response to concerns among conservative Democrats about the cost of the bill, and that some House Democrats were reluctant to embrace the income surtax on high-earners without knowing whether the Senate would go along.
Indeed, even as Ms. Pelosi insisted that Congress was closer than ever to achieving a comprehensive overhaul of the nation’s health care system, leaders of the Blue Dogs, a conservative faction of Democrats, said a deal was still a long way off. Asked if the House Energy and Commerce Committee could resume work on the bill by late Thursday, as House leaders hoped, Representative Charlie Melancon, a Blue Dog from Louisiana, said: “No way.”
A senior Democratic aide on Capitol Hill said party leaders now believed it was essential for Mr. Obama to be more specific about what he wanted in a health care bill — and not just exhort Congress to pass one.
“The president needs to step in more forcefully and start making some decisions,” said the aide, speaking on condition of anonymity because he did not want to be publicly identified as criticizing Mr. Obama. “Everyone appreciates the fact that Obama has devoted so much time to health care. The bully pulpit is powerful. But in view of the deadlines Congress has missed, we would like to hear more from the president about what he wants in this bill.”
While he faces pressures from fellow Democrats, Mr. Obama is also fending off attacks from Republicans who sense an opportunity to knock him off his stride by arguing that the health care bill, estimated as costing more than $1 trillion over the next decade, will not slow or reduce the growth of health spending.
The White House has been in a running debate this week with Senator Jim DeMint, Republican of South Carolina, who predicted that health legislation would prove to be Mr. Obama’s “Waterloo moment” and would break the president. To that, Mr. Obama said: “This isn’t about me. I have great health insurance, and so does every member of Congress.”
In his opening remarks Wednesday night, Mr. Obama said he was aware that many Americans are asking, “What’s in this for me?” But he also tried to appeal to the nation’s conscience, casting the issue as a matter of urgency to families who are losing their life savings trying to pay for medical care and to businesses burdened by trying to provide coverage to their employees.
Asked what the rush was to meet his August deadline for passage of House and Senate bills, Mr. Obama replied: “I’m rushed because I get letters every day from families that are being clobbered by health care costs. They ask me, ‘Can you help?’ ”
In fact, there is another reason Mr. Obama is rushed: he knows time is not on his side. The more Congress delays passage of a health bill, the more time his Republican opponents will have to marshal their opposition and kill it.
“If you don’t set deadlines in this town, things don’t happen,” Mr. Obama said. “The default position is inertia.”
“If I see a proposal that is primarily funded through taxing middle-class families, I’m going to be opposed to that,” Mr. Obama said in a prime-time news conference in the East Room of the White House. A surcharge on the highest-income Americans, under consideration in the House, “meets my principle,” he said.
On a day when the leader of fiscally conservative Democrats said a deal was a long way off and House Speaker Nancy Pelosi insisted that she had the votes to push a bill through, Mr. Obama used the news conference to take his message over the heads of lawmakers and straight to the public. Conceding that “folks are skeptical,” he sought to convince Americans that overhauling the nation’s health care system would benefit them and strengthen the economy.
“If somebody told you that there is a plan out there that is guaranteed to double your health-care costs over the next 10 years,” he said, “that’s guaranteed to result in more Americans losing their health care, and that is by far the biggest contributor to our federal deficit, I think most people would be opposed to that,”
“That’s what we have right now,” he said. “So if we don’t change, we can’t expect a different result.”
While Mr. Obama declared, “it’s my job, I’m the president,” he did not use the appearance at the White House to make any fresh demands on Congress, which is struggling to meet his timetable for both chambers to pass legislation before members break for August recess. Mr. Obama did not repeat that demand Wednesday night.
Instead, he sounded cerebral as he delved into policy specifics for nearly an hour and tried to link them to the concerns of ordinary Americans.
As he sought to reassure the public that a new health care system would be an improvement, he also acknowledged that there would be changes that could be unsettling, a point that is often raised by critics of overhauling the health care system.
“Can I guarantee that there are going to be no changes in the health-care delivery system? No,” Mr. Obama said. “The whole point of this is to try to encourage changes that work for the American people and make them healthier.”
Health legislation is Mr. Obama’s highest legislative priority, and his success or failure could shape the rest of his presidency. But while he is under increasing pressure from leading Democrats to delve more deeply into the negotiations by taking positions on specific policy issues, he largely resisted doing so Wednesday night.
But the president did weigh in how the government might pay for the plan.
In addition to saying he would be open to taxing those households earning more than $1 million — a scaled-back version of an earlier proposal that would have imposed a surcharge on households earning $350,000 or more — he signaled that he was also receptive to another idea under consideration in the Senate: taxing employer-provided health benefits, as long as the tax did not fall on the middle class.
On Capitol Hill, Ms. Pelosi said Democrats remained on track to reach a deal on major health care legislation. But she acknowledged that the process had slowed in response to concerns among conservative Democrats about the cost of the bill, and that some House Democrats were reluctant to embrace the income surtax on high-earners without knowing whether the Senate would go along.
Indeed, even as Ms. Pelosi insisted that Congress was closer than ever to achieving a comprehensive overhaul of the nation’s health care system, leaders of the Blue Dogs, a conservative faction of Democrats, said a deal was still a long way off. Asked if the House Energy and Commerce Committee could resume work on the bill by late Thursday, as House leaders hoped, Representative Charlie Melancon, a Blue Dog from Louisiana, said: “No way.”
A senior Democratic aide on Capitol Hill said party leaders now believed it was essential for Mr. Obama to be more specific about what he wanted in a health care bill — and not just exhort Congress to pass one.
“The president needs to step in more forcefully and start making some decisions,” said the aide, speaking on condition of anonymity because he did not want to be publicly identified as criticizing Mr. Obama. “Everyone appreciates the fact that Obama has devoted so much time to health care. The bully pulpit is powerful. But in view of the deadlines Congress has missed, we would like to hear more from the president about what he wants in this bill.”
While he faces pressures from fellow Democrats, Mr. Obama is also fending off attacks from Republicans who sense an opportunity to knock him off his stride by arguing that the health care bill, estimated as costing more than $1 trillion over the next decade, will not slow or reduce the growth of health spending.
The White House has been in a running debate this week with Senator Jim DeMint, Republican of South Carolina, who predicted that health legislation would prove to be Mr. Obama’s “Waterloo moment” and would break the president. To that, Mr. Obama said: “This isn’t about me. I have great health insurance, and so does every member of Congress.”
In his opening remarks Wednesday night, Mr. Obama said he was aware that many Americans are asking, “What’s in this for me?” But he also tried to appeal to the nation’s conscience, casting the issue as a matter of urgency to families who are losing their life savings trying to pay for medical care and to businesses burdened by trying to provide coverage to their employees.
Asked what the rush was to meet his August deadline for passage of House and Senate bills, Mr. Obama replied: “I’m rushed because I get letters every day from families that are being clobbered by health care costs. They ask me, ‘Can you help?’ ”
In fact, there is another reason Mr. Obama is rushed: he knows time is not on his side. The more Congress delays passage of a health bill, the more time his Republican opponents will have to marshal their opposition and kill it.
“If you don’t set deadlines in this town, things don’t happen,” Mr. Obama said. “The default position is inertia.”
Wednesday, July 22, 2009
Challenge to Health Bill: Selling Reform
WASHINGTON — What’s in it for me?
On the subject of health care reform, most Americans probably don’t have a good answer to the question. And that, obviously, is a problem for the White House and for Democratic leaders in Congress.
Current bills would expand the number of insured — but 90 percent of voters already have insurance. Congressional leaders say the bills would cut costs. But experts are dubious. Instead, they point out that covering the uninsured would cost billions.
So the typical person watching from afar is left to wonder: What will this project mean for me, besides possibly higher taxes?
Barack Obama was able to rise from the Illinois State Senate to the presidency in large measure because of his ability to explain complex issues and then to make a persuasive argument. He now has a challenge worthy of his skills.
Our health care system is engineered, deliberately or not, to resist change. The people who pay for it — you and I — often don’t realize that they’re paying for it. Money comes out of our paychecks, in withheld taxes and insurance premiums, before we ever see it. It then flows to doctors, hospitals and drug makers without our realizing that it was our money to begin with.
The doctors, hospitals and drug makers use the money to treat us, and we of course do see those treatments. If anything, we want more of them. They are supposed to make us healthy, and they appear to be free. What’s not to like?
The immediate task facing Mr. Obama — in his news conference on Wednesday night and beyond — is to explain that the health care system doesn’t really work the way it seems to. He won’t be able to put it in such blunt terms. But he will need to explain how a typical household, one that has insurance and thinks it always will, is being harmed.
The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average.
We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises.
In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste — bureaucratic and medical.
One thing we don’t get is better health than other rich countries, whether it’s Canada, France, Japan or many others. In some categories, like emergency room care, this country seems to do better. In others, like chronic-disease care, it seems to do worse. “The fact that we spend all this money and don’t have better outcomes than other countries is a sign of how poorly we’re doing,” says Dr. Alan Garber of Stanford University. “We should be doing way better.”
So far, no one has grabbed the mantle as the defender of the typical household — the opponent of spending that creates profits for drug companies and hospitals at no benefit to people’s health and at significant cost to their finances.
Republicans have actually come out against doing research into which procedures improve health. Blue Dog Democrats oppose wasteful spending but until recently have not been specific. Liberals rely on the wishful idea — yet to be supported by evidence — that more preventive care will reduce spending. The American Medical Association, not surprisingly, endorses this notion of doing more care in the name of less care.
Mr. Obama says many of the right things. Yet the White House has not yet shown that it’s willing to fight the necessary fights. Remember: the $6,500 tax benefits someone. And that someone has a lobbyist. The lobbyist even has an argument about how he is acting in your interest.
These lobbyists, who include big names like Dick Armey and Richard Gephardt, have succeeded in persuading Congress to write bills with a rather clever feature. They include some of the ideas that would cut costs — but defang them.
One proposal would pay doctors based on the quality of care, rather than quantity, but it’s a pilot project. Doctors who already provide good care may well opt in; doctors providing wasteful but lucrative care surely will not. The bills would also finance research on which treatments are effective. But Medicare officials would not be prevented from continuing to spend taxpayer money on ineffective treatments.
In reaction, some people who should be natural supporters of reform have become critics. The Mayo Clinic — one of Mr. Obama’s favorite models of care — says the legislation fails to “help create higher-quality, more affordable health care.”
On Thursday, Mr. Obama will visit another example he likes to cite, the Cleveland Clinic. Its successes capture what real reform would look like. Like Mayo, the Cleveland Clinic pays its doctors a salary, rather than piecemeal, and delivers excellent results for relatively little money.
“I came here 30-some years ago,” Delos Cosgrove, a heart surgeon who is the clinic’s chief executive, told me. “And I have never received any additional pay for anything I did. It never made a difference if I did five heart operations or four — I got paid the same amount of money. So I had no incentive to do any extra tests or anything.”
This is the crux of the issue, economists say: the current fee-for-service system needs to be remade. The administration has made some progress, by proposing a powerful new Medicare overseer who could force the program to pay for good results and stop paying for bad ones.
But even a strong Medicare plan won’t be enough. Reform will need to attack the piecemeal system in numerous ways. Among the most promising, which Mr. Obama has resisted, is a limit on tax subsidies for the costliest health insurance plans. This limit would give households and employers a reason to become smarter shoppers.
Above all, reform can’t revolve around politely asking the rest of the medical system to become more like the Cleveland Clinic.
In recent weeks, polls have shown that a solid majority of Americans support the stated goals of health reform. Most want the uninsured to be covered and want the option of a government-run insurance plan. Yet the polls also show that people are worried about the package emerging from Congress.
Maybe they have a point.
On the subject of health care reform, most Americans probably don’t have a good answer to the question. And that, obviously, is a problem for the White House and for Democratic leaders in Congress.
Current bills would expand the number of insured — but 90 percent of voters already have insurance. Congressional leaders say the bills would cut costs. But experts are dubious. Instead, they point out that covering the uninsured would cost billions.
So the typical person watching from afar is left to wonder: What will this project mean for me, besides possibly higher taxes?
Barack Obama was able to rise from the Illinois State Senate to the presidency in large measure because of his ability to explain complex issues and then to make a persuasive argument. He now has a challenge worthy of his skills.
Our health care system is engineered, deliberately or not, to resist change. The people who pay for it — you and I — often don’t realize that they’re paying for it. Money comes out of our paychecks, in withheld taxes and insurance premiums, before we ever see it. It then flows to doctors, hospitals and drug makers without our realizing that it was our money to begin with.
The doctors, hospitals and drug makers use the money to treat us, and we of course do see those treatments. If anything, we want more of them. They are supposed to make us healthy, and they appear to be free. What’s not to like?
The immediate task facing Mr. Obama — in his news conference on Wednesday night and beyond — is to explain that the health care system doesn’t really work the way it seems to. He won’t be able to put it in such blunt terms. But he will need to explain how a typical household, one that has insurance and thinks it always will, is being harmed.
The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average.
We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises.
In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste — bureaucratic and medical.
One thing we don’t get is better health than other rich countries, whether it’s Canada, France, Japan or many others. In some categories, like emergency room care, this country seems to do better. In others, like chronic-disease care, it seems to do worse. “The fact that we spend all this money and don’t have better outcomes than other countries is a sign of how poorly we’re doing,” says Dr. Alan Garber of Stanford University. “We should be doing way better.”
So far, no one has grabbed the mantle as the defender of the typical household — the opponent of spending that creates profits for drug companies and hospitals at no benefit to people’s health and at significant cost to their finances.
Republicans have actually come out against doing research into which procedures improve health. Blue Dog Democrats oppose wasteful spending but until recently have not been specific. Liberals rely on the wishful idea — yet to be supported by evidence — that more preventive care will reduce spending. The American Medical Association, not surprisingly, endorses this notion of doing more care in the name of less care.
Mr. Obama says many of the right things. Yet the White House has not yet shown that it’s willing to fight the necessary fights. Remember: the $6,500 tax benefits someone. And that someone has a lobbyist. The lobbyist even has an argument about how he is acting in your interest.
These lobbyists, who include big names like Dick Armey and Richard Gephardt, have succeeded in persuading Congress to write bills with a rather clever feature. They include some of the ideas that would cut costs — but defang them.
One proposal would pay doctors based on the quality of care, rather than quantity, but it’s a pilot project. Doctors who already provide good care may well opt in; doctors providing wasteful but lucrative care surely will not. The bills would also finance research on which treatments are effective. But Medicare officials would not be prevented from continuing to spend taxpayer money on ineffective treatments.
In reaction, some people who should be natural supporters of reform have become critics. The Mayo Clinic — one of Mr. Obama’s favorite models of care — says the legislation fails to “help create higher-quality, more affordable health care.”
On Thursday, Mr. Obama will visit another example he likes to cite, the Cleveland Clinic. Its successes capture what real reform would look like. Like Mayo, the Cleveland Clinic pays its doctors a salary, rather than piecemeal, and delivers excellent results for relatively little money.
“I came here 30-some years ago,” Delos Cosgrove, a heart surgeon who is the clinic’s chief executive, told me. “And I have never received any additional pay for anything I did. It never made a difference if I did five heart operations or four — I got paid the same amount of money. So I had no incentive to do any extra tests or anything.”
This is the crux of the issue, economists say: the current fee-for-service system needs to be remade. The administration has made some progress, by proposing a powerful new Medicare overseer who could force the program to pay for good results and stop paying for bad ones.
But even a strong Medicare plan won’t be enough. Reform will need to attack the piecemeal system in numerous ways. Among the most promising, which Mr. Obama has resisted, is a limit on tax subsidies for the costliest health insurance plans. This limit would give households and employers a reason to become smarter shoppers.
Above all, reform can’t revolve around politely asking the rest of the medical system to become more like the Cleveland Clinic.
In recent weeks, polls have shown that a solid majority of Americans support the stated goals of health reform. Most want the uninsured to be covered and want the option of a government-run insurance plan. Yet the polls also show that people are worried about the package emerging from Congress.
Maybe they have a point.
Tuesday, July 21, 2009
Employer Health Insurance Mandates: House vs. Senate
The two big health bills in the news at the moment — the one introduced in the House yesterday, and the one approved by the Senate HELP committee today — would both extend health insurance to millions more people. Both would also require that all but the smallest employers either offer health insurance to their workers, or pay a penalty.
But there are some key differences between the penalties that would be imposed by the two bills.
The mandate in the Senate bill, which applies to businesses with more than 25 employees, requires companies to pay a penalty of $750 per full-time employee.
Under the House bill, employers with payrolls of more than $400,000 a year would have to provide health insurance or pay an 8% penalty. Companies with payrolls between $250,000 and $400,000 would pay lower penalties; smaller companies wouldn’t be subject to the mandate.
So if we do a quick, back-of-the-envelope calculation, we can imagine a 50-person company paying each employee $50,000 for a total payroll of $2.5 million a year. That company’s penalty under the House bill for not offering insurance would be $200,000, or $4,000 per employee.
The Senate bill’s $750-per-employee penalty, by contrast, would add up to $37,500.
(Source: Wall Street Journal, Link: http://bit.ly/12SxyX)
But there are some key differences between the penalties that would be imposed by the two bills.
The mandate in the Senate bill, which applies to businesses with more than 25 employees, requires companies to pay a penalty of $750 per full-time employee.
Under the House bill, employers with payrolls of more than $400,000 a year would have to provide health insurance or pay an 8% penalty. Companies with payrolls between $250,000 and $400,000 would pay lower penalties; smaller companies wouldn’t be subject to the mandate.
So if we do a quick, back-of-the-envelope calculation, we can imagine a 50-person company paying each employee $50,000 for a total payroll of $2.5 million a year. That company’s penalty under the House bill for not offering insurance would be $200,000, or $4,000 per employee.
The Senate bill’s $750-per-employee penalty, by contrast, would add up to $37,500.
(Source: Wall Street Journal, Link: http://bit.ly/12SxyX)
Monday, July 20, 2009
Friday, July 17, 2009
House Panels Approve Health Plans
WASHINGTON — The House Committee on Education and Labor approved legislation on Friday morning to remake the nation’s health care system by a vote of 26 to 22. Three Democrats crossed party lines and voted against the bill — Jason Altmire of Pennsylvania, Jared Polis of Colorado and Dina Titus of Nevada.
The vote came eight hours after the House Ways and Means Committee approved the measure, 23 to 18, with three Democrats voting no. The dissident Democrats were Ron Kind of Wisconsin, Earl Pomeroy of North Dakota and John Tanner of Tennessee.
Democrats who voted against the bill cited such concerns as the tax increases, their effect on small businesses and the possibility that a new government-run health insurance plan might underpay doctors and hospitals by using Medicare reimbursement rates.
Of the five Congressional committees working on the legislation, three have now approved it.
On Thursday, a party-line Senate committee vote on health care legislation also underscored the absence of political consensus on what would be the biggest changes in social policy in more than 40 years.
The bill, which aims to make health insurance available to all Americans, was approved, 13 to 10, by the Committee on Health, Education, Labor and Pensions. The panel was the first Congressional committee to approve the health legislation.
“If you don’t have health insurance, this bill is for you,” said Senator Christopher J. Dodd, Democrat of Connecticut, who presided over more than three weeks of grueling committee sessions. “It stops insurance companies from denying coverage based on pre-existing conditions. It guarantees that you’ll be able to find an insurance plan that works for you, including a public health insurance option if you want it.”
The bill would also help people who have insurance, Mr. Dodd said, because “it eliminates annual and lifetime caps on coverage and ensures that your out-of-pocket costs will never exceed your ability to pay.”
But the partisan split signified potential trouble ahead. Republicans on the panel, who voted unanimously against the measure, described the idea of a new public insurance option as a deal-breaker. They said they still hoped that a consensus bill would emerge from the Senate Finance Committee.
The health and finance committees share jurisdiction over health issues. The finance panel, the next step on the way to passage of any measure, is now the focus of intense scrutiny. It must say how it intends to pay for its proposals and, unlike the health panel, has the power to do so because it can write tax legislation and has authority over Medicare and Medicaid.
President Obama hailed the Senate health committee’s action, but reiterated his insistence that each chamber of Congress approve a health care bill before the August recess. His comments increased pressure on the chairman of the Finance Committee, Senator Max Baucus, Democrat of Montana, who has been struggling for months to get a bipartisan bill.
“The HELP committee’s success should give us hope, but it should not give us pause,” Mr. Obama said. “It should instead provide the urgency for both the House and Senate to finish their critical work on health reform before the August recess.”
Senators said the White House had been sending mixed signals. For months, they said, it emphasized the need for a bipartisan bill. But in the last 10 days, one Democrat said, the message has been: “Hurry up. If you have to go without Republicans, it’s not the end of the world.”
As a presidential candidate, Mr. Obama boasted of his ability to transcend partisan splits that had stymied action in Washington. At a candidates’ forum in Las Vegas in March 2007 — even before he had a detailed health care proposal — Mr. Obama declared that “the most important challenge is to build a political consensus” on covering all Americans.
The Senate majority leader, Harry Reid of Nevada, has said he hopes to have a health care bill on the floor by July 27. That goal appears unrealistic, even though members of the Finance Committee said they were making progress in talks on how to pay for their bill, expected to cost at least $1 trillion over 10 years.
Several Democratic Finance Committee members, including Kent Conrad of North Dakota and Charles E. Schumer of New York, said they were intent on reaching an agreement with Republicans and were more concerned about the contents of the bill than the timetable.
It is unclear how long the White House and Democratic leaders in Congress will give Mr. Baucus to work things out. The senator said he was still optimistic about winning support from several Republicans on his committee like Charles E. Grassley of Iowa and Olympia J. Snowe of Maine.
Mr. Schumer said: “There’s a strong preference for bipartisanship because it makes the bill easier to pass. But if we cannot get bipartisanship, we must forge ahead because health care reform is too important."
Republicans said they were prepared for the possibility that Mr. Baucus or leaders of his party would lose patience and plow ahead on their own, in the absence of a bipartisan agreement.
“Time is fleeting,” Mr. Grassley said, praising Mr. Baucus’s efforts. On the most contentious issues, like the proposal for a new public insurance plan, he said, Mr. Baucus has shown that “he is willing to find a middle ground; he’s not an ideologue.”
Mr. Dodd said it was more important to get “a good bill” than a bipartisan one, even as he acknowledged that a bill with bipartisan support would be more sustainable in the long run.
“There’s a value in achieving bipartisanship,” Mr. Dodd said, “but I will not sacrifice a good bill for that. The people we are working for are not our colleagues, but the American public.” Mr. Dodd presided in the absence of Senator Edward M. Kennedy, Democrat of Massachusetts, the longtime champion of universal coverage who is battling cancer.
White House officials said they had a new standard for bipartisanship: the number of Republican ideas incorporated in the legislation, rather than the number of Republican votes for a Democratic bill. Mr. Obama said the health committee bill “includes 160 Republican amendments,” and he said that was “a hopeful sign of bipartisan support for the final product.”
Republicans said many of those amendments were technical, and they were scathing in their criticism of the bill approved by the health committee.
With a hint of sarcasm, Senator Michael B. Enzi of Wyoming, the senior Republican on the panel, noted that the bill’s title was the Affordable Health Choices Act. But “with its trillion-dollar price tag,” he said, “this bill is anything but affordable.”
“The bill gets an F,” Mr. Enzi said.
Senator Orrin G. Hatch of Utah, a Republican who has teamed up with Democrats to pass major health care bills over the last 25 years, said the measure approved Wednesday was “totally partisan.”
“From the start of the health care debate,” Mr. Hatch said, “Democrats have completely shut us out of the process.”
Senator Judd Gregg, Republican of New Hampshire, said the bill would not provide universal coverage or reduce health costs, but would result in some Americans’ losing insurance or even their jobs. “Small business will be massively impacted,” Mr. Gregg said.
Senator Barbara A. Mikulski, Democrat of Maryland, said the Republicans were sore losers. “We gave them hours of debate and opportunities to offer unlimited amendments,” she said. “At the end of the day, they did not want to support universal health coverage.”
The vote came eight hours after the House Ways and Means Committee approved the measure, 23 to 18, with three Democrats voting no. The dissident Democrats were Ron Kind of Wisconsin, Earl Pomeroy of North Dakota and John Tanner of Tennessee.
Democrats who voted against the bill cited such concerns as the tax increases, their effect on small businesses and the possibility that a new government-run health insurance plan might underpay doctors and hospitals by using Medicare reimbursement rates.
Of the five Congressional committees working on the legislation, three have now approved it.
On Thursday, a party-line Senate committee vote on health care legislation also underscored the absence of political consensus on what would be the biggest changes in social policy in more than 40 years.
The bill, which aims to make health insurance available to all Americans, was approved, 13 to 10, by the Committee on Health, Education, Labor and Pensions. The panel was the first Congressional committee to approve the health legislation.
“If you don’t have health insurance, this bill is for you,” said Senator Christopher J. Dodd, Democrat of Connecticut, who presided over more than three weeks of grueling committee sessions. “It stops insurance companies from denying coverage based on pre-existing conditions. It guarantees that you’ll be able to find an insurance plan that works for you, including a public health insurance option if you want it.”
The bill would also help people who have insurance, Mr. Dodd said, because “it eliminates annual and lifetime caps on coverage and ensures that your out-of-pocket costs will never exceed your ability to pay.”
But the partisan split signified potential trouble ahead. Republicans on the panel, who voted unanimously against the measure, described the idea of a new public insurance option as a deal-breaker. They said they still hoped that a consensus bill would emerge from the Senate Finance Committee.
The health and finance committees share jurisdiction over health issues. The finance panel, the next step on the way to passage of any measure, is now the focus of intense scrutiny. It must say how it intends to pay for its proposals and, unlike the health panel, has the power to do so because it can write tax legislation and has authority over Medicare and Medicaid.
President Obama hailed the Senate health committee’s action, but reiterated his insistence that each chamber of Congress approve a health care bill before the August recess. His comments increased pressure on the chairman of the Finance Committee, Senator Max Baucus, Democrat of Montana, who has been struggling for months to get a bipartisan bill.
“The HELP committee’s success should give us hope, but it should not give us pause,” Mr. Obama said. “It should instead provide the urgency for both the House and Senate to finish their critical work on health reform before the August recess.”
Senators said the White House had been sending mixed signals. For months, they said, it emphasized the need for a bipartisan bill. But in the last 10 days, one Democrat said, the message has been: “Hurry up. If you have to go without Republicans, it’s not the end of the world.”
As a presidential candidate, Mr. Obama boasted of his ability to transcend partisan splits that had stymied action in Washington. At a candidates’ forum in Las Vegas in March 2007 — even before he had a detailed health care proposal — Mr. Obama declared that “the most important challenge is to build a political consensus” on covering all Americans.
The Senate majority leader, Harry Reid of Nevada, has said he hopes to have a health care bill on the floor by July 27. That goal appears unrealistic, even though members of the Finance Committee said they were making progress in talks on how to pay for their bill, expected to cost at least $1 trillion over 10 years.
Several Democratic Finance Committee members, including Kent Conrad of North Dakota and Charles E. Schumer of New York, said they were intent on reaching an agreement with Republicans and were more concerned about the contents of the bill than the timetable.
It is unclear how long the White House and Democratic leaders in Congress will give Mr. Baucus to work things out. The senator said he was still optimistic about winning support from several Republicans on his committee like Charles E. Grassley of Iowa and Olympia J. Snowe of Maine.
Mr. Schumer said: “There’s a strong preference for bipartisanship because it makes the bill easier to pass. But if we cannot get bipartisanship, we must forge ahead because health care reform is too important."
Republicans said they were prepared for the possibility that Mr. Baucus or leaders of his party would lose patience and plow ahead on their own, in the absence of a bipartisan agreement.
“Time is fleeting,” Mr. Grassley said, praising Mr. Baucus’s efforts. On the most contentious issues, like the proposal for a new public insurance plan, he said, Mr. Baucus has shown that “he is willing to find a middle ground; he’s not an ideologue.”
Mr. Dodd said it was more important to get “a good bill” than a bipartisan one, even as he acknowledged that a bill with bipartisan support would be more sustainable in the long run.
“There’s a value in achieving bipartisanship,” Mr. Dodd said, “but I will not sacrifice a good bill for that. The people we are working for are not our colleagues, but the American public.” Mr. Dodd presided in the absence of Senator Edward M. Kennedy, Democrat of Massachusetts, the longtime champion of universal coverage who is battling cancer.
White House officials said they had a new standard for bipartisanship: the number of Republican ideas incorporated in the legislation, rather than the number of Republican votes for a Democratic bill. Mr. Obama said the health committee bill “includes 160 Republican amendments,” and he said that was “a hopeful sign of bipartisan support for the final product.”
Republicans said many of those amendments were technical, and they were scathing in their criticism of the bill approved by the health committee.
With a hint of sarcasm, Senator Michael B. Enzi of Wyoming, the senior Republican on the panel, noted that the bill’s title was the Affordable Health Choices Act. But “with its trillion-dollar price tag,” he said, “this bill is anything but affordable.”
“The bill gets an F,” Mr. Enzi said.
Senator Orrin G. Hatch of Utah, a Republican who has teamed up with Democrats to pass major health care bills over the last 25 years, said the measure approved Wednesday was “totally partisan.”
“From the start of the health care debate,” Mr. Hatch said, “Democrats have completely shut us out of the process.”
Senator Judd Gregg, Republican of New Hampshire, said the bill would not provide universal coverage or reduce health costs, but would result in some Americans’ losing insurance or even their jobs. “Small business will be massively impacted,” Mr. Gregg said.
Senator Barbara A. Mikulski, Democrat of Maryland, said the Republicans were sore losers. “We gave them hours of debate and opportunities to offer unlimited amendments,” she said. “At the end of the day, they did not want to support universal health coverage.”
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