Stalemate

President Obama failed to offer any path to break the congressional stalemate over health reform in his address last night, simply offering another rallying cry for his signature domestic policy initiative and repeating talking points he's made in countless speeches all year.

The president insists people would like his plan if only they understood it. But the American people do understand it, and they don't like it. The latest CNN/Opinion Research Corporation poll taken last week found 69 percent of Americans want Congress to either draft a new bill or drop the issue altogether.

Congress is at war with itself over the best way to proceed after Massachusetts transformed the political landscape, and Mr. Obama needed to do a lot more than restate the problems in our health sector which virtually everyone agrees must be fixed in order to move Congress off dead center.

Rep. Anthony Weiner (D-NY) crystallized the dilemma, telling reporters yesterday: "The Republicans are our opposition. The Senate is our enemy."

The president and Hill leaders spent the weekend desperately trying to convince House Democrats to pass the Senate health overhaul bill, promising the Senate would use the 51-vote reconciliation process to fix their concerns.

But that means asking House Democrats to vote for the Cornhusker Kickback, a tax on high-cost health plans without labor union exemptions, and dozens of other provisions they hate.

Yesterday, the House came up with a package of the fixes it wants the Senate to make. But the price tag was a whopping $300 billion, pushing the full cost toward $1.2 trillion even in the most conservative estimates. Senators were aghast and felt the House was preparing to target them as the reason health reform fails.

In his speech last night, the president challenged anyone to come up with a better plan, basically dissing Democratic committee chairmen who have spent countless hours trying to advance his agenda.

Virginia Gov. Bob McDonnell answered the president's request during his response last night, calling for cross-state purchasing of health insurance, a reform that University of Minnesota economists Stephen Parente and Roger Feldman found would not cost the federal government a penny but would mean 12 million more people would be insured. And he encouraged Congress to tackle lawsuit abuse as a first order of business.

Finally, if the president were a practiced politician and genuinely wanted bipartisan action, he would have done two things. He would have thanked the five Democratic committee chairmen who have worked incredibly hard over the last year to deliver on health reform. A thank you from the president in front of a national audience would have motivated them to keep working.

And if he really wanted to bring Republicans to the table, he might have thrown an olive branch to Sen. Olympia Snowe (R-ME) and a few others to try to get them to the negotiating table. None of that was to be found, only more partisan blame games.

Clearly the president is looking for another miracle that will get the Senate back to 60 Democrats to pull health reform out of the fire. Anything can happen, but that's a pretty risky strategy.

Leadership, anyone?

An abbreviated version of this post appears today on The New York Times' Room for Debate blog.

CLIP OF THE WEEK

Dr. C. Everett Koop appeals to Congress for a fair and transparent health reform process that protects American health consumers, especially senior citizens. In addition to being one of the leaders in the field of pediatric surgery, Dr. Koop was appointed by President Ronald Reagan as the thirteenth United States Surgeon General. Now 93 years old, Dr. Koop is working on behalf of the 60 Plus Association to make sure Congress remembers that health reform is about making sure people have access to health care — at all ages.

GALEN IN THE NEWS

Hitting the Wall on Health Overhaul

Grace-Marie Turner, Galen Institute
National Review Online: Critical Condition, 01/27/10

The frantic push for health care reform has come to a screeching halt, as members of the House and Senate have rebuffed appeals from both President Obama and their leaders to swallow hard and quickly pass the legislation that has consumed Congress for a year, Turner writes. But just because the current legislation is failing doesn't mean the American people want health reform to die. They want action, but they don't want anybody's 2,000-page bill. They want smaller steps they can understand that move in the right direction and don't try to put Washington in charge of transforming one-sixth of our economy. The best advice: Go slow with a step-by-step approach, and don't try to do everything at once. Read More »

Health Reform Is Not Dead

Grace-Marie Turner, Galen Institute
National Review Online: Critical Condition, 01/25/10

A Washington Post poll taken in Massachusetts after Tuesday's election blows apart the Left's claims that the election was not about health reform. Health care was a huge issue and people strongly opposed the president's plan, but the White House is trying to spin the results and ignore the Bay State's powerful message, Turner writes. White House advisors David Plouffe, Valerie Jarrett, and Robert Gibbs all said over the weekend that passing health reform legislation remains a top priority. If the president can convince enough House members to pass the Senate bill, his massive health overhaul plan will be on his desk in 24 hours. This debate will not be over until the final gavel falls and Congress adjourns for the year. Read More »

HEALTH REFORM

Why a Public Plan is Unnecessary to Stimulate Competition

Christopher J. Conover, Ph.D., Duke University and Thomas P. Miller, American Enterprise Institute
American Enterprise Institute, 01/26/10

Proponents of a public health insurance plan, including President Obama, claim it is needed to stimulate competition. Conover and Miller challenge that claim from a national, state and local perspective. The evidence shows that at the national level the health insurance market generally is highly competitive for the 61% of privately insured Americans who now purchase their coverage through large groups. Even at the local level, roughly three-quarters of
local markets that appear to have weak competition are dominated by nonprofit plans. Such plans are no different than a public plan in terms of profit motive. In areas where lack of competition adversely affects those seeking to purchase health insurance, policymakers should consider more effective tools to restore competition that would be superior to reliance on a public plan. These include more effective state regulation of the individual and small group markets, more aggressive antitrust enforcement and allowing interstate sales of health insurance. Read More »

What the Health Care Debate Is Really All About

James Capretta, Ethics and Public Policy Center
RealClearPolitics, 01/24/10

The choice the country faces in health care reform is a stark one with profound ramifications, Capretta writes. What process will best deliver affordable quality health care to all Americans, a government-driven or market-driven one? We can choose to rely entirely on the federal government to allocate resources in the health care sector, or we can choose to let consumers and suppliers make decisions in a decentralized marketplace with the government providing oversight and enforcing consumer protections. There is an irreversible aspect to this decision, which perhaps explains why it has been delayed so long in our political processes. Once we finally decide, definitively, to head down one of these paths, it will be very difficult to change course later and go the other way. Which is why all concerned are bringing to the current fight in Congress every resource they can muster to prevail. Read More »

Dynamic Analysis of Surtaxes in the House and Senate Health Bills

Stephen J. Entin and Michael Schuyler
Institute for Research on the Economics of Taxation, 01/19/10

Entin and Schuyler examine two proposed surtaxes on upper-income individuals in the House and Senate versions of the health reform bill. The official budget scores of the bills claim the burden of the surtaxes would fall only on the rich. These claims are based on unrealistic static economic assumptions, they write. In reality, the bills would depress economic growth, and everyone would feel the effect of the taxes — not just the rich. Much less revenue would be raised than forecast. The bills would increase the federal deficit. State and local budgets would be hit, too. If paired with expiration of the portions of the Bush tax cuts that had applied to upper-income taxpayers, the adverse economic effects would be even worse. Read More »

Six Ways Not to Reform Health Care

John E. Calfee
American Enterprise Institute, 01/10

Instead of proposing legislation that would improve health care quality and offer real relief to struggling Americans, Congress is demonstrating, sadly, how not to transform health care, Calfee writes. An attempt to change all aspects of the health care system at once has led to complex legislation that is difficult to understand or measure effectively. Further, the legislation ignores important consequences and fails to address key problems in the health care system, such as cost control, in any meaningful way. A faulty assumption that any health care reform bill is better than no bill may result in health care reforms that do more harm than good for American consumers. Read More »

Squeezing Out Private Health Plans

Robert A. Book, Ph.D. and Kathryn Nix
The Heritage Foundation, 01/22/10

Though it may seem unlikely today that regulators would deliberately put all health plans out of business, the Senate health care bill provides ample authority for this scenario to develop, Book and Nix write. The Senate bill would give federal regulators the power to define minimum benefit packages; specify by law the minimum amount that health plans must spend on medical claims; and impose new taxes that will not count toward those minimums. By putting an inflexible ceiling on how much insurers can spend on medical costs and how much they can charge in premiums — without any limit on what cost they could be required to incur — this legislation opens the door to the complete elimination of people's ability to choose private health plans. Read More »

Letter to Congressional Leaders Detailing Health Care Reform Concerns

American Academy of Actuaries, 01/14/10

The American Academy of Actuaries has detailed concerns for congressional leaders to consider as they negotiate combining the House and Senate versions of health care reform legislation. The actuaries underscore the need to limit adverse selection, whether it is stemming from new issue and rating restrictions or inherent with the current design of a new federal long-term care insurance program, better known as the CLASS Act. The actuaries also write that an effective and enforceable mandate will minimize adverse selection resulting from more restrictive issue and rating rules that are included in both versions of health care reform legislation. The actuaries also addressed other significant areas of the bills including an excise tax on employer-sponsored coverage, grandfathering provisions and medical loss ratios. Read More »

HEALTH INSURANCE

What Employers Want from Health Insurers in 2010: Better Information, More Value

PricewaterhouseCoopers' Health Research Institute, 01/19/10

PricewaterhouseCoopers looked at how employers viewed health plans in 12 key service areas across four main categories: financial, customer service and claims administration, use of technology, and population health management. Key findings:

  • Interest in personal technology tools is surging. Nearly half of all employers now say it is important for insurers to offer them; however, less than half are satisfied. Satisfaction with personal health records and online comparison tools has dropped 10% for large employers.
  • Employers continue to want more meaningful and higher-quality data to help them control costs and keep their employees healthy. Employers would like insurers to take an active role in waste reduction and are looking for consistency and transparency in their health benefit plans.

Read More »

 

MEDICAID

The Rich Get Richer: The Senate's Medicaid Proposal Gives a Bigger Bailout to Wealthier States

John R. Graham
Pacific Research Institute, 01/21/10

The biggest problem with the Medicaid expansion in the Senate health bill is not the "Cornhusker Kickback," but that it leverages an already flawed formula to determine federal payments to state Medicaid programs, Graham writes. The Senate bill would motivate states to invest more resources in recruiting higher-income residents into Medicaid, rather than traditionally eligible beneficiaries, including the blind and disabled. The bill would increase the risk of fraud, waste, and corruption. The Senate bill also gives richer states a bigger Medicaid bailout than lower-income ones. New Hampshire, Maryland, and Connecticut get the biggest handouts, while Mississippi, West Virginia, and Arkansas are short-changed. The federal government should eliminate entirely the current funding formula in favor of block grants to states, Graham concludes. Read More »

Events

Grand Valley Summit on Health Care Reform
Grand Valley State University Conference
January 28-29, 2010
Grand Rapids, MI
Featuring Thomas Miller (American Enterprise Institute), Michael Tanner (CATO Institute), Timothy Noah (Slate Magazine), and Dr. Kalahn Taylor-Clark (Brookings Institution) as moderator.

County Health Rankings
Robert Wood Johnson Foundation and University of Wisconsin Briefing
Wednesday, February 17, 2010
9:30am-11:30am
Washington, DC

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