Starting Over

Frustration: The Democrats seem to be in the anger phase of grief over the collapse of their health overhaul, with a sharp and heated meeting between top White House advisers and Senate Democrats on Wednesday. Politico reports:

"Sen. Al Franken ripped into White House senior adviser David Axelrod this week during a tense, closed-door session with Senate Democrats. Five sources who were in the room tell Politico that Franken criticized Axelrod for the administration's failure to provide clarity or direction on health care and the other big bills it wants Congress to enact…

"But they also said the Minnesotan wasn't the only angry Democrat in the room. 'There was a lot of frustration in there,' said a Democratic senator who declined to be identified."

According to grieving expert Elisabeth Kubler-Ross, after anger, comes the bargaining stage. Now this also from Politico:

"Months after Congress abandoned any hopes of a broad bipartisan deal on health care reform, President Barack Obama said Thursday the 'next step' on health care reform involves going back to the negotiating table with Republicans.

"Obama told supporters at a Democratic National Committee fundraiser that he wants to have a meeting with Republicans, Democrats and health care experts to go through the bills 'in a methodical way.' 'And then, I think that we've got to go ahead and move forward on a vote,' he said."

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Starting over? During the House GOP retreat in Baltimore last week, Mr. Obama said that many Republican proposals were incorporated into legislation by the Democratic leadership, including:


  • Allowing inter-state purchase of health insurance
  • Catastrophic health insurance for young people
  • High-risk pools for uninsured people with pre-existing conditions
  • Small business health plans
  • Incentives for wellness
  • Allowing young adults to stay on their parents' policies


While not every Republican or Democrat would agree with every item on the list, it is a start for a bipartisan discussion.

And to that list, I would add several others that were in the health policy platforms of both Sens. McCain and Obama during the campaign, including agreement on the importance of:


  • Targeted financial help for the uninsured
  • Incentives for prevention and early treatment
  • Coordination of care and disease management
  • Greater use of information technology and electronic medical records
  • New approaches to "best practices" in treatment


There are serious differences about how to structure the underlying policy on any of these items and whether more power and control go to government or to doctors and patients. But these lists nonetheless could be a start for a bipartisan conversation.

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Targeting Ryan: The White House has declared war on Rep. Paul Ryan, R-WI, over his Roadmap for America's Future. The legislation creates a 21st century plan for reforming tax policy, Medicare, Medicaid and Social Security. It has been scored by the Congressional Budget Office as putting entitlement programs and the federal budget on a sustainable path, reversing the tsunami of red ink facing the next generations and creating dramatic economic growth.

But White House Budget Director Peter Orszag laid into the plan this week, saying in part:

"[Ryan] introduces individual accounts, privatization into Social Security. He has significant changes to the tax code … He eliminates the tax preference that currently exists for employer-sponsored insurance… He has put forward an interesting plan. There are many aspects of that that are worthy of further discussion and debate, but it is a dramatically different approach in which much more risk is loaded onto individuals and in which the Medicare program in particular is dramatically changed from its current structure."

Ryan came right back at him with a detailed rebuttal, concluding:

"There are few paths forward more destructive, more painful, and more irresponsible than the one advanced by those clinging to the unsustainable status quo. There is consensus that entitlement reform is urgently needed, and I welcome constructive criticism of my plan — a CBO-certified plan that actually solves the long-term fiscal crisis.

"What is unaffordable and unacceptable, however, are political attacks unaccompanied by alternative plans. Those who would rather kick the can down the road are consigning the next generation of Americans to not only a broken social safety net, an inferior standard of living, and bankruptcy — but a future in which America's best days are behind it.

Change is essential. Paul Ryan has a plan that deserves to be taken seriously that offers a vision for reform and that would take years to pass and implement. He and the next generation of political leaders can prevail in advancing real change if they engage a much more informed electorate in a serious debate about policy challenges and alternatives.

People want to be involved, and they want the truth. Helen Darling of the National Business Group on Health told The Wall Street Journal that the legislation the House and Senate passed wouldn't have accomplished much to slow costs, and thus its death won't matter much.

There are serious and very real problems in our health sector that must be fixed — relentlessly rising health costs, an explosion of entitlement spending, and financial pressures on businesses among them. Americans figured out that the legislation that both the House and Senate have passed does not help and will in fact make these problems worse.

We are entering a new era in the political and policy debate with tens of millions of people having access to information to allow them to focus on the details of policymaking. Engaging the power of the Information Age could lead to the transformative change that our country desperately needs to create a new century of growth and prosperity.

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Bracing: Washington is bracing for a record snowstorm that already has started. We may get as much as 24 inches before it's done tomorrow evening. Maybe all of Washington can calm down, tone down the rhetoric, and take the long view of what's right for our country.


This week, the British medical journal The Lancet retracted a study published in 1998 claiming a link between common childhood vaccines and autism. This week's Clips of the Week feature two health experts — Dr. Paul Offit of the Children's Hospital of Philadelphia and Galen Institute President Grace-Marie Turner — discussing the impact of this retraction on the medical, pharmaceutical and health research communities.


Obama Signals a Dangerous 2010 Strategy

Grace-Marie Turner, Galen Institute
The Washington Examiner, 02/02/10

During the exchange with President Obama at last week's retreat in Baltimore, House Republicans took on the president in a serious policy debate, Turner writes. The president called for bipartisanship and sounded baffled that Republicans won't go along with his "moderate" health reform plan, arguing that it incorporates so many of their own ideas, such as allowing for inter-state purchase of health insurance, incentives for wellness, and small business health plans. But the problem with these and other initiatives is that all of his solutions involve a huge injection of higher taxes and big government. The approach that Congress has taken is anything but moderate. We need a fresh start. Read More »

There Is a Better Plan

Grace-Marie Turner, Galen Institute
The New York Times: Room for Debate, 01/28/10

During his State of the Union address last week, the president challenged anyone to come up with a better health reform plan. Virginia Gov. Bob McDonnell did just that in his response, including a call 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 could be insured. Read More »


The President's Budget and Health Care Reform

James C. Capretta, Ethics and Public Policy Center
Kaiser Health News, 02/04/10

The release of the president's budget for fiscal year 2011 marks another turning point in the health reform debate, one that means the climb toward passage of the health overhaul bill – or any bill for that matter – has only gotten steeper, Capretta writes. The president and congressional majority should take the opportunity a new budget and legislative year brings to rethink how they are proceeding. The nation faces daunting challenges, economically and budgetarily. There are opportunities for building bipartisan consensus on sensible solutions, including in health care, where both parties could come together to expand coverage and slow the pace of rising costs, but those opportunities will almost surely vanish if Democrats continue to insist on rewriting American health care their way – which is to say in a way that much of the country plainly does not support. Read More »

Rethinking Health Reform: The Need for a More Incremental Approach

Joseph Antos, American Enterprise Institute
Health Affairs Blog, 01/29/10

We need to rethink both the goals and the methods of health reform, Antos writes. Rather than claiming that we can solve every problem in the health system, we should admit that we must set priorities. Rather than locking in policies that are rigidly interconnected, we should take more measured steps that allow us to make frequent mid-course corrections. Rather than imposing top-down solutions, we should recognize that real reform depends crucially on the way individuals, health providers, employers, and others respond to change in initiatives. Principles for practical health reform include putting our fiscal house in order, saving Medicare and Medicaid first, reforming private insurance without malice, and making consumerism more than a slogan. Read More »

Another Obama Tax Hike

Douglas Holtz-Eakin, Manhattan Institute and Alex Brill
The Wall Street Journal, 02/03/10

The president's policies in the stimulus and health care bills would increase current barriers to the American dream, Holtz-Eakin and Brill write. These legislative efforts raise to shocking levels the effective marginal tax rates on lower and middle-income singles and families — with the government taking up to 41% of each additional dollar. As Congress thinks about the future, it should put full weight on the importance of reforms to a tax code that supports the ability of the poor and middle-class to achieve their dreams. The Massachusetts special election sends the strongest message that voters want Washington to scale back its interference in their lives. Read More »

How Health Care Reform Will Affect Young Adults

Rea S. Hederman, Jr., and Paul L. Winfree
The Heritage Foundation, 01/27/10

Both of the current House and Senate health care bills disproportionately burden younger, healthier Americans with higher insurance premiums. To ensure that these young people buy health insurance anyway, Congress has decided to nudge them into purchasing insurance by enforcing a penalty for those who fail to buy coverage. Hederman and Winfree estimate that many under age 35 will opt out of buying insurance altogether, choosing to pay the penalty instead. If younger workers do not join the risk pool, insurers will be forced to raise premiums even higher to cover higher-benefit payouts to older people. Either way, younger Americans will have less disposable income — which means they are able to buy and save less – a lose-lose situation. Read More »


Health Spending Projections Through 2019: The Recession's Impact Continues

Christopher J. Truffer, Sean Keehan, Sheila Smith, Jonathan Cylus, Andrea Sisko, John A. Poisal, Joseph Lizonitz, and M. Kent Clements, Centers for Medicare and Medicaid Services Office of the Actuary
Health Affairs, 02/04/10

In 2009, the health share of the gross domestic product is expected to reach 17.3% — the largest single-year increase since 1960, according to actuaries from the Centers for Medicare and Medicaid Services. Public spending is projected to account for more than half of all U.S. health spending by 2012, compared to 47% in 2008. Federal spending for Medicaid rose significantly more than state spending on the shared program, reflecting the shift in funding from the states to the federal government as a result of provisions in the stimulus bill. Federal spending on Medicaid is projected to increase by another 10.8% this year. Overall spending by private payers in 2009 rose only 3%, while spending by publ
ic payers rose 8.7%.

Read More »



CIGNA Choice Fund Experience Study

CIGNA, 12/09

As overall medical costs continue to increase by double digits annually, medical costs for individuals in account-based consumer-driven health plans (CDHPs) went down 26% over four years, while levels of care for their preventive medicine, chronic disease management and evidence-based treatments were higher than their counterparts in traditional PPO and HMO health plans, according to a new multi-year study of health care claims experience of 655,000 CIGNA customers. Highlights:


  • CDHP medical costs are 14% less than traditional plans the first year, cumulative cost savings rise to 19% in the second year, 23% in the third year and 26% in the fourth year.
  • " Medical cost trend was substantially less for CIGNA Choice Fund customers with hypertension (27% less), joint disease (21% less), and diabetes (15% less), than for individuals with either of those diseases in traditional CIGNA health plans. According to the data, these savings were achieved without sacrificing care.
  • Disease management program follow-through and completion rates are 22% higher among those in CIGNA Choice Fund plans than their counterparts in traditional CIGNA managed care plans.
  • Preventive care visits for first-year CIGNA Choice Fund customers were an average 16% greater when compared to traditional plans, with CDHP preventive care visits continuing at higher rates than those in traditional plans in the second year.


Read More »



Canadian Official Seeks Heart Surgery in U.S.

The Associated Press, 02/02/10

The premier of Canada's east coast province is undergoing heart surgery in the United States this week because the treatment he is seeking was not available in his home province, the Associated Press reports. The announcement about of Newfoundland and Labrador Premier Danny Williams' plans has triggered a debate since Canada prides itself on its universal health care system. A spokeswoman wouldn't comment on whether the type of surgery Williams was having was available elsewhere in Canada. The Vancouver-based Fraser Institute estimates that 41,000 Canadians sought health care services in the U.S. in 2009. Read More »



The Case For Medical Liability Reform Gets Stronger
Health Caucus Policy Forum
Tuesday, February 9, 2010
9:30am – 10:30am
Washington, DC
To register, email

County Health Rankings
Robert Wood Johnson Foundation and University of Wisconsin Briefing
Wednesday, February 17, 2010
Washington, DC

Would the Senate Health Care Bill Keep The Poor Poor?
Cato Institute Policy Forum
Monday, February 22, 2010
Washington, DC

The Promise of E-Health in the Developing World
Health Affairs Briefing
Tuesday, February 16, 2010
9:00am – 12:00pm
Washington, DC