Dr. Jeffrey B. English: Obamacare Puts an End to the Doctor-Patient Relationship
Dr. Jeffrey B. English is a Board Certified Neurologist with sub-specialty training in Clinical Neurophysiology, currently in private practice in Atlanta, Georgia. Dr. English is the Clinical Research Director at the Multiple Sclerosis Center of Atlanta, a non-profit organization for the treatment of patients with multiple sclerosis which he helped to develop. He is also a national speaker on multiple sclerosis and on the economics of health care delivery. He admits to having "no formal economic background," just extensive "real life, in the field" experience. He is the author of the book, "Now It's Personal: The Truth About Health Care, Doctors, and Patients” in 2009.The following is a letter Dr. English recently wrote regarding the recently-passed health reform bill, reposted here with his permission:
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To my family and friends,
I wanted to share my thoughts and give you my educated opinion about the new health care law. I hope you will read all of this and pass it along to everyone you know, no matter where they stand on the issue. It is long, but it is important! While you may not agree with my political assessment (which is an educated assessment), I am correct about the destruction of our system. Keep in mind, I don’t take care of Democrats or Republicans, I only take care of patients!
As you all know, I have had such great pleasure being a doctor, despite the long hours, starting every day at 630 am and working all day without a break. I have been able to practice as a doctor with one mission in mind, to extend the best health care possible serving the best interest of my patients. I employ a large staff to help with all facets of care, we work feverishly to make sure the best care is given in a timely manner, and we do not let insurance or scheduling obstacles stand in the way of that care.
It is with great sadness that I inform you the new health care law will put an end to the doctor-patient relationship and my ability to provide effective and efficient care. I will no longer be working for the patient, I will be working for the Government. As many of you know, I have been a health care reform advocate for years. This is not a new issue for me and I am educated on the delivery of health care around the world. I know that instead of fixing the problems with our system and preserving the qualities that make it the best system in the world, the health care “reform” essentially socializes medicine.
President Obama said, “We have accomplished something that we have been trying to do since 1912.” Do you know what he meant? He was referring to President Theodore Roosevelt’s desire to socialize medicine. The new law will 100% accomplish this within the next 4-8 years if it is executed as planned. This process never set out to reform our system, it set out to change our system to the detriment of your health. Sen. Max Baucus and Howard Dean both stated this week that the new law will “address the mal-distribution of wealth” in this country. (It set out to spread the wealth, not the health.) Rep. John Dingell stated on March 24th that “it takes a long time to do the necessary administrative steps...to put the legislation together to control the people.” Need I say more?
Here is what the law does to patient care:
Pages 148/149 of the law state that the Health and Human Services Secretary (HHS), who is a lawyer, will set up protocols for all physicians who take government or private insurance. Yes, the government for the first time in history will dictate the care private citizens obtain. I will no longer be following recommendations from expert physician panels to provide patients with the best care possible. I will have to watch people suffer whom I could have helped because of recommendations set forth by an appointed government panel.
Starting on page 642, penalties on physicians who deviate from the protocols are explained. If our years of experience tell us to deviate from the protocols, we run the risk of a financial penalty and/or a poor quality rating by the Government.
Starting on page 1149, the HHS is given the authority to remove services from Medicare based on task force recommendations. This is the same task force that just recommended against the use of mammograms in women between the ages of 40-49 because while they save lives, they weren’t “cost effective.” The bill instead has millions of dollars that will go to communities for such crucial items as parks and family education.
Medicare cuts will start now. We have seen a steady decrease in disability in the elderly as they live much more independent, active lives. We will be taking money directly away from the care that enables this, such as hip replacements and cardiac procedures, and shifting it to such necessary projects like a new park. Interestingly, abortion will be covered without question while hip replacements, bypass surgery, and cataract surgery will be given as the Government sees fit. The Roe v Wade decision gave women the right to privacy of her body. Ironically, the new health care law takes away that privacy with the exception of her uterus during pregnancy. She does not control her uterus outside pregnancy, nor her hip, shoulder, heart, etc...
Here is what happens to private health insurance:
Taxes start now and costs will be passed on to patients. These taxes will include medical device companies, prescription drugs, and insurance taxes, among others. According to the CBO, this will cause private health insurance premiums to go up 10-13% higher than they normally would have by 2016. We all know that the private industry subsidizes the public industry (eg. Medicare). Health insurance and drug prices have already gone up in 2009 and will continue to unnecessarily escalate.
The Government will add mandates for coverage to ALL private insurance plans, such as pregnancy coverage, even if you are out of child bearing age. Similar legislation in New York has already proven costly and has caused policies to be ten times higher than similar policies in other States.
These measures will cause premiums to increase and healthy Americans will not purchase insurance. Similar legislation is causing reform in Massachusetts to fail and similar legislation has already caused reform to fail in Tennessee. Eventually, the premiums will be so high that the private industry will not be able to subsidize the public system. Private insurance will cease to exist. We will all then be under a Federal insurance program, ie. we will have socialized medicine.
This didn’t have to happen. Reform should have been patient-centered, with insurance reform, support for those with pre-existing conditions, and malpractice reform. This should have been a bi-partisan process as both the Democrats and the Republicans had good ideas. Make no mistake about it; Democrats did not listen to the Republican ideas. None of the 14 health professionals in the House or the 2 doctors in the Senate were asked to give their input (with real experience on how the system really works) in the reform process. Every health care economist agrees (even those who promote socialized medicine) that the primary problem with our current health care system is the fact that the tax deduction for health insurance is tied to one’s employment. Why did they not fix this universally known problem and let everyone own their health insurance? Did they run out of pages and couldn’t go over 2,800? No, they left it out because that would have given the patient, not the government, more control and the private system would have survived.
We can still hope to repeal some of the law and reform the system correctly, with both Democrat and Republican ideas. I encourage all of you to read Rep. Paul Ryan’s “Roadmap to Recovery” where he details the path to correcting health care for everyone with patient control at the center. People must be in control of their own care and doctors must serve you, not the Government. Those who like socialized medicine please also remember that it is failing in Great Britain and Canada. As we speak, their systems are incorporating more and more private medicine, ie. they are moving towards our current system. I know health care economics very well. The current plan will cost 3-4 times what they project and this will result in rationed care to a degree unheard of in Great Britain.
Please go to docs4patientcare.org for more details. I joined this organization as it is non-partisan and represents patient’s rights to care and the protection of the doctor-patient relationship. We need your help growing our physician base so please pass along this information to your own physicians.
Jeffrey B. English
It's Not Over Grace-Marie TurnerGalen Institute: Health Policy Matters, 03/26/10
It has been a very difficult week of shock, disbelief, depression, and outrage -- all the phases of grief except acceptance -- among those of us who so strongly oppose the arrogant approach and method of passing ObamaCare, especially in the face of such overwhelming public opposition.
Let's start with the hubris of thinking that it is even remotely possible to write 2,900 pages of legislation and get it right in overhauling one-sixth of our economy. In just the first few days, we have begun to see the mistakes:
Oops, we didn't actually mean it when we said children with health problems could immediately get insurance. Turns out somebody made a mistake in the drafting, but the White House is going to try to get HHS Secretary Sebelius to fix that...
Caterpillar and John Deere, two important U.S. manufacturers, are among major companies that announced this week they may be forced to shave as much as $14 billion from corporate profits this year because the law changes provisions impacting retiree drug coverage. The drug coverage of several million retirees of these and other companies also is threatened.
Gov. Mitch Daniels of Indiana is making plans to terminate his incredibly popular Healthy Indiana Program that provides health insurance to 50,000 low-income Hoosiers. "I hope those folks will do all right when they are pitched into Medicaid," he wrote in today's Wall Street Journal.
And Massachusetts State Treasurer Timothy Cahill said in the Journal of his state's health overhaul upon which ObamaCare was modeled: "It has been a fiscal train wreck…The only reason MassCare has survived is that we have been repeatedly bailed out by the federal government. But that raises the question: Who will bail America out?"
I could go on, but it's too painful…
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Take two: The second health overhaul bill that Congress passed yesterday increases taxes even more, in a most reckless and economically destructive way, by subjecting investment income to Medicare taxes! The tax burden of ObamaCare alone will squeeze the life out of a recovering economy and will burden small businesses that historically have been the engine of jobs creation.
Is it any wonder that the latest CBS poll says that 62% of the American people want Republicans to continue to challenge the bill? Rep. Paul Ryan, in a commentary article in today's New York Times, wrote that "we will need to repeal the entire faulty architecture of the government behemoth and replace it with real reform," starting with tax reform and empowering the states to strengthen the safety net for those with problems getting coverage.
It seemed yesterday that the country was a tinder box, ready to combust with public outrage, as this Washington Postarticle about an Iowa citizen protestor reported. Other people have gone over the edge with gunshots into campaign offices, coffins on lawns, and threats to members of Congress.
The president is president of all the people, and he has a responsibility to tone down the rhetoric, not fuel it. But his speech in Iowa yesterday was combative, and its us-against-them tone was most vividly illustrated when he taunted those who want to repeal ObamaCare to "Go for it." Is he really trying to change the tone in Washington with comments like this about his own citizens?
Passage of ObamaCare this week is a huge shock to our economy and health system. Members of Congress are heading home this weekend, and they will see and hear from constituents who can now tell them in person what they think of this health overhaul law.
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Looking forward: We hosted another fabulous conference in our series about the value of innovation in health care yesterday in Washington. Our terrific team at the Galen Institute put together a dynamite list of speakers who talked about the remarkable new technologies that bring us the medical miracles we have come to expect from our health sector.
But these will certainly be threatened by the suffocating government bureaucracy of ObamaCare, patent rights being seized by foreign governments, and the reluctance of investors to support the huge and expensive risks of developing new medicines and technologies if government bureaucrats can arbitrarily block their entry to market.
You can access archived presentations of this incredible program featuring talks by Dr. David Brailer on the culture of innovation in health care, Rep. Dan Lungren on the enormous overreach of subjecting one-sixth of our economy to government power, and Dr. Julian Goldman on the importance of thinking past electronic medical records to the interoperability of health information and technology.
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Pauly: If you are in Washington this coming week, you won't want to miss the program on Thursday April 1, "Health Reform without Side Effects: Making Markets Work for Individual Health Insurance," at the American Enterprise Institute. Wharton Professor Mark Pauly will discuss his latest monograph Health Reform without Side Effects: Making Markets Work for Individual Health Insurance that provides both a warning about the risks of getting health insurance reform wrong and guidelines on how to do it right. Please join us!
Breaking Trust With America Grace-Marie TurnerNational Review Online: Critical Condition, 03/22/10Article availablehere and here.
The health-care reform debate has been at the center of a decades-long struggle in this country to find the balance between liberty and equality — two fundamental principles that form the genius of America.
Freedom is the fulcrum of our prosperity, with respect for the right of each one of us to pursue our dreams and happiness. And the conviction that all of us are created equal guides our compassion out of respect for the dignity of every person. America is great because we value both, and both are vital to the strength of this great country.
Legislators bring those convictions to the process of developing legislation, and that, I think, lies behind their cry for bipartisanship. The American people want respect for both liberty and equality to guide careful legislative decisions that balance these principles in our unique democracy.
But last night we saw an arrogant abuse of the process and of political power. The American people have spoken in every way they can that this bill does not produce either equality or liberty; they fear it will devolve more and more power to Washington and to the political process — that it puts too much power in the hands of government and too little in the hands of freedom-loving people.
I had the privilege of watching the debate unfold in the House gallery last evening as a guest of Rep. Jeff Fortenberry (R., Neb.) and his chief of staff, Kelly Lungren McCollum. I thank them deeply for inviting me. Along the way, I heard many false promises. “Every uninsured American can become insured,” said Rep. Lloyd Doggett (D., Tex.). Speaker Pelosi said: “This legislation will lead to healthier lives, more liberty to pursue hopes and dreams and happiness for the American people. This is an American proposal that honors the traditions of our country.”
Other Democrats said that Americans won’t have to lose their health coverage, and that they can see a doctor anytime they want. And over and over we heard that this huge new government entitlement will reduce the deficit.
But the actual bill defies those promises.
“You can’t improve the health of a nation by bankrupting its children,” Rep. Jeb Hensarling said. “This bill fundamentally changes the relationship between government and free people.”
Rep. Paul Ryan spoke about the larger vision of America. “America is not just a nationality,” he said. “America is an idea. It’s the most pro-human idea ever designed by mankind.”
But he warned:
We are fast approaching a tipping point where more Americans depend on the federal government than on themselves for their livelihoods — a point where we, the American people, trade in our commitment and our concern for our individual liberties in exchange for government benefits and dependencies . . .
Do we believe that the goal of government is to promote equal opportunity for all Americans to make the most of their lives — or do we now believe that government’s role is to equalize the results of people’s lives?
The European social welfare state promoted by this legislation is not sustainable. This is not who we are and it is not who we should become.
Today marks a major turning point in American history. Our founders got it right, when they wrote in the Declaration of Independence that our rights come from nature and nature's God — not from government.
Thirty-four Democrats voted with the Republicans and against Obamacare. Not one of them was given a chance to speak last night. Most agree with the Republicans in their concern about how this violates the culture of this country.
The American people are rising up and letting their legislators know in every way they can that Obamacare got it wrong. This sweeping, 2,700-page bill will be signed into law, likely this week. The debate over a second bill in the Senate is only a sideshow. The health-care overhaul law is passed. Obamacare will be the law of the land.
Battles will continue in the courts, in the states, in Congress, in the media, and around dining-room tables, likely for years to come. And the people’s voice will be heard the next time they have a chance to speak, at the polls in November. But today is a sad day for our great country. Neither equality nor liberty has been served. As Republican leader John Boehner told his fellow congressmen, by passing this bill, “we break our trust with Americans.”
Get Ready to Play Defense Grace-Marie TurnerNational Journal: Health Experts Blog, 03/22/10Article availablehere and here.
The 219 House Democrats who voted to pass ObamaCare may think their vote puts health reform behind them so they can move on to other issues.
Dream on. President Obama’s reassurances that the public’s opposition to this massive overhaul legislation will turn to approval are pure fantasy.
The American people have rejected the substance of the health overhaul legislation, they are repulsed by the special deals and pork used to get it passed, and they are outraged that Speaker Pelosi jammed the bill through with threats and promises to members despite the deafening disapproval of the American people.
Democrats issued a list of the Top Ten Immediate Benefits the bill will offer, but they are either too modest to affect many people or likely will cause unintended consequences. Everything bad that happens next in our health sector will be blamed on the inevitable failings of this top-down, centralized approach to reform.
The uninsured rolls will continue to swell, it will be harder and harder to find a doctor as many quit the practice of medicine altogether, deficits will continue to soar, and the quality of care will get steadily worse as doctors and hospitals become more responsive to bureaucrats than to patients. In addition:
1. Cost: Health insurance costs will continue to soar. Premiums will continue to rise and will likely rise faster because of new mandates on insurers that add costs to policies.
2. Medicare: The added drug benefit will assist a few, but at least 10 million seniors are threatened with losing their Medicare Advantage benefits and plans because of deep cuts to the program. When they lose their coverage, they will blame ObamaCare. And it will come sooner rather than later.
3. Jobs: Employers will face new taxes as well as fines and penalties if they don’t provide insurance or if one or more of their employees seeks coverage in the new government exchange. Hiring new workers, particularly entry-level employees, will be a risk fewer employers will be willing to take.
4. Coverage: Many people who value their job-based insurance could lose it. Employers will face huge risks if they continue to offer health insurance, and already are considering dropping health benefits altogether. Many will find it is cheaper to pay the fine and send their employees to the exchanges or other government plans than to pay for increasingly-expensive, government-defined insurance for their workforce.
Members who voted for this bill, boasting of its benefits, should expect to find themselves perpetually on defense in explaining the cascade of problems it creates. An electorate that has been so ignored in this process will look for every opportunity to remind them of the high cost of false promises.
Welcome Weekly Standard Readers and Sirius/XM Radio Listeners! Welcome to The Weekly Standard readers and Sirius/XM radio listeners! We hope you find this site helpful in not only explaining the myriad of problems with the current bills in Congress, but also in describing alternative, market-based approaches to health reform. Check out our newest video that features Grace-Marie Turner of the Galen Institute explaining how, "if the Senate bill is passed through the House, and President Obama signs it, Obamacare is done."
March Madness for Health Care Votes Grace-Marie Turner, Galen InstituteNational Review Online: Critical Condition, 03/20/10Article availablehere and here.
The mad scramble for votes to pass Obamacare turned into a nail-biting drama on Saturday in Washington, with the outcome just as uncertain as the March Madness college-basketball playoffs.
President Obama made it clear to reluctant House Democrats during a rally in the Capitol that his presidency hangs in the balance if the legislation fails. But rank-and-file Democrats believe their careers hang in the balance as well if they vote for a bill that is so massively unpopular with the American people.
The telephone lines to congressional offices were in virtual meltdown this week, struggling to handle 100,000 calls an hour for a system with only half that capacity. The president’s approval rating continues to fall the longer he talks about health care, with Rasmussen reporting Saturday that it has dipped to its lowest level yet at 43 percent.
This is the end result of a political system that rewards politicians who put winning and power over good policy and that try to pit one constituency against another to gain votes.
If Speaker Pelosi succeeds in getting 216 votes this weekend, Obamacare will quickly be signed into law in the guise of the 2,700-page Senate bill. Then the Senate will begin the tortured process of trying to pass a second health-reform bill through its budget-reconciliation process to fix what the House doesn’t like in the first one.
Rather than healing the nation, as Obama promised during his campaign, passing his signature domestic-policy legislation will tear at the fabric of the country, pulling us further apart.
The American people are on to the game. They know they are being lied to about what the bill will do, with the president and his allies talking about window dressing when people know there will be a flood of red for years to come to pay for new entitlements we can’t afford.
But worse, the bill changes the very nature of the relationship between people and the government. The Senate bill contains at least 163 references to penalties and more than 1,000 new requirements that could bring in the feds.
The House added $10 billion in the second bill so the government can hire at least 16,000 more IRS agents. The government will be able to peer into the books of every company in the country to see if it is complying with the complex rules telling them what health insurance they must provide to their workers and how much they must pay.
In Massachusetts, where a similar mandate already is on the books, business owners have told pollsters that complying with the regulatory red tape of the state’s health-reform law is even more onerous than the cost of providing the insurance.
In addition, every American will be forced to report to the government if they have the required health-insurance policy. Agents soon will be snooping into our health information and health habits and looking at the details of our tax forms to see if we do, in fact, qualify for federal health-insurance subsidies. Fines, penalties, and possibly even jail terms could follow.
Then there will be battles pitting states against the federal government. At least 37 states have introduced legislation saying they will refuse to comply with Washington’s new mandates. And lawsuits already are prepared to challenge the validity of the process and content of Obamacare, likely bringing the Supreme Court into the fray.
Clearly, these us-against-them political games would much better left to the basketball courts than the political process. If this bill is passed, the president may well gain a political legacy, but it’s very likely to be one that he and the country will regret for decades.
And Now, the Kaiser Geyser Grace-Marie Turner, Galen InstituteNational Review Online: Critical Condition, 03/20/10Article availablehere and here.
Politicians just can’t help themselves. Even with all the public outcry about special vote-buying deals in Obamacare, they have put even more of them in the latest iteration. No doubt these provisions are trade-offs for reluctant Yes votes when the final bill comes to the House floor for a vote.
A new deal was tucked into the reconciliation bill for the benefit of Tennessee — which knows all too well that government-run health-reform plans can quickly swamp cost projections. So the bill includes tens of millions of extra Medicaid dollars for the state to help assuage nervous Tennessee Democrats such as Rep. Bart Gordon — who, perhaps not coincidentally, just announced he is a Yes vote. Surprise, surprise.
The Cornhusker Kickback is out of the fix-it bill, but UConn and the Louisiana Purchase stayed in. And a new one has been added, which we’ll call the Kaiser Geyser. This deal seems to bring special benefits to the dominant player in California’s HMO-intensive health sector — Kaiser Permanente, headquartered in Oakland.
Here’s how it works: The Senate bill puts a new tax on health-insurance products, but the reconciliation bill would give non-profit HMOs of the same type as Kaiser Permanente a special break so they only have to pay 50 percent of the tax, while their competitors pay the full freight. Besides Kaiser, other non-profit HMOs that would benefit are the Group Health Cooperative, based in Seattle, and Tufts Health Plan, in Boston.
These HMOs already have advantages because they are exempt from federal income taxes. Now they would be exempt from half of the new excise tax as well. But there’s more: The reconciliation bill also makes it much easier for fully qualified HMO plans like Kaiser, Tufts, and Group Health to get certain quality bonuses through Medicare.
There are a lot of things wrong with this: The government is providing big tax incentives for people to join HMOs, which many people hate, and it seems to be singling out a particular kind of health plan, the biggest one of which is based in California, for favored tax treatment and bonus payments.
Don’t they ever learn?
The Failure of RomneyCare Grace-Marie TurnerWall Street Journal, 03/17/10Article availablehere and here.
Former Massachusetts governor and likely 2012 presidential aspirant Mitt Romney has been on the wrong side of the defining political battle of our time.
Mr. Romney claimed earlier this month on "Fox News Sunday" that the Massachusetts health reform plan he signed into law in 2006 is "the ultimate conservative plan." But there are many similarities between it and the ObamaCare loathed by conservative voters.
Both have an individual mandate requiring most residents to have health insurance or pay a penalty. Most businesses are required to participate or pay a fine. Both rely on government-designed purchasing exchanges that also provide a platform to control private health insurance. Many of the uninsured are covered through Medicaid expansion and others receive subsidies for highly-prescriptive policies. And the apparatus requires a plethora of new government boards and agencies.
While it's true that the liberal Massachusetts legislature did turn Mr. Romney's plan to the left, his claims that his plan is "entirely different" will not stand up to the intense scrutiny of a presidential campaign, especially a primary challenge. Mr. Romney needs to be more honest about his Massachusetts experiment and its failings.
Mr. Romney insisted in a recent interview on "Fox News Sunday" that "our plan is working well," and he defended his state's right to create its own plan. He also said in his book "No Apology" that because of the plan everyone in Massachusetts now has access to "portable, affordable health insurance." Not exactly.
While Massachusetts' uninsured rate has dropped to around 3%, 68% of the newly insured since 2006 receive coverage that is heavily or completely subsidized by taxpayers. While Mr. Romney insisted that everyone should pay something for coverage, that is not the way his plan has turned out. More than half of the 408,000 newly insured residents pay nothing, according to a February 2010 report by the Massachusetts Health Connector, the state's insurance exchange.
Another 140,000 remained uninsured in 2008 and were either assessed a penalty or exempted from the individual mandate because the state deemed they couldn't afford the premiums.
Mr. Romney's promise that getting everyone covered would force costs down also is far from being realized. One third of state residents polled by Harvard researchers in a study published in "Health Affairs" in 2008 said that their health costs had gone up as a result of the 2006 reforms. A typical family of four today faces total annual health costs of nearly $13,788, the highest in the country. Per capita spending is 27% higher than the national average.
The state's stubbornly high health costs are partly the result of intrusive government regulations that stifle competition in the insurance market and strict mandates on what services insurance must cover. A 2008 study by the Massachusetts Division of Health Care Finance and Policy found that the state's most expensive insurance mandates cost patients more than $1 billion between July 2004 and July 2005. The Massachusetts health reform law left all of them in place.
Further, insurance companies are required to sell "just-in-time" policies even if people wait until they are sick to buy coverage. That's just like the Obama plan. There is growing evidence that many people are gaming the system by purchasing health insurance when they need surgery or other expensive medical care, then dropping it a few months later.
Some Massachusetts safety-net hospitals that treat a disproportionate number of lower-income and uninsured patients are threatening bankruptcy. They still are treating a large number of people without health insurance, but the payments they receive for uncompensated care have been cut under the reform deal.
The Bay State is also suffering from what the Massachusetts Medical Society calls a "critical shortage" of primary-care physicians. As one would expect, expanded insurance has caused an increase in demand for medical services. But there hasn't been a corresponding increase in the number of doctors. As a result, many patients are insured in name only: They have health coverage but can't find a doctor.
Fifty-six percent of Massachusetts internal medicine physicians no longer are accepting new patients, according to a 2009 physician work-force study conducted by the Massachusetts Medical Society. For new patients who do get an appointment with a primary-care doctor, the average waiting time is 44 days, the Medical Society found.
As Dr. Sandra Schneider, the vice president of the American College of Emergency Physicians, told the Boston Globe last April, "Just because you have insurance doesn't mean there's a [primary care] physician who can see you."
The difficulties in getting primary care have led to an increasing number of patients who rely on emergency rooms for basic medical services. Emergency room visits jumped 7% between 2005 and 2007. Officials have determined that half of those added ER visits didn't actually require immediate treatment and could have been dealt with at a doctor's office—if patients could have found one.
Mr. Romney insists that in Massachusetts, "We didn't do what President Obama's doing, which is putting controls on our system of premiums for private insurance companies."
But that is what's happening now: Faced with soaring medical expenses, Gov. Deval Patrick, Mr. Romney's successor, wants to cap insurance rate increases at 4.8%, not the 8% to 32% increases the companies have requested for April 1. Three of the four major health insurers in Massachusetts showed operating losses for 2009. If their rates are capped, they say they'll be forced to cut payments to health providers, putting further pressure on doctors and fragile hospitals.
One of the challengers Mr. Romney could face in 2012 is Gov. Mitch Daniels of Indiana. Mr. Daniels went in a very different direction in tackling the problem of the uninsured. He created a program targeted to lower-income uninsured people who weren't eligible for Medicaid or employer insurance. Mr. Daniels's Healthy Indiana program has a fixed budget and relies on shared responsibility between the newly insured and the government in managing health spending.
The nation may well be eager to have a leader in three years with Mr. Romney's experience in tackling and fixing complex systems and who has a record as a successful businessman. But health care is likely to be the defining issue of the 2010 and 2012 elections. Unless Mr. Romney is more honest about the system he set in motion in Massachusetts, he will have a hard time convincing Republican primary voters that he has learned his health-care lesson.
Will Slaughter Rule? The Last Stand for Obamacare Grace-Marie TurnerNational Review Online: Critical Condition, 03/13/10Article availablehere.
This week will be the last stand for Obamacare, and the trickery that Speaker Pelosi is concocting to get the 2,700-page Senate bill through the House almost defies belief. It’s aptly called the “Slaughter Strategy,” after Rep. Louise Slaughter (D., N.Y.), who chairs the House Rules Committee.
Under this scheme, House members would vote on a bill of amendments to the despised Senate bill, and the Senate bill would be “deemed” to have passed if this companion bill is approved. This is supposed to inoculate House members, who could say they never actually voted for the Senate bill.
Former Speaker Newt Gingrich has the best line: Last year, the House was passing bills without reading them. This year, they’re passing bills without voting on them.
If you pull out your copy of the U.S. Constitution, you will find that in Article 1, Section 7, it clearly states that the House and Senate have to pass a bill before it is sent to the president to be signed into law.
The Senate bill is the only realistic vehicle for passage of Obamacare, but so many House members hate various provisions in it that Pelosi can’t round up the necessary 216 votes unless there are major changes. Undecided members say they will buy into the Slaughter Strategy only if they get a guarantee that the Senate will absolutely, positively pass a second health-care reform bill that makes the original Senate bill more to their liking by getting rid of things like the Cornhusker Kickback. (The Louisiana Purchase, apparently, will stay in.)
The Slaughter Strategy would allow the Senate bill to be approved by the House via a “self-executing rule.” (These terms, straight out of a Dickens novel, may well describe what will happen to Democrats who try this.) It is not surprising that Pelosi lieutenant Rep. Chris Van Hollen (D., Md.) has warned members to avoid any talk of the unconstitutional way they plan to pass the Senate bill.
The president has delayed his trip to Indonesia, presumably because the Senate parliamentarian has said the bill must be signed into law before the Senate can begin work on the bill of amendments. Will there be a big signing ceremony? Will House members show up to get their pictures taken as the president signs a bill they despise? Or will there be a stealth signing of the president’s signature domestic-policy legislation?
After he signs, the president will leave the country, and then the process will begin to pass the second health-care reform bill in the Senate. The legislation must go through committee before it comes to the floor for what surely will be a protracted and painful process and set of votes.
There is one simple fact behind all these bizarre contortions of the legislative process: The House completely distrusts the Senate. The House has passed nearly 300 bills that are stuck in the Senate. But House members are told that this time will be different. The House must trust the Senate to wage and win an incredibly difficult battle to pass a second bill to fix the things in the first bill that the Senate approved but the House hates.
Senate Republicans can’t keep the Democrats from reaching the 51-vote threshold for passing measures through the budget-reconciliation process, but they can make sure that any provisions proposed for this process are thrown out unless they strictly adhere to its narrow rules. The bill of amendments likely will be turned into a Swiss cheese. And then Senate Democrats will be forced to take a series of painful votes as Republicans propose amendment after amendment to the bill.
What possible incentive would the Senate have to carry through with this tedious and troublesome maneuver once its own bill has been signed into law? If the Senate fails to do so, House members will be on the hook to defend their votes for all the special deals in the original Senate bill that have repulsed the American people.
The longer the debate goes, the more heat members take, and, as Rep. Bart Stupak (D., Mich.) says, “They just want this over.” But it will be far from over if the House approves the Senate bill. Whether House members vote directly for that bill or for a measure that “deems” it passed, they will still be on the hook for everything in it.
Their leadership should be asking, “Do you want to walk off this cliff yourself, or should I give you a shove?” For House members, the end result is likely to be the same. They are being asked to take a fall so the president can claim passage of a health overhaul bill the American people despise almost as much as House members do.
Rep. Mike Pence (R., Ind.) gave the rallying cry for opponents in a speech this week: “This is a five-alarm fire! Think about the biggest battle you have ever fought and double your effort. This is the most important fight of our time!”
Slaughter Strategy Grace-Marie TurnerHealth Policy Matters, 03/12/10
Here's the bottom line: For health reform to become law, the 2,700-page Senate bill somehow has to get through the House.
The trickery that Speaker Pelosi is concocting to get that done almost defies belief. It's aptly called the "Slaughter Strategy," after Rep. Louise Slaughter, D-NY, who cooked it up.
Here's how it would work: The House would "deem" the main Senate bill to have passed without directly voting on it as long as the House approves a companion bill of amendments to the Senate bill.
Got it? The original bill and the bill of fixes would be tied together on final passage. Enough House members hate provisions in the Senate bill that Pelosi can't round up 216 votes to pass the Senate bill alone.
The Slaughter Strategy (more likely describing what would happen to House members in November if they try this) would allow House members to say they never voted for the Senate bill, just the amendments to fix it.
Former Speaker Newt Gingrich had the best line: Last year, the House was passing bills without reading them. This year, they're passing bills without voting on them.
How is this possibly even remotely constitutional?!
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Five alarm: I attended a meeting in the Capitol on Tuesday with the top Republican leaders from the House and Senate in which Congressman Mike Pence said, "This is a five-alarm fire! Think about the biggest battle you have ever fought and double your effort. This is the most important fight of our time!"
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Trust us! There is one simple fact behind all of these bizarre contortions of the legislative process: The House simply doesn't trust the Senate.
The only way that the legislative process can move forward right now is for the House to pass the Senate bill. Then they have to trust that the Senate will wage and win an incredibly difficult battle to pass a totally separate second health reform bill to fix the things in the bill the House hates.
The operable term here is "Trust us."
"The House has a right to be skeptical," Sen. Richard Durbin (D-IL) told reporters. The House has passed almost 300 bills that are "somewhere lost in the Senate," he said. That includes such things as Cap and Trade legislation that the Senate apparently has no intention of bringing to a vote.
The House will have to believe that the Senate will come through for them and pass a second health care bill to amend problems with the first one.
This reminds me of a line from one of my favorite country and western songs: "Just give me one more last chance."
So the House wants a guarantee that the Senate will vote on a second health reform bill that removes the Cornhusker Kickback, the Louisiana Purchase, Gator Aid, and the dozens of other sweetheart deals in the Senate bill.
But the Senate Parliamentarian told congressional leaders that the Senate can't consider a second bill to amend ObamaCare until the original bill is passed and signed into law.
But what happens if the House "deems" the Senate bill to be passed because it was piggy-backed onto the package of associated amendments?
Under normal procedures, if the House passes the Senate bill, the president will sign it, and ObamaCare will be the law of the land.
In fact, AP reported yesterday: "White House spokesman Robert Gibbs said that if the Senate bill is cleared by the House and reaches Obama's desk, he'll sign it."
The operable question of the day is whether the president could sign a bill the House "deemed" to have passed before the Senate votes on the actual bill of amendments it was attached to.
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Senate strategy: And another thing: There is no "reconciliation package." That would assume some normalcy to the legislative process -- like a conference committee you learned about in civics. They aren't doing that.
The Senate plans to use the process designed for budget reconciliation to get past normal Senate rules that require 60 votes. This ultra-partisan process would be used to consider this totally separate bill that no one has seen yet to amend its own bill to suit the House.
What possible incentive does the Senate have to carry through with this incredibly difficult maneuver once its own bill has been signed into law?
And the battle will be difficult: Senate Republicans have signed a pledge that they are going to hold the leadership to a very strict interpretation of what will be allowed to pass the Senate through the narrow budget reconciliation pipeline. Republicans don't have enough votes to impact the 51-vote threshold for passing the measure or amendments, but they can make sure that any provisions are thrown out unless they strictly adhere to the rules.
Abortion language won't clear the hurdle, and it became clear yesterday that the House is not even going to try to fix the liberal abortion language in the Senate bill. That means Rep. Bart Stupak (D-MI) and other strong pro-life House Democrats will have a very, very difficult time voting for the Senate bill because it clearly allows abortion coverage in federally funded health plans. Jim Capretta has an excellent post today explaining this on National Review.
If the Senate doesn't pass a second health reform bill, that means House members will be on the hook, likely forever, to defend their votes for all the special deals in the Senate bill that have repulsed the American people.
Senate Majority Leader Harry Reid is trying to explain this, clearly saying that passing the Senate bill through the House is the main event: "[T]he reconciliation bill now under consideration would not be the vehicle for comprehensive reform -- that bill already passed outside of reconciliation with 60 votes," Reid wrote on Thursday in a letter to Senate Republican Leader Mitch McConnell. That is, 60 votes before Sen. Scott Brown came along.
Reconciliation is the process through which the Senate may -- or may not -- pass a totally separate, second piece of health reform legislation that would attempt to address some, but surely not all, of the House's problems with the Senate bill.
It would be a long and painful debate in the Senate.
But trust me! They'll do it. If only the House votes first. To pass the Senate bill.
Want to buy a bridge, anyone?
