The Hubbub

Listing all Hubbub postings by date.

'Trust Me,' the Senate Says to the House
Grace-Marie Turner
National Review Online: Critical Condition, 03/12/10
Article available here and here.

Here’s the bottom line: For health reform to become law, House members will have to take a straight up or down vote on the hated, 2,700-page Senate bill.

And 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 amend the original bill.

The swirl of controversy and complexity over the “reconciliation package” has continued all week, kicking up a totally unnecessary dust storm of confusion to obscure this simple process.

It’s straight out of seventh-grade civics class: If the House passes the Senate bill, the president will sign it, and Obamacare will be the law of the land, whether or not the Senate gets around to passing a second health-reform bill. This simple fact seems to be eluding too many people who are tangled up in trying to understand and explain the complexities of the budget reconciliation process and parliamentary procedure.

AP reported today: “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 Senate Parliamentarian ruled today that is what must happen before the Senate can consider a second bill to amend Obamacare.

Speaker Pelosi is trying to line up 216 votes in the House to pass the Senate bill as is. 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 to pass a law. This ultra-partisan process would be used to consider a totally separate bill that no one has seen yet but which is supposed to fix some of the many problems the House has with the Senate bill.

The operable term here is “trust me.”

“The House has a right to be skeptical,” Sen. Richard Durbin (D., Ill.) 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.

But this time, 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.”

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.  They 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 today 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., Mich.) and other strong pro-life Democrats will have a very, very difficult time voting for the Senate bill because it clearly allows abortion coverage in federally-funded health plans.

That also means House members are going to have to trust that the Senate will get them off the hook for their votes on the Cornhusker Kickback, the Louisiana Purchase, and any number of other special protections won to get the votes of senators from Michigan, Florida, and other states and which even President Obama has repudiated.  But the president doesn’t have a vote in the Senate anymore. That means the pork likely stays in the bill, and House members will be on the hook, likely forever, to defend their votes. 

Even Senate Majority Leader Harry Reid is trying to explain the truth, clearly saying that passing the Senate bill through the House is the main event: “The 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 irrelevant and is only a process, not a bill! The confusion comes from the double-entendre of the word: Even House members are being told that their leadership is working out a reconciliation package as though it was a merger of the House and Senate bills.

But it is not. 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? 

Fact Checking President Obama
Grace-Marie Turner
The Missouri Record
Article available here and here.

President Obama will be visiting the St. Louis area Wednesday to garner support for his health reform plan.  As Washington prepares for a final bare-knuckled battle this month, the stakes could not be higher.  With Republicans united in opposition, Democratic leaders are planning to enact a sweeping health overhaul that the American people continue to say in the every way possible that they don’t want.

While the president can make a compelling case for action, his assertions about his plan are not backed by facts.  Based upon his most recent health reform statements, the president will continue to make arguments refuted by the facts and independent analyses when he visits Wednesday.  Here are just a few examples:

President Obama said at the White House on March 3 that his plan will “bring down the cost of health care for millions – families, businesses, and the federal government.”

But the non-partisan Congressional Budget Office (CBO) says health insurance premiums will continue their steady upward climb under the Senate bill.  Families purchasing insurance in the individual market would see an increase of $2,100 in the year 2016, over and above increases they already will be facing.  That means those families would be paying $15,200 in 2016 for health insurance if the Senate bill passes, and $13,100 if it doesn't. 

His legislation will do nothing to slow the steady climb of health costs.  Families who get health insurance through small businesses will be paying $19,200 in six years, and those working for large firms, $20,100, according to CBO.

And the Obama administration’s own Chief Medicare Actuary estimates that, under the Senate bill, "Federal expenditures would increase by a net total of $279 billion" between 2010 and 2019.

So it would cost families, businesses, and taxpayers more, not less, if his plan passes.

President Obama: “If you like your plan, you can keep your plan.”

He claims no one will have to change plans, but at the health reform summit, the president acknowledged that the Senate bill could take away the current health insurance coverage for eight to nine million Americans.

The steep cuts in Medicare Advantage that President Obama supports would mean at least one-third of seniors in Missouri, Illinois and 45 other states likely could lose their comprehensive Medicare Advantage coverage as their plans are forced to withdraw from the program, cut their benefits, or raise premiums (three states received sweetheart deals to protect their seniors from the cuts).  In addition, about 10 million people with employer-sponsored insurance could lose their current coverage, according to the CBO.

President Obama says his plan “brings down our deficit.”

No one believes this to be true and for good reason.  The president and congressional leaders employed trillion-dollar budget gimmicks to make this assertion.  CBO, the budget scorekeeper, was cynically given a bill with ten years of tax hikes and Medicare cuts to pay for only six years of new entitlement subsidies.  The IRS would throw ordinary Americans in jail if they used this type of accounting.

In reality, the ten-year cost of the Senate bill is estimated at $2.4 trillion.  The Senate legislation would significantly expand, not shrink, the deficit.

So just on these three examples – keeping your current coverage, lowering costs, and reducing the deficit – the president’s assertions are wrong.  One hopes his St. Louis speech will not employ what we’ve seen from President Obama throughout this debate: using the same arguments that have been proven as inaccurate by independent studies and analyses, and hoping that maybe, just maybe, this time the speech will work.

Irreconcilable Differences on Federal Level
Grace-Marie Turner
Richmond Times-Dispatch, 03/10/10
Article available here and here.

Talk about hard to swallow. At last Wednesday's White House press conference, President Obama urged Congress to pass his massive health reform bill without Republicans votes. This would be possible only by using a procedural tactic known as reconciliation, which would allow the Democrats to pass their measure with a simple up or down vote. Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi support this move.

Congress never has used reconciliation for such sweeping change. The arcane procedure, first used in 1980, was designed to fast-track legislation affecting budgets and the deficit. The rules for using reconciliation require that everything in the bill must have an impact on federal spending. Debate is limited, and -- perhaps most significantly -- instead of requiring the usual 60 votes, the bill can pass with only 51.

In the past, Democratic and Republican lawmakers alike have resisted using reconciliation except on budget-focused bills. Democratic West Virginia Sen. Robert Byrd led a charge to restrict the use of reconciliation, creating the "Byrd rule" that allows the Senate parliamentarian to strip out any items in the bill deemed "extraneous." Byrd also was among the Democratic leaders who urged President Clinton not to use the reconciliation process to push through his health reform package back in 1994.

And yet in February, four Democrats in the Senate -- Kirsten Gillibrand of New York, Michael Bennet of Colorado, Sherrod Brown of Ohio, and Jeff Merkley of Oregon -- as well as 119 in the House of Representatives signed a letter to Reid urging him to use reconciliation to pass the Senate health care bill and include a public plan. The idea is snowballing with more senators and representatives signing on every week.

Why are some Democrats endorsing reconciliation now? After Massachusetts Sen. Scott Brown's surprise election, Reid doesn't have the 60 votes in his caucus to push legislation over the finish line. But forcing legislation through reconciliation would be a huge mistake.

Former Senate parliamentarian Robert Dove, who has overseen reconciliation measures, recently told reporters the process simply wasn't designed for complex policymaking and would turn any legislation into a Swiss cheese. "It would be very difficult to achieve a number of things that people want to achieve," Dr. Dove said.

While formal debate would be limited to just 20 hours under reconciliation, senators are entitled to offer as many amendments as they want, so at the very least, the American people would witness a long and exhausting vote-a-rama.

More importantly, though, congressional leaders would be thwarting the will of the people who want a smaller, bipartisan bill.

Support for health reform legislation has been tumbling steadily. According to the latest poll from CNN, 73 percent of Americans want Congress to either scrap the current bill and start over or stop working on health reform altogether. Only 25 percent of Americans believe Congress should go ahead and pass health reform.

Democrats promised that passing their overhaul bill would save the average family $2,500 a year, allow everyone to keep their current coverage, reduce the burden of health costs for American businesses, and not add a penny to the deficit. But the best nonpartisan analyses say the legislation passed by both the House and the Senate fails to meet those goals.

For example, the Congressional Budget Office (CBO) says that if the legislation is enacted, families purchasing insurance in the individual market would see an increase of $2,100 in their premiums by 2016, over and above the increases they already will be facing if Congress does nothing. A family would pay $15,200 for health insurance by 2016 if the Senate bill is enacted, and $13,100 if it isn't.

Businesses would face an avalanche of new spending and reporting requirements, penalties, and potential fines under the law --- undoubtedly hurting job growth.

Total spending on health would likely increase too: The chief actuary for Medicare, Richard Foster, found that the Senate bill would bend the cost-curve up, and that new taxes on drugs, devices, and health insurance plans will increase prices and health insurance costs for consumers.

Instead of forcing Americans to swallow this bitter pill, it's time to scrap the current approach and start over, with a smaller, step-by-step approach to reform. With the current Senate bill and with reconciliation, legislators have bitten off more than they can chew. 

Nancy's Nutty New Rules
Grace-Marie Turner
New York Post, 03/10/10
Article available here and here.

The next act in the drive to pass ObamaCare is the mother-of-all political maneuvers -- in which Democrats will use an incredibly convoluted and possibly unconstitutional process.

Things were already arcane: President Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid have been threatening to enact "health-care reform" through the narrow path of budget reconciliation. It's a ploy to allow the Senate to pass "reform" with just 51 votes -- making the election of Scott Brown as the 41st senator against ObamaCare irrelevant.

To use reconciliation, Pelosi must first get House members to vote for the exact bill the Senate passed in December. That is, the House would "keep the process moving" so both the House and Senate could pass a second bill to fix things members don't like in the Senate measure.

But the speaker is having trouble rounding up the 216 votes she needs to get the Senate bill through the House. Her members rightly fear that the Senate might prove unwilling or unable to pass the "fixed" bill -- and, at the least, would have a huge advantage in negotiations over just what "fixes" to make.

The problem is straight out of a 7th-grade civics class: If both houses of Congress pass identical bills, the bill can go to the president to be signed into law.

House members are being told that they must vote for the Senate bill as a procedural step. But the bill would then be only a presidential signature away from becoming law. That is, House members might end up voting for the Senate's Cornhusker Kickback, Louisiana Purchase, "Cadillac" tax, abortion coverage and other unpopular provisions -- and then find it's all become law.

The risks are plain enough that Pelosi doesn't yet have the votes: Her members fear they'll be left hanging to defend their votes for the hated Senate bill.

So now Democratic leaders say they'll package a two-for-one vote: Moving the original Senate bill simultaneously with a "reconciliation" bill -- thus, if the House votes for the bill of fixes, the main Senate bill will be deemed to also have passed. Then the reconciliation bill will go back to the Senate, where it only needs 50 votes (plus Vice President Joe Biden's) to pass.

Hmm. Nowhere in the US Constitution does it say that Congress can deem a bill to have passed. Pelosi & Co. aren't just making up policy as they go, but also procedure -- possibly unconstitutional procedure, at that. All to enact a bill remaking a sixth of the US economy over the 3-1 opposition of the American people. 

Dangerous Negotiations Over Abortion
Grace-Marie Turner
National Review Online: Critical Condition, 03/06/10
Article available here and here.

America’s Catholic bishops are being used in a negotiating ploy that could lead to enactment of Obamacare and to federal funding of abortion.

Representatives of the bishops reportedly are working with the White House and Democratic leaders in Congress to write legislative language that would “fix” the liberal abortion provisions in the Senate health-care reform bill. They are being told that congressional leaders will pledge to enact their abortion protections as separate legislation amending the Senate bill after it’s passed. That is a smokescreen designed to keep the bishops at the negotiating table while the real action to enact Obamacare takes place in the House.

President Obama and his congressional allies are meeting with House Democrats to convince them that they must pass the Senate’s version of the bill “to keep the process moving.” But it’s more than just one step in a process; if the House passes the Senate bill with a simple majority of 216 votes, Obamacare will become the law of the land.

Once that happens, the Senate may, or may not, pass a second bill to “fix” the original bill’s abortion language. It’s far from certain that this will happen; in fact, it would be extremely difficult to do so. Abortion provisions historically have been barred from the 51-vote Senate reconciliation process as being not germane to the budget, and there are not 60 pro-life votes in the Senate to pass such a bill through regular order.

It would be the scam of all time if House members were talked into going first and voting for the Senate bill “to keep the process moving” toward passage of a reconciliation package, only to find that they have put Obamacare over the finish line with no guarantee of any changes. If the House passes legislation identical to the Senate bill, the president will surely sign it, and it will become law. That means House Democrats will have voted for a bill that clearly allows federal funding for abortion, which the U.S. Conference of Catholic Bishops solidly opposes. Any promises that this would be fixed later on won’t be worth the paper they might, or might not, be written on.

The National Right to Life Committee issued a strong statement on Friday saying:
When all of the pro-abortion provisions are considered in total, the Senate bill is the most pro-abortion single piece of legislation that has ever come to the House floor for a vote, since Roe v. Wade. Any House member who votes for the Senate health bill is casting a career-defining pro-abortion vote. A House member who votes for the Senate bill would forfeit a plausible claim to pro-life credentials. No House member who votes for the Senate bill will be regarded, in the future, as having a record against federal funding of abortion . . .
House members who vote for the Senate bill will be accountable to their constituents for what the Senate bill contains, including its pro-abortion mandates and subsidies, without regard to . . . solemn assurances that Congress will revisit the issue in future legislation.

The bishops must insist that the House never votes on the Senate bill, but instead starts with new health-reform legislation that protects against federal funding of abortion. They will have leverage only if protections against abortion are explicitly included as part of a larger health-reform bill.

The House could vote anytime on the Senate bill, and the bishops must not be part of this deceptive and dangerous strategy.

The Route to Reconciliation: The End Game
Grace-Marie Turner
Medical Progress Today, 03/05/10
Article available here and here.

The health reform debate can be bewildering, with thousands of pages of legislation and mind-numbing complexity of parliamentary procedures. But none of that matters now.

The Congress is just one vote away from passing legislation that would put one sixth of our economy under permanent government control. 

How can that be when this legislation is so overwhelmingly disapproved by the American people? 

President Obama and his congressional allies are meeting with House Democrats to convince them to vote for the Senate bill "to just keep the process moving." 

But if the House passes the Senate bill with a simple majority of 217 votes, ObamaCare becomes the law of the land. Nothing else matters. The Senate may, or may not, pass a second bill to "fix" problems the House has with their provisions. It matters not. 

It would be the dupe of all time if House members were to be convinced that they must go first to keep the process moving forward, only to find that ObamaCare has passed the finish line. If the House passes legislation identical to the Senate bill, the president signs it, and it becomes law.

That means House Democrats will be on the hook for a vote for:

The Cornhusker Kickback, the Louisiana Purchase, and every other vote-buying deal buried in the Senate bill. 
Abortion language that clearly allows federal funding for abortion and which the U.S. Conference of Bishops solidly opposes. 
The Cadillac tax on high-cost health insurance policies that labor unions hate. 
Weak enforcement provisions for the individual mandate that health insurers say will cause pools to disintegrate, causing premiums to skyrocket for those still buying policies. 
If the House complies, and Speaker Pelosi is close to having the needed votes, then President Obama would sign his comprehensive health reform plan in the form of the Senate bill the next day, and the job would be done. Any promises that it would be fixed later on aren't worth the paper they might, or might not, be written on.

This is the end game. The White House is going for broke on ObamaCare. 

The End Game for Obamacare
Grace-Marie Turner
National Review Online: Critical Condition, 03/05/10
Article available here and here.

Let's get to the heart of the debate: First, set aside the extraordinary complexity of thousands of pages of health-reform legislation. Next, throw out the labyrinth of impossible details about the Senate reconciliation process. Not important.

Only one thing really matters. And that is convincing the House to pass the Senate bill. Everything else is a side show at best.

White House Press Secretary Robert Gibbs said Thursday the next step is for the House to pass the Senate bill so the process of reconciliation can move forward. The president says he wants this to happen by March 18 — two weeks from now.

But if the House passes the Senate bill exactly as written, Obamacare becomes the law of the land. The deal will be done.

The president wants the House to go first with the promise that problems would be fixed in subsequent legislation.

But if the House passes the Senate bill, there is no need for another bill. President Obama would be able to sign this massive 2,700-page Senate bill into law the next day, and it is done. Any promises that it would be fixed after that aren't worth the paper they might, or might not, be written on.

The White House is desperately trying to find every vote possible to get to the current majority number of 216 votes in the House to pass Obamacare. The president cleared his schedule Thursday afternoon for marathon meetings with House members.

Rep. Bart Stupak, Democrat of Michigan, said on ABC that he and eleven colleagues who voted for the earlier version of the House bill will vote "no" this time if abortion language isn't changed from the Senate version.

"Let's face it, I want to see health care," Stupak said. "But we're not going to bypass some principles and beliefs that we feel strongly about."

But they and others are being told that if they want health reform, they have to take the first vote so the leadership has a bill to fix. 

The package of fixes being negotiated between Stupak and others is a distraction at best.

Once House members take the vote on the Senate bill, they have absolutely no control over what the Senate does next. The Senate may or may not be able to get a second bill passed to address concerns of the House.

And that means House Democrats will have taken the fall by voting for:

• The Cornhusker Kickback, the Louisiana Purchase, and every other vote-buying deal buried in the Senate bill.

• Abortion language that clearly allows federal funding for abortion and which the U.S. Conference of Bishops solidly opposes.

• The Cadillac tax on high-cost health-insurance policies that labor unions hate.

• Weak enforcement provisions for the individual mandate that health insurers say will cause pools to disintegrate, causing premiums to skyrocket for those still buying policies.

And that's just for starters.

It would be the dupe of all time if House members were to be convinced that they must go first to keep the process moving forward, only to find that Obamacare passes the finish line in the form of the Senate bill.

It will be interesting to watch conservative Democrats this fall trying to explain to constituents, who already have told them in no uncertain terms that they hate this legislation, that they were promised that they would have a second chance to take a vote to fix it.

In this game, there will be no second chances. 

Congressional leaders are making plans to pass health reform in a stealth maneuver that is in full view of the nation. Astonishing.

Obama’s prescription for health reform more of the same
Grace-Marie Turner
The Daily Caller, 03/05/10
Article available here and here.

There was absolutely nothing new in President Obama’s much-heralded speech Wednesday. No game-changing ideas. No genuine efforts at bipartisanship. No change in his determination to impose government control over our health sector for decades to come.

Worse, the president repeated the arguments he’s been using for a year, which have been proven wrong by numerous independent studies. Take just three examples from his White House speech on Wednesday:

President Obama: “If you like your plan, you can keep your plan.”

The steep cuts in Medicare Advantage he supports would mean at least one-third of seniors likely could lose their comprehensive Medicare Advantage coverage as their plans are forced to withdraw from the program, cut their benefits, or raise premiums. In addition, at least 10 million people with employer-sponsored insurance could lose their current coverage, according to the Congressional Budget Office.

Mr. Obama himself acknowledged at last week’s health reform summit that “8-9 million people…might have to change their coverage.”

President Obama said his plan will “bring down the cost of health care for millions—families, businesses, and the federal government.”

The Congressional Budget Office has reported that health insurance premiums will continue their steady upward climb under the Senate bill. Families purchasing insurance in the individual market would see an increase of $2,100 in the year 2016, over and above increases they already will be facing. That means those families would be paying $15,200 in 2016 for health insurance if the Senate bill passes, and $13,100 if it doesn’t.

Families that get health insurance through small businesses will be paying $19,200 in six years, and those working for large firms, $20,100.

PricewaterhouseCoopers released a study, commissioned by America’s Health Insurance Plans, which showed the cost of a family plan in 2019 would be $4,000 a year higher if reform passes.

And Chief Medicare Actuary Rick Foster estimates that, under the Senate bill, “Federal expenditures would increase by a net total of $279 billion” between 2010 and 2019. So his plan would cost families, businesses, and the federal government more, not less.

President Obama said his plan “brings down our deficit.”

Congressional leaders hammered the CBO into submission as they drafted their legislation, using the CBO’s scoring tactics against them to pretend the legislation reduces the deficit.

But former CBO Director Doug Holtz-Eakin concludes the bills “can claim to be deficit-neutral only because during its first decade it offers 10 years of taxes compared with six years of subsidies. “The Republican staff of the Senate Budget Committee estimates that, fully implemented, Democratic legislation would cost $2.4 trillion over 10 years, nearly three times the cost projected by the Congressional Budget Office,” Holtz-Eakin said. This would significantly expand, not shrink, the deficit.

Further, CBO shows the Senate bill double-counts Medicare savings. Savings to the Medicare program “would be received by the government only once … they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs.”

Medicare Chief Actuary Richard Foster made the same point: A series of accounting maneuvers makes it appear that Medicare’s Part A trust fund would be in better shape under the Senate bill that is the basis of the president’s plan, but that’s not so. “In practice, the improved Part A financing cannot be simultaneously used to finance other Federal outlays (such as the coverage expansion under [the Senate bill]) and to extend the trust fund,” Foster wrote.

Further, Foster said, making the cuts to Medicare that the Senate bill requires in order to get its deficit score would “represent an exceedingly difficult challenge.”

So just on these three examples—keeping your current coverage, lowering costs, and reducing the deficit—the president is wrong. It is though he simply dusted off the same speech he has been giving for a year, using arguments that have been proven as inaccurate by independent studies and analyses, and hoping that maybe, just maybe, this time the speech will work.

The president and his aides may twist arms and torture Congress into passing ObamaCare, but the more he forces this through, the more the American people are going to reject being force-fed a health plan they strongly oppose.

A Far Cry from Argentina
Grace-Marie Turner
National Review Online: Critical Condition, 03/03/10
Article available here and here.

Newsweek’s Howard Fineman writes, in his latest column, about the hospital care he received for a severe bout of food poisoning during his recent trip to Argentina. His conclusion, after covering health reform in the United States for a year, is that the health-reform debate here needs to be about cost.

Yes, cost. And quality. And access.

Fineman was treated in a private hospital in the resort town of Bariloche, where he was visiting his daughter. “I got great care at a tiny fraction of what the cost would have been in the U.S. — even correcting for cost-of-living and currency values,” Fineman writes.

He estimates the hospital bill in the United States would have been $10,000 to $15,000. Later in the article he says:

In figuring the bill, let’s say that, since the Argentine peso is worth about one forth [sic] of a U.S. dollar, the “real” cost of my care in Bariloche was $6,000. That is still about half of what I would have paid back the United States.

A tiny fraction? About half? What’s the difference when you’re talking about a model for reforming the $2.5 trillion U.S. health-care economy? Nonetheless, he seems to argue that the Argentine hospital’s lower-tech approach to care suited him just fine.

He notes in an off-handed comment that “most Argentines rely on a rickety public system” while those who are “better off rely on private, for-profit hospitals.” Two-tier medical care is what most socialized health systems produce: There’s a rickety public system with waiting lines and limited access to new technologies, while those who can afford to pay privately buy their way out, either at private hospitals like the one Fineman was in, or by traveling to the United States, as the premier of Newfoundland did when he flew to Florida for heart surgery last month. When interviewed about escaping the Canadian system for the U.S., Premier Danny Williams said unapologetically, “I did not sign away my right to get the best possible care for myself when I entered politics.”

Oh dear.

There are many reasons that care may be less expensive in Argentina than in the U.S., even at a private hospital. Just for starters: Argentina has a lower cost of living and lower wages; its legal system does not expose doctors to huge medical liability costs; many fewer citizens have access to the latest medical technologies; and they spend a fraction of what the U.S. spends on research and development of new medicines and technologies that the rest of the world relies on.

I’m glad that Howard was able to get good care in Argentina. I’m also pleased that he sees the importance of cost: If health care and health insurance were more affordable, millions more would have insurance. And I’m pleased that he has now seen what happens when you have a centralized, government-run health-care system: Rich people buy their way out.

Last spring I was in Guatemala for a conference of the Association of Private Enterprise Education, and I visited a state-of-the-art hospital in Guatemala City that is one of a network of six private hospitals operated by the Grupo Hospitalario Guatemala. This, too, was a private hospital catering to an affluent, private-paying clientele.

The hospital was as modern and as well equipped as you would find in any American city, with nuclear-medicine diagnostic equipment, cardiac surgical centers, neonatal intensive-care units, four operating rooms, and much more. Most doctors are board-certified in the United States. This is in sharp contrast to the crowded, poorly equipped, and understaffed public hospitals in the country’s universal health-care system.

All payment at Grupo Hospitalario Guatemala is private, and prices are posted up front, with payment plans available. Prices often depend upon convenience and amenities — MRIs cost less at night, for example. The most common surgeries are for gastric bypass. A private hospital suite costs about $85 a night, with a one-to-one nurse-patient ratio. Surgical charges are about 25 percent of prices charged in the U.S.

The real solution in the U.S. is to give people an incentive to understand the cost of the care they are receiving and get the best value. That is the path to a health-care system that provides good-quality, affordable care to everyone. And that is precisely the opposite of the approach that Congress currently is taking with its health overhaul legislation, turning us instead toward a system of government control that will inevitably lead to the two-tier medicine that we see in other countries that have traveled this path — and that those who support this legislation surely would decry.

Doubling Down
Grace-Marie Turner
National Review Online: Critical Condition, 03/03/10
Article available here and here.

The president’s determination to enact his collectivist health-reform agenda at any political cost despite overwhelming public opposition is unprecedented in modern times.

Today, Mr. Obama is expected to say he will not heed the will of three-quarters of the American people who either want Congress to stop work on health reform altogether or start over, and will instead tell Congress to charge ahead through the minefield of budget reconciliation to pass a bill that will put one-sixth of our economy under government control.

Rational arguments and facts are discarded. When Rep. Paul Ryan (R., Wisc.) detailed at the summit the budget gimmicks in the bills that would put executives of private companies in jail, the president just brushed past his remarks and said he “disagrees.”

That means Mr. Obama disagrees with the Congressional Budget Office and the chief Medicare actuary whose analyses are based upon the facts of his double-counting of Medicare savings, ten years of taxes with six years of spending, creation of new budget-busting entitlements, one-fifth of Medicare providers going out of business and jeopardizing care for seniors, and health-insurance premiums rising even faster if the bill is passed than if not.

The president’s offer to adopt four Republican ornaments, including one very bad idea by Sen. Tom Coburn, is a joke. Senator Coburn’s idea to send federal undercover agents into doctors’ offices to pose as patients is a police-state tactic that will compromise care for every patient and make it even more difficult for new patients — strangers who might be federal plants — to get appointments.

The White House clearly has no new ideas. The president is expected to ask the Senate to twist its rules to force its health-overhaul legislation through a process designed exclusively for budget and spending-related issues. These are desperate, hard-ball political tactics.

In order to move the president’s process forward, House members who fear for their political lives will be forced to vote for a Senate bill that they hate. That means they will have to vote for a bill that contains the Cornhusker Kickback, the Louisiana Purchase, the Union Payback, and liberal abortion language. And then they must trust that the Senate can't fix it through a second reconciliation bill that also must pass both houses of Congress, followed by a likely third piece of legislation to address changes that can pass through reconciliation. That is going to require an unprecedented level of trust that no one has seen on Capitol Hill in a very long time.

The American people are doing everything they can to stop this. If Congress manages to pass this before the Easter Recess as planned, the uprising during Easter recess town-hall meeting will make August look like a children’s tea party.

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