Liberals Bark Back

Roll Call is reporting that, “House Energy and Commerce Chairman Henry Waxman (D-Calif.) postponed the health bill markup that he planned to hold Wednesday afternoon amid a backlash from liberals to the deal that he cut earlier with four conservative Blue Dog Democrats. ”


The weakening of the public option incensed some liberal Members, with Congressional Progressive Caucus Co-Chairwoman Lynn Woolsey (D-Calif.) declaring she would vote against it.

“It has to be much stronger to get our support,” Woolsey said after a meeting with Speaker Nancy Pelosi (D-Calif.), who tried to sell them on the deal.

The big beef liberals have is that they don’t want the government plan to negotiate rates as the agreement with Blue Dogs calls for, but to use Medicare rates — which is what they typically mean by “strong public option.”

Woosley said, “We’ve got a long way to go before this gets to the House floor.”

This is a dynamic I’ve been trying to focus on. Or as I put it last month, “Will the Left Kill Health Care Reform?”

Blue Dogs Wave White Flag

As many had speculated, the bark of the Blue Dog Democrats has proven bigger than their bite, and they have now struck a deal with Henry Waxman that should move the bill out of the House energy and Commerce Committee, while extracting an agreement that would put off a floor vote by the full House until after August recess.

The Politico has these details of the deal:

The Blue Dogs also succeeded in cutting $100 billion from the overall cost of the bill, bringing the total price tag under $1 trillion. The legislation will now exempt small businesses with a payroll greater than $500,000 from paying for any government-sponsored health coverage – double the $250,000 in the initial draft. And finally, under the terms of the deal Ross announced, doctors and other health care providers will be allowed to negotiate their payment rates with the government-sponsored health care arm.

Assuming these are all the changes, it wouldn’t alter the overall infrastructure of the bill. It would still mean a massive expansion of Medicaid, providing subsidies for people to purchase government-designed insurance policies on a government-run exchange, creating a new government-run health care program that would put the nation on a pathway to single-payer, mandates on individuals to purchase insurance or pay a tax, and a tax hike on employers that did not provide health care to their workers. And it’s not clear how many of the compromises will be adopted by the full House once this bill is reconciled by the two other committees.

But by delaying the full House vote until September, it means that there will still be time for Blue Dogs to change their mind on the final bill if they take a lot of heat from their constituents during August recess.

UPDATE: In the Politico quote, “greater than $500,000” should be “less than $500,000.”

Enzi Said Finance Committee Deal Not Even Close

Sen. Mike Enzi, one of three Republican Senators involved in the Finance Committee negotiations, has just released a statement pushing back against media reports that the committee was on the verge of a bipartisan compromise:

“We still have several areas where we haven’t been able to come to a consensus. No deal is at hand and substantive issues, big and small, remain under discussion and need to be resolved.  We need to keep working together.

 “I will need to see complete language and a final estimate from the Congressional Budget Office before I can agree to any health care reform bill…

 “I also need commitments from Senator Reid and Speaker Pelosi, as well as the Administration, that the bipartisan agreements reached in the Finance Committee will survive in a final bill that goes to the President.”

If Enzi means what he says, his demand makes it effectively impossible for him to back a compromise. There’s absolutely no way that Pelosi, Reid and Obama would preemptively agree to a deal that included neither a government-run plan or an employer mandate just to attract the support of a lone Senator of the minority party. And even if they were willing to, they don’t have the power to guarantee that liberal members would go along with any such deal. After reading this statement, I’m starting to think that we may see Enzi follow Orrin Hatch’s lead, and drop out of negotiations.

Health Care Squeezing Out “Card Check”

As health care gets bogged down in the legislative process, it is also sucking up so much oxygen on Capitol Hill, that it’s making it harder for Democrats to push other aspects of their agenda. And today, Congress Daily reports:

Senate efforts to compromise on a watered-down version of the Employee Free Choice Act have been put firmly on the chamber’s back burner — perhaps for the rest of the year — as senators, aides and lobbyists focus on health care and other legislation, participants said.

 “We’re not doing anything right now,” Sen. Tom Harkin, D-Iowa, said of talks he has led among a group of Democrats since it became clear in late March that a more ambitious “card check” bill to help unions organize could not win 60 Senate votes.

“We’ve got the healthcare bill; we’ve got appropriations bills, and we’re lacking two senators that we need right now,” Harkin said in an interview. “Nothing is happening on that right now.”

“Cost-Containment” in Obama-ese

After the Director of the Congressional Budget Office, Doug Elmendorf, delivered a serious blow to President Obama’s credibility on health care when he testified that none of the current Democratic bills does anything to control costs — the stated goal of reform — the White House responded with a novel idea: create a commission! The new Independent Medicare Advisory Council would be for a panel of experts chartered to make recommendations on how to contain costs in Medicare. But when Obama was asked about it during yesterday’s AARP townhall, he backtracked that cost-containment actually the point of the commission. Er, maybe he didn’t. Okay, let’s just look at the relevant portion of the transcript (with emphasis on my part):

Q    Hello, Mr. President.  My question is some concern we have about the possibility of a cost containment commission.  If you could comment on that.

THE PRESIDENT:  The idea is not the cost — it’s not a cost containment commission that’s been proposed.  It’s been what I just described — an independent medical advisory committee modeled on the kind of committee that is called MedPAC right now.  It’s got people who are health care experts, nurses, doctors, hospital administrators.  The idea is how do you get the most value for your health care dollar.

Now, the objective is to control costs.  But it’s not cost containment by just denying people care that they need.  Instead it’s reducing costs by changing the incentives and the delivery system in health care so that people are not paying for care that they don’t need.  The more we can reduce those unnecessary costs in health care, the more money we have to provide people with the necessary costs — the things that really pay high dividends in terms of people becoming healthier.

Got that? It isn’t a cost-containment commission even though its objective is to control costs. I can think of no more concise demonstration of Obama’s double-speak on health care. The problem Obama faces is that he wants to push the idea that he’s going to reduce Medicare spending to satisfy the CBO and those concerned about exploding deficits, but he doesn’t want senior citizens to think any of the cuts will affect the care they currently receive. And this gets to the heart of his failure as a leader — his inability to acknowledge that tradeoffs exist. This has been the case no matter the issue. He wants to drastically increase spending and reduce the deficit while maintaining that he’ll cut taxes on 95 percent of Americans and only raise them a slight amount on the very wealthy; he claims he’ll rein in entitlement spending by creating a massive new entitlement; he argues that a national energy tax (which he won’t admit is a tax on energy) will help the environment and improve the economy at the same time; and he says that we can give health insurance to 46 million more people, save money, improve the quality of care, and avoid rationing.

But for a moment, let’s take Obama at his word. Let’s say that the $622 billion in Medicare cuts he’s proposed would merely eliminate waste, fraud, abuse and inefficiency and would not affect care. And let’s say that the proposed Medicare panel finds that billions more are being thrown away by Medicare, and simply paying for services that patients don’t need. Uh, doesn’t that kind of undermine Obama’s case that we need to create a new government-run health care program because it will be efficient and have low administrative costs?

Gallup Suggests Obama Losing the Health Care Battle

Gallup delivers a sober analysis its latest health care poll findings: “These results do not coalesce into a terribly optimistic picture of Americans’ views of the perceived impact of healthcare reform.” That would be putting it mildly. The findings show that Americans are not buying President Obama’s claims that legislation would improve quality, expand access, and reduce costs among the general population, and the numbers get worse when people are asked how they think the proposed changes would effect them personally.

Specifically, the poll found a minority 44 percent thought legislation would improve the nation’s medical care, while just 26 percent said it would improve their own; 47 percent said it would expand access overall, compared to 21 percent who said it would expand their own access; just 30 percent bought the idea that health care costs would go down, and only 18 percent said their own costs would fall.

Put it all together, and it means that Obama’s arguments have failed to convince a skeptical public as it is, and his approval ratings continue to get worse with each passing day. (See: NPR Poll Finds Tough Sledding For Obama.)

UPDATE: The NPR poll also found, “when asked about the plan now moving through Congress, a plurality of 47 percent was opposed and 42 percent said they were in favor, based on what they had heard about the plan so far.”

Waiting for Finance

The health care push is deadlocked right now as everybody waits to see what emerges from the Senate Finance Committee, where Republicans Chuck Grassley, Mike Enzi and Olympia Snowe are trying to hash out a deal with Democratic Chairman Max Baucus and two other more moderate Democrats. But the dribs and drabs of information we do have about what they are considering make it sound like a plan that would be acceptable neither to conservatives nor liberals. From what we know so far, that the deal is likely to create some sort of non-profit co-op insurer to compete with private insurers as a substitute for creating a new government-run plan and it will drop a mandate that would tax employers who did not provide health care. 

For liberals, this would simply be unacceptable. To them, the creation of a government-run plan is not just one feature among many, but the central part of reforming the health care system — this is especially true among those who are single-payer advocates at heart. And liberals don’t think that a non-profit co-op would have the scope to really drive down prices and threaten private insurers (or as they would say, “keep private insurers honest”). Asking them to drop a government plan is difficult enough as it is, but to also drop the idea of an employer mandate will be even harder to swallow. Furthermore, as we’ve seen so far, having an employer mandate helps the evaluation of the Congressional Budget Office. Not only does the tax raise some money and help marginally with financing, but the CBO thinks that if employers would face a penalty for not providing coverage, few would drop coverage — meaning the mandate makes it easier for Democrats to claim that people who like the insurance they have, can keep it, and helps them get closer to universal coverage. Absent the mandate, the CBO has found, a lot more employers would drop coverage — providing Republicans with the talking point that millions would lose their employer-based health care.

At the same time, assuming the agreement maintains features of other bills, I don’t see how it would be acceptable to any actual conservative. While a co-op would not be as bad as a government-run plan, we’d most likely still end up with a system in which government provides subsidies to individuals to purchase government-designed insurance from a government-run exchange. And if they want the CBO to score the bill as coming close to universal coverage, those subsidies would have to be generous, and the bill would also have to include an expansion of Medicaid. Both in terms of regulation and the creation of the exchange, you’d still be creating the infastructure for the eventual government takeover of health care. You’d basically have a system like the failed and financially unsustainable model they have in Massachusstets. As time goes by, Congress could easily make more people and employers eligible to join the exchange, and perhaps add a government plan down the road (or even take over the co-op plan if it runs into trouble).

Politically, a Finance Committee agreement before recess would provide some face-saving momentum for the Obama administration, and allow them to point to some bipartisan cooperation. But I don’t see how it solves the larger issue — how do you create a bill that is acceptable to both liberals and moderate Democrats?

President Obama’s $6,000 Lie

During last week’s prime time press conference, President Obama incorrectly said the United States spends $6,000 more per person than any other country in the world. Perhaps his defenders would chalk it up to an honest mistake he made during a long press conference. But the problem is, he not only repeated, but elaborated on the error this time, making additional factual errors.

Here’s Obama during this afternoon’s townhall with AARP, based on the official White House transcript:

Last point I would make, just to give you a sense of why I know that we can get savings in the system without over the long term spending more money.  We spend about $6,000 per person more than any other industrialized nation on Earth — $6,000 more than the people do in Denmark, or France, or Germany, or — every one of these other countries spend at least 50 percent less than we do, and you know what, they’re just as healthy. 

However, if you look at OECD data (which can be downloaded here), you will find the following statistics for per capita health care costs, adjusted for purchasing power parity:

United States: $7,290

Denmark: $3,512

France: $3,601

Germany: $3,588

Obama is correct that all of those countries spend less per person on health care, but it isn’t anywhere near $6,000 less. The widest gap among the countries mentioned, between the U.S. and Denmark, is $3,778 per person. Of course, other systems don’t keep costs down with magic wands, but with rationing care to the sick — something Obama denies he wants to do in the U.S.

AARP Goes to Bat for Obama Again

Last week, I detailed the cozy relationship that AARP has developed with the Obama administration. Today, the nation’s largest organization of older Americans has devoted the front page of its website to promoting a telephone town hall meeting with President Obama at 1:30. You can register to attempt to ask a question here.

 The group already has a Q&A up trying to counter legitimate concerns about his proposals. A sample:

Why is AARP not standing up for seniors when Obama says he will cut Medicare to help pay for health care?

The proposed changes to Medicare will help to get fraud, waste and abuse out of the system and create payment incentives to reward doctors and hospitals for the quality, rather than the quantity, of care they provide. They will not cut the benefits our members rely on in the traditional Medicare program, but will help to keep it affordable to make sure you get the care you need.

Isn’t this socialized medicine?

No. In socialized medicine the government directly owns the hospitals and directly employs the doctors. No one in Washington is talking seriously about anything like that. What health reform will do instead is provide people with a system much like the one members of Congress enjoy today. They will be able to choose from a range of quality, affordable private health plans, and possibly a publicly run option as well. These plans will have to accept everyone regardless of preexisting conditions or age. There also will be sliding-scale subsidies for people with moderate to low incomes to make sure the coverage is affordable for everyone.

If you can’t tell much difference between the spin given by AARP and what you hear from Obama himself, that’s because there isn’t any. AARP has essentially turned the organization into a de facto branch of the White House media operation. The group, which bills itself as nonpartisan, has thrown its full weight behind Obama’s health care proposals even though they would slash Medicare spending by $622 billion. As a conservative, of course, I’m all for reining in entitlement spending, but this is a group that spreads fear whenever Republicans try to do anything about the issue, no matter how modest. As I previously noted, in 2006, when Bush proposed far smaller Medicare cuts of $105 billion over 10 years, USA Today quoted an AARP spokesman as saying, “The Congress, in an election year, is not going to pass these disastrous provisions.”