Consumer Directed Healthcare

By Madison Park, CNN

Spurred by Apple co-founder and transplant recipient Steve Jobs, the bill has gained support from major politicos, including California Gov. Arnold Schwarzenegger, and is expected to land on his desk this summer.

Meanwhile, on the East Coast, a far more sweeping transplant bill would make every person an organ donor who doesn’t opt out. This would create an organ donation system in New York similar to the ones used in several European countries, but the measure is already facing opposition.

The two states have vastly different bills, but their intents are the same.

With more than 100,000 U.S. patients waiting for organ transplants, better methods of encouraging organ donations are needed, supporters say.

California

This bill creates a living donor registry for kidneys. Read the bill (enter SB 1395)

Patients who need kidney transplants often have friends or family members who are willing to donate their organs. But sometimes, these organs do not match.

Registries have been set up on the Web or by transplant centers where kidney patients and their donors seek to swap organ matches.

Having a state registry would “take it from a process that has been spontaneous and driven by the Web into a more organized fashion, that allows transplant centers to feel a greater degree of security and confidence,” said Dr. Bryan Becker, the president of the National Kidney Foundation, which supports the California bill.

The registry might increase the number of transplants, he added. About one-third of U.S. kidney transplants come from living donors.

Jobs, the CEO of Apple, was a major player in bringing the bill to the forefront, said Schwarzenegger, in a March 19 press conference.

“He’s a wealthy man,” Schwarzenegger said at the news conference. “That helped him get a transplant. But he doesn’t want that — that only wealthy people can get a transplant.”

A pancreatic cancer survivor, Jobs received a liver transplant at Methodist University Hospital Transplant Institute in Memphis, Tennessee, last year.

Livers are scarce, as only about one-third of the people on the national transplant waiting list receive one. Jobs’ transplant stirred controversy about whether celebrity and wealth gained him an advantage.

“He wants every human being — if you have no money at all or you’re the richest person in the world — everyone ought to have the right to get a transplant,” Schwarzenegger said. “This is why he has talked to my wife; he has talked to me to put the pressure on us to get this bill going so there’s enough organs available for all the potential recipients.”

Jobs spoke at the conference and noted that more than 400 Californians died waiting for a liver transplant.

“Last year, I received a liver transplant. I was very fortunate because many others died waiting to receive one while I received one…” he said. “I was almost one of the ones who died waiting for a liver in California last year.”

The bill is expected to be at the governor’s desk by July or August.

Also under the proposal, residents would be asked whether they would like to become organ donors when they receive or renew their driver’s licenses or identification cards. If they leave the box unmarked, a clerk will verbally ask the question.

New York

A New York assemblyman whose daughter’s life was saved by two kidney transplants said he wants more organ donations. One of Assemblyman Richard Brodksy’s most controversial ideas: Make everyone an organ donor unless the individual opts out.

This is also known as “presumed consent” — a marked departure from what’s done in the United States. Several European countries, such as Spain, France, and the Netherlands operate on this concept. Brodsky said this would save more lives.

“We can trust the decency of the American people,” Brodsky said. “But the government needs to come up with a program that lets people express that decency. That’s what’s missing — a connection between the fundamental goodness of the American people and a system that is not producing the organs that save lives.” Read Brodsky’s bill here

Every year, 500 New Yorkers die waiting for an organ transplant, he said.

Another one of Brodsky’s bills would prevent relatives from overriding organ donation decisions made by the deceased.

He became inspired by his 18-year-old daughter, Willie Brodsky, who had transplants because of an autoimmune disease.

While sympathizing with Brodsky’s perspective, Tarris Rosell, a chairman at the Center for Practical Bioethics in Kansas City, Kansas, said presumed consent infringes on individual’s rights.

“The saving of life is a deep, American value, but in this sort of situation, such as presumed consent, it goes up against other American values, like right to privacy, even property rights, which begins with our bodies and a deeply inscribed individualism,” he said.

Some religious and cultural beliefs value the integrity of the body and oppose organ donations, he added.

United Network for Organ Sharing, a nonprofit organization that administers the nation’s organ matching and placement process, does not support presumed consent, because of “inadequate safeguards for protecting the individual autonomy of prospective donors.”

These recent proposals in New York and California do not mean that public opinion toward organ donations is changing, said Sheldon Kurtz, a law professor at the University of Iowa who has drafted organ donation legislation.

“You can’t assume because bills are pending that public opinions have changed,” he said.

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By Parija Kavilanz, senior writer
CNNMoney.com

NEW YORK (CNNMoney.com) — The new health law puts the nation’s hospitals on strict notice.

Either they improve the safety and quality of care for patients or the government will hit them where it hurts the most — their revenue.

The legislation contains dozens of provisions, including fining hospitals, to reduce medical errors, hospital-borne infections and costly preventable readmissions.

Those three issues alone drain billions of dollars annually from the health care system.

Industry watchers and consumer advocates say the measures were sorely needed and will go a long way to protect patients and enhance efficiency in the system.

But for hospitals, the new law could present a tough challenge.

Preventable readmissions: These cost the health care system about $25 billion every year, according to consulting firm PricewaterhouseCoopers.

To tackle the problem, beginning in 2012, the Department of Health and Human Services (HHS) will publish each hospital’s readmission track record.

Experts say high readmission rates — when patients return within 30 days of discharge — indicate hospitals aren’t adequately addressing patient issues or they’re discharging them prematurely.

In 2012, Medicare will stop paying hospitals for preventable readmissions tied to health conditions such as heart failure or pneumonia. In 2014, HHS will expand that policy to cover four additional health conditions.

Medical harm: The second penalty for hospitals is tied to hospital-acquired conditions stemming from medical errors or infections.

Here, the government has set a carrot-or-stick approach.

For instance, the government currently gives hospitals an incentive payment for simply reporting their performance on things like patient satisfaction and care quality tied to treatment of conditions such as heart failure, pneumonia and hospital-borne infections.

That’s changing.

Under the legislation, hospitals won’t be paid for just reporting their performance, but beginning in 2012, will be paid commensurate to their score. Higher scoring hospitals will receive higher payment and vice versa.

In 2015, HHS will also start reporting each hospital’s record for medical errors and infections pertaining to Medicare patients.

About 15 million instances of injury or harm as a result of a medical treatment occur every year in the United States, according to non-profit group the Institute for Health Care Improvement.

These include more than than 30,000 people who die annually from catheter-related blood stream infections, according to consumer advocacy group Consumers Union’s Safe Patient Project.

In 2015, Medicare will reduce its payments by 1% to hospitals with the highest rate of medical errors and infections. The government will also no longer pay hospitals for treatment when a Medicaid patient is harmed during a hospital stay.

Doctors: A tough job just got tougher
A medium-sized general hospital could lose upward of $1 million a year from these penalties at a time when all providers are struggling to keep up with escalating health care costs.

“That’s real money,” said Brad Bowman, director with PricewaterhouseCoopers’ health care advisory practice.

On top of that, Bowman warned of an even bigger risk to hospitals — a tainted reputation.

“Think about a town with three or four hospitals,” said Bowman. “Once the local press has access to hospitals’ detailed quality and performance scores, consider the impact a story about a poor-performing hospital can have on its business.”

It will be many times more than the dollars lost to penalties, he said. “Guess what? People will now say ‘Don’t take me to hospital D but to hospital A.’”

For its part, hospitals’ main trade group, the American Hospital Association (AHA), said it is supportive of some provisions but concerned about others.

“The penalties are intended to send a strong message from Congress that they want hospitals to be efficient and keep patients safe,” said Nancy Foster, AHA’s vice president of quality and patient safety. “That’s exactly what our members are working hard to do.”

Regarding readmissions, Foster said the government has to be “strategic” about how to bring down what it labels “preventive” readmissions.

“You don’t want a fear of penalties preventing hospitals from readmitting people who may need to come back soon after they were released,” Foster said, adding that many times, patients’ economic status prevents them from properly following post-hospital care and thus landing them back in a hospital.

“We’re eagerly awaiting regulations that improve these provisions to make sure these types of cases are thought about,” she said.

If regulations aren’t sensitive to people’s social issues, she warned that the measures could frequently punish hospitals that cater to the disadvantaged population.

Michael Young, CEO of Atlanta-based Grady Memorial, one of the largest public hospitals in the nation, said Foster makes a valid point.

As many as 95% of Grady’s patients are in the low income bracket and 40% of those don’t have insurance, which forced the hospital to provide $300 million in “free care” last year.

“When these patients can’t pay for things like home nurse care and readmissions go up, it’s the hospital that’s getting blamed under these measures,” he said.

“The legislation is a step in the right direction but the penalties are a legitimate concern,” Young said. “For public hospitals, the next five years will be a tremendous challenge.”

A victory for consumers
From a consumer perspective, PWC’s Bowman said the law is a big win.

“Up until this point, consumers have had so little information on health care providers,” he said. “You can get more information easily on a company’s stock in India than on a hospital down the street.”

The law, he said, cracks this door open so that consumers can make more informed choices about providers.

Lisa McGiffert with Consumers Union Safe Patient Project, agreed. “These measures put us on a path to improving care because when you change their payment structure, the behavior in hospitals improves.”

And even though most of these measures affect public insurance payments, McGiffert is hopeful of a knock-on effect on private insurance payments as well.

“As Medicare goes, typically so do other private insurers,” she said. “Medicare by virtue of being the largest insurance program in the country is considered the trendsetter for insurers and providers.”

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Business Insurance

By Jerry Geisel

Under the provision, employees would have to meet two conditions to be entitled to the employer-funded vouchers: their family income could not exceed 400% of the federal poverty level; and the premium contributions their employers require them to make must be between 8% and 9.8% of their income. Some experts believe the 9.8% figure was a drafting error and will be changed later in a technical corrections bill to 9.5%.

If those conditions are met, those employees would be entitled to receive a voucher from their employers, and the value of the voucher would not be tied to the plan in which the employee was actually enrolled.

Instead, the voucher’s value would be equal to what the employer would pay if the employee were enrolled in whichever of its plans offered the largest premium contribution by the employer. Experts say it isn’t clear whether “largest” refers to the percentage of the premium paid by the employer or the dollar amount of the contribution.

Then, the employee could use the voucher to purchase health insurance coverage from a state health insurance exchange. The exchanges are authorized under the reform law and are supposed to be set up by 2014.

If the cost of a policy purchased by an employee through the exchange is less than the value of the voucher, the employee could pocket the difference in cash, which would be considered income and taxed.

The voucher feature could prove costly to employers, especially those that have a heavy concentration of low-wage employees—such as retailers—and require employees to make hefty employee premium contributions, relative to their incomes.

And depending on how the legislative language is interpreted in subsequent regulations, it also could prove costly to employers that offer employees a choice of health care plans ranging from relatively low-cost to very expensive plans.

Experts say the provision is almost certain to result in adverse selection, inflating employer costs.

For example, a young, low-paid employee working for a company with a high concentration of older, less healthy and expensive-to-insure employees likely would receive a voucher whose value would be much higher than the cost of buying coverage in an exchange, especially if the employee purchased a lower-cost high-deductible plan. Under the reform law, exchanges can base premiums on the age of policyholders.

As a result, employees remaining with the employer’s plan would be the most costly to insure, pushing up the employer’s insurance premiums.

“We are talking about something that could be very costly to employers,” said Chantel Sheaks, a principal with Buck Consultants L.L.C. in Washington.

“As I read it, any employer that offers comprehensive benefits and has low-wage employees could be impacted,” said Helen Darling, president of the National Business Group on Health in Washington.

Despite the potential financial impact of the provision, few employers have focused on the voucher provision, noted Jennifer Henrikson, a legal consultant with Hewitt Associates Inc. in Lincolnshire, Ill.

The likely reason for that, Ms. Henrikson said, is that employers now have to concentrate on reform-related issues that are more pressing. The voucher provision does not go into effect until 2014, while numerous others, such as elimination of lifetime dollar limits, go into effect beginning in 2011.

The intent of the provision isn’t clear, experts say. A much broader version of the provision was backed by Sen. Ron Wyden, D-Ore., who has sponsored a proposal in which employers no longer would offer coverage to their employees, but instead would give them cash that they would use to purchase health care coverage on their own.

Many issues involving the provision itself are not clear. “There is a lot of complexity here that has to be figured out,” said Sandi Hunt, a principal in the San Francisco office of PricewaterhouseCoopers L.L.P.

For example, the provision says the voucher contribution would be equal to the amount the employer would have paid if the employee had been “covered under the plan with respect to which the employer pays the largest portion of the cost of the plan.”

That legislative language is about as “clear as mud,” Ms. Henrikson said. For example, it isn’t clear whether the largest portion of the premium refers to the percentage of the premium paid by employers or the actual dollar amount employers pay, though experts say it likely is the latter.

If the latter interpretation is adopted through regulation, the provision could have a costly impact on employers that give employees a choice between lower-cost plans, such as consumer-driven health care plans and much more costly plans, such as traditional preferred provider organizations.

Take the case of a young employee enrolled in a high-deductible plan with a premium of $10,000, of which the employer paid $7,000. The employer also offered a more traditional PPO plan costing $15,000, of which the employer paid $10,000.

In that example, the employee would be entitled to a $10,000 voucher, funded by the employer. If the employee then found coverage in the exchange, perhaps similar to the high-deductible plan in which he was enrolled, for $8,500, he could purchase the coverage and then have $1,500 in additional cash. But his employer’s health insurance cost would be $1,500 higher.

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American Chronicle
Michael Jordan – April 09, 2010

Any time of year can be the right time to consider setting up a Health Savings Account (HSA). If you need a new way to reduce taxes while you put money away, an HSA may be just the thing for you.

Insurance Information

These high-deductible health insurance plans coupled with IRA-style savings accounts are really pretty easy to understand, offer a number of benefits and are becoming more popular.

What is an HSA? HSAs were developed to maximize your savings on health insurance while providing a valuable tax break. The two parts of an HSA program are an eligible, high-deductible health plan and a tax-advantaged savings account. For an individual, an HSA-eligible health insurance plan must have an annual deductible of at least $1,050 for individuals and $2,100 for families.

Insurance Tips

The second part of an HSA program is an IRA-style savings account that allows you to reduce your taxable income by building savings. You can deposit funds up to the total of your health plan’s deductible into the HSA each year. So, within certain regulatory limits, the higher your health plan’s deductible, the more you can tuck away tax-free.

How does the Tax Savings work? If you make $40,000 a year and you put $2,000 in your HSA, you’ll only pay taxes on $38,000. Like an IRA, the HSA is meant to encourage you to save for retirement. Funds placed into your HSA can be invested and the balance will roll over each year into retirement.

You can use your HSA funds to cover medical expenses such as over-the-counter drugs, eyeglasses, co-payments and any medical costs incurred before your annual deductible is met.

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You can ask the IRS for more time to file your tax return.  However that won’t extend the deadline for funding an individual retirement account or a health savings account for last year.  There’s a firm deadline of April 15th, 2010, for making a contribution to your 2009 traditional IRA, your 2009 Roth IRA, or your 2009 health savings account.

Tax deductions for HSA contributions are limited to maximum dollar amounts set per year:

Report your tax-deductible HSA contributions on IRS Form 8889, with the total contributions also reported on Form 1040.  Insurance companies report your HSA contributions to the IRS using Form 5498-SA.

If you would like more information, please contact NEOS Consumer Driven Healthcare at 877-636-7472 or by visiting our website at www.NEOSCDH.com

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By LAURAN NEERGAARD, AP Medical Writer

WASHINGTON – Better beat the crowd and find a doctor.

Primary care physicians already are in short supply in parts of the country, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain.

The new law goes beyond offering coverage to the uninsured, with steps to improve the quality of care for the average person and help keep us well instead of today’s seek-care-after-you’re-sick culture. To benefit, you’ll need a regular health provider.

Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack.

A growing movement to change how primary care is practiced may do more to help with the influx. Instead of the traditional 10-minutes-with-the-doc-style office, a “medical home” would enhance access with a doctor-led team of nurses, physician assistants and disease educators working together; these teams could see more people while giving extra attention to those who need it most.

“A lot of things can be done in the team fashion where you don’t need the patient to see the physician every three months,” says Dr. Sam Jones of Fairfax Family Practice Centers, a large Virginia group of 10 primary care offices outside the nation’s capital that is morphing into this medical home model.

“We think it’s the right thing to do. We were going to do this regardless of what happens with health care reform,” adds Jones. His office, in affiliation with Virginia Commonwealth University, also provides hands-on residency training to beginning doctors in this kind of care.

Only 30 percent of U.S. doctors practice primary care. The government says 65 million people live in areas designated as having a shortage of primary care physicians, places already in need of more than 16,600 additional providers to fill the gaps. Among other steps, the new law provides a 10 percent bonus from Medicare for primary care doctors serving in those areas.

Massachusetts offers a snapshot of how giving more people insurance naturally drives demand. The Massachusetts Medical Society last fall reported just over half of internists and 40 percent of family and general practitioners weren’t accepting new patients, an increase in recent years as the state implemented nearly universal coverage.

Nationally, the big surge for primary care won’t start until 2014, when the bulk of the 32 million uninsured starts coming online.

Sooner will come some catch-up demand, as group health plans and Medicare end co-payments for important preventive care measures such as colon cancer screenings or cholesterol checks. Even the insured increasingly put off such steps as the economy worsened, meaning doctors may see a blip in diagnoses as those people return, says Dr. Lori Heim, president of the American Academy of Family Physicians.

That’s one of the first steps in the new law’s emphasis on wellness care over sickness care, with policies that encourage trying programs like the “patient-centered medical home” that Jones’ practice is putting in place in suburban Virginia.

It’s not easy to switch from the reactive — “George, it’s your first visit to check your diabetes in two years!” — to the proactive approach of getting George in on time.

First Jones’ practice adopted an electronic medical record, to keep patients’ information up to date and help them coordinate necessary specialist visits while decreasing redundancies.

Then came a patient registry so the team can start tracking who needs what testing or follow-up and make sure patients get it on time.

Rolling out next is a custom Web-based service named My Preventive Care that lets the practice’s patients link to their electronic medical record, answer some lifestyle and risk questions, and receive an individually tailored list of wellness steps to consider.

Say Don’s cholesterol test, scheduled after his yearly checkup, came back borderline high. That new lab result will show up, with discussion of diet, exercise and medication options to lower it in light of his other risk factors. He might try some on his own, or call up the doctor — who also gets an electronic copy — for a more in-depth discussion.

“It prevents things from falling through the cracks,” says Dr. Alex Krist, a Fairfax Family Practice physician and VCU associate professor who designed and tested the computer program with a $1.2 million federal grant. In a small study of test-users, preventive services such as cancer screenings and cholesterol checks increased between 3 percent and 12 percent.

Pilot tests of medical homes, through the American Academy of Family Physicians and Medicare, are under way around the country. Initial results suggest they can improve quality, but it’s not clear if they save money.

Primary care can’t do it alone. Broader changes are needed to decrease the financial incentives that spur too much specialist-driven care, says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice.

“What we need is not just a medical home, but a medical neighborhood.”

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Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle. “This legislation will not fix everything that ails our health care system, but it moves us decisively in the right direction,” Obama said shortly after the historic vote. “This is what change looks like.” With Democrats chanting the signature line of the Obama presidential campaign – “Yes we can!” – the House voted 219-212 to send a sweeping overhaul of the nation’s health care system to be signed into law. “We tonight will make history for our country and progress for the American people,” Speaker Nancy Pelosi declared shortly before the vote. “Today we have the opportunity to complete the great unfinished business of our country.”

The Democrats passed the bill without a single Republican vote – and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor. “If we pass this bill, there will be no turning back,” warned minority leader John Boehner. “It will be the last straw for the American people.”

Suspense about the outcome continued until the final hours of the debate. Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure. That only came after President Obama promised to sign an executive order reaffirming that the bill would maintain a “consistency with longstanding restrictions on the use of federal funds for abortion.” In reality, that executive order was more a symbolic move than an actual concession; the bill’s supporters have insisted all along that it does nothing to change the current federal policy, known as the Hyde Amendment, which has been in effect since 1976.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation. Such changes would be filibuster-proof in the Senate, though that process could still drag on a while if Republicans choose to draw it out with objections and amendments. Even so, it will be an anticlimax to Sunday’s historic House vote, which will send the underlying Senate bill to President Obama’s desk for signature.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, “Kill the bill.” It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival – especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House. The crowd was stoked by regular appearances that lawmakers made on a balcony overlooking the protesters. “It’s interesting how many faces they recognize,” said Republican Congressman Steve King of Iowa. Republicans flashed handwritten signs with the word No on them, sending the crowd into rapture.

Democrats also got into the act. Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, “God bless America. We’re glad you’re here.” She also flashed two fingers in a mischievous V for victory. The response? “Someone flipped a third finger,” she said.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down. There was also the distraction of March Madness to pass the hours. One aide said of Obama: “He’s in the West Wing, getting updates, dropping in on staff, and like the rest of America, examining the rubble of his bracket.” At one point during the afternoon, the Commander in Chief ordered his health care czar, Nancy-Ann DeParle, to take a break and go out for a run.

With passage of the legislation, Obama has achieved the signature domestic goal of his presidency, and the most sweeping piece of social legislation since the 1960s Great Society initiatives that saw the passage of Medicare and Medicaid. Universal coverage is a goal that has eluded Presidents going at least as far back as Teddy Roosevelt, and Obama’s bill comes as close to that target as anyone has. The bill would provide health coverage to an estimated 32 million additional Americans, meaning 95% of those who are legally in this country would have health insurance, up from 83% today.

The bill also promises to rein in health costs by reorienting the practice of medicine, making it more efficient, with health care providers rewarded on how well they treat their patients, rather than how much care they give them. Whether it actually achieves that latter ambition, however, is far more uncertain.

In the early years, most Americans will see only minor changes in the health care system. It will almost immediately end some insurance-company practices, such as denying coverage to children with pre-existing conditions. And dependent children under the age of 26 would be allowed to remain on their parents’ policies if they cannot get health insurance elsewhere. Adults with pre-existing conditions would also be able to buy coverage through expanded high-risk pools.

Beginning in 2014, more far-reaching measures will begin to take effect. States would be required to set up new “exchanges,” or insurance marketplaces, that would offer a variety of health care plans for small businesses and individuals who do not get coverage from their employers. Government subsidies would be available to those earning up to 400% of poverty. Employers with 50 or more workers who do not offer coverage would be fined, and for the first time, most people would be required to obtain health coverage – either at work, or by purchasing it on their own – or pay a penalty.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

But while the bill is headed toward becoming law, the fighting over it isn’t going away anytime soon. Republicans have already issued notice that they plan to campaign in this fall’s midterm elections on a pledge to repeal it. There will be constitutional challenges. And in dozens of states, legislatures are considering measures that would attempt to exempt their citizens from some of its provisions, including the requirement that individuals purchase insurance.

By KAREN TUMULTY / WASHINGTON Karen Tumulty / Washington

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Sources Say ‘Dramatic’ Developments in Late Negotiations but Vote Count Unclear
By JAKE TAPPER
WASHINGTON, March 12, 2010—

Speaking volumes about how Democrats lack the votes to pass health care overhaul legislation, President Obama has decided to delay next week’s trip to Indonesia and Australia.

The president was due to leave Thursday, which is the deadline that the White House gave Congress to finish negotiations and pass a bill.

But the White House has confirmed that Obama will leave three days later on Sunday, March 21, and without his wife and daughters as originally planned.

White House officials and congressional Democratic sources expressed confidence that the compromise House-Senate legislation will ultimately pass, but as of now, House Speaker Nancy Pelosi, D-Calif., does not have the votes.

“We’ll take whatever time is required forus to pass the legislation,” Pelosi told reporters today.

She needs 216 votes — a majority of the House’s 431 members — to pass the Senate bill and changes to it. Anti-abortion Democrats, led by Rep. Bart Stupak, D- Mich., have said they will not support the Senate bill because it has less restrictive language on abortion than the House bill.

Democratic congressional leaders had asked the president to delay his trip until after the health care overhaul vote so he could make a personal appeal to House Democrats to vote for legislation that has consumed so much of his presidency.

“I’m delighted the President will be here for the passage of the bill. It’s going to be historic,” Pelosi said.

Meanwhile, Senate Majority Leader Harry Reid, a key figure in the ongoing negotiations, is facing a personal health care crisis of his own.

Reid’s wife and daughter are recovering from a car accident Thursday that left the women hospitalized in serious condition.

Democrats Await CBO Score to Move Ahead
DemocSen. Reid’s wife, Landra, 69, suffered a broken nose, back and neck. Daughter Lana Reid Barringer, 48, has a neck injury and facial lacerations. Both are “conscious, can feel their extremities, and according to doctors, their injuries are nonlife threatening,” a Reid spokesman said.

The incident put Democrats’ intense legislative negotiations temporarily on hold Thursday as Reid rushed to the hospital to be by their sides. But Reid soon after returned to the Capitol; one sign that negotiations among House and Senate Democrats have become make-or-break.

“If Nancy Pelosi had the votes, they’d have already voted on this,” conservative commentator Laura Ingraham said on “Good Morning America” today. “Obviously, the president, he’s put it all on the line here. It’s not going to be good for Democrats, no matter what they do.”

But Democrats insisted they have the will and the votes to pass a bill soon.

“We’re in the home stretch,” Democratic strategist Donna Brazille told ABC News’ George Stephanopoulos. “There’s no question the Democrats will round up the votes.”

The White House had set a deadline for the House to pass the Senate bill by March 18, when the president was originally scheduled to leave for an overseas trip to Indonesia and Australia.

The White House has since backed off its deadline.

“Our hope is to get this done as soon as possible,” White House press secretary Robert Gibbs said Thursday. “If it … takes a couple extra days after a year, it takes a couple of extra days.”

One reason for the delay is the eagerly anticipated Congressional Budget Office score on how much the health care bill now before the House will cost. Its release is expected any day.

The Congressional Budget Office issued an updated cost estimate of the health care bill that passed the Senate Dec. 24, but that estimate didn’t include the changes being negotiated with the White House. The updated estimate was up slightly, from $871 billion to $875 billion over 10 years. And the total deficit reduction went from $132 billion to $118 billion.

‘Full Speed Ahead’ for Reid Despite Personal Matter
After congressional Democrats broke from their meeting Thursday night, White House chief of staff Rahm Emanuel told reporters, “It was a very good meeting. A lot of decisions were made. We’re getting towards the end.”

Sources described “dramatic” developments in the closed-door meetings in the past 24 hours.

As for whether Reid’s personal situation will affect the process ahead, many people close to the senator say that’s unlikely.

“This won’t slow him down, although he may have to spend quite a bit of time with his wife here in the next few days,” Sen. Mark Pryor, D-Ark., said “It’s going to be a full speed ahead for him for sure.”

The House budget committee may begin writing the “fixes” to the Senate bill Monday.

ABC News’ Devin Dwyer contributed to this report.

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By Tom De Luca
Wed Mar 3, 1:14 pm ET
 
New York – The debate over healthcare reform should have been about doctors, patients, insurance and drug companies, and coverage. Instead, much of the attention has been focused on a preexisting condition.

A filibuster allows a senator to delay or defeat legislation through endless talk – or merely the threat of it. That gives the minority breathtaking power to cause gridlock and discredit the majority by stopping it from pursuing the program it was elected on. That is exactly what 41 Senate Republicans are doing to 59 Democrats right now.

The filibuster has become so potent a political weapon that President Obama is reportedly approving the use of the controversial “reconciliation” process to pass healthcare reform. Under this method, Democrats could turn the reform bill into law with a simple majority of senators instead of the 60 now needed to end a filibuster. Critics are calling reconciliation an “abuse of power,” “undemocratic,” and “the nuclear option.” The real undemocratic abuse of power, however, is the present way in which the filibuster is used.

While the use of a simple majority through reconciliation to pass legislation would restore constitutional sanity to the Senate, it does not go far enough. The Senate should rewrite the filibuster rule entirely. Full and thorough debate should be preserved, but the unconstitutional practice of requiring supermajorities to pass important legislation must be ended. 

Many of us first learned about the filibuster in “Mr. Smith Goes to Washington.”

In that classic film, the filibuster is our quintessential American hero Sen. Jefferson Smith’s last hope of stopping corruption and symbolically saving the American republic.

In the real world of American politics today, however, the filibuster has become the weapon of choice to thwart a democratically elected majority on important legislation. Once rare, it’s now used routinely. Filibusters used to be hard work. Senators had to actually stand and talk in the Senate 24/7 until they literally dropped. Now they merely need to threaten a filibuster to stop legislation from ever coming to a vote.

This usurpation is more than an unheroic partisan power grab. It is an unconstitutional change in which the entire Senate – and both parties – are complicitous.

The Framers were explicit about those rare cases, such as constitutional amendments, in which supermajorities are required. They fashioned a document that assumed the majority rule principle for legislation, and based important arguments for the constitution’s ratification on that assumption.

In “The Federalist No. 10,” James Madison defended the newly proposed constitution on the grounds that it created the kind of republic that could prevent factions from undermining liberty. He was most worried by the abusive potential of a majority faction and prescribed, not supermajority rule, but a large and strong republic supplemented by federalism and separation of powers.

Minority factions could be more easily handled, he believed, by simply applying the “republican principle” of majority rule, enabling “the majority to defeat [the minority’s] sinister views by regular vote.”

The filibuster also upends the Great Compromise of 1787 that gave us a bicameral legislature. Small-population states wanted congressional representation based on state equality, while large-population states wanted to base it on the number of inhabitants in a state (or the amount of taxes it contributed).

The deal was to have both: a Senate and a House of Representatives. In granting an extraconstitutional veto to a minority faction of senators, the filibuster increases their (and their states’) power relative to that of other senators (and states). It also upsets the balance of power with the House and its members. The filibuster undermines the state equality and proportionality principles at the same time.Â

Debates over when “extraordinary majorities” would be required were part of the horse-trading that led to final agreement on the constitution. Southern states, for example, depended on agricultural exports and some wanted a legislative supermajority to be required for passage of laws that affected navigation, something the New England shipping states opposed. They traded this demand away for a 20-year guarantee of continuance of the slave trade and a ban on export taxes. Because sectional and state interests played an important role in these deals and compromises, it is inconceivable that the back door would have been left open for supermajorities to sneak in.

Article I, Section 5 offers filibuster-defenders one slim reed to grasp: that “Each House may determine the rules of its proceedings.” However, it also says that each senator shall have “one vote” and that “a majority of each [House] shall constitute a quorum to do business.” The filibuster both deviates from the equality of power idea intrinsic to the “one vote” principle, and changes the meaning of the words “to do business” – unless they were intended by the Founders to mean “do nothing but talk.”

The filibuster “rule” is in reality not a rule at all. It is a structural change to the meaning of the Constitution itself, something even a unanimous Senate is not empowered to do. Its defenders should ask themselves this question: If the filibuster “rule” were written into the constitution’s draft, would the constitution have been ratified? Without a new round of debates and compromises, the answer is no.

As the president of the Senate, Vice President Joe Biden should rule unconstitutional any use of the filibuster to block major legislation. As a political matter, such a move would be highly controversial, but as a constitutional matter, it merely restores the Framers’ intent regarding using majority votes to move legislation in each house of congress – something conservatives should support. After all, the status quo distorts the Constitution. And it robs the vice president of the only real power he has: to cast the tiebreaking vote when the Senate is “equally divided,” an impossibility if the meaningful vote is the one that requires 60 senators to end debate.

If Mr. Biden takes this step and gets attacked, it would be a perfect time to treat his Senate colleagues to a filibuster of his own, by reading to them, in its entirety, “The Federalist No. 51,” which explains how to avoid excessive concentration of power: “Ambition must be made to counteract ambition,” Madison wrote. “The interest of the man must be connected with the constitutional rights of the place.” In protecting his own power from Senate usurpation, Biden would also be fulfilling Madison’s constitutional plan. Mr. Smith would be very proud. But not as proud as Madison.

Tom De Luca, a professor of political science at Fordham University, is coauthor of “Liars! Cheaters! Evildoers! Demonization and the End of Civil Debate in American Politics.”

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By RICARDO ALONSO-ZALDIVAR and JENNIFER LOVEN, Associated Press Writers Ricardo Alonso-zaldivar And Jennifer Loven, Associated Press Writers

WASHINGTON – With tempers flaring, President Barack Obama and congressional Republicans clashed in an extraordinary live-on-TV summit Thursday over the right prescription for the nation’s broken health care system, talking of agreement but holding to long-entrenched positions that leave them far apart.

“We have a very difficult gap to bridge here,” said Rep. Eric Cantor, the No. 2 House Republican. “We just can’t afford this. That’s the ultimate problem.”

With Cantor sitting in front of a giant stack of nearly 2,400 pages representing the Democrats’ Senate-passed bill, Obama said cost is a legitimate question, but he took Cantor and other Republicans to task for using political shorthand and props “that prevent us from having a conversation.”

And so it went, hour after hour at Blair House, just across Pennsylvania Avenue from the White House — a marathon policy debate available from start to finish to a divided public.

The more than six-hour back-and-forth was essentially a condensed, one-day version of the entire past year of debate over the nation’s health care crisis, with all its heat, complexity and detail, and a crash course in the partisan divide, in which Democrats seek the kind of broad remake that has eluded leaders for half a century and Republicans favor much more modest changes. With Democrats in control of the White House and Congress, they were left with the critical decision about where to go next.

Obama and his Democratic allies argued at Thursday’s meeting that a broad overhaul is imperative for the nation’s future economic vitality. The president cast health care as “one of the biggest drags on our economy,” tying his top domestic priority to an issue that’s even more pressing to many Americans.

“This is the last chance, as far as I’m concerned,” Rep. Louise Slaughter, D-N.Y.

Obama lamented partisan bickering that has resulted in a stalemate over legislation to extend coverage to more than 30 million people who are now uninsured. “Politics I think ended up trumping practical common sense,” he said.

And yet, even as he pleaded for cooperation — “actually a discussion, and not just us trading talking points” — he insisted on a number of Democratic points and acknowledged agreement may not be possible. “I don’t know that those gaps can be bridged,” Obama said.

With hardened positions well staked out before the meeting, the president and his Democratic allies prepared to move on alone — a gamble with political risks no matter how they do that.

One option — preferred by the White House and progressives in the Democratic caucus — is to try to pass a comprehensive plan without GOP support, by using controversial Senate budget reconciliation rules that would disallow filibusters. GOP Sen. Lamar Alexander asked Democrats to swear off a jam-it-through approach, while Senate Majority Leader Harry Reid, D-Nev., defended it. Obama weighed in with gentle chiding, asking both sides to focus on substance and worry about process later — a plea he made repeatedly throughout the day with little success.

A USA Today/Gallup survey released Thursday found Americans tilt 49-42 against Democrats forging ahead by themselves without any GOP support. Opposition was even stronger to the idea of Senate Democrats using the special budget rules, with 52 percent opposed and 39 percent in favor.

A second alternative for Obama and his party is going smaller, with a modest bill that would merely smooth some of the rough edges from the current system. A month after the Massachusetts election that cost Democrats their Senate supermajority and threw the health legislation in doubt, the White House has developed its own slimmed-down health care proposal so the president will know what the impact would be if he chooses that route, according to a Democratic official familiar with the discussions. That official could not provide details, but Democrats have looked at approaches including expanding Medicaid and allowing children to stay on their parents’ health plans until around age 26.

Obama himself hinted at a Democrats-only strategy. When asked by reporters as he walked to the summit site if he had a Plan B, he responded: “I’ve always got plans.”

Many lawmakers and Obama stressed areas of agreement, including items such as allowing parents to keep young adult children on their health plans into their 20s, cutting fraud and waste and ensuring that sick people aren’t dropped by insurance companies. But such items occupy the edges of reform.

Indeed, any skepticism about reaching broad consensus was vindicated as soon as the first Republican spoke — in opposition to the mammoth bills that have passed the House and Senate. Alexander, of Tennessee, said Congress and the administration should start over and take small steps, including medical malpractice reform, high-risk insurance pools, a way to allow Americans to shop out of state for lower-cost plans and an expansion of health savings accounts.

“We believe we have a better idea,” Alexander said. “Our views represent the views of a great number of American people.”

Disagreements were not always expressed diplomatically.

Alexander challenged Obama’s claim that insurance premiums would fall under the Democratic legislation. “You’re wrong,” he said. Responded Obama: “I’m pretty certain I’m not wrong.”

As with much in the complicated health care debate, both sides had a point. The Congressional Budget Office says average premiums for people buying insurance individually would be 10 to 13 percent higher in 2016 under the Senate legislation, as Alexander said. But the policies would cover more medical services, and around half of people could get government subsidies to defray the extra costs.

Obama and his 2008 GOP opponent for the presidency, Sen. John McCain of Arizona, had a barbed exchange. McCain complained at length about what he said was a backdoor process to produce the original bills that resulted in favors for special interests and carve-outs for certain states.

“We’re not campaigning anymore. The election’s over,” responded a clearly irritated Obama.

“I’m reminded of that every day,” McCain shot back, adding that “the American people care about what we did and how we did it.”

Said Obama: “We can have a debate about process or we can have a debate about how we’re actually going to help the American people at this point. And I think that’s — the latter debate is the one that they care about a little bit more.”

Generally, polls show Americans want solutions to the problems of high medical costs, eroding access to coverage and uneven quality. But they are split over the Democrats’ sweeping legislation, with its $1 trillion, 10-year price tag and many complex provisions, including some that wouldn’t take effect for eight years.

The Democratic bills would require most Americans to get health insurance, while providing subsidies for many in the form of a new tax credit. The Democrats would set up a competitive insurance market for small businesses and people buying coverage on their own. Democrats also would make a host of other changes, which include addressing a coverage gap in the Medicare prescription benefit and setting up a new long-term-care insurance program. Their plan would be paid for through a mix of Medicare cuts and tax increases.

“Not only are lawmakers polarized, the parties’ constituencies are far apart,” said Robert Blendon, a Harvard University professor who follows public opinion trends on health care. “The president is going to use it as a launching pad for what will be the last effort to get a big bill passed. He will say that he tried to get a bipartisan compromise and it wasn’t possible.”

The Blair House setting wasn’t grand, or even particularly comfortable. About 40 senators, representatives and administration officials were crowded shoulder-to-shoulder around a hollow square table, perched for the six-hour marathon on wooden chairs with thin cushions. Coffee breaks were ruled out, so the only pause in the action came during lunch.

C-SPAN carried complete coverage, while news operations from cable networks to public broadcasting were making it the focus of their day.

Leaving the site during a lunch break, Obama was asked by waiting reporters if he thought the debate was engendering a lot of interest across the country.

“I don’t know if it’s interesting watching it on TV,” he responded.

___

Associated Press writers Erica Werner, Ben Feller and Natasha Metzler contributed to this story.

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By Bernadine Healy, MD

Salvage efforts are underway for the president’s health reform package, put into a stall by the recent surprise election of Republican Sen. Scott Brown in Massachusetts, which disrupted the one-vote margin that would have passed the legislation last month. On the one hand, President Obama seems conciliatory; a proposed televised summit in late February would allow key members from both sides of the aisle to hear from those who have different ideas. On the other, he does not seem willing to scrap the health reform bills that were a year in the making and would radically restructure both the financing and delivery of healthcare. Last week, Secretary of Health and Human Services Kathleen Sebelius delivered the message that the administration would not budge from its comprehensive approach to lowering costs and covering the uninsured, since the “pieces of the puzzle are too closely tied to one another.”

She has a point there. The Obama­care puzzle, a centrally driven plan that requires at least a trillion dollars to succeed, counts on a combination of taxation, fines, penalties, and cost savings; a reallocation of major resources within the current health system; and a willingness among doctors and patients to accede to substantial new government controls. Regardless of how workable the administration’s grand design appears to be on paper—about 4,000 pages of paper—it will fail if all of these big puzzle pieces are not in place. Most obviously, are the needed resources there for the tapping? There are at least two giant reasons that I think the puzzle is now imploding on its own, and neither has anything to do with political partisanship. And no televised show of hand-holding will make one whit of difference.

The first fatal flaw: leaning on Medicare. Obamacare counts heavily on its ability to drain off money from Medicare—which, by the administration’s own accounting, is slated to go into bankruptcy in seven years even as it is. It seems like a heavy dose of voodoo eco­nomics to expect that this program, with its ranks just starting a big swell because of aging baby boomers, has the capacity, no less the will, to cough up half a trillion dollars to pay for half of the cost of health reform. Much has been made of the savings to be found in ending fraud and abuse, but success there would in no way be sufficient to prevent a hike in Medicare payroll taxes on working Americans (who would not be pleased), higher Medicare premiums for beneficiaries, and a big bite out of the medical care our elders now receive.

Health reform proposes to save lots of government money by keeping seriously and chronically ill old folks from being readmitted to the hospital too frequently, a major source of Medicare expenditure. Sounds good, but it is easier said than done, both medically and ethically. Political pundits who would have you think that a hospital admission should cure the disease and that a readmission is a sign of doctor or hospital failure know little about the nature of the formidable degenerative diseases that affect the hearts and lungs, bones and brains, and immune systems of the elderly. Patients who can be tuned up with a few days in the hospital and return home better, even if it’s more than once, are not candidates for hospice. Where else are they to turn? Washington is threatening to cut reimbursement to the doctors and hospitals with higher readmission rates, or label them as poor performers, without analyzing the circumstances. It won’t work.

Another source of money is slated to come from ending Medicare Advantage, a popular but costlier option that covers 10 million elderly in privately managed healthcare organizations that provide pharmaceuticals and impose small or no copayments. Though the savings here are sure to be realized, they come at the risk of citi­zen discontent. Especially so when some elders, namely Floridians, are exempt. Who was the hero who saved Advantage for the 1 million elderly in the Sunshine State? It was their own Sen. Bill Nelson, who made that loophole the price for his health reform “Aye” vote.

The second seed of destruction: counting on Medicaid. The current plan to cover half of the uninsured by putting them into Medicaid has special appeal to federal budgeteers, since the states would be forced to kick in as much as 50 percent of the expense. But Medicaid is already literally bankrupting many states, which unlike the federal government have no way to print money. This new unfunded federal requirement would inevitably mean higher state income taxes that, yes, would hit the middle class despite the president’s promise otherwise.

On this point, give a tip of the hat to the other Nelson, the unrelated Sen. Ben Nelson of Nebraska, who got the bill passed even as he struck a special—and a bit tacky—deal to protect his state. Stridently opposed to the health bill up until the 11th hour, Nelson finally traded his 60th and winning vote in return for a promise that the feds would pay for Nebraska’s portion of Medicaid costs related to health reform in perpetuity. This did not sit well with other governors. Indeed, in his January State of the State address, California’s Gov. Arnold Schwarzenegger went ballistic about reform that would dump huge costs on states already struggling to pay their bills. Once a supporter, he called health reform a “trough of bribes, deals, and loopholes” and challenged the state’s congressional delegation “to fight for the same sweetheart deal Senator Nelson of Nebraska got for the Cornhusker State.”

If the federal government were to make the Nebraska deal with every state, reform would add billions more to the federal deficit, and the president by his own promise would have to veto the bill. But if the “I’ll vote for the law as long as I don’t have to follow it” approach is what carries health reform to his desk, he should by his own conscience consider using his veto pen.

Clearly, fixing the Obamacare mess will take time, if it’s possible at all. But one bipartisan effort that’s worth tackling and is doable right away is targeted insurance regulation. Let’s begin creating a health reform puzzle with this key piece: a system with no denials of access; no cherry-picking of the healthy over the sick; and, rather than one-size-fits-all coverage, an open market where people can search anywhere across the country to find the best policy at the best price for their own needs. Such change would cause insurers to compete to win the trust of, and lower the premiums for, their “covered lives” in order to keep their business. That would be real change.

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Health Insurers Post Record Profits

Insurance Firms Rake in Profits as They Cut Patients, Advocacy Group Says

By EMILY WALKER
MedPage Today Staff Writer
Feb. 12, 2010—

In the midst of a deep economic recession, America’s health insurance companies increased their profits by 56 percent in 2009, a year that saw 2.7 million people lose their private coverage.

The nation’s five largest for-profit insurers closed 2009 with a combined profit of $12.2 billion, according to a report by the advocacy group Health Care for American Now (HCAN).

“The outsized earnings are a vivid reminder that without comprehensive national health care reform, the gatekeepers of our broken health insurance system always will put the short-term interests of Wall Street before the needs of millions of patients and a national economy plagued by joblessness,” the report said.

A spokesman for the nation’s health insurers said their profits are reasonable and represent only a small part overall increase in health insurance costs.

The HCAN report attributed this year’s profits largely to insurers’ dropping coverage of 2.7 million people, who then moved onto public insurance plans such as Medicaid.

Under questioning from reporters, Richard Kirsch, national campaign manager for HCAN, conceded that insurance companies don’t bear all the blame for eliminating people from their rolls. He said the recession induced many employers to cut back on benefits, including health plans. Also, many who were laid off lost their insurance coverage and were forced to enroll in Medicaid.

Even so, insurance companies have also offloaded their most expensive patients by cancelling their policies and raising premiums drastically, Kirsch asserted in a Thursday press call.

Among the report’s findings on specific insurance companies:

 - Wellpoint increased profits 91 percent from 2008 while it chopped 3.9 percent of its total enrollment.

 - United Health’s profit increased 28 percent from 2008, while enrollment dropped by 3.4 percent.

 - Cigna’s profit increased 346 percent and enrollment dropped 5.5 percent.

 - Humana’s profit increased by 61 percent while enrollment decreased by 1.7 percent.

 - Aetna was the only company with a drop in profit and a gain in enrollment. The company’s profit declined by 8 percent from 2008, and enrollment grew by 7 percent.

Lawmakers and critics who took part in the HCAN call said they were disgusted by the notion of insurance companies profiting while unemployment rates soar and more than 40 million people lack health insurance.

“How did they accomplish this feat in the midst of a sharp economic downturn that reduced wealth across the board?” asked Rep. Rosa DeLauro (D-Conn.). “Easy. They delayed payments to doctors, hospitals, patients. They raised premiums, increased co-pays and deductibles.”

California’s largest insurer, Blue Cross, announced last week that it will raise premiums 30 percent to 39 percent for many of its 800,000 customers.

“Without reform, we’re going to continue to see double-digit rate increases,” Kirsch said. “Without requiring that everyone’s covered, without regulating insurance companies, and without subsidies for people to make it more affordable, the data this year will continue unabated,” Kirsch said.

The health care bills being considered in Congress would impose regulations on insurance companies, prohibiting them from denying insurance or cancelling policies based on a pre-existing health condition. Both bills would also require insurance companies to spend money from premiums on health care, not on administrative costs.

Insurance companies agreed to the deal because of a provision that would require most Americans to buy health insurance, which would increase their customer base.

Some say the health care reform movement stalled with the election of Republican Scott Brown to Sen. Edward Kennedy’s old Massachusetts Senate seat, and President Barack Obama is holding a televised health care summit on Feb. 25 in hopes of bringing Republicans and Democrats together on some kind of agreement.

A spokesman for the insurance industry said health insurance profits “are well below other industries in the health care sector.”

“For every dollar spent on health care in America, less than one penny goes towards health plan profits,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans (AHIP). He argued that in 2009, it was spending on hospitals, physicians and prescription drugs that “continued to soar.”

Indeed, a recent report by the Centers for Medicare and Medicaid Service (CMS) found that health spending grew 5.7 percent, reaching $2.5 trillion in 2009, even though the overall economy declined by 1 percent. The report pointed to increased spending on hospitals, doctors, and medications as major drivers in the rising cost of health care.

Copyright © 2010 ABC News Internet Ventures

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By Bernadine Healy M.D.,

Posted: February 2, 2010

In his State of the Union address, President Obama vowed not to “walk away” from healthcare reform, though he was clearly chastened by the upset in Massachusetts that had swept Republican Scott Brown into the Senate, depriving Obama, at the 11th hour, of a signed bill before the speech. The legislation barely made it through each chamber, and the 60-vote victory on Christmas Eve in the Senate came without a vote to spare. The president did not reveal how he would move forward, but his rescue options are sorely limited. Still, whatever path he chooses, the walk provides a totally unexpected opportunity for the country: the chance to go back and make changes that would not have been possible before Massachusetts voters weighed in.

There are really only two paths forward, and both will take time. In the faster (and perhaps too clever) way, the House would pass the Senate bill untouched and send it to the president, bypassing the need for a final Senate vote that includes Brown. Secret negotiations are underway at both ends of Pennsylvania Avenue to modify the 2,700-page Senate monster to the House’s liking—but any changes can be voted on only after the president signs the bill into law. The post-facto recasting would use a political gimmick, a process called reconciliation, that applies to budget issues and requires a simple majority vote (51 percent) rather than the supermajority (60 percent) often needed to pass controversial legislation in the Senate. If the House balks at this feat of legislative engineering, Congress will have to take a deep breath, step back, and fashion a more bipartisan bill.

Both scenarios mean that healthcare reform could still be made far more respectful of patients’ individual choices and their pocketbooks—not just the federal purse. Let me suggest two big-ticket areas that badly need attention: prescription drug costs and insurance premiums. Both must be affordable, or a central goal of reform—ready healthcare for all—will never be achieved.

Pharmaceuticals: In the United States, medicines in exactly the same doses commonly run three to four times, and in some cases 10 times, prices in other places on the planet with drug-safety and approval systems like our own. The issue became hot in 2003, when older folks were caught boarding buses to Canada to buy their drugs at huge discounts. Rather than being cheered on by Uncle Sam for saving healthcare dollars, the renegades were threatened with confiscation of their “illegal” purchases. The federal government refused to relax the Food and Drug Administration’s rules against citizens’ importing drugs, even those obtained from perfectly legitimate pharmacies. And the consumers’ revolt was vigorously opposed—surprise, surprise—by the drug companies, which lobbied heavily to continue to soak American taxpayers under the guise of safety. A bill to allow such drug imports, cosponsored by none other than Barack Obama when he was in the Senate, was roundly defeated.

 Shortly after he was inaugurated, Obama vowed to bring down the cost of drugs by making it possible for Americans to fill prescriptions outside the country. It did not take long, however, for the special interests to entice him to cave. In a stunning surprise, given his legislative record and earlier promises, Obama made a backroom deal with the pharmaceutical lobby. Big Pharma would support Obamacare and even contribute $80 billion to the healthcare reform effort. The president would quash efforts in support of the citizen revolt.

Then, in mid-December, in one of the few bipartisan moves related to health reform, a majority of senators voted to amend the bill to allow Americans to buy drugs from Canada, Europe, Australia, New Zealand, and Japan. How could they not do so? The Congressional Budget Office had just estimated that the amendment would save the government almost $20 billion, and Democratic Sen. Byron Dorgan of North Dakota, who sponsored the bill, said it would lower patients’ costs by $80 billion. The amendment did not get the 60 votes necessary to be added to the health reform bill, but a reconciliation strategy that needs only 51 votes, or a new bill fashioned from scratch, could and should get the gray panthers a win after all. Health reformers ought to place value on healthy competition, which, if allowed to flourish, can lower costs to individuals as well as to the U.S. Treasury.

Insurance reform: In the same spirit of allowing competition and consumer choice to thrive, the way health insurance is sold should be addressed. The current system bears no resemblance to an open market where people can shop for the best policy for themselves and their families at the best price, as they can, say, for car insurance. Now, patients have little leverage. Those with health risks can be rejected out of hand, existing coverage can be canceled, and claims can be denied for little or no reason. Outlawing such abuses is the one part of the current healthcare reform legislation that has strong bipartisan support. And this is an imperative that cannot be walked away from.

But even then, a nagging problem remains: People don’t feel insurers are working for them, although the companies manage lots of their money and weigh in on their health. This could get worse, since a keystone of health reform—the individual mandate—would force people to buy coverage restricted to that sold through either a government-run exchange or an employer. Only the federal government would define the “essential” coverage every American must have and would set up the rules of the exchange.

Instead, to preserve patient choice while trimming cost, we need multiple nationwide exchanges, public and private, that will foster competition among insurers, expand choices, and lower prices by helping patients to be smart consumers. Rather than being forced to buy a one-size-fits-all, comprehensive, government-approved policy, for example, most young people could get insurance for thousands of dollars less by choosing a scaled-back, high-deductible cata­strophic plan that brings access to discounted ­prices for preventive and primary care.

Face it: Since most of the uninsured fall into the relatively healthy under-40 group, the current bills will force tens of millions of Americans to overpay for coverage, a juicy deal for insurers but not for anyone else. A bonus to allowing high-deductible plans is that they force people to think about the cost of their care and, much as those elders did when they boarded buses to cross the border to get cheaper drugs, to search for ways to save. We cannot ignore the power of the people to make their own wise decisions. Let’s give them an incentive to do so, and we’ll develop a generation of prudent healthcare consumers. 

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Experts Disagree Over Legislation’s Fate

By JOSEPH BROWNSTEIN
ABC News Medical Unit
Jan. 21, 2010—

With Republican Scott Brown’s victory in Massachusetts on Tuesday, Republicans in the Senate captured a seat long held by Democrats, and, perhaps more importantly, the possible 41st vote necessary to filibuster any new health care bill.

But while the future of a health care overhaul remains unclear, experts are divided as to how to read the tea leaves in public opinion on the issue following a vote from a state that already has universal health care. Brown, then a state senator, voted in favor of the measure when the Massachusetts legislature passed it in 2006.

Brown has vowed to halt the current version of health care reform, passed by the Senate on Dec. 24, saying he did not think the current plan was a good one for the country — or Massachusetts.

“We already have 98 percent of our people insured here,” Brown said Wednesday afternoon, repeating one of his campaign themes. “We know what we need to do to fix it. But to have the one-size-fits-all plan that is being pushed nationally — it doesn’t work.”

Experts were split on whether health care overhaul could continue forward at this point.

“President Obama’s already unpopular health plan didn’t lose just one vote in the Senate. It lost maybe a handful of votes in the Senate and perhaps a dozen or more in the House,” said Michael Cannon, director of health policy studies at the Cato Institute.

“Antipathy toward the Obama plan was the number one reason for Brown’s victory, and that has vulnerable Democrats in Congress running scared,” he said. “They are now far more likely to vote against the Obama plan, particularly since the elections in New Jersey and Massachusetts show that Obama can’t help them on the campaign trail.”

But others disagree.

“Health reform is not doomed. It just depends who does it,” said Uwe Reinhardt, a professor of economics and public affairs at Princeton University. “The task will always be much, much more difficult for Democrats, because they are suspected of plotting government hegemony just breathing. It is much simpler for Republicans to do the same thing.”
State of Opposition
To be sure, nationwide numbers have shown the public to be divided on the issue, with a slight majority opposed to the measure.

But it remains unclear how those numbers translate to Massachusetts, traditionally one of the most Democratic-leaning states in the union, but one that has some unusual circumstances when it comes to health care overhaul.

During his campaign, Brown said the health-care bill passed by the Senate would force Massachusetts to subsidize care in other states.

“It is a good point that Massachusetts residents didn’t ‘need’ national reform,” said David Dranove, a professor of health industry management at the Kellogg School of Management at Northwestern University. “But they must have been furious about having to pay for healthcare in Nebraska and Louisiana on top of paying for their own healthcare.”

He also noted that Massachusetts voters “could see that the national reform effort was a badly compromised version of their own reforms,” noting that Democrats in Congress struck some deals that he feels voters found unpalatable.

But some also noted the fact that Massachusetts has had some level of health care reform may be a sign that voters did not cast their votes based on that issue — and perhaps politicians shouldn’t interpret it to mean that.

“I do find it ironic that many people outside of Massachusetts are interpreting this vote as a message that those living in the state oppose health care reform, when a very similar system is very popular inside that state,” said Dr. Aaron Carroll, director of the center for health policy and professionalism research at the Indiana University School of Medicine. “If they were truly opposed, you should have seen at least one campaign running on a platform of scrapping their system. None did.”
Second Life Or Dead On Arrival?
While some may see health care overhaul as a lost opportunity, others see the vote as a setback that can be overcome.

Reinhardt noted that in the past, Republican administrations have pushed bills through Congress that brought price controls set by the federal government. Under Ronald Reagan the target was the hospital sector, and under George H.W. Bush it was doctors.

“Both times it went without a huge public outcry. But now imagine if a Democratic president — e.g., Bill Clinton or Obama — had done the same thing. He would swiftly be denounced as trying to impose Soviet-style pricing on American hospitals which, in effect Reagan’s [pricing systems] were,” he said.

“Moral of the story: There is a double standard here,” Reinhardt said. “Perhaps only Republicans can get health reform done, because only they can get away with doing even Soviet-style policies.”

Other ideas for a bill passage have been floated.

Some proponents of health reform have held out hope of persuading Maine Sen. Olympia Snowe, a Republican, to vote for a bill, and others wanted to speed through health care reform before Brown was seated, although Obama has nixed that idea.

“Here is one thing I know, and I just want to make sure this is off the table,” he told ABC News’ George Stephanopoulos on Wednesday. “The senate certainly shouldn’t try to jam anything through until Scott Brown is seated. People in Massachusetts spoke. He’s got to be part of that process.”

Leadership Unclear
Even Democrats in the Senate do not appear to have a clear plan for how to proceed right now.

In response to a question from ABC News correspondent Jonathan Karl about whether he was committed to finishing the health care bill and confident he could pass it on to the president, Senate Majority Leader Harry Reid replied, “I am confident that health care is an issue in this country. We are going to do everything we can to alleviate the pain and suffering of people who cannot afford health care and who want to maintain what they have.”

He then noted that the House had until Dec. 24, 2010 to pass the bill the Senate had passed at the end of last year and send it to the President.

His representative clarified afterward.

“We are still committed to getting health care done,” Reid spokesman Jim Manley said.

But Brown himself has given some hints that even if the current incarnation of health care reform is not something he will vote for, it does not mean he will oppose any proposal.

“I think it’s important for everyone to get some kind of health care,” he said Wednesday. “It’s just a question of whether we’re going to raise taxes, cut a trillion from Medicare, we’re going affect veterans’ care — I think we can do it better.”

ABC News’ Political Unit in Washington contributed reporting. The ABC News Medical Unit is based in Needham, Mass.

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From Dana Bash and Ed Henry, CNN

(CNN) — Faced with the once-unthinkable prospect of losing the Massachusetts Senate race, Democratic officials on Capitol Hill are quietly talking about options for passing health care reform without that critical 60th Senate vote.

Top White House aides insist they are not engaging in any talk of contingency plans, because they believe Democrat Martha Coakley will beat Republican Scott Brown in Tuesday’s crucial Senate battle.

“We are not having any discussions like that,” White House spokesman Bill Burton told CNN. “We believe she is going to win.”

Asked about potential contingency plans as Air Force One returned to the Washington area after President Obama’s Sunday campaign rally for Coakley in Boston, White House Press Secretary Robert Gibbs insisted to reporters the plan is to still pass health care reform with 60 votes. “We think Coakley will win this race,” Gibbs said.

But Democratic sources on Capitol Hill say “what-if” discussions are taking place about how they could proceed with health care if Coakley is defeated, and they privately admit none of their alternatives is very good. According to senior Democratic congressional officials, here are options under discussion:

Pass health care reform before Scott Brown is seated.

But multiple Democratic sources say this is unlikely. Even if House and Senate Democrats could reach a deal to meld their bills and pass them in the next couple of weeks — a big if — there would be a huge outcry from not only Republicans, but also an increasingly distrustful public.

For that reason, one senior Democratic source says some Democratic lawmakers who voted yes last time have already warned they would vote no if health care is voted on in advance of any swearing in of Brown.

The House passes the Senate health care bill.

Democratic sources also call this extremely unlikely, because House Speaker Nancy Pelosi likely wouldn’t have the votes to pass it. Many House Democrats have major differences with several provisions in the Senate bill, especially the way the Senate structured a tax on high-cost insurance plans.

Revisit the idea of trying to push health care through the Senate with only 51 votes, a simple majority.

But to do that, Democrats would have to use a process known as reconciliation, which presents technical and procedural issues that would delay the process for a long time, and Democrats are eager to put the health care debate behind them and move onto economic issues such as job creation as soon as possible this election year.

Try once again to get moderate Maine Republican Olympia Snowe’s vote. They could try for a compromise health reform plan with the independent-minded Republican, but multiple Democratic sources say they believe that is unlikely now.

Their health care overhaul dies.

Although some Democrats are not ruling out this possibility, numerous top Democrats say not passing a health care bill for the president to sign is unthinkable after he put so much political capital into passing a reform bill, and congressional Democrats spent much of last year working on it.

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Advocate Groups Say Incentives For Wellness May Hurt The Poor and Elderly
By EMILY P. WALKER MedPage TodayWashington Correspondent
WASHINGTON, Jan. 10, 2010—
Incentives within the U.S. Senate health care bill designed to encourage healthy lifestyles unfairly target the poor, elderly, overweight and disabled, and could be exploited by insurance companies for financial gain, advocacy groups claim.

Dozens of health, justice, and disability organizations have signed a letter urging senators to remove a provision in the health care reform bill that would allow insurers to provide reimbursements or incentives to workers who meet certain fitness goals laid out in workplace wellness programs.

In rewarding healthy people for making good choices, those who don’t meet fitness goals would be unfairly penalized, the groups said.

“It’s indistinguishable from medical underwriting,” Sue Nelson, vice president for federal advocacy of the American Heart Association (AHA), told reporters during a Thursday call.

“This is a loophole that [insurance companies] will drive right through on day one,” added Andrew Kurz, former chief financial officer of Wisconsin Blue Cross-Blue Shield. “This can lead to huge differences in premiums.”

Under the existing Health Insurance Portability and Accountability Act, group health insurance plans can’t discriminate based on an individual’s health status by varying insurance premiums.

But the law does allow insurers to provide incentives tied to voluntary “wellness programs,” either solely for participating in a workplace wellness program, or for meeting certain health and fitness benchmarks, such as reaching a certain body mass index target.

Those incentives can take the form of extra reimbursements, but they can’t top more than 20 percent of the employer’s cost of covering the employee.

The Senate bill would raise that figure to 30 percent, so an individual who doesn’t meet the wellness goals could hypothetically be paying up to $1,410 more in annual premiums than an employee who met wellness goals.

The amount could be raised to 50 percent, with government approval. People with medical conditions that preclude participation would be offered an alternative program, the bill says.

“Such exorbitant penalties undermine a fundamental goal of healthcare reform — the creation of a system in which no one can be charged more based on their health status,” said the letter, signed by representatives of groups including the American Heart Association, AARP, the American Diabetes Association, and the National Disability Rights Network.

The basic idea sounds intuitive and hardly controversial: Reward people for being healthy.

“Weight gain and unhealthy lifestyles that focus on smoking and lack of exercise have sky-rocketed our healthcare costs,” said the sponsor of the provision, Sen. John Ensign (R-Nev.), in a statement when the Finance Committee adopted his amendment in a bipartisan vote.

“These costs could be lowered by focusing on what makes us healthy — through weight loss programs, smoking cessation, and preventive care. Voluntary employee participation in these areas should naturally be reflected in lower healthcare costs,” he said.

However, it’s not so cut-and-dry, advocacy groups contend. Employers could first raise premiums for workers across-the-board, and then lower premiums for employees that meet certain goals, such as having low cholesterol or reaching a certain body mass index.

Those who are unable to meet such goals would be forced to pay a high premium that could well be unaffordable.

“Attainment incentives provide welcome rewards for employees who manage to comply but may be unfair for those who struggle, particularly if they fail,” wrote Harald Schmidt of the Harvard School of Public Health in a recent “Perspective” published in the New England Journal of Medicine. “In some cases, the incentives are really sticks dressed up as carrots.”

“This is not workplace wellness, this is cost-shifting,” added AHA’s Nelson, arguing that costs would likely move from healthy employees to sick employees, and from employers to employees.

Schmidt said the incentive programs would unfairly penalize lower-paid workers, who are more likely to be unhealthy.

Advocates say it’s unfair to expect the same level of exercise and diet from a law school graduate who has a gym in his condo and a single mother who works two jobs, can’t afford a gym membership, and lives in an area with a limited supply of healthy foods.

“It’s really important to ask what is the motivation behind these programs,” Schmidt told reporters. “Is it really to make people more healthy or to reduce costs? Or to do both? In the end, there is nothing wrong if we can achieve both, but we do have a problem if … it leads to unfairness and inequity.”

Sen. Tom Carper (D-Del.), a co-sponsor of the amendment said the provision contains “strong protections against discrimination” for employees.

“Companies using similar incentives have not only seen their employees’ health improve, but they have seen a significant decrease in healthcare costs,” Carper said in an e-mail.

During the health care reform debate, the grocery store chain Safeway was referenced countless times as a company that implemented a successful employee wellness program that helped workers quit smoking, lose weight, and eat healthily while saving the company money.

But critics say that because the Senate bill doesn’t include guidelines on what a workplace wellness program should look like, one might involve nothing more than testing cholesterol levels while ignoring fitness and motivational components, said Nelson.

Employers would have little incentive to spend money to install a workplace gym or hire smoking cessation counselors, she said.

Nelson said the AHA and other groups are working with congressional staff to remove the provision and instead have the final bill include the House language, which would merely set up pilot programs to test the idea.

A spokesperson for Senate Majority Leader Harry Reid declined to comment on whether the provision would be eliminated during conference, but said “differences will be negotiated with the House.”
Copyright © 2010 ABC News Internet Ventures

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Legislation Clears First Hurdle; Debate Is Far From Over
ABC News Medical Unit
Dec. 25, 2009-

Now that the Senate’s $871 billion health care overhaul bill has passed, many may still have questions about the exact nature of the bill — and how it may affect their health choices in the decade to come.

To learn more, the ABC News Medical Unit reached out to some of the nation’s top experts in health care policy. More than a dozen replied. Below are some of their comments on the Senate bill, its potential impact and how it differs from the House bill.

What Will It Mean?
Health reform proponents overwhelmingly spoke out in favor of the bill though some noted that more remains to be done.

“It’s a start,” said Donald Kemper, chairman and CEO of Healthwise Incorporated. “It focuses on reducing the inequities, and that’s not a bad place to start.”

Karen Davis, president of the health care reform group the Commonwealth Fund, called the bill “another milestone on the way to historic and significant changes to the U.S. health care system.”

The Senate’s passage of the bill had its share of industry support as well.

“We applaud the Senate for taking an important and historic step toward expanding high-quality, affordable health care coverage and services to tens of millions of Americans, many of whom are struggling today financially,” said the Pharmaceutical Research and Manufacturers of America in a statement.

But not all were in favor of the bill.

“For the first time in our history, the federal government will tell you what type of insurance you have to have and effectively — where you will get it and even what price you have to pay,” said John Goodman of the conservative think tank National Center for Policy Analysis.

How Is It Different From the House Bill?
Of course, the Senate version of the health care reform bill is only one side of the story. Lawmakers will now begin the task of reconciling the Senate legislation with the House bill, which passed in November.

“The major unresolved issues that the conference committee will have to resolve are one, the sources of financing for the program, and two, the fate of the public option,” said Daniel Blumenthal, chair of the department of community health and preventive medicine at the Morehouse School of Medicine in Atlanta, Ga.

“[The House bill] has better premium and cost-sharing assistance for low-income families,” Davis said, adding that the House and Senate bills have different provisions on abortion coverage, which could also be a major point of contention.
Cost and Coverage
In its current form, the Senate bill asks for $871 billion over the next 10 years. What would Americans get for this sum? Uwe Reinhardt, professor of economics and public affairs at Princeton University in Princeton, N.J., said poorer families would be one group that would come out on the winning end.

“Starting somewhere between 2013-14, but no later than 2014, the bill will channel about $870 billion divided by roughly 6 years … $145 billion a year toward lower-income American families that would otherwise find themselves priced out of health insurance by the ever rising cost of coverage.”

In total, 31 million more Americans would ostensibly receive health coverage with the passage of the bill. But Republicans argue that the Senate health care bill would add an extra $1 trillion to the budget deficit a figure that differs from the nonpartisan Congressional Budget Office’s estimate that it would reduce the deficit by $132 billion over 10 years.

“Politics has caused compromises that may make the ‘victory’ hollow in that $1 trillion will not buy adequate truly affordable health care for a large segment of the population,” said Arthur Garson, dean of the school of medicine at the University of Virginia in Charlottesville.

What It Might Mean for Americans
Health care reform proponents lauded the fact that the bill would provide the same coverage to people regardless of pre-existing conditions.

“The industry will no longer be able to base the individual’s premiums on the individual’s health status,” Reinhardt said.

David Orentlichter, co-director of the Center for Law and Health, Indiana University, concurred. “Insurers will have to charge the same rates to all persons — with some freedom to charge higher rates based on age.”

Others noted that the legislation, if ultimately passed, will have other beneficial effects as well.

“New Medicare payment and quality reporting strategies will improve patient safety, cut medical errors, and increase the quality of care,” said Washington and Lee University law professor and health care expert Tim Jost.

But some expressed concern that the effort could have unintended consequences.

“Every one of these new regulations … will necessarily increase costs of insurance and raised premium costs — exactly what the Democratic leadership claims won’t happen,” said Richard Saltman, an international health expert at Emory University in Atlanta.

“Doctors will be forced to change how they make their medical decisions,” said Scott Gottlieb of the conservative think tank American Enterprise Institute. “The Centers for Medicare and Medicaid Services will be given the authority to unilaterally write new rules on when medical devices and drugs can be used, and how they should be priced.”

Going Forward: What It Means for Politics
If there is one matter upon which those from both sides agree, it is that the fierce fight over the direction of health care in the next decade will lead to lasting rifts between those in favor of the bill and those who are opposed to it.

“The nearly complete detachment of one of our main political parties from addressing the challenges of either coverage or cost control is also found nowhere else in the world,” noted Alan Sager, director of the Health Reform Program at the Boston University School of Public Health. And Saltman said the battle is “only the first chapter in a new phase of what will become an increasingly acrimonious and politically volatile period in our health system — one that many politicians on both sides of the political divide may soon wish had never begun.”
Copyright © 2009 ABC News Internet Ventures

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ABC News’ Jonathan Karl reports:

Democrats are in an all-out push to pass health care reform that will likely keep the Senate in session non-stop — 24-hours-a-day — between now and Christmas eve.

They are doing this because they think they can pass the bill now and don’t want to risk losing momentum when Congress goes on recess.   The only remaining hold-out is Ben Nelson, however, and if he does not come on board, not even Senate all-nighters can get it done.

To pass the bill, it will take a total of four separate votes, each requiring 30 hours of debate.  And first the Senate must pass the Defense appropriations bill (which requires two votes).

Here’s the current plan:

-    Votes on Defense appropriations at 1am tonight and 7am Saturday. 

-    Saturday morning, Reid introduces his compromise deal – aka “manager’s amendment” – and moves to cut off debate.

-    Republicans likely force a reading of the Reid amendment.  I’m told it’s 500 pages. 

-     The first health care vote – to cut-off debate on Reid’s amendment  – happens as early as  Sunday night after 1am.

-     The 2nd health care vote would come 30 hours later or sometime after 7am Tuesday.

-    30 hours after that, the 3rd vote, possibly by Wednesday afternoon, December 23.

-    Republicans could insist on another 30 hours of debate, which would lead to final vote Christmas eve.

Despite this mad dash to pass a bill by Christmas, Harry Reid still hasn’t released his compromise bill or an estimate of how much it will cost.  I am told we are likely not to see either until tomorrow.

And remember … this bill still needs to be reconciled with the one passed in the House … and that reconciled bill then needs to be passed again in both chambers.   A final bill by the New Year?  Don’t hold your breath.

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Washington (CNN) — The health care bill being negotiated in the Senate would allow caps on annual insurance benefits, reversing a previous version of the plan that would have prevented insurance companies from establishing such limits, according to three Democratic aides.

“We were trying to minimize premium impacts,” said Jim Manley, a spokesman for Senate Majority Leader Harry Reid, acknowledging the change.

The trade-off has drawn criticism from the American Cancer Society’s Cancer Action Network, a patient advocacy group.

“We were very surprised by this,” said Stephen Finan, the group’s senior policy director. Finan worries that cancer patients, who often require expensive procedures, could still face major financial losses if annual coverage benefits are capped too low.

Policymakers on Capitol Hill are defending the legislation.

“The provisions in the bill are a big improvement over the current system in which cancer patients have to fight for coverage and often don’t get the preventative services that catch cancers at an early stage. We hope to make the provisions even stronger in the bill Congress sends to the president,” a Democratic Senate aide, who declined to be identified, said about the change.

Aides say senators will continue to review the policy closely as the process moves forward.

“Ensuring affordable health care costs requires a balance between too much insurance market regulation and not enough,” said Erin Shields, an aide to Senate Finance Chairman Max Baucus, D-Montana. “That balance is what this bill aims to achieve, especially with regard to annual limits. Senators want to ensure this provision provides as much consumer protection as possible while keeping premiums affordable.”

CNN’s Ted Barrett, Ed Hornick, John Bonifield and Elizabeth Cohen contributed to this report.

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From CNN Associate Producer Martina Stewart

Washington (CNN) – The Ranking Republican on the Senate Foreign Relations Committee said Sunday that the Senate should set aside the impending debate on the health care reform bill and, instead, use the remainder of the year to focus on the appropriate strategy for the Afghanistan war, funding the war, and passing the appropriations bill necessary to keep the federal government running.

“I would just make this suggestion,” Republican Sen. Richard Lugar said Sunday on CNN’s State of the Union, “that in the three weeks of debate we still have ahead of us, we really ought to concentrate in the Congress on the war, on the overall strategy of our country and the cost of it. And we ought to be on the budget – passing appropriations bills in a proper way. . . . We may wish to discuss higher taxes to pay for [the war]. But we’re not going to do that debating health care in the Senate for three weeks through all sorts of strategies and so forth.”

“The war is terribly important,” Lugar continued, “Jobs and our economy are terribly important. So this may be an audacious suggestion, but I would suggest we put aside the health care debate until next year, the same way we put cap and trade and climate change [aside] and talk now about the essentials: the war and money.”

Democratic Sen. Jack Reed, who sits on the Senate Armed Services Committee, disagreed with Lugar.

“Absolutely not,” Reed replied when asked by CNN Chief National Correspondent John King whether the Senate put off debate on the health care reform bill until 2010.

“I think we’re in the midst of probably the most significant debate and conclusion with legislation that we’ve ever had,” Reed told King, “And the health care debate is essential to our economic future. There are – Businesses and individuals each year pay more and more for health care. It has become unaffordable. We have to go ahead and conclude this debate.

“To stop now would be stopping on the edge of, I think, significant reform, which is so important for the country. And frankly, it’s ironic, there’s – under the Bush administration, there was no serious debate about Afghanistan. That was relegated to the sidelines. There was no attempt to pay for it. And suddenly, now, that becomes a critical need that we put aside health care. I don’t think so.

I think we have to push forward. I think the president’s speech [Tuesday about Afghanistan] will be appropriate. I think the strategy we’ll analyze in the committees and I think we can go forward on both fronts and we have to.”

After months of deliberation, Obama is set to give a speech Tuesday evening that outlines his plans for the war in Afghanistan. Also this week, the full Senate is set to begin debate on a health care reform bill crafted by Senate Majority Leader Harry Reid, who managed to garner just enough votes to get the bill to the floor.

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Should Healthcare Reform include coverage for Illegal Immigrants?

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Washington (CNN) — The push to overhaul health care received a major boost Thursday as the American Medical Association and AARP endorsed legislation drafted by top House Democrats.

The AARP, the nation’s largest organization of older Americans, is a nonpartisan group that advocates for people 50 and older. The AMA, historically an opponent of health care reform, is considered one the nation’s most influential doctors’ advocacy groups.

“I want to thank both organizations again for their support, and I urge Congress to listen to AARP, listen to the AMA and pass this reform for hundreds of millions of Americans who will benefit from it,” President Obama said at the White House.

The backing of those two groups comes as House Speaker Nancy Pelosi, D-California, oversees final changes to the $1.1 trillion health care bill. The measure likely will come to a final vote Saturday.

A 42-page manager’s amendment on the health care legislation posted Tuesday night made mostly technical changes in the nearly 2,000-page bill compiled from three Democratic proposals passed by three House committees.

By making the changes public Tuesday, House Democratic leaders could open floor debate on the bill Friday, while fulfilling their pledge to allow 72 hours of review before bringing the measure to the full chamber.

Pelosi insisted Thursday she will have the 218 votes necessary to pass the bill. Meanwhile, President Obama is set to huddle Friday with congressional Democrats on Capitol Hill to review the legislation.

In a statement, AARP CEO Barry Rand said, “We started this debate more than two years ago with the twin goals of making coverage affordable to our younger members and protecting Medicare for seniors.

“We can say with confidence that [the House bill] meets those goals with improved benefits for people in Medicare and needed health insurance market reforms to help ensure every American can purchase affordable health coverage.”

The AMA’s president, Dr. J. James Rohack, told reporters Thursday that the legislation is “not a perfect representation of our views” but is close enough to warrant his group’s support and keep the reform process moving forward.

Rohack said the bill needs to be accompanied by legislation reversing scheduled Medicare reimbursement payment reductions to physicians.

Responding to the AMA endorsement, Obama said the doctors’ group is “supporting reform because [its members have] seen firsthand what’s broken about our health care system,” Obama said.

“They would not be supporting it if they really believed that it would lead to government bureaucrats making decisions that are best left to doctors.”

Meanwhile, House Republicans on Thursday continued to signal their opposition to the measure. GOP leaders held a rally on Capitol Hill along with “Tea Party” movement protesters and other activists to warn that the House legislation would translate into a full-blown government takeover of the health care system.

Rep. Michele Bachmann, R-Minnesota, told CNN’s “American Morning” on Thursday that Democrats had forgotten the lessons of August’s town hall meetings when angry conservatives criticized health care legislation.

“I think what we’re going to see is the town hall coming to Washington, D.C., just to remind members of Congress [that] we’re the ones we would like you to pay attention to, not lobbyists. And we don’t want the government to own our health care,” Bachmann said.

Speaking at Thursday’s opposition rally, actor John Ratzenberger, who played Cliff on the sitcom “Cheers,” slammed the Democratic bill as a form of socialism.

“These are Woodstock Democrats,” Ratzenberger said. “We have to remember where their philosophy comes. It doesn’t come from America. It comes from overseas. It comes from socialism. And socialism is a philosophy of failure.”

House Democrats have rejected an alternative $60 billion Republican plan as inadequate for meeting the goals of expanding health coverage to most of the nation’s 46 million uninsured while bringing down costs and ending controversial industry practices such as denying coverage for pre-existing conditions.

Pelosi’s bill would extend insurance coverage to 36 million uncovered Americans and guarantee that 96 percent of Americans have coverage, according to the Democratic leadership.

The claim is based on an analysis by the nonpartisan Congressional Budget Office.

Among other things, the bill would subsidize insurance for poorer Americans and create health insurance exchanges to make it easier for small groups and individuals to purchase coverage. It also would cap annual out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Pelosi’s office has said the bill would cut the federal deficit by roughly $30 billion over the next decade. The measure is financed through a combination of a tax surcharge on wealthy Americans and spending constraints in Medicare and Medicaid.

Specifically, individuals with annual incomes more than $500,000 — as well as families earning more than $1 million — would face a 5.4 percent income tax surcharge. Growth in Medicare expenditures would be cut by 1.3 percent annually.

The House bill also includes a government-run public option. Under the House plan, health care providers would be allowed to negotiate reimbursement rates with the federal government. Pelosi and other liberal Democrats had argued for a more “robust” public option that would tie reimbursement rates for providers and hospitals to Medicare rates plus a 5 percent increase. Several Democrats representing rural areas, however, killed the proposal after complaining that doctors and hospitals in their districts would be shortchanged under such a formula.

One thorny issue yet to be resolved among House Democrats is the bill’s final language on abortion. Rep. Bart Stupak, D-Michigan, has been pushing leaders to add stronger language prohibiting the use of federal money to pay for abortions under the health care overhaul.

Stupak has vowed that if he isn’t allowed a vote on the issue, a group of 40 anti-abortion Democrats will work to block the bill from getting to the House floor.

The House bill differs from legislation the Senate is considering in a number of critical ways. Senate Majority Leader Harry Reid, D-Nevada, also favors a public option but would allow individual states to opt out of the plan.

An $829 billion bill recently passed by the Senate Finance Committee does not include a tax surcharge on the wealthy but would impose a new tax on high-end health care policies, which critics have dubbed “Cadillac” plans. A large number of House Democrats are opposed to taxing those policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.

Individuals under the $829 billion Finance Committee plan would be required to purchase health insurance coverage or face a fine of up to $750. The House bill imposes a more stringent fine of up to 2.5 percent of an individual’s income. Both versions include a hardship exemption for poorer Americans.

The Finance Committee bill would require large companies to contribute to the health care costs of lower income workers if those workers received a government subsidy for insurance. The House legislation would require larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.

Democratic leaders in both chambers agree on establishing nonprofit health care cooperatives and stripping insurance companies of an anti-trust exemption that has been in place since the end of World War II.

Reid refused earlier this week to predict when the chamber would pass a health care bill, possibly signaling difficulty in generating support from his entire Democratic caucus.

CNN’s Dana Bash, Lisa Desjardins and Deirdre Walsh contributed to this report.

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By LAURIE KELLMAN, Associated Press Writer, Yahoo! News

WASHINGTON – For Democrats determined to get a health care bill, Sen. Roland Burris is like the house guest who couldn’t be refused, won’t soon be leaving and poses a plausible threat of ruining holiday dinner.

Suddenly, he can no longer be ignored.

The Illinois Democrat, appointed by disgraced former Gov. Rod Blagojevich, says he’ll only vote for a bill to provide health care to millions more Americans as long as it allows the government to sell insurance in competition with private insurers.

And he says he won’t compromise.

“I would not support a bill that does not have a public option,” Burris, 72, said in a recent interview with The Associated Press. “That position will not change.”

Those words caught the attention of the very Democratic leaders who tried to keep Burris out of the Senate, suggested he resign and have shunned him in unprecedented fashion. Burris is not the only Democrat to insist on creation of a government-run health plan. But he is the one who has the least to lose by defying President Barack Obama and the Democrats who once turned him out in the cold rain.

It was early January and Blagojevich had appointed Burris, a former Illinois attorney general, to Obama’s former Senate seat — defying Democrats in Washington who had wanted someone without a tainted patron and with a better chance of winning election in 2010.

What happened next was a procession of ugly images, from Burris’ rain-swept news conference after Democrats turned him away from a swearing-in to Illinois Rep. Bobby Rush daring Democrats to block an accomplished lawyer who would be the chamber’s only black.

Bitterly, the Democrats seated Burris. But when it came out that Burris had admitted what he had denied under oath — that he’d unsuccessfully tried to raise money for Blagojevich — Majority Whip Richard Durbin, D-Ill., suggested that Burris resign. He refused.

A Senate ethics committee probe is pending into Burris’ statements. Democratic leaders, meanwhile, refused to support any effort by Burris to seek a full term, and he will leave the Senate in 2011.

Meanwhile, his relationship with the rest of his caucus has settled into one of mutual, if chilly, benefit.

It works this way: Burris stays mum about any bitterness he may feel about his reception, and he gets Obama’s Senate seat for two years. Democrats seat him, don’t speak of him and can count on his loyal vote at a time when all 58 Democrats and two independents must vote together to prevent Republican filibusters.

They’ve never needed 60 votes like they do on the yet-to-be-finalized health care bill. A disciplined grin shows that Burris knows it.

No, he says, he will not vote for any version of a government-run plan circulating in the Senate, other than the full-blown one from the Senate Health, Education, Labor and Pensions Committee.

He won’t vote, for example, for Republican Sen. Olympia Snowe’s idea to use the threat of a public option to force insurers to lower premiums by certain deadlines. He hasn’t seen the details of another idea, proposed by Sen. Tom Carper, D-Del., that would allow each state to decide whether to offer public coverage to compete with private insurers. The health committee’s proposal, he says, must be in the final bill to earn his vote.

“Yeah, that’s the one,” Burris said.

By definition, all 100 senators are relevant because any one can block Senate business unless there are 60 votes to override the objection. But Burris’ stated position on the public option means that Democrats can no longer take his vote for granted.

It’s too early to tell whether the public option, or some version of it, ends up in the final compromise between a committee of House and Senate lawmakers. First, each chamber must pass its version of a health care bill. House Democrats are insisting on the government-run plan; but in the Senate, the public option is less popular in both parties.

Every Democratic vote is important. And yet, Democratic leaders aren’t talking about Burris.

Instead, they’re talking confidently about having the votes for the biggest policy overhaul in a generation, a signature issue for Obama and the Democratic Party.

Finance Committee Chairman Max Baucus, D-Mont., said Burris’ demand alone makes him no different than other senators seeking this or that in the bill.

“I will do what I can to address the thises and thats,” Baucus said. “But my strong feeling is in the end, the need for health care reform is to get 60 votes (and) is going to trump the concerns that some might have.”

For his part, Burris says he’s just representing the wishes of his state. And he’s relentlessly loyal to the arrangement. His only acknowledgment of being treated differently than others is a reference to the “distractions” that marked his first weeks in office.

Ask him whether he feels badly treated by the leaders, and he’ll answer with a question:

“By whose standard?”

Go a couple more rounds, and he’ll elaborate, generally.

“I feel that I’ve had great opportunities here,” Burris said. “I feel like anytime I had a question that needed answered, anytime I needed something, there was certainly assistance there.”

Does he feel respected and listened-to? Burris pauses and looks puzzled.

“Yes. I’m a senator from Illinois representing 13 million people. I’m one of 100, and I speak on the floor, I preside over the Senate, I co-sponsor legislation,” he says. “I’m very busy, I’m very challenged, and I have one problem.”

He grins.

“I enjoy what I’m doing.”

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By: Jennifer Newell
Published: Thursday, 15 October 2009 ~ HealthNews

It is complicated. Listening to a singular pundit or TV channel for news about health care reform may only provide talking points, and attempting to put together the entire debate and its current status leaves most people confused and frustrated. The ins and outs of health care reform are undoubtedly complicated, especially as hundreds of pages of legislation filled with political-speak will likely dictate the future of health care in America. But the issues at stake are rather simple, and though the debates rage on, a basic understanding of the core of health care reform is necessary for the public to stay aware and involved in the process.

Health care reform became an issue partially because the public demanded it. Not only are there more than 46 million Americans currently without any type of health insurance, another 25 million people are underinsured. And recent economic woes have sent hundreds of thousands more into the category of uninsured as unemployment numbers rise. Another contributing factor to the underinsured and uninsured is medical costs that continue to rise; Health Affairs reported that $2.4 trillion was spent in 2007, which is 52 percent more than any other nation in the world. Add to those numbers the fact that of the 1.5 million Americans that are likely to declare bankruptcy in 2009, more than 60 percent of them result from medical bills, per a 2009 study by the American Journal of Medicine. Thus, the need for action increases by leaps and bounds.

When President Barack Obama campaigned for the office he currently holds, he spoke of the need for health care reform on a consistent basis. And just over one month after taking the oath of office, he reiterated his focus on the health care crisis that “cannot wait.” By June of 2009, he brought the issue to Congress as a must-do item on the agenda, and he urged the idea of a government-sponsored health insurance plan, similar to Medicare and now known as the “public option,” to compete with the private insurance companies now dominating the market, along with the mandatory removal of preexisting conditions as a reason for refusal of any health care.

While some Democrats in Congress embraced the plan, others were skeptical of implementing a public option, and Republicans blatantly rejected the idea, fearing low quality care and the strain that might cause private insurance companies to be put out of business. The debates then began in the hall of Congress but quickly disintegrated to divisive jabs when erroneous information spread that illegal immigrants would be covered under the public option, that death panels would be instituted to rid society of some of its sick or elderly members, and that people would not be able to keep their current insurance coverage if they chose to do so. Some of the public became fearful that the public option would create a socialist form of medical care in the United States, and many in Congress fell in line with those fears, standing back from support of any drastic changes to the current system.

Another stumbling block for potential agreement on the issue of reform is the ability of the government to find ways to pay for it. Numerous ideas have been introduced, including cutting excess from Medicare, and while those continue to be debated, the general consensus remains that any health care reform package should provide a viable alternative to increasing the U.S. government’s current deficit.

It should also be noted that a great majority of the members of Congress have or continue to accept large campaign donations from private insurance companies and their executives, making it more difficult to stand for changes that those companies staunchly oppose. Senators and Representatives who have chosen to support drastic health care reform have likely done so at the risk of losing campaign contributions and possibly future elections, if they accepted said monies in the first place.

The latest development in the ongoing saga of Congress’ attempt to address health care reform involves a bill introduced to the Senate on September 16, 2009, by Senator Max Baucus (D-MT). America’s Healthy Future Act proposes a 10-year overhaul of the health care system that would cost roughly $829 billion, though the Congressional Budget Office’s study revealed it would not only be paid for by taxes on expensive and comprehensive health plans and reductions in Medicare Advantage spending, but it would reduce the deficit by $81 billion over the next decade.

The meat of the bill proposes the creation of health insurance cooperatives (co-ops), which are non-for-profit insurance groups controlled by consumers to compete with private insurance companies. However, this is different from the aforementioned public option in that it would not be regulated by the government (after its initial launch and sponsorship by federal funding). Along with the co-op initiative, the Baucus bill proposes an individual mandate that will require every American to buy some form of insurance or pay a penalty, with those living three times below the poverty level eligible to receive subsidies to aid in their purchases.

Baucus prepared his bill to come before the Senate Finance Committee on October 13 for a vote, but on October 12, a lobby representing a group of insurance companies released a previously-commissioned study by PricewaterhouseCoopers that warned of insurance premiums rising drastically should the Baucus bill eventually be passed into law. It was speculated that the news was released to deter members of the committee from passing the bill, though it seemed to effect none of the votes either way.

The October 13 hearing was held as scheduled, and the Baucus bill passed by a vote of 14 to 9, split directly down the line with Democrats voting for it and Republicans voting against it with one sole exception when Olympia Snowe (R-ME) crossed party lines to cast her vote in favor of the bill.

Where does that leave health care reform?

Many steps remain in the process. Changes to the Baucus bill are inevitable, as it must be combined with the previously-passed Health Committee bill that provided for a public option. Ultimately, the bill that comes before the Senate must win at least 60 votes to pass and avoid the possibility of a Republican filibuster, and Congressional aides estimate that the meetings to merge the bills and finding consensus between House and Senate proposals will require a minimum of several weeks, according to CNN.

Therefore, Americans must wait. While constituents can contact their representatives in Congress to express their opinions, they must then wait as the fate of their health care coverage is debated on Capitol Hill. The goal is to pass some form of health care before the end of the 2009 calendar year, but what kind of reform eventually passes remains to be seen.

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Mississippi, Other Southern States Do Poorly as Midwest, New England Provide Best Care
By Susan Donaldson James
Oct. 8, 2009—

Vermont leads the nation in the delivery of its health care, while Mississippi is rated the worst, according to a non-partisan study that compares all 50 states and the District of Columbia.

Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire ranked 1 to 5 in 38 indicators of health care.

At the bottom were Mississippi, along with Oklahoma, Louisiana, Arkansas, Nevada and Texas.

The Commonwealth Fund Commission’s “Scorecard on Health System Performance,” which was released today, rated the states on access, quality, costs and health outcomes in a follow up to their 2007 report.

Overall, the states which did best on the Commonwealth scorecard were in New England and the upper Midwest, and the worst states were in the South.

Vermont, with only 640,000 residents, has nearly universal health care coverage with 93 percent insured. Its innovative “Blue Print for Health” focuses on prevention of chronic diseases.

Click Here to Compare Health Care Quality State By State
http://www.commonwealthfund.org/Charts-and-Maps/State-Scorecard-2009.aspx

“We’re small. There are 19 cities larger than the state of Vermont,” said Susan Besio, director for health care reform and Medicaid for Vermont.

“But I believe there is something unique about Vermont in terms of its culture,” she told ABCNews.com. “We want to take care of each other and we are a healthy state.”

In Mississippi, however, about 20 percent are uninsured despite having some of the highest rates of hypertension, diabetes and asthma.

According to the report, only 35.7 percent of adults 50 or over in Mississippi receive recommended screening and preventive care.

“When you compare Mississippi on almost any socio-economic profile, we are a struggling population that has a large percentage of low-income individuals, high unemployment rates, low rate of education,” said Robert Pugh, director of the Mississippi Primary Health Care Association.

The scorecard “paints a picture of health care systems under stress, with deteriorating health insurance coverage for adults and rising health care costs,” according to co-author Cathy Schoen, who is senior vice president of the commission.

“Where you live matters for access, quality of care and whether you live a long and healthy life,” she told ABCNews.com. “These wide and persistent gaps among states highlight the need for national reforms and federal action to support states.”

For example, 32 percent of working-age adults in Texas are uninsured, compared to only 7 percent in Massachusetts in the most recent survey.

“It’s very hard to have a high performing health care system and hospitals that do well for everyone if you have a high rate of uninsured in the state,” said Schoen.

In 1999-00, there were only two states with 23 percent or more of adults uninsured. But by 2007-2008 there were nine.

Children fared much better, due in large part to the Children’s Health Insurance Program (CHIP) under Medicaid. The number of states with 16 percent or more of children uninsured dropped from nine to three during the same time period.

Other findings of the report were that in a, costs rose and quality improved in areas where outcomes were reported to the public.

Vermont’s ‘Blue Print For Health’ A Model
The Green Mountain state was cited for its model “Blue Print” program. Launched by Republican Gov. Jim Douglas, it covers everything from teaching children healthy eating to helping seniors stay in their homes rather than going to costly nursing homes.

“You betcha, I feel good about the reforms we put in place,” Douglas told ABCNews.com. “It’s centered on quality and containing costs. Care shouldn’t start in the emergency room.”

All Vermonters are encouraged to have yearly exams and adults are notified when they are due for check-ups.

Douglas talks to children about “getting off the couch” and set an example just this week by joining elementary students on a walk to school.

With the second oldest population in the nation, Vermont subsizes care for seniors and the disabled to defray the costs of home care. Nursing home beds were reduced by 200 last year.

In one pilot program, electronic medical records can avert expensive tests like MRIs and x-rays. One emergency room doctor seeing a woman with stomach pains discovered in her online medication history that she had not filled her prescription for ulcer medicine.

“It takes time and so a lot of the fruits come from years of work and planning and cooperation,” said Douglas.

Health Care Affects a State’s Economy
But Mississippi, with the highest infant mortality and low birth rates in the nation, makes access to these Medicaid programs more difficult, according to Roy Mitchell, director of the Mississippi Health Advocacy Program (MHAP).

“I am not at all surprised we were 51st on the list,” he told ABCNews.com. “We are last on several health indicators. Our policy makers work hard at being last.”

Despite one of the highest matches of federal to state dollars in Medicaid funding, the state mandates “face-to-face” eligibility, requiring all new applicants and those reapplying for benefits to come in for an interview.

“As a direct result, 65,000 children have fallen off the rolls,” Mitchell said.

“Mississippi does virtually no outreach at all. They don’t publish where these face to face stations are and what times,” he said. “It’s a bureaucratic maze even to find out where to go. And when they get there they don’t have a certain document.”

Of those, about 77 percent would be eligible, he said. “It’s touted as fraud prevention.”

These disparities between the highest and lowest ranked states could be alleviated with national reform, according to Commonwealth.

The report emphasizes the need for insurance reform that rewards good outcomes, payment reform with an emphasis on prevention and advanced information systems that travel with the patient from physician to physician, saving time, money and preventing errors.

“What the scorecard is showing is that we have a system under stress, no matter where we live,” said co-author Schoen. “The costs are rising more than people’s incomes. We need to act.”

Schoen said she has hope for reform. “There is real leadership and people are taking reform seriously.”
Copyright © 2009 ABC News Internet Ventures

Popularity: 1% [?]

Anita Raghavan – Forbes.com

As a young man working for Suhrkamp Verlag, the renowned publishing house in Berlin, Michael Prolingheuer bought private health insurance. Coverage was then relatively cheap (though it now costs $905 a month). It also promised greater choice of doctors and easier access to care than Germany’s statutory quasi-public plan, which consists of 187 nonprofit insurers closely supervised, but not run, by the government.

Today, 28 years later, he’s having second thoughts. In January 2007 Prolingheuer, now 54, was diagnosed with amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease), a progressive disease of the nervous system that paralyzes and ultimately kills a patient. Not long after he got the grim news, the fight with his insurer began. At first his carrier, Allianz, balked at paying for the respirator that helps him breathe, arguing it wasn’t specified in his policy. It only relented after a doctor at Berlin’s Charite-Universitaetsmedizin, a teaching hospital, sent a letter saying that without the machine he would die. Then Allianz suggested cutting the amount of time Prolingheuer was hooked up to the respirator, which would lower treatment costs by eliminating round-the-clock home nurses. In a letter dated June 10, 2009 it asked him for a medical report that would state “to what extent your daily breathing treatment could be reduced to heighten your quality of life” and inquired to what degree his wife assisted him in his daily routine, as “she has been trained in using these machines.”

“We deeply regret causing Mr. Prolingheuer distress,” says an Allianz spokesperson. She adds that while his policy “does not cover the particular medical equipment he requested, Allianz nevertheless provided it after confirming with his m.d. that this was needed.”

Prolingheuer isn’t having any of it. “My insurer would like to see me dead,” he taps out on his black laptop. Lying in a short-sleeve black sports shirt and striped pajama bottoms, Prolingheuer can no longer speak and is mostly confined to his bed. He paid insurance premiums for many years. “Now that I need the basic care, they say no.” He figures his care costs as much as $370,000 a year, of which his out-of-pocket cost is $21,000 in addition to his monthly premiums. If he had to do it over again, Prolingheuer says, he would be part of Germany’s public insurance system–the choice of 90% of the population, 74 million or so people.

People like Angela Jansen, 53. Diagnosed with ALS in March 1995, her care is covered by public insurer Barmer, which, together with the government, pays $360,000 or so a year to support round-the-clock nurses. Jansen, too, can no longer speak or use her hands and legs but relies on a computer with a laser camera that captures the movements of her left pupil as it scans letters on the keyboard. “This thing called Eyegaze the insurer paid for, the wheelchair, the breathing machines … the things I need to live,” she writes. Where it skimps: on medicines, offering generics, which “are not always the best. Sure I get what’s on the list, but not everything is on it,” she writes. One excluded item is a cream that might prevent her bedsores.

This pair of patients with extreme needs represents the two faces of health care in Germany and its mix of private and quasi-public insurance plans. More than any model in the world, the German system offers a glimpse of what health care could look like in the U.S. That’s assuming any bill survives the popular revolt. Unlike many countries with national health–Canada, say, or the U.K.–where private insurance generally supplements public coverage, Germany has two separate systems that coexist, with private plans indirectly benefiting from the cost controls of the public system.

Whether they have public or private coverage, most Germans love their care. In a recent survey by m&m Management & Marketing Consulting 84% of private insurance clients expressed satisfaction; so did 85% of those who rely on the public system. Tough to find that in America. Germany spends $3,588 per capita, per year, or 10.4% of its GDP, on health care. The U.S. shells out $7,290 per person, 16% of economic output. This difference is not because we have more old people. One in five Germans is 65 or older, compared with one in eight in the U.S.

“If you want a health care system where you don’t have to worry that you could go broke, where you could lose your health insurance or get off-the-charts doctors bills, look at the German model,” says Uwe Reinhardt, economics professor at Princeton University. He believes that German and Swiss systems, which offer near-universal care without rationing services, come closest to something that Americans, long used to a private system, could stomach.

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Senate Finance Committee Chairman Unveiled An $856 Billion Proposal
By HUMA KHAN and Z. BYRON WOLF
Sept. 16, 2009—

Senate Finance Committee Chairman Max Baucus today released a 10-year, $856 billion health care proposal, which is already being met with criticism on both sides of the political aisle.

The Montana Democrat dubbed his bill as balanced and fiscally responsible. At a news conference, Baucus expressed confidence that the final bill will get bipartisan support, despite his appearing without any fellow party members or Republicans.

“Everyone should understand it’s just the beginning, but it’s a good beginning. The choice is now on those on the other side of the aisle,” he said. “At the end of the day, there will be Republican support for this bill.”

The nonpartisan Congressional Budget Office estimates the Baucus bill would cost a total of $774 billion over 10 years. But the bill would, in effect, cost more than $800 billion, Finance committee staffers say, because of differences in scoring between the CBO and Finance committee. That would not account for the $900 billion in federal revenue raised by taxes on insurance companies, employers who don’t offer coverage and assumed cost savings in Medicare that are envisioned to pay for the bill and keep it deficit neutral.

The White House had little to say about the plan, except that it would provide momentum to the president’s goal of achieving health care overhaul in the near future.

“Last week, the president laid out his plan to bring stability and security to Americans who have insurance, and high-quality, high-quality, affordable coverage for those who don’t have insurance,” White House spokesman Reid Cherlin said. “The Senate Finance Committee [proposal] released by chairman Baucus is another boost of momentum for the president’s effort to reform the health system.”

Baucus’ Health Care Plan
Under Baucus’ plan, all Americans would be required to purchase health care or pay a fine if they don’t. It also includes provisions barring insurance companies from prohibiting care based on pre-existing conditions, and prevents practices such as charging more to people with more serious health problems. But, at the same time, the language in the bill suggests that those rules could be relaxed based on tobacco use, age and family composition. It would also place caps on yearly health care costs.

Baucus’ proposal includes a provision to create an insurance exchange system on the Internet, an idea President Obama also proposed last week during his joint address to Congress.

The “state-based Web portals, or ‘exchanges,’… would direct consumers purchasing plans on the individual market to every health coverage option available in their Zip codes,” according to the plan. “The exchanges would offer standardized health insurance enrollment applications, a standard format companies would use to present their insurance plans, and standardized marketing materials.”

Much to the chagrin of some Democratic lawmakers and liberal groups, the proposal does not include any language for a government-run insurance plan that would compete with the private sector. But it opens the way for health care cooperatives — member-owned, non-profit companies providing health insurance. All other bills produced in Congress so far — three in the House and one in the Senate — include a public option.

The proposal also outlines measures to improve and expand Medicaid. Baucus’ plan would make all parents, children, pregnant women and childless adults at or below 133 percent of the federal poverty level eligible for Medicaid. The plan would be paid for with $507 billion in cuts to government health programs and $349 billion in new taxes and fees.

“The Finance Committee has carefully worked through the details of health care reform to ensure this package works for patients, for health care providers and for our economy,” Baucus said in a statement. “We worked to build a balanced, common-sense package that ensures quality, affordable coverage and doesn’t add a dime to the deficit. Now, we can finally pass legislation that will rein in health care costs and deliver quality, affordable care to the American people.”

Under Baucus’ plan, illegal immigrants would not get insurance, a point that became increasingly contentious after South Carolina’s GOP Rep. Joe Wilson’s outburst during Obama’s speech last week.

Senate Majority Leader Harry Reid, D-Nev., said the Democrats are going to hold a special caucus Thursday to discuss the package put forward by the Finance Committee. Baucus’ bill will be voted on next week in the Finance committee before it goes on to the Senate floor.

Since returning from recess last week, the “gang of six” senators of the Finance committee have been working for hours behind closed doors to reach a bipartisan solution. Baucus had set today as his deadline for the bill, despite outcry from both his party members and the GOP. Some Democrats said they would not vote for the bill in its current form because it lacks a “public option,” a government-run insurance program that would compete with private insurance companies. Republicans say the plan is too costly.

Despite the differences, the bill that would pass the Senate Finance Committee has the best chance at bipartisanship. Bills proposed by three House committees and the Senate Committee on Health, Education and Labor led to backlash by conservatives and a rowdy recess for many Democratic lawmakers.

Democrats, Republicans Unhappy With Health Care Proposals
As some Democrats start the difficult task of rallying support in their own party for Baucus’ health care plan, Republicans are lining up against it. Even those who were involved in the negotiations with Baucus, including Sen. Olympia Snowe, R-Maine, and Sen. Charles Grassley, R-Iowa, say additional talks are needed before they can get on board.

“I believe the chairman’s legislation moves in the right direction away from a government-run system contained in bills that have passed other Congressional committees, but a number of issues still need to be addressed — including cost assumptions and ultimate affordability to both consumers and the government as well as ensuring appropriate competition in the health insurance exchange,” Snowe said in a statement.

Other GOP leaders are complaining that the plan would lead to a government takeover of health care in the United States but, at the same time, they are also raising alarm bells that the plan would cut benefits for seniors, who already receive government-run health care in the form of Medicare.

Senate Minority Leader Mitch McConnell, R-Ky., gave Baucus’ plan a thumbs down, saying that it will cut Medicare and set up government-run health care for others.

“This partisan proposal cuts Medicare by nearly a half-trillion dollars, and puts massive new tax burdens on families and small businesses, to create yet another thousand-page, trillion-dollar government program,” McConnell said in a paper statement. “Only in Washington would anyone think that makes sense, especially in this economy.”

McConnell added that it’s just another “trillion-dollar” bill, although the Baucus bill is only $856 billion in its current form. As for Medicare cuts, the bill assumes those savings will be realized with greater efficiency.

Republicans are making a talking point of all the “thousand-page” bills Democrats want to pass, including the other health care bills and the stimulus package. The Baucus bill, as written, is only 223 pages long, but it will get longer when it’s translated into legal language.

But Republican opposition is not the only issue that supporters of Baucus’ plan will have to face. Even before the release of the proposal, Democrats expressed their disapproval with the lack of a public option in Baucus’ proposal.

“There is no way, in its present form, that I vote for it unless it changes in the amendment process by vast amounts,” Sen. Jay Rockefeller, D-W.V., said in a conference call with reporters Tuesday.

Others expressed concern about the proposed taxes on higher-end insurance plans, expected to rake in about $349 billion in new taxes and fees.

“They tax the sort of wealthiest benefit packages, and you’ve got some health insurance, you know — quite a bit of health insurance policies in America that during the next couple of years will top the $16,000 and $21,000 mark that exists in their bill that triggers taxation,” said Rep. Debbie Wasserman Schultz, D-Fla., on ABC News’ “Top Line.”

Democratic Oregon Sen. Ron Wyden said the plan would cost lower-income Americans too much and give many people too little choice of insurance plans.

“If the Baucus proposal passes,” Wyden said in an interview with the Washington Post. “They’re going to say, ‘Huh? Health-care security means I pay a whole lot more than I’m paying today or I get to be exempt from it, or I pay a penalty?’ They’re not going to say that meets the definition of health-care security.’”

ABC News’ Teddy Davis contributed to this report

Popularity: 2% [?]

By SHERYL GAY STOLBERG – The New York Times

WASHINGTON — The conventional wisdom, here and around the country, is that the centerpiece of President Obama’s domestic agenda — remaking the health care system to cut costs and cover the uninsured — is on life support and that only a political miracle could revive it.

Here’s why the conventional wisdom might be wrong:

While the month of August clearly knocked the White House back on its heels, as Congressional town hall-style meetings exposed Americans’ unease with an overhaul, the uproar does not seem to have greatly altered public opinion or substantially weakened Democrats’ resolve.

Critical players in the health care industry remain at the negotiating table, meaning they are not out whipping up public or legislative opposition.

Despite tensions between moderate and liberal Democrats, there is broad agreement within the party over most of what a package would look like. Four of the five Congressional committees considering health care legislation have already passed bills. Each would require all Americans to have insurance and provide government subsidies for those who cannot afford it. Each would bar insurance companies from refusing coverage for pre-existing conditions; imposing lifetime caps on coverage; or dropping people when they get sick.

Getting a bill through the Senate remains a big challenge, but even there, the Obama administration has a reasonable chance of corralling the 60 votes it would need to pass legislation more or less on its terms. One wavering Democratic moderate, Senator Ben Nelson of Nebraska, signaled over the weekend that he might be able to go along with one of the compromise proposals under discussion. Senator Olympia J. Snowe, the Maine Republican whose vote would be vital to Mr. Obama, remains deeply engaged in negotiations, and there are indications that one or two other Republicans, like Senator George V. Voinovich of Ohio, might be in play.

Politically, there is an imperative for Democrats to act; they remember well the disastrous political fate that befell them in 1994, when they lost control of the House and Senate after failing to pass a health bill under President Bill Clinton. Rahm Emanuel, the bare-knuckled political operative and former Clinton aide who is now the White House chief of staff, has wasted little time in reminding his fellow Democrats that, as he said in an interview Tuesday, “the inability to act here will have political consequences.”

None of this is to understate the magnitude of the task facing Mr. Obama as he begins a final drive for the legislation with a nationally televised address to Congress on Wednesday night. The size and complexity of the legislation, the deep partisan divide, the undercurrent of concern among voters about whether government is getting too big and intrusive, opposition from special interests — all create land mines that could still blow up the effort.

But even after weeks filled with seemingly ominous portents for Mr. Obama’s ambitions, there is evidence that public opinion remains basically supportive of him. Despite intense controversy over the “public option,” a government-backed insurance plan that would compete with the private sector, a CBS poll at the end of August found that 60 percent of Americans still support the idea, down from 66 percent in July. And half the respondents to the poll said Mr. Obama had better ideas on health care than Republicans, down from 55 percent.

Mr. Obama likes to say that in the 100 years since President Theodore Roosevelt began advocating universal health care, “we’ve never had such broad agreement on what needs to be done.” On Capitol Hill, it is possible to see how a compromise could come together; Mr. Nelson indicated over the weekend that he could back a provision known as a “trigger” to create a public option if private efforts to cover the uninsured failed.

And despite the fracas of August, the major stakeholders in the health care debate — hospitals, doctors, insurers and the pharmaceutical industry — have not abandoned the negotiations. Ralph G. Neas, chief executive of the National Coalition on Health Care and a veteran of Washington legislative fights, said this was especially significant.

“They’re saying to themselves: ‘We’re going to get 30 to 40 or 50 million new customers. This is in our economic self interest,’ ” Mr. Neas said. “That, as much as anything else, could propel this forward to a law that does provide quality health care for all.”

Mr. Obama still clearly has not closed the deal, which is a major reason he will be making his case directly to the American people and their elected representatives on Wednesday night. The CBS poll found that 6 in 10 Americans say Mr. Obama has not clearly explained what his plans for health reform would mean.

That is a problem for the White House, though it also presents the president with an opportunity to reframe the debate on his own terms. In his address on Wednesday, Mr. Obama has promised to outline what he wants to see in a bill; Republican leaders say the message from August is that Democrats and the president need to start over.

“At this point, there really should be no doubt where the American people stand: the status quo is not acceptable, but neither are any of the proposals we’ve seen from the White House or Democrats in Congress,” Senator Mitch McConnell of Kentucky, the Republican leader, said in a statement, adding: “It should be clear by now that the problem isn’t the sales pitch. The problem is what they’re selling.”

Yet Mark McClellan, who ran the Food and Drug Administration and later Medicare under President George W. Bush, said he saw the churning in August as a part of the public’s education, a “necessary step in the process” and not a fatal blow.

Whether or not Mr. Obama gets the kind of comprehensive bill he is hoping for, Dr. McClellan said, Congress is all but certain to take up health legislation by early next year to fix a measure that would impose a draconian 21 percent cut in Medicare reimbursements to doctors. And once it is tinkering with health care, he said, it is not that big a leap to imagine lawmakers using that bill to take smaller steps toward expanding coverage and passing insurance market reforms.

“Everybody is talking about how the public is very concerned about some of the specifics that they’ve heard,” Dr. McClellan said. “But the public is also very concerned about some aspects of the health care system, including the cost, including the security of their coverage. So depending on how this plays politically, I think there is the foundation for building support for broader legislation.”

Popularity: 2% [?]

WASHINGTON (CNN) — While a government-run public health care option irks conservatives, and even some fiscally minded Democrats, the idea of health care cooperatives has emerged as an option in the reform debate.

Small health care cooperatives have worked in a couple of markets. But whether the idea can be applied on a national scale is debatable.

Sen. Kent Conrad, chairman of the Senate Budget Committee, is pushing the co-op idea as an alternative to a government-sponsored insurance program that would compete with private insurers. He doesn’t think a government option will pass in the Senate.

Conrad, a North Dakota Democrat, told CNN’s “American Morning” on Tuesday that his model could attract 12 million members and “be the third-largest insurer in the country and be a very effective competitor [with private insurance companies].”

“If you believe competition helps drive down costs, then they would certainly contribute to holding down costs,” Conrad said.

But Tim Jost, a professor at Washington and Lee University, said that Conrad is not offering concrete statistics on how the plan will help reform health care.

“I have not seen anything, other than Sen. Conrad’s statements to the press, explaining how this is going to work,” he said. “He put out a couple of one-pagers early on, but he is talking about this actuarial data. Let’s make it public, let’s find out who the actuaries are.”

Co-ops are nonprofit organizations that aim to provide better coverage at a lower cost for their members. They put profits back into the system, so any money that is earned is used on patients and other costs. In addition, patients elect a governing board.

Cooperatives are already established in cities such as Minneapolis, Minnesota, and Seattle, Washington.

In order for a co-op to have reduced costs, analysts say, it needs to have tens of thousands of members. That could be a hard slog for the nonprofits because start-up costs would probably be in the millions. That may be where the federal government steps in — by adding seed money for the program.

That government infusion of money probably would put Democrats at odds with Republicans, who are worried about the rising federal deficit and an expanded role of government in health care. 

And the costs of a cooperative might not allow enough people to sign up, meaning that some of the nearly 46 million uninsured Americans wouldn’t be able to buy into the program. Other health reform alternatives, such as the public option, cost less for participants.

“Let’s see how they [Conrad and others] explain that they are going to get to 10 to 12 million members. … I can’t see how that’s going to happen,” Jost said.

Probably the biggest barrier, Jost said, is entering a new market and trying to establish a network.

“You have to go out there, you have to contract with hospitals, doctors, other providers of care. Well, the private insurers have their networks in place, and they often have what they call ‘most favored nations’ clauses, which provide that a provider cannot [offer] a lower rate than it does to the dominant insurer.”

The idea of co-ops appears to have received some support from the Obama administration.

A top White House aide told Bloomberg Television’s “Conversations with Judy Woodruff” that President Obama may accept nonprofit health insurance cooperatives in place of a new government-run plan.

“We would be interested in that” if certain conditions are met, said Nancy-Ann DeParle, director of the White House Office of Health Reform.

And the idea has gotten support from a key Republican senator.

Sen. Richard Shelby, R-Alabama, said on “Fox News Sunday” that co-ops are “a step in the right direction.”

“I don’t know if it will do everything people want, but we ought to look at it. I think it’s a far cry from the original proposals.”

But not everyone is so sure that co-ops will work to reduce health care costs across the board.

CNN Medical Correspondent Elizabeth Cohen, who spoke with top officials at both co-ops, said this type of model would not solve the problem of uninsured Americans.

“Will co-ops solve that? No. That is according to two folks who run co-ops [one in Seattle and one in Minneapolis]. … They said ‘we are not charities. You have to spend money and pay premiums to join our co-ops. And we don’t take everyone. We sometimes say no to people with pre-existing conditions,’ ” she said.

Co-ops also may not have the industry clout of the big insurance companies. 

“They [co-ops] would have some cost advantages over private plans — they wouldn’t have to make a profit — but they are going to be running on a very small scale, at least initially, and therefore they are going to have very high administrative costs proportionate to claims,” Jost said.

“But again, the big problem is how are they going to get providers to give them a better deal than the providers give the private insurers. They may not even be able to legally do that under their contracts with the commercial insurers,” he added.

CNN’s Dana Bash, Lesa Jansen and Chris Welch contributed to this report.

Popularity: 2% [?]

The popular media is currently hotly debating the pros and cons of universal healthcare as President Obama ramps up his efforts to get his plan through Congress. Most Americans, however, know less about the issue than they should, even though more than 48 million of them have no health insurance and will thus be most directly affected by the implementation of a national system.

The major argument for a universal system can be found in the spiraling cost of health care in the United States, where insurance premiums continue to rise as do the costs of prescription medication and medical procedures — to the tune of about $2.5 trillion annually. In the current recession, providing health care benefits to employees is a burden many small businesses cannot bear. By the same token, workers who have lost their jobs are hardly in a position to pick up expensive private policies on their own.

Advocates for universal health care argue that such a system is inherently more efficient as it would encourage more preventive care, streamline record keeping for individual patients, and cut out on the repetitive mountains of paperwork that underpin even the most simple insurance claim. Proponents, however, are quick to counter with the real fact that there is no such thing as “free” health care. The services the government proposes providing will be paid for by taxes and no doubt by budget cuts in other areas, perhaps some as crucial as defense and education, thus shifting an unfair burden of cost onto healthy Americans who will be paying for their unhealthy counterparts while losing services in other sectors.

Given the government’s often muddled record of inefficiency, proponents also argue that the transition period from a private to a public system will be one filled with chaos and will, in the end, create an even larger bureaucracy than that already in place. Some estimates place the cost of implementing and supporting a universal health care system at as much as $1.5 trillion over the next decade, a figure far larger than the $634 billion set aside by the Obama administration to jump-start the system.

At the most basic levels, then, the “pro” argument is that the only way to reign in health care costs is to implement universal health care that encourages preventative medicine and levels the playing field of expense while improving record keeping and information sharing. The “con” argument is that such a system will raise taxes, force crucial budget cuts, limit consumer choice, and potentially encourage medical abuses as patients are more likely to access services they do not need because they are “free” for the taking. As is often the case, both sides have valid points, and in either scenario, the American consumer will continue to pay — either through higher taxes or through insurance premiums he may or may not be able to afford.

Given the enormous influence of the insurance and pharmaceutical companies and the significant profit loss a universal health care system would pose for them, the Obama administration faces a long, hard fight in Congress to get its package enacted into legislation and, provided they are successful, an even longer transitional period that will, most likely be fraught with mistakes and red tape. No matter how you shake out the scenarios, it seems that at least in the short term, it will be the American people who bear the greatest burden in either scenario.

Popularity: 13% [?]