Wednesday, January 20, 2010

Boston Tea Party

Massachusetts voters tell Democrats to shelve ObamaCare.

'It is to me a new and consolatory proof that wherever the people are well-informed they can be trusted with their own government; that whenever things get so far wrong as to attract their notice, they may be relied on to set them to rights."
—Thomas Jefferson to Richard Price, January 8, 1789.
Two hundred and twenty-one years later, the sage of Monticello has been proven right again. Aroused and well-informed by a year of watching a liberal majority go very far wrong, Massachusetts voters handed a Senate seat held by Ted Kennedy for 47 years to Republican Scott Brown, a little known state senator from Wrenthem.
The resounding five-point victory in one of America's most liberal states is an upset heard 'round Washington—and one that ought to force Democrats to rethink their entire agenda, national health care in particular. Despite an 11th-hour intervention by President Obama in a state he carried with ease only 14 months ago, state Attorney General Martha Coakley was routed even in such unlikely tea-party outposts as Andover (58%) and amid a large turnout for a midwinter special election.


Democratic delusionists are already attributing Mrs. Coakley's defeat solely to her weaknesses as a candidate, and those were real enough (Curt Schilling, "Yankee fan"). But the last time the Bay State elected a Republican to the Senate was 1972, and a mere 15% of state voters now belong to the GOP. Mr. Brown won because moderates and independents swarmed to him, and because he had the wit and nerve to make the race a referendum on Democratic policies in Washington.
[Brown] Associated Press
Scott Brown
The White House insists that the election had nothing to do with health care. But Mr. Brown ran explicitly on a promise to be the 41st Senator against ObamaCare. "I can stop it,'' he declared in one debate.
Massachusetts passed a prototype of the Obama plan in 2006, and residents have since watched as their insurance premiums have risen to the highest in the nation, budget costs have soared, and bureaucrats are planning far more draconian regulation of medical practice. Mr. Brown accurately said the national sequel would be too expensive and reduce the quality of care, and that it would be a "raw deal" forcing Massachusetts taxpayers to subsidize all other states.
It's telling, too, that at his rally for Mrs. Coakley on Sunday, Mr. Obama mentioned health care only by implication. The Commander in Chief did find time to deride Mr. Brown's pickup truck—six separate times. Mrs. Coakley also didn't mention health care in her final TV ad. The Democratic Party's top priority had become such a political albatross that Democrats didn't dare mention it lest it drive more votes to Mr. Brown.


The question now is how Democrats will respond to this historic election rebuke. Only a fleeting supermajority and corrupt logrolling has allowed ObamaCare to advance as far as it has, but many liberals will be tempted to keep telling voters to shut up and learn to like what Democrats give them. "Let's remove all doubt," Speaker Nancy Pelosi told reporters this week. "We will have health care one way or another."
Sometimes politicians really are as obtuse as they seem.
One of those Pelosi ways would be to delay certifying the election or seating Mr. Brown, and then rushing a bill to a vote in the next 15 days. But even liberals can't relish that spectacle of disdain for voters. Another option is to use the budget reconciliation process that would require only 51 Senators. But that would take several more months of committee work and controversy when the White House desperately wants to move on to jobs and its "austerity budget."
A third bloody-minded option would be for the House to pass the Senate's Christmas Eve bill, word for word without amendment. Liberals might swallow that humiliation, but then again ObamaCare only slipped through the House by an eyelash before Thanksgiving, and the bill keeps getting more unpopular.
Many Members may be curled on the floor in a fetal position now that the GOP has won even in the People's Republic of Massachusetts. (We'd love to eavesdrop on the next Blue Dog caucus meeting, or Indiana Senator Evan Bayh's conversations with his pollster.) And assuming they're not paper tigers, Bart Stupak (D., Mich.) and his band of 10 or so pro-life Democrats have said they can't accept the Senate language on funding abortions.
Even if one of these partisan efforts in brute political force succeeded in passing a bill, the effort would only further enrage the public and lead to an even larger Democratic rout in November.
The sensible alternative would be for Democrats to concede how badly they have misread the mandate of their 2008 victory and the public mood. They were elected to fix the economy and to replace a tapped-out GOP, not to exhume and pass every dead 20th-century liberal dream.
The place to start such a rethinking is on health care, by dumping the House and Senate bills and negotiating one that can attract Republican votes. A de minimis package that fixed some of the cost-drivers embedded in the tax code and added refundable tax credits to help the uninsured wouldn't be our policy ideal, but it would be better than the vast new entitlement spending, taxation and central planning that is ObamaCare. Mr. Brown (like everyone) says he supports universal coverage, and what an irony it would be if he and other Republicans ultimately voted for a more moderate plan that saved Democrats from their worst ideological obsessions.
More broadly, Mr. Brown's entire platform was built on change in Washington, and his candidacy tapped into the economic anxiety and political estrangement that voters feel nationwide. The electorate is livid about bailouts, blowout spending and the coming tax increases that Democrats will claim are necessary because of the deficits they have created.
On the economy, Mr. Brown didn't merely oppose tax increases; he was forthright in proposing across the board tax cuts to spur the economy. One of his ads cited JFK's supply-side cuts, and Democrats would be wise to heed that message and reconsider their desire to let the Bush tax cuts expire at the end of this year. Cap and tax on energy, easier unionization and higher estate taxes should all be dropped as burdens holding back job creation and the pace of the economic recovery.


Yesterday's vote wasn't a repudiation of Mr. Obama's Presidency, or at least it needn't be. The President remains more popular than his policies, and voters want him to succeed. But they are also telling him he needs to steer a more moderate, less partisan course, returning to the pragmatism and comity that shaped his political rise but have vanished in his first, squandered year.


Tuesday, January 19, 2010

Reform options may be hard to find

Scott Brown speaks at an event.
A harsh reality is sinking in among Democrats -- that a Republican victory by Scott Brown Tuesday could spell the end of health reform because there is no good option to rescue the plan from this latest brush with political death. Photo: AP

Ever since health care reform flamed out in the 1990s, Democrats thought lots of things might derail their longtime dream this time around. Losing a Senate seat in liberal Massachusetts was not on the list.

But that is the harsh reality sinking in among Democrats — that a Republican victory Tuesday could spell the end of health reform because there is no good option to rescue the plan from this latest brush with political death.

Publicly, the White House and top Democrats held firm to their stance that health care reform will pass this year. And Speaker Nancy Pelosi (D-Calif.) said Monday that Democrats will need to figure out a way to proceed if Republican Scott Brown wins, “but that doesn’t mean we won’t have a health care bill.”

“Let’s remove all doubt that we will have health care one way or another,” Pelosi told reporters in San Francisco.

But privately, Democrats are getting cold feet about pushing ahead full bore on health care. Moderate Democrats who have long been skeptical of the administration’s focus on the issue could begin to peel away in the face of a convincing loss for Democrat Martha Coakley, dealing a fatal blow to legislation that had no room for error in either chamber.

Democrats have options to salvage reform following a Brown victory, but all have serious deficiencies.

One idea that looked promising a week ago — passing a bill through the House and Senate before Brown was seated — has dropped down the list of alternatives, as Democrats fear it would look like a partisan power play that ignored the will of Massachusetts voters.

The White House-favored option is to ask the House to adopt the Senate bill, with a promise to make additional changes later through the budget reconciliation process. But House Democratic liberals, as well as some conservatives, don’t like key parts of the Senate bill and don’t want to make it their own.

Ron Pollack, a longtime health care insider and executive director of Families USA, has floated a variation on this theme with the administration and congressional aides: a two-step process that would reassure House members their wishes would be met in the bill.

Under Pollack’s proposal, the House would take up the Senate bill only after the White House and congressional leaders struck a deal on key issues, such as taxes and the subsidies to purchase insurance. They would incorporate those changes into a separate budget reconciliation bill.

The House would pass both the Senate bill and the reconciliation bill, possibly on the same day. The Senate would then take up the reconciliation bill, which would require only 51 votes for passage.

“It is eminently doable — and quickly,” Pollack said Monday. “It is the combination of two things that wouldn’t work separately but, when done in tandem, make a lot of sense.”

This approach, however, would prevent any fixes that did not have a direct impact on the federal budget, such as changes to language on abortion and immigration and, possibly, even the insurance exchanges. The exchange question could be particularly problematic for House Democrats who have sacrificed the public option in return for the national insurance exchanges under the House bill.

“Progressives and conservatives in the caucus won’t go for it,” one aide predicted Monday. But they may not have a choice. Another aide acknowledged a Brown win would force party leaders to recalibrate and said that Obama and Pelosi would have to convince a skeptical rank and file that this was the only course of action.

Friday, January 15, 2010

The Health Lady Has Yet to Sing

ObamaCare is still no sure thing.

Republican Scott Brown is running strong in Massachusetts on a promise to be the 41st vote against health care in the Senate. Democrats' bigger worry right now is whether Mr. Brown might prove the 218th vote against health care in the House.
The drama of a Christmas Eve health vote left the country with a feeling of ObamaCare inevitability. The Senate was, after all, the heavy lift. If the White House could just bag Nebraska's Ben Nelson and other Senate teases, this debate would be over, save the regulating. A brief ping-pong between the chambers, and Mr. Obama would have his State of the Union triumph.
Political memories are short. Think back to November, when Nancy Pelosi was attempting her own clean-and-jerk of health care. It took three weeks of bribes, cajoling and threats for speaker to eke out a three-vote margin. The action is now back in the House and here's what Ways and Means don Charlie Rangel had to say about it this week: We've got "a serious problem."
Martin Kozlowski 
The biggest problem is that January isn't November. In November, when moderates such as California's Dennis Cardoza were being squeezed for last-minute yes votes, they could take solace that the public was still open to congressional action. This week's Quinnipiac poll has 34% of respondents "mostly" approving the bill. A token 26% of independents back it. In November, House Democrats were being reassured by a relatively popular president. Gallup this week has a mere 37% of Americans approving of his handling of health care. The president has moved from asset to liability.
In November, House Democrats had not yet absorbed the wipeout of the Virginia and New Jersey elections. They hadn't witnessed four prominent House members choose to retire rather than face defeat, or two powerful incumbent senators follow suit. They hadn't seen Alabama Democrat Parker Griffith sprint to the Republican side. They weren't holding 40 of the 50 most competitive House seats.
They hadn't caught a new poll that is all the congressional gossip right now, showing that North Carolina freshman Democrat Larry Kissell remains relatively popular in his conservative district and easily leads potential Republican opponents. Mr. Kissell was a no vote on health care. What makes the poll particularly relevant is data that shows that among the 44% of voters who incorrectly believe Mr. Kissell voted for the bill, the matchups are tied. Among the 29% who correctly understand he voted against the legislation, Mr. Kissell wins huge.
Finally, House Dems hadn't been presented with the mind-blowing sight of a Republican Senate contender running openly against health-care reform—in a state that went 26 points for Mr. Obama—and getting somewhere. "There are a lot of [Democrats] asking the question: There's a need for health-care reform, but our constituents just don't want this, and who are we to say they are wrong?" said one Democratic staffer for a member from a more conservative House district.
This is why Mrs. Pelosi (still) has a math challenge. Of her three-yes-vote margin, Democrat Robert Wexler has resigned; his seat remains unfilled until April. Republican Joseph Cao won't be the final vote for a Democratic bill. As for the 39 Dems who initially voted against the legislation, a vote flip now would be an invitation to be singled out—a la Blanche Lincoln—as the individual who brought the nation ObamaCare.
The potential for flips the other way is big. Michigan pro-lifer Bart Stupak is still vowing that he and up to 10 other Democrats will bolt without his abortion language. Some 190 members have signed a letter demanding the end of the tax on high-value health plans—which President Obama needs to fund the bill. Liberals are still vowing revenge for the death of the public option (though the Award for Most Empty Threats in One Debate still goes to this crew.)
House Republicans smell at least a whiff of blood, enough to launch a campaign targeting 37 Democrats who may have a case of yes-vote regrets. These include members like Oregon freshman Kurt Schrader; 49% of his seniors are enrolled in Medicare Advantage, which will be gutted under the legislation. Also up for special attention are Democrats hailing from flat-broke states that will nonetheless be saddled with huge new Medicaid costs under the bill.
Critics of the legislation shouldn't get their hopes too high. The Democratic leadership is now clinically obsessed with passage. No first-round yes vote has yet jumped ship, and even if some do, Mrs. Pelosi has options. Prior no votes might be convinced that a more "moderate" Senate bill gives them cover to flip. Three no votes, including Tennessee's John Tanner, are retiring, and may feel liberated. The White House no doubt has a list of plum jobs it can offer people as consolation prizes for voting yes and losing their seats.
The point is rather that there is now officially enough nervousness that anything can happen. Whatever the Tuesday election outcome, Mr. Brown already claims victory for rattling Democratic minds. And should he win, health care becomes even more toxic. This isn't over yet.
Write to


Wednesday, January 13, 2010

Taxing Details That Harm Patients

A new levy on Medicare Advantage plans would hurt lower-income seniors the most.

While rushing to save a patient, a physician's first responsibility is to "do no harm." That requires remembering that sometimes a treatment can make things worse. And so it should be with the health-care reform moving through Congress. Clearly this issue is too big and too important to ignore. For America's sake, reform needs to happen. But it's also too complex an issue to rush a treatment with details that might cause harm.
Most of us agree that America's health-care system needs to be fixed. Families and businesses are struggling to keep pace with soaring costs. Too many Americans are without adequate coverage. And all of this is damaging our economy. But it will do no good to reform the system if it ends up degrading the quality of care most of us currently receive or saddling future generations of Americans with unconscionable debt.
As always, the devil is in the details, and we'd better be paying very close attention to their rich potential for unintended consequences. For example, one provision in the Senate's version of health-care reform would impose a new tax on a number of federally-funded health-care benefits.
In effect, the federal government would be taxing the money it provides for Medicare and a host of other important programs. By so doing, it would unintentionally jeopardize the quality of care that many of our oldest, sickest and most vulnerable citizens depend on.

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The Senate legislation imposes this yearly premium tax on for-profit and not-for-profit health plans, generating an estimated $60 billion in tax revenues over its first nine years. Government-run programs would be exempt from the tax. However, the tax would be levied on Medicare, the Children's Health Insurance Program, Medicaid, and Tri-Care for the families of military dependents when delivered by a private-sector plan.
Large private-sector health plans offering a diverse line of products would likely recover the cost of the tax by raising premiums on their other products.
But for those health plans specializing in Medicare, Medicaid and other government programs, there would be no such option. These providers are strictly bound by federal contracts and frequently operate at or near cost, serving America's older, higher-risk and higher-cost patient populations. Since they have no profits with which to absorb the tax or any ability to pass it on, they'll have only one option—to reduce the health-care services they provide. Certainly this isn't what the Senate intends.
Nonetheless, some 10.2 million Americans who now choose to purchase Medicare Advantage through private providers because it gives them better benefits at lower cost may be hurt. These are frequently lower-income elderly people with a multitude of serious health problems. The services they receive allow many of them to remain in their homes close to friends and family during their final years, rather than be moved into nursing homes where their care would be far more expensive and their days much emptier. They would be among the victims of this new federal tax.
What kind of Americans are we talking about? Here are a few real examples: An 89-year-old woman who lives alone recovering from a mastectomy, who has osteoarthritis, glaucoma and degenerative joint disease. An 81-year-old gentleman living in his daughter's home who has bone, liver and bladder cancer. An elderly couple where the wife has trouble walking because of arthritis, while the husband suffers from Alzheimer's requiring 24-hour care. These are the kind of people health-care reform should be helping, not hurting. Extending benefits to some Americans by cutting care for others isn't reform—it's unfair.
Fixing our nation's health-care system is a historic undertaking. As Congress works toward a solution, I encourage my former colleagues to pay very close attention to the details and be mindful of the unintended consequences of what they do today, because the impact of their decisions will be with us for generations. A treatment that leaves the system in worse shape isn't a cure.
Mr. Dole, a former Senate majority leader, was the 1996 Republican nominee for president. He is a founding advisory board member of the nonprofit Bipartisan Policy Center, which is working for principled compromise on health care and other issues. His firm, Alston & Bird, represents a range of health-care organizations.

Saturday, January 9, 2010

Married Couples Pay More Than Unmarried Under Health Bill

WASHINGTON -- Some married couples would pay thousands of dollars more for the same health insurance coverage as unmarried people living together, under the health insurance overhaul plan pending in Congress.
The built-in "marriage penalty" in both House and Senate healthcare bills has received scant attention. But for scores of low-income and middle-income couples, it could mean a hike of $2,000 or more in annual insurance premiums the moment they say "I do."
The disparity comes about in part because subsidies for purchasing health insurance under the plan from congressional Democrats are pegged to federal poverty guidelines. That has the effect of limiting subsidies for married couples with a combined income, compared to if the individuals are single.
People who get their health insurance through an employer wouldn't be affected. Only people that buy subsidized insurance through new exchanges set up by the legislation stand to be impacted. About 17 million people would receive such subsidies in 2016 under the House plan, the Congressional Budget Office estimates.
The bills cap the annual amount people making less than 400% of the federal poverty level must pay for health insurance premiums, ranging from 1.5% of income for the poorest to 11% at the top end, under the House plan.
For an unmarried couple with income of $25,000 each, combined premiums would be capped at $3,076 per year, under the House bill. If the couple gets married, with a combined income of $50,000, their annual premium cap jumps to $5,160 -- a "penalty" of $2,084. Those figures were included in a memo prepared by House Republican staff.
The disparity is slightly smaller in the Senate version of health-care legislation, chiefly because premium subsidies in the House bill are more targeted towards low-wage earners.
Under the Senate bill, a couple with $50,000 combined income would pay $3,450 in annual premiums if unmarried, and $5,100 if married -- a difference of $1,650.
Republicans say the effect on married couples whose combined income makes them ineligible for subsidies is even greater -- up to $5,000 or more -- but that is more difficult to measure because it includes assumptions about the price of insurance policies.
Democratic staff who helped to write the bill confirmed the existence of the penalty, but said it cannot be remedied without creating other inequities.
For instance, they said making the subsidies neutral towards marriage would lead to a married couple with only one bread-winner getting a more generous subsidy than a single parent at the same income-level.
"The Finance Committee, along with other committees in the Senate, took pains to craft the most equitable overall structure possible, and that's what we have here," said a Democratic Senate Finance Committee aide.
If the bill passes in its current form, it would be far from the first example of federal and social benefits creating incentives to remain single. Under current law, marriage can have a negative impact on a person's ability to claim the earned income tax credit and welfare benefits including food stamps.
In any progressive system of taxes or benefits, there are trade-offs between how well-targeted a subsidy is and how equitable it is, said Stacy Dickert-Conlin, an economics professor at Michigan State University.
"You might like to have it be progressive, equitable and marriage-neutral. But you have to decide what your goals are, because you can't accomplish all three," she said.
The marriage penalty in the health bill has not been a major focus of attack by Republican opponents of the bill, who are focusing on larger themes such as new taxes in the bill and growth in government spending.
But it has caught the attention of some conservative groups, who claim that the prospect of reduced subsidies will dissuade people from tying the knot.
"This seems to not only penalize the married, but also those who would have the most to gain from marriage -- the poor," said Jenny Tyree, an analyst at the Colorado-based Focus on the Family.
Ms. Dickert-Conlin said that isn't borne out by research in the area.
"Most of the literature says that people do not make decisions about whether or not to get married based on" government benefits, she said.
"You might see bigger effects on the timing -- someone choosing to get married in January, instead of December," she said.
Write to Martin Vaughan at

Obama Promised Eight Times During Campaign To Televise Health Hearings

Friday, January 8, 2010

Sestak puts blame on Democratic leaders for slipping support

By Salena Zito and Mike Wereschagin
Thursday, January 7, 2010
Last updated: 10:25 am

Rep. Joe Sestak blames Democratic leaders for the plunge in public support for overhauling the health care system, saying Wednesday they failed to defend proposals that helped carry the party to victories in 2008.
"They said it would be transparent. Why isn't it?" said Sestak, a Delaware County Democrat, in a meeting with Tribune-Review editors and reporters. "At times, I find the caucus is a real disappointment. We aren't transparent, not just to the public but at times to the members."
Sestak is challenging Sen. Arlen Specter in the May 18 primary, as is Dravosburg's state Rep. Bill Kortz. Former Rep. Pat Toomey of the Lehigh Valley and Peg Luksik, a Johnstown activist, are seeking the Republican nomination for the seat.
A Quinnipiac University poll last month showed Specter holding a 53 percent to 30 percent lead over Sestak, a former Navy admiral, in the primary. Kortz, who often is overlooked, is not included in the polls.
Sestak says the two defining aspects in the polls in his favor are the high number of undecided voters and Specter's re-election numbers. Recent polls have shown that fewer than 40 percent of people think Specter deserves re-election, a vulnerability considered dangerous by most pollsters.
Specter's office said the senator "carried the torch" for President Obama's health care message with town hall meetings and key caucus meetings, helping to secure provisions on tougher Medicare fraud enforcement.
"Senator Specter has consistently stated he has wanted the health care debate to be an open process, including supporting the bill being posted online 72 hours in advance of votes," his office said in an e-mailed response. "He's supportive, in general, of giving Americans more access to government goings-on."
Sestak said political deals that Democratic Sen. Ben Nelson of Nebraska and others cut in closing the health care bill were a disgrace: "To think that you would hold out to close a deal for a special interest is absolutely wrong."
Nelson gave his critical support to the Senate version of the health care bill after securing a provision for Nebraskans that will require the federal government to permanently pay the entire cost of Medicaid expansion in his state, while paying the costs of expansion in the other 49 states for just three years.
Nelson could not be reached for comment yesterday.
Sestak points to that move as one reason Americans are uneasy about Democrats. "They should be," he said. "I think that Democrats have failed as much as Republicans as erstwhile servants."
Specter's reception
As his campaign gears up, Sestak has distanced himself from the Washington establishment and the Democratic Party. For months, he said, Democratic Sen. Robert Menendez of New Jersey, the Senatorial Campaign Committee chair, urged him to run; yet Sestak said he was asked to forget the idea when Specter, who is seeking a sixth term, switched parties in April after 44 years as a Republican.
"Three, four weeks later, Arlen converts, and they call and say, 'Sit down,' " Sestak said. Party leaders said he should drop out of the race to make way for Specter. "What kind of deal is this? If there's anything that has to change, it has to be that."
"Clearly, the biggest obstacle that he must overcome is the Democratic leaders' mandate of the party apparatus to support Specter," said Keystone College political scientist Jeff Brauer.
Brauer said without such a mandate, there is little doubt Sestak could lead in polls because rank-and-file Pennsylvania Democrats have given Specter a lukewarm reception.
Financial gap
Brauer said Sestak's other challenges include fundraising and increasing his name recognition. That's why Sestak said he drove across the state in a snowstorm at 2:15 a.m. from Bucks County to Westmoreland County, to meet with voters and party faithful.
"I need to let people know there's a principled alternative," Sestak said. "How can you trust someone who switched parties to keep his job?"
Though Sestak's $4.7 million campaign account trailed Specter's by about $4 million at the end of the last reporting period in September, Sestak claims he has raised more than any challenger Specter has faced.
If Sestak beats Specter for the Democratic nomination, the most recent Quinnipiac poll showed Toomey winning over Sestak, 40 percent to 35 percent.
Sestak said he genuinely likes Toomey; in September, the two held a cordial health care town hall at Muhlenberg College, near Allentown, and drank beer together afterward. But he noted that he and Toomey have clear differences politically: "Pat Toomey voted for the same savage and regressive tax policies that favored the well-to-do. And he voted to deregulate Wall Street and let them gamble."
Toomey said that although he, too, likes Sestak, he finds it curious that Sestak would hit him on the topic of Wall Street. "Both he and Specter supported bailing out Wall Street, something that I vehemently and publically opposed," Toomey said. He described Sestak as a principled liberal, "which means he supports bailouts, spending, public options and a dramatic expansion of government."