Friday, August 14, 2009

Obama giving health care critics upper hand

(08-14) 04:00 PDT Washington - --

A president famous for his campaign skills has let the opposition define the debate on health care reform, the central issue of his party and his presidency.

Testing Obamacare’s Meddle

To cut costs, government must meddle not just with how we live, but how we die.

By Jonah Goldberg

If I went to a Democratic town hall, I’d probably boo, too. Hence, according to various Democrats and supporters of Obamacare, I’m paranoid and just a bit unpatriotic.

Well, let me dilate on my paranoid treachery for a moment.

Under the plan discussed at President Obama’s infomercial-esqe town halls, America would cut costs and expand coverage while avoiding rationing. Apparently, it’s paranoid to think that’s too good to be true.

Imagine you’re in charge of bringing pie to a company picnic. You’re planning to provide dessert for 100 people. Then, your boss says you need to hand out pie to 150. Fine, you say, I’ll make more pies. But — oh no! — you can’t, because you’ve also been told costs must go down. Okay, then you can cut slices of the existing pies smaller so everyone can have a piece. Wait! You can’t do that either, because you’re not allowed to ration (i.e., give less to more).

According to Obama, the health-care pie will be sliced into more pieces, of equal or greater size than available now, for less money — all because government is so much better than the private sector at managing large projects.

Such contradictions run through the talking points for Obamacare. Consider life expectancy. In his big speech before the American Medical Association in June, Obama insisted that “the quality of our care is often lower, and we aren’t any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do.”

It’s true, a few countries beat us in terms of life expectancy. But life expectancy is only partly about health care. Other factors matter. Swaziland’s life expectancy is 31.88 years. That doesn’t mean the average Swazi dies just a couple of weeks before his 32nd birthday. It means lots of people die young and a few people die old and the average comes out to around 32.

According to the CIA World Factbook’s 2009 estimate, American life expectancy is 78.11 years. In the U.K. — with its nationalized system — it’s a whopping 79.01. Taiwan’s is 77.96 and so is Albania’s. Do we really think the best explanation for all this is how they pay for medical care? Or perhaps things like diet and culture are more important? Is Japan’s health-care system what explains Japanese longevity, or is it that fish and seaweed are staples of the Japanese diet?

Even greater disparities exist within America. Asian-American women, according to a 2006 study by Harvard’s School of Public Health, have a life expectancy of 87 years, while for African-American men it’s 69. The healthiest white people in America are the low-income folks of the Northern Plains states. Again, is our health-care system the biggest factor?

But here’s the kicker: The more life expectancy improves, the more we will spend on health care. Despite his professed outrage over charges of “death panels” and whatnot, Obama admits this. In an interview with the New York Times last spring, he acknowledged that oldsters are a “huge driver of cost.” The “chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health-care bill out here,” Obama explained. Which is why he advocated an advisory panel of experts to offer “guidance” on end-of-life care and costs. But don’t you dare call it a “death panel.”

Now, I don’t think Soylent Green-style solutions are coming down the pike. (Government cheese is people!) But every nationalized health-care system to one degree or another rations care based on the quality of life and number of “life years” a procedure will yield. That’s perfectly reasonable. If you put me in charge of everyone’s health care, I would do that, too. That’s a really good argument for not giving me — or anyone else — that power.

When it comes to civil liberties, liberals are often distrustful of government power. But, for reasons that baffle me, they are quite comfortable with Uncle Sam getting into the business of deciding, or providing “guidance” on, which lives are more valuable than others. A government charged with extending life expectancy must meddle not just with our health care, but with what we eat, how we drive, how we live. A government determined to cut costs must meddle not just with how we live, but how we die.

That sounds scary and un-American to me. And if that makes me paranoid and unpatriotic, then I am what I am.

— Jonah Goldberg is editor-at-large of
National Review Online and the author of Liberal Fascism: The Secret History of the American Left from Mussolini to the Politics of Meaning. © 2009 Tribune Media Services, Inc.

Thursday, August 13, 2009

Emanuel's Brother Becomes a Target


WASHINGTON -- Ezekiel Emanuel, a top health-care adviser to President Barack Obama and older brother of White House Chief of Staff Rahm Emanuel, is emerging as a target of conservatives critical of Democrats' health-care effort.

Rahm Emanuel's Brother New Focus in Health Debate


Critics of Obama's health-care push are focusing on Dr. Ezekiel Emanuel, brother of White House chief of staff Rahm Emanuel. WSJ's Naftali Bendavid explains why the longtime scholar of medical ethics and health reform is drawing criticism over who should receive care.

Dr. Emanuel, a prominent oncologist and medical ethicist who has taught at Harvard Medical School and served at the National Institutes of Health, has written dozens of scholarly articles over the years. Critics are using his writings to suggest Dr. Emanuel favors withholding care from the elderly and disabled.

One of their most-cited examples is a 1996 article Dr. Emanuel wrote in the bioethics journal Hastings Center Report. Exploring which medical services should be guaranteed to all Americans, Dr. Emanuel cited an approach that would favor active people, adding, "An obvious example is not guaranteeing health services to patients with dementia."

In a radio interview last month, Betsy McCaughey, a scholar at the conservative Hudson Institute, cited the article in asserting that Dr. Emanuel believes patients with incurable diseases shouldn't be guaranteed health care. She and other critics have suggested a tie between Dr. Emanuel's views and a provision in a House health bill that would pay doctors to counsel Medicare patients on end-of-life issues such as living wills. Ms. McCaughey said the bill provided "counseling on how to cut your life short."

Ezekiel Emanuel, shown speaking to the AMA in Washington in March, is an oncologist and medical ethicist advising the White House.
Associated Press

Ezekiel Emanuel, shown speaking to the AMA in Washington in March, is an oncologist and medical ethicist advising the White House.

The White House forcefully defends Dr. Emanuel, saying he is an academic who explores tough questions surrounding life and death.

In an interview Tuesday, Dr. Emanuel said his 1996 piece was "attempting to analyze different philosophical trends," not expressing his own views. Dr. Emanuel noted that he was a well-known opponent of euthanasia and assisted suicide.

"I'm an oncologist who has cared for scores, if not hundreds, of dying patients," he said. "For 25 years, I've been a researcher, one of the first to go into the field of end-of-life care with the goal of improving it....It's a perversion of everything I've done to take one or two quotes completely out of context, without any of the qualifiers I've added, and distort them."

In another article, in the Lancet last January, Dr. Emanuel said age was one of several factors that could be considered in deciding who receives scarce organs or vaccines. "Unlike allocation by sex or race, allocation by age is not invidious discrimination," he wrote. "Every person lives through different life stages."

Rep. Michele Bachmann (R., Minn.) blasted that and other Emanuel statements on the House floor July 27. "The president's adviser defends discrimination against older patients," she said. Other Republicans, including former Alaska Gov. Sarah Palin and former House Speaker Newt Gingrich, have suggested the Democrats' plans could lead to euthanasia, a notion dismissed as ludicrous by the bill's authors.

Dr. Emanuel and other supporters of Mr. Obama see the criticisms as misleading. "I find it a little dispiriting, after a whole career's worth of work dedicated to improving care for people at the end of life, that now I'm 'advocating euthanasia panels,' " Dr. Emanuel said.

Dr. Emanuel, who heads the bioethics department at the Clinical Center of the National Institutes of Health, is working temporarily at the White House. White House spokesman Kenneth Baer said Dr. Emanuel was brought in by budget director Peter Orszag, and that his role owes nothing to that of his brother.

Ms. McCaughey apparently launched the assertion that Democratic bills encourage people to die in her July 16 radio interview. House Minority Leader John Boehner (R., Ohio) said a week later the bill "may start us down a treacherous path toward government-encouraged euthanasia."

Ms. Palin warned Friday on Facebook that "my parents or my baby with Down syndrome will have to stand in front of Obama's death panel." Mr. Gingrich said on ABC's "This Week" that "you're asking us to trust turning power over to the government, when there clearly are people in America who believe in establishing euthanasia."

Sen. John Cornyn (R., Texas) said the death panel allegation is "probably an exaggeration of what is actually in the plans." But he said it stems from fears that Democrats would allow government intrusion in personal health matters. "The most important thing here is that those decisions must be left in the hands of the families and individuals most directly affected," Mr. Cornyn told reporters Monday.

Rep. Earl Blumenauer (D., Ore.), co-sponsor of the end-of-life House measure, said it was a bipartisan provision that would encourage people to think about issues such as living wills before it was too late. The criticism "illustrates just how desperate some people are to do anything they can to derail health insurance reform," he said.

The Health Care Reform Paradox

By David Paul Kuhn

Americans are of two distinct minds on health care reform.

Most Americans continue to support major reform. But multiple polls show they are also overwhelmingly satisfied with the quality of their personal medical care, as well as their insurance coverage.

This health care reform paradox is the core reason why Democrats are finding it increasingly difficult to rally the public behind their dramatic effort to overhaul the nation's medical system.

About three-in-four Americans believe the nation's health care system requires major reform. Most Americans view U.S. health care as flawed.

But public support for reform significantly declines when associated with taxing high-end health plans, adding to the deficit, increasing personal costs or decreasing personal flexibility.

At least a quarter of those who support fundamental reform appear unwilling to accept significant personal cost to enact that reform, or risk worsening the status quo.

Health reformers, in fact, never had a clear mandate for major reform. This is because dissatisfaction with the system is met by personal satisfaction.

In late July, a Time magazine poll found that 55 percent of Americans rate their health care system as "only fair" or "poor." Six-in-ten had a negative view of private health insurance companies' job performance. But 86 percent of Americans still said, when asked, that they were satisfied with their own health care plan.

One month earlier, an ABC News/Washington health care poll found that six-in-ten respondents backed reform and even the creation of a government-funded entity that would offer health insurance to the uninsured.

But the same poll also found that about eight-in-ten Americans are, again, satisfied with the quality of their care and their insurance. Fifty-five percent of Americans even express satisfaction with the personal costs related to health care (including 61 percent of the insured). Kaiser Family Foundation polls in 2008 and 2006 echo the same pattern.

This health care reform paradox partly explains why a strong majority of Americans remain supportive of the concept of major reform, and even the broad strokes of a likely Democratic bill, but are concurrently divided over the current legislation being negotiated in Congress.

To an extent, the paradox follows a common trend in public opinion. Americans tend to disapprove of Congress but when asked about their own congressman, they respond, "Oh, he's a good guy;" they approve. Americans want public school reform but will speak well of their child's teacher.

Yet health care reform remains unique. The extent to which personal satisfaction with health care translates into a positive sentiment has yet to be explored in depth. And in practical terms, what matters is that the paradox remains and therefore, so does Democrats' problems.

Explaining the Paradox

About three-in-four Americans say it is "necessary to make major structural changes" to "make sure that all Americans have health insurance" or "to reduce health care costs," according to a recent CNN poll. But "Obama's plan to reform health care" won only a sliver more support than opposition, by a margin of 50 to 45 percent.

One explanation for this slide in support is that, for most of the year, Obama and top Democrats have advocated reform most Americans did not believe would impact their lives for the better.

Only about one third of adults now believe health care legislation will personally "benefit" them, according to a recent CBS/New York Times poll. By a 65 to 29 percent margin, Time found, Americans believe the final legislation will make "everything more complicated," rather than "simpler."

Americans generally support the policy that supports them. It's a lesson Democrats began to learn the hard way at the apex of the Great Society.

Top Democrats have caught on this time, albeit belatedly. This summer Obama began increasingly emphasizing that the final bill will not "mess with" an American who hopes to keep her doctor or insurance.

Obama's weekly radio address at the end of July had "health insurance reform" in its title rather than "health care reform." The week before, the title used the term "heath care reform" but the address included "health insurance reform." The week before that, the phrase "health insurance reform" did not even appear in the address.

This linguistic shift signified an overdue insight. Health care reform was initially framed around a keystone reform: offering coverage to those who have none. But Time's poll, as well as others, have long found that only about one tenth of U.S. adults say they have no health care coverage.

"Health insurance reform" is meant to place the emphasis on improving everyone's experience, not simply the uninsured. But even this repackaging of message and mission are not easily reconcilable with most Americans' satisfaction with their personal experience.

The reform instinct is no less real, however. Time recently found that 55 percent of Americans favor "major reform" over "minor adjustments." The CBS/Times poll has steadily found that more then eight-in-ten Americans want "fundamental changes" or to "completely rebuild" the health care system, rather than "minor changes."

More Harm than Help?

Democrats are left with a public that supports overhauling the nation's system but they lack a public personally invested in that overhaul. The public supports reform but have come to believe reform will not support them.

This explains why the latest NBC News/Wall Street Journal Poll found that only 41 percent of Americans approve of how Obama is "handling the issue of health care reform."

But the same poll proceeded to detail a plan that Obama will likely support. Pollsters described a plan that requires: pre-existing condition coverage, most employers to cover the uninsured, tax-credits for those who cannot afford insurance and a plan that raises taxes on the wealthy. Americans supported the plan by a 56 to 35 percent margin.

Polls show a majority of the public will support raising taxes on the ultra-rich or even the wealthy to fund such reform but that is, of course, because a majority of Americans don't see themselves as wealthy or rich.

About six-in-ten Americans are, for example, against taxing expensive health care plans or "tighter restrictions on what medical procedures Medicare and Medicaid will cover," the Pew Research Center found last month, likely because enough Americans believe those measures will immediately or eventually cost them.

Perhaps more problematic for Democrats, only about a fifth of Americans believe Obama will uphold his promise to not deepen the deficit with health care reform, according to a recent Quinnipiac University poll.

The lubricant of major reform has also always been high public anxiety. But only about a third of Americans say they are worried about losing their health care coverage in the next year, according to the Time poll.

In practical terms, the health care fight has become bigger than itself. It is a proxy for a larger, and often partisan, American debate over the role of government.

The ABC/Post poll found 54 percent of Americans support a smaller government with fewer services than a larger government with more services. And as the poll noted, this explains why health care support plummets if private plans are threatened. Polls show Americans would still rather trust their health care to private over public plans--this, despite about a quarter of U.S. adults depending upon public plans like Medicare for insurance.

But to many Americans, and especially seniors, the current legislation is raising red flags that even their government plan is threatened.

For the wider public, there are few concerns greater than cost and liberty. Yet the Time poll found that Americans believe by about a 2 to 1 ratio that the final plan will raise their health costs, not lower them, and offer less freedom to choose doctors and coverage rather than more.

The negative views of the current legislation are partly rooted in the lack of definitive legislation. Democrats have a handful of programs cooking rather than one.

The CNN poll may ask about "Obama's plan" but, we tend to forget, he has no plan. This provides the opposition a garden of flaws to highlight, and offers Obama no one plan to defend. By early September, Obama will likely begin to promote a singular plan.

Yet the canvas of polling illustrates why even if many fears are addressed, Obama has a hard sell before him. Foremost, only so much of the electorate is open to the sale. Two-thirds of Republicans and GOP leaning independents want their representative to oppose health care reform, according to a Gallup poll. And there is no indication that there is significant room to change Republicans' minds, particularly because the defeat of this legislation would be an immense blow to Obama's presidency.

Obama's burden is ultimately dependent on his ability to unite the centrists and conservatives within his own party. And the ease of corralling those legislators will, in substance and message, depend on reconciling much of the health care reform paradox.

Democrats still must convince most Americans, independents in particular, that what is good for the nation's health care system will not be bad for them. For now, the public believes the opposite.

David Paul Kuhn is the Chief Political Correspondent for RealClearPolitics and the author of The Neglected Voter. He can be reached at and his writing followed via RSS

Protesters raise voices to 'big government'

STATE COLLEGE, Pa. (AP) — Nancy Snyder says she kept quiet when abortion was legalized and prayer in schools was eliminated. Not this time.

"They did it for prayer, they did it for abortion, and they're not going to do it for our health care," the 70-year-old nurse from Philipsburg, Pa., said Wednesday as she and her husband Robert, 74, a retired coal miner, waited in a long, snaking line for Democratic Sen. Arlen Specter's town hall meeting.

"We're not standing back this time," Snyder said.

Instead, the Snyders and many Americans like them are adding their voices to a populist backlash evident in the taunts, jeers and rants at lawmakers' health care forums around the country in the past week and a half. The contentious sessions highlight the difficulty for President Obama and the Democrats as they push for a comprehensive remaking of the nation's health care system.

Many of those raising their voices and fists at the town halls have never been politically active. Their frustration was born earlier this year with government bailouts and big spending bills, then found an outlet in the anti-tax Tea Parties in April and has simmered in the punishing recession.

In some cases, it's been nurtured by talk radio and Glenn Beck's 9-12 Project, which seeks to unify Americans around nine values such as honesty, hope and sincerity and 12 principles, including, "I work hard for what I have and I will share it with who I want to. Government cannot force me to be charitable."

There is an element of organized opposition, just as on the other side unions and Obama's political organization are trying to turn out supporters to town halls and other events. The insurance industry lobby, America's Health Insurance Plans, is encouraging workers to attend town hall events to make their views known. So is the group Conservatives for Patients' Rights.

Still another group, Americans for Prosperity, has two buses emblazoned with the slogan "Hands off our Health Care!" that are traveling around the country to rallies and town halls, including Specter's. At the town halls, small groups of volunteers circulate petitions opposing any legislation allowing greater government involvement.

But it's not just about organization.

"I don't want someone else to select and say this is what you can and can't have," Nancy Snyder said.

"Nobody told us to come," she added. "I float my own boat."

The protesters have several concerns, but a unifying emotion is distrust of the government and federal intrusion into individual liberties or personal choices.

The emerging movement is almost the mirror image of the grass-roots campaign that helped sweep Obama into office by pulling in people who'd never been politically active. This time Obama is seeing the other side of what can happen when people are motivated, connect over the Internet and seemingly reach a tipping point that turns them from onlookers into activists.

"You have awakened a sleeping giant," one woman told Specter at a town hall meeting he held Tuesday in Lebanon, Pa.

Protesters interviewed at Specter's town hall events in central Pennsylvania this week were almost exclusively white, conservative and working class. But they ranged in age and their concerns went beyond health care to deficit spending, taxes, government growth and other issues. Many contradicted claims from Democratic leaders that their protest was manufactured by lobbyists or that they represented an orchestrated opposition led by Republicans or national conservative groups.

"I had it on my calendar before town halls became the big thing," said Jennifer Moeny, 32, a stay-at-home mom who attended Specter's town hall in State College on Wednesday. "I just came to voice my opposition. ... They should be open and honest instead of ramming it through."

For many opponents the health care overhaul amounts to the final straw. After seeing Obama bail out banks and car dealers, push a major energy bill and pass a $787 billion economic stimulus package that hasn't driven down unemployment, overhauling the $2.5 trillion U.S. health care system is a step too far.

"This is all being pushed way too fast. It's just being rammed down our throat," said Bette Jackson, a retiree from State College. "I agree we need health care reform, but I don't want the government taking over."

Nick Sidorick, 38, who said he owns a sports bar in Clearfield, Pa., drove an hour to attend his first town hall Wednesday after staying up until 2 a.m. the night before making signs to protest government intrusion. "I work 14 hours a day and I can't get ahead because of what the government takes from me."

"It's just exhaustion, I guess," Sidorick said of his motivation to attend.

A volunteer for Americans for Prosperity, Ron Rutigliano, 41, a high school teacher from Long Island, N.Y., said his parents grew up in Italy and he's seen firsthand the government-run system there, which he said provides poor care.

Democrats' plan would "just take away from the person that has a full-time job, that's been doing the right thing," Rutigliano said.

Wednesday, August 12, 2009

Democracy Aside: The Public Option

The Public Option
In rushing health-care reform, Obama has pushed democracy to the side.

By Ivan Kenneally

In the last few weeks, the debate over health care has taken an angry and contentious turn by any standard. Town-hall meetings and public rallies, not known for their docile tenor under normal circumstances, have been punctuated by unusually spirited opposition to Democrat proposals for sweeping reform. What began as a few isolated outbursts of spontaneous frustration has become commonplace at public gatherings, prompting many Democrats to cancel
appearances and limit their communications to press releases. While Obama’s administration continues to claim broad and deep public support for its legislative efforts, poll after poll indicates growing suspicion that Democrat-authored proposals are fiscally reckless and, despite repeated protests to the contrary, designed to nationalize the health-care industry as a whole.

In response to the unwelcome rumblings of dissent, leading Democrats have attempted to squash public debate under the sheer weight of rhetorical condescension. White House press secretary Robert Gibbs has mocked town-hall attendees’ “manufactured anger” and has called them the “Brooks Brothers Brigade,” following California senator Barbara Boxer’s claim that they are too “well-dressed” to be true grassroots activists. The Democrat National Committee has referred to these outspoken critics of Obamacare as “mobs.” Reps. Nancy Pelosi and Steny Hoyer, speaker of the House and House majority leader respectively, co-authored an op-ed in USA Today referring to such clamorous objection as “un-American.” The White House has established a “Reality Check” website that supposedly debunks any and all challenges to their policy positions, suggesting that dissent is the product of either dishonesty or delusion — no intelligent or sincere American could possibly take issue with the only rational avenue available for serious reform.

However uncivil some of the town-hall interruptions have been, the palpable irritation on the part of so many disgruntled citizens is not only an expression of political opposition to a particular policy but a bubbling over of resentment at the feeling of general powerlessness. At every turn, the Obama administration has attempted to fast-track an immensely complex piece of legislation, ensuring that a transparent national debate is impossible and that even our legislators remain ignorant of the details of any proposal. The real question here is not whether these protests are “organized” or even disruptive — the Democrats used union-funded political organizations in 2005 to stage public protests, orchestrate “grassroots” political advocacy, and televise professionally produced advertisements to undermine President Bush’s platform for Social Security reform. Rather, the point is the audacity of disagreement. Obama has tried to create the illusion that debate is dangerous, given the exigency of the current crisis, and unnecessary, given the solid public consensus.

Unfortunately, the contempt for public debate is one of the hallmarks of Obama’s technocratic approach to politics — in place of a healthy and democratic deference to public opinion, we get the assurance of expertise that comes with a bevy of special-issue czars. The key ingredients of President Obama’s election victory were technocratic competence and a therapeutic populism — his Ivy League intellect would be the key to solving our average-Joe problems. Nevertheless, it’s not at all clear that the technocratic conception of politics is compatible with a robust deliberative democracy. And Obama’s technocratic side is winning out.

Obama’s populism is based on the satisfaction of the will of the people — he decries, however insincerely or inconsistently, the undermining of general consent by the overrepresentation of special interests or of the wealthy. However, Obama’s conception of techno-politics is based on the embrace of a kind of techno-aristocracy — hyper-educated elites with specialized political or scientific expertise are singled out to manage the benighted rest of us. The conspicuous contradiction embedded within Obama’s political program is between his populist embrace of consent and his technocratic dismissal of it: The former presumes the prudence of common sense; the latter rejects it as radically untutored.

Examples of this tension are numerous. In his March 9, 2009 “Executive Order Removing Barriers to Responsible Scientific Research Involving Human Stem Cells,” President Obama equated President Bush’s restrictions on federal funding for stem-cell experimentation to “limitations on scientific inquiry itself.” Similarly, in the remarks Obama delivered to the press announcing the executive order, he described his revision of his predecessor’s position as a means for “protecting free and open inquiry,” implying that the moral objections shared by so many Americans were not only the product of irrational superstition but tantamount to a wholesale rejection of the quest for truth.

It has also become impossible to deny that Democrats deliberately concealed the jurisprudential philosophy that clearly guided Sonia Sotomayor’s 18 years on the bench. While this made political sense, given that a considerable portion of the public would probably find her rejection of judicial objectivity unpalatable, it was democratically dubious. As was the goal underlying Sotomayor’s nomination in the first place: To increase the role of the judiciary in making policy while decreasing that of the people’s elected representatives — an updated paternalism that seeks to protect the people from themselves.

Finally, despite a burgeoning distrust of both the economic and environmental defensibility of the cap-and-trade bill, Obama has proceeded swiftly, pointing to non-existent mandates from the scientific community and the public at large. Again, it would be edifying to the American public if their representatives in the House slowed the frenetic pace of this legislation and drew attention to the disputes over the bill and the science behind it. However, the tripartite formula for technocratic politics — the illusion of immanent crisis, the pretense of public consensus, and the suppression of open debate — has prevented a serious and non-ideological dialogue from emerging.

The real danger of Obama’s technocratic administration lies in its habit of tendentiously recasting serious moral and political debates as misguided arguments about plainly observable empirical facts. Such intellectual self-indulgence preemptively labels all disagreement as uninformed or nefarious and renders democratic process — and all those that demand it — tiresome and frustrating. This transforms every nuanced policy debate into a choice between the light of reason and the darkness of ignorance; this heavy-handed dogmatism inevitably creates a cultural cleavage between the chosen bearers of truth and those who stupidly refuse the gifts bestowed by progress. Senate Finance Committee chairman Max Baucus recently remarked that Democratic health-care reform was stamped with a “sense of inevitability,” but there are still plenty of Americans with real anger about their “manufactured” consent — for these citizens, the conclusion of this political trial is not yet foregone. Whether or not Republicans can defeat Obama’s health-care reforms, they owe their constituents a genuine national debate that does justice to the public option that matters most — the one for democracy.

— Ivan Kenneally is an assistant professor of political science at the Rochester Institute of Technology in Rochester, N.Y. He is currently writing on technocracy and American politics.

AARP tells Obama: No health plan endorsement yet

WASHINGTON — A group usually seen as one of Barack Obama's allies in the health care debate — AARP — says the president went too far Tuesday when he said the seniors lobby had endorsed the legislation pending in Congress.

AARP is sensitive to the issue because polls show that Medicare beneficiaries are worried their health care program will be cut to subsidize coverage for the uninsured.

At the town hall in Portsmouth, N.H., Obama said, "We have the AARP onboard because they know this is a good deal for our seniors." He added, "AARP would not be endorsing a bill if it was undermining Medicare."

But Tom Nelson, AARP's chief operating officer, said, "Indications that we have endorsed any of the major health care reform bills currently under consideration in Congress are inaccurate."

Like Obama, AARP wants action this year to cover the uninsured and restrain health care costs, but the organization has refrained from endorsing legislation. Nelson said AARP would not endorse a bill that reduces Medicare benefits.

A spokesman said the Medicare cuts that have been proposed so far would not affect benefits.

Robert Gibb's response:

John Mackey: The Whole Foods Alternative to ObamaCare

Eight things we can do to improve health care without adding to the deficit.

"The problem with socialism is that eventually you run out
of other people's money."

—Margaret Thatcher

With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people's money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

Chad Crowe

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.

Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan's costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America

Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor's Business Daily. In England, the waiting list is 1.8 million.

At Whole Foods we allow our team members to vote on what benefits they most want the company to fund. Our Canadian and British employees express their benefit preferences very clearly—they want supplemental health-care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health-care benefit dollars if they already have an "intrinsic right to health care"? The answer is clear—no such right truly exists in either Canada or the U.K.—or in any other country.

Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.

Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.

Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age.

Health-care reform is very important. Whatever reforms are enacted it is essential that they be financially responsible, and that we have the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices. We are all responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health. Doing so will enrich our lives and will help create a vibrant and sustainable American society.

Mr. Mackey is co-founder and CEO of Whole Foods Market Inc.

Support For Congressional Health Reform Continues To Drop

While the American public remains broadly supportive of the goals for health reform, a new Rasmussen poll shows that Congress' roadmap for getting there is becoming less and less popular by the week.

Back in late June, 50 percent of respondents supported the bill(s) working through Congress, while 45 percent were opposed. Today the numbers are 42 percent in favor, 53 percent opposed. More troubling for proponents of reform, the intensity of opposition to the reform is high, with 44 percent of respondents strongly opposing the effort, while only 26 percent strongly support it.

This is beginning to remind me of the debate on social security, where voters were broadly in favor of measures such as "shoring up social security," and even in favor of the actual plan making its way through Congress: voluntary partial accounts restricted to younger voters. But the perception of what the plan contained got away from the reality, and it floundered.

It is way too early to predict doom for health care reform, even with a public option. There's too much of a growing perception that failure to pass it will wreck Obama's Presidency (hint: Obama's Presidency will rise and fall with the economy, just like almost every President's). But these numbers are sobering, and could indicate real problems for 2010 if Congress rams through a bill that is perceived poorly by the public.

Rasmussen Reports

Rasmussen: Support for Congressional Health Care Reform Falls to New Low

Public support for the health care reform plan proposed by President Obama and congressional Democrats has fallen to a new low as just 42% of U.S. voters now favor the plan. That’s down five points from two weeks ago and down eight points from six weeks ago.

A new Rasmussen Reports national telephone survey shows that opposition to the plan has increased to 53%, up nine points since late June.

More significantly, 44% of voters strongly oppose the health care reform effort versus 26% who strongly favor it. Intensity has been stronger among opponents of the plan since the debate began.

Sixty-seven percent (67%) of those under 30 favor the plan while 56% of those over 65 are opposed. Among senior citizens, 46% are strongly opposed.

Predictably, 69% of Democrats favor the plan, while 79% of Republicans oppose it. Yet while 44% of Democratic voters strongly favor the reform effort, 70% of GOP voters are strongly opposed to it.
Most notable, however, is the opposition among voters not affiliated with either party. Sixty-two percent (62%) of unaffiliated voters oppose the health care plan, and 51% are strongly opposed. This marks an uptick in strong opposition among both Republicans and unaffiliateds, while the number of strongly supportive Democrats is unchanged.

(Want a free daily e-mail update? If it's in the news, it's in our polls). Rasmussen Reports updates are also available on Twitter or Facebook.

Despite the loss of support, 51% of all voters still say it is at least somewhat likely that the health care proposal will become law this year. That figure has hardly budged since the debate began and now includes 18% who say passage is very likely. Thirty-nine percent (39%) say passage of the plan is unlikely, but only 10% say it is not at all likely.

Congress is now in recess until early September, but Democratic congressional leaders have vowed to pass some form of the health care plan when they return to Washington. Town hall meetings many of the congressmen are holding to get public feedback on the plan have turned into protest sessions, and the New York Times reports today that the president and Democratic leaders are revamping the sales strategy for the reform effort because they find themselves on the defensive.

As for the protesters at congressional town hall meetings, 49% believe they are genuinely expressing the views of their neighbors, while 37% think they’ve been put up to it by special interest groups and lobbyists.

The latest polls shows that 26% of voters believe that passage of the Congressional health care plan will lead to a better quality of health care. But most voters (51%) disagree and say the quality will get worse. Seventeen percent (17%) expect it to stay the same.

Voters ages 18 to 29 are closely divided on the question of quality, but those in all older age groups by sizable margins expect quality to worsen.

Seventy-five percent (75%) of Republicans and 59% of unaffiliated voters say passage of the health care plan will cause the quality of health care to go down. Among Democrats, 41% say quality will improve, 25% get worse and 26% stay the same.

Fifty-one percent (51%) of all voters say the cost of health care will go up if the reform proposal passes. Nineteen percent (19%) say costs will go down, and 21% say they will stay the same.

Voters in all age and income groups, again by large margins, believe passage of the reform measure will drive up health care costs.

Republican voters overwhelmingly say costs will go up with the new plan. By a two-to-one margin, unaffiliated voters agree. Democrats are fairly evenly divided as to whether costs will go up or down.
When it comes to health care decisions, 51% of voters fear the federal government more than private insurance companies. But 41% fear the insurance companies more.

Yet only 25% agree with House Speaker Nancy Pelosi that health insurance companies are "villains."
While Congress has debated reforms to the U.S. health care system, Americans have begun to show greater confidence in it. Forty-eight percent (48%) of adults now say the health care system is good or excellent, and only 19% say it’s poor.

Fifty-four percent (54%) of voters say tax cuts for the middle class are more important than new spending for health care reform, although the president’s top economic advisers have indicated that tax hikes may be necessary to fund the reform plan. That helps explain why 76% say it is likely that taxes will have to be raised on the middle class to cover the cost of health care reform, and 59% say it’s very likely.

Thirty-two percent (32%) favor a single-payer health care system where the federal government provides coverage for everyone, but 57% are opposed to a single-payer plan.

Government Health Care Will Wrap Patients in Red Tape

Over the past decade, Americans have struggled as the price of health care has soared at a much faster pace than workers’ earnings and the general rate of inflation. In Pennsylvania alone, premiums have skyrocketed 86 percent from 2000 to 2007, rising 6.4 times faster than earnings.

And yet, the mammoth bill being pushed through Congress does nothing to address this serious core problem.

Instead, the plan will deny millions of people choice, cost American jobs and give government bureaucrats the power to dictate what should be private medical decisions between a doctor and patient.

At the heart of the bill that presently has gone the farthest through Congress is an employer mandate that forces all but the tiniest businesses to provide workers with a government-approved insurance plan. If they fail to meet this mandate, they are hit with a new tax ranging from 2 percent to 8 percent of the company’s payroll.

As a result, millions of workers will either lose their employer-provided health insurance or lose their jobs altogether. For many large businesses, the new tax will be preferable to the $12,000 average they now pay for employee insurance, pushing millions of people out of their current coverage and into the clutches of the government’s new health care bureaucracy. For many small businesses, the mandate and accompanying tax impose a burden they simply can’t afford. They will be forced to lay off workers, adding further to our current jobs crisis.

The nonpartisan Lewin Group’s analysis shows the health care proposal will shift almost 90 million people from their employer-based insurance to the new government-run plan. These individuals and families suddenly will have to contend with government agents who have the power to deny treatment, determine how much a life is worth and counsel patients on “dying with dignity” in order to cut costs.

That’s not the American way. And it’s totally unnecessary to address the central problem in health care – rising consumer costs. Instead of a government-run health care plan that subjects millions of individuals to bureaucratic red tape, we can institute a few important policies that will go a long way toward reducing costs and giving individuals more control over their health care decisions.

First, it is high time Congress eliminated the long-standing unfair discrimination built into our tax code. Congress should give individuals who buy health insurance the same tax deduction that employers enjoy when they buy health insurance for their employees. This will automatically make health care more affordable for millions of uninsured Americans.

Second, Congress should give individuals and businesses the right to buy insurance from other states. Believe it or not, the current law prohibits a self-employed Pennsylvanian from buying health insurance from a neighboring state. Instead, he has to choose from a limited array of prices and benefits that might or might not meet his unique needs or those of his family. In Pennsylvania, this system gives some health insurance companies a near monopoly, and it’s a big part of the reason costs have climbed so high. Changing this law will force health insurance companies to compete with each other across the country, much as life and car insurance companies do today.

Finally, Congress should crack down on frivolous medical lawsuits. Everyone agrees that patients should have a right to hold doctors accountable for negligence and malpractice, but runaway lawsuits have created an environment of skyrocketing premiums for doctors and hospitals who have done nothing wrong, and those enormous costs get passed on to patients.

In addition to the direct costs of litigation, lawsuit abuse forces health care providers to practice costly, defensive medicine – ordering tests and procedures that are not medically necessary – in order to reduce their risks of being sued. Comprehensive legal reform that stops junk lawsuits will bring down health care costs for everyone.

These policies might not seem as “bold” as the one making its way through Congress. But if “bold” means fewer choices in health care, government intervening between doctors and patients, higher costs, higher taxes, a higher deficit and fewer jobs, then “bold” is the wrong way to go. The country needs thoughtful and targeted solutions, not taxpayer-funded extreme makeovers.

Instead of a government-run health care plan that subjects millions of individuals to bureaucratic red tape, we can institute a few important policies that will go a long way toward reducing costs …

Pat Toomey, a resident of Lehigh County, is a Republican candidate for the U.S. Senate. For information, go to

Tuesday, August 11, 2009

The Barack Obama Experiment

Obama’s Tone-Deaf Health Campaign

Obama’s Tone-Deaf Health Campaign

The president shouldn’t worry about the protestors disrupting town hall meetings. He should worry about the Americans who have been sitting at home listening to him.


It didn’t take chaotic town-hall meetings, raging demonstrators and consequent brooding in various sectors of the media to bring home the truth that the campaign for a health-care bill is, to put it mildly, not going awfully well. It’s not hard now to envision the state of this crusade with just a month or two more of diligent management by the Obama team—think train wreck. It may one day be otherwise in the more perfect world of universal coverage, but for now disabilities like the tone deafness that afflicts this administration from the top down are uninsurable.

Consider former ABC reporter Linda Douglass—now the president’s communications director for health reform—who set about unmasking all the forces out there “always trying to scare people when you try to bring them health insurance reform.” People, she charged, are taking sentences out of context and otherwise working to present a misleading picture of the president’s proposals. One of her key solutions to this problem—her justly famed message encouraging citizens to contact the office at if they got an email or other information about health reform “that seems fishy”—set off a riotous flow of online responses. (The word “fishy,” with its police detective tone, would have done the trick all by itself.)

These commentaries, packed with allusions to the secret police, the East German Stasi and Orwell, were mostly furious. Others quite simply hilarious. Ms. Douglass, who now has, in her public appearances, the air of a person consigned to service in a holy order, was not amused.


Neither has she seemed to entertain any second thoughts about the tenor of a message enlisting the public in a program reeking of a White House effort to set Americans against one another—the good Americans protecting the president’s health-care program from the bad Americans fighting it and undermining truth and goodness.

She intended no such outcome, doubtless. That this former journalist, now a communications director, failed to notice anything amiss in the details of that communiqué is a bit odd but not altogether surprising.

Crusades are busy endeavors, the enlistees in this one, like those in every undertaking of this White House, concerned with just one message. Which is that the Obama administration is in possession of vital answers to ills and inequities that have long afflicted American society (whether Americans know it or not), and that those opposed to those answers and that vision are cynics, or operatives of the powerful vested interests responsible for the plight Americans find themselves in (whether they know it or not), or political enemies bent on destroying the Obama administration.

It shouldn’t have been surprising, either, that the tone of much of the commentary on the town-hall protests was what it was. There was Mark Halperin for one, senior political editor for Time, bouncing off his chair, Sunday, in agitation over all the media coverage of this rowdiness—“a horrible breakdown of our political culture, our media culture” and so “bad for America,” as he told CNN’s Howard Kurtz. “I’m embarrassed about what’s going on, as an American.” The disruptions and coverage thereof distorted serious discussion, he explained. Mark Shields said much the same on Friday’s PBS NewsHour, if with less excitation, pointing out that these events were “not good for the democratic process,” and were a breakdown of civil debate.

There was no such hand-wringing over the decline of civil debate, during, say, election 2004, when cadres of organized demonstrators carrying swastika-adorned pictures of George W. Bush routinely swarmed about, and packed rallies. There was also that other “breakdown of our media culture,” that will dwarf all else as a cause for embarrassment, the town-hall coverage included, for the foreseeable future. That would be, of course, the undisguised worshipful reporting of the candidacy of Barack Obama.

That treatment, or rather its memory—like the adulation of his great mass of voters—has had its effect on this president, and not all to the good. The election over, the warming glow of those armies of supporters gone, his capacity to tolerate criticism and dissent from his policies grows thinner apace. His lectures, explaining his health-care proposals, and why they’ll be good for everybody, are clearly not going down well with his national audience.

This would have to do with the fact that the real Barack Obama—product of the academic left, social reformer with a program, is now before that audience, and what they hear in this lecture about one of the central concerns in their lives—his message freighted with generalities—they are not prepared to buy. They are not prepared to believe that our first most important concern now is health-care reform or all will go under.

The president has a problem. For, despite a great election victory, Mr. Obama, it becomes ever clearer, knows little about Americans. He knows the crowds—he is at home with those. He is a stranger to the country’s heart and character.

He seems unable to grasp what runs counter to its nature. That Americans don’t take well, for instance, to bullying, especially of the moralizing kind, implicit in those speeches on health care for everybody. Neither do they wish to be taken where they don’t know they want to go and being told it’s good for them.

Who would have believed that this politician celebrated, above all, for his eloquence and capacity to connect with voters would end up as president proving so profoundly tone deaf? A great many people is the answer—the same who listened to those speeches of his during the campaign, searching for their meaning.

It took this battle over health care to reveal the bloom coming off this rose, but that was coming. It began with the spectacle of the president, impelled to go abroad to apologize for his nation—repeatedly. It is not, in the end, the demonstrators in those town-hall meetings or the agitations of his political enemies that Mr. Obama should fear. It is the judgment of those Americans who have been sitting quietly in their homes, listening to him.

Ms. Rabinowitz is a member of the Journal’s editorial board.

Thursday, August 6, 2009

Cornyn accuses White House of compiling 'enemies list'

Cornyn accuses White House of compiling 'enemies list'

10:27 AM CDT on Thursday, August 6, 2009

Texas Sen. John Cornyn, accusing the White House of compiling an "enemies list," has asked President Barack Obama to stop an effort to collect "fishy" information Americans see about a health care overhaul.

Cornyn, who leads the Republicans' Senate campaign effort, said Wednesday in a letter to Obama that he's concerned that citizen engagement on the issue could be "chilled." He also expressed alarm that the White House could end up collecting electronic information on its critics.

"I can only imagine the level of justifiable outrage had your predecessor asked Americans to forward e-mails critical of his policies to the White House," Cornyn wrote.

Cornyn was responding to a post on the White House's blog Wednesday in which users are asked to help stop the spread of disinformation about legislation to overhaul health insurance. The post offers an e-mail address,, for users to forward anything "on the web about health insurance reform that seems fishy."

The White House said the post was merely designed to fight "intentionally misleading" information in the health care debate.

"We want to be sure people have the facts about health insurance reform that will lower costs, protect consumers from insurance regulations that deny them coverage and assure quality and affordable health care for all Americans," said Adam Abrams, a White House spokesman. He said no lists or sources of the information would be compiled.

In his letter, Cornyn asked that the effort cease immediately and that the administration inform Congress what it's doing to ensure that names and electronic information about citizens weighing in on health care are not collected.

Kevin McLaughlin, a spokesman for the senator, said that the office had received no response from the administration.

He said Cornyn had not yet considered whether he would push for legislation to address the matter if necessary.