Friday, October 30, 2009

So-Called 'Death Panel' Measure Survives in House Health Bill

WASHINGTON -- It's alive.
The Medicare end-of-life planning provision that 2008 Republican vice presidential nominee Sarah Palin said was tantamount to "death panels" for seniors is staying in the latest Democratic health care bill unveiled Thursday.
The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.
For years, federal laws and policies have encouraged Americans to think ahead about end-of-life decisions, and make their wishes known in advance through living wills and similar legal documents. But when House Democrats proposed this summer to pay doctors for end-of-life counseling, it touched off a wave of suspicion and anger. Prominent Republicans singled it out as a glaring example of government overreach.
Sen. Charles Grassley, R-Iowa, at the time a lead negotiator on health care legislation, told constituents at a town hall meeting they had good reason to question the proposal.
"I don't have any problem with things like living wills, but they ought to be done within the family," he said. "We should not have a government program that determines you're going to pull the plug on grandma."
Thursday, the sponsor of the provision said the barrage of criticism may have actually helped.
"There is nothing more basic than giving someone the option of speaking with their doctor about how they want to be treated in the case of an emergency," said Rep. Earl Blumenauer, D-Ore. "I think the outrageous and vindictive attacks may have backfired to help raise awareness about this problem, which is why it's been kept in the bill."
The legislation would allow Medicare to pay for a counseling session with a doctor or clinical professional once every five years. The bill calls for such sessions to be "completely" voluntary, and prohibits the encouragement or promotion of suicide or assisted suicide.
The counseling provision is supported by doctors' groups and AARP, the seniors' lobby. It was not included in health care bills passed by two Senate committees.

Regarding Harry

The public option diverts attention from the legislation's real faults.

You couldn't swing a cat this week without hitting a discussion of the public option. Somewhere, in some Capitol office, Senate Majority Leader Harry Reid is grinning.
Two weeks ago, the subject of a government-run insurance plan was a sore point with the Nevadan. He didn't have the votes for it, his base was bitter, and he didn't want to talk about it. This week, a transformed Mr. Reid devoted an entire news conference to it. Americans support the public option! His caucus supports a public option! He supports a public option! The public option is in! No problem!
In the real world, this kind of behavioral shift lands you in a psych ward. In Washington, the press just marked it down to forces bigger than Harry. The majority leader had been pushed into a public option by his liberal members, we were told. Chuck Schumer was scarier than Ben Nelson. The Huffington Post was even scarier than Chuck Schumer. Poor Mr. Reid, clucked observers, had been backed into a corner.
Maybe. Then again, maybe he is majority leader for a reason. Maybe Mr. Reid didn't just wander out of the Nevada desert. Maybe he has a plan. Maybe, just maybe, he sees a big upside in turning the public option into the centerpiece of the health-care debate. After all, what does he have to lose?
Up for re-election next year, Mr. Reid is facing Nevada polls that suggest he's lost most voters outside his base. His base too, was slipping, with making him a punching bag for not embracing the public option. With this week's announcement, he is once again the hero of the left, and has that baboon off his back.
Who knows? It might even work. Mr. Reid included the fig leaf of an "opt-out" for states that don't want the public option. It's a ruse, but it might provide cover for votes. If not, he's got room to maneuver. There's the "opt-in" alternative, which even some Republicans claim to like. There's the fall-back "trigger," which re-earns him Olympia Snowe.
Getty Images
Senate Majority Leader Harry Reid

And if it doesn't fly, well, is that so bad? Mr. Reid can still say he gave it the varsity try. He'll get it to the floor and let those swing-state Democrats amend the public option away. Not his fault! What he also knows, even if the press doesn't, is that for all the big talk of his liberal members, they are the more likely to give way. Even without a public option, this bill is a big step toward a single-payer system. And it isn't as if any of them risk losing their seats by voting "only" for a $1 trillion health expansion.
Better yet, by turning the public option into the big, bad bogeyman, he makes it more likely he'll snag those swing-state votes in the end. Nebraska's Mr. Nelson, Arkansas's Blanche Lincoln, Indiana's Evan Bayh—they can all claim victory for stripping the bill of a national insurance plan, then feel comfortable voting for all the tax hikes and Medicare cuts that remain.
Speaking of tax hikes, premium jumps and Medicare cuts, notice how nobody is today talking about them? Mr. Reid surely has. The public option might be controversial in D.C., but the majority leader knows most of the country doesn't understand it, or assumes it doesn't apply to them. Most Americans already have health care that they like, and polls show their real fear is that this experiment will leave them paying more for less. This, not the public option, is ObamaCare's exposed jugular.
The insurers get this, which is why (as they now try to bottle the genie they helped loose) they are issuing reports on how "reform" will double or triple premium prices. It is why America's Health Insurance Plans, the lobby group, has run ads in swing states warning about huge cuts to Medicare Advantage. Some of the grass roots get it, too, which is why Americans for Tax Reform is now live on TV in Nebraska noting Sen. Nelson has signed its taxpayer pledge and that he'd violate it by voting for the bill's nearly $500 billion in tax increases.
If Mr. Reid had pulled the plug on the public option, these highly unpopular policy issues would be front and center. As it is, the public-option sideshow is sucking up all the air, and will continue to. It even overshadowed liberal divisions, such as union pushback on Cadillac-plans taxes. Maybe, just maybe, Mr. Reid likes it that way.
Granted, this is the cynic's view of Democrats' health-care strategy. Mr. Reid did, after all, goof last week, failing to round up the votes to pass his party's proposed "fix" to Medicare reimbursement rates. Maybe he doesn't know which way is up. Maybe he is taking a flier.
Then again, anyone who has watched this debate has earned the right to cynicism. Democrats are determined to get a health bill, and Mr. Reid is no rube. His opponents—those trying to save the country from this wreck of a bill—would be wise not to forget it.
Write to


CBO Puts House Health Bill Total Cost At $1.055 Trillion

WASHINGTON -(Dow Jones)- The Congressional Budget Office said Thursday a U.S. House health-care system re-write would extend health insurance to 96% of the nonelderly U.S. population by 2019, and spend $1.055 trillion to do so.
Penalties imposed on individuals who did not purchase insurance, and employers who did not offer coverage to their workers, would raise $161 billion over that time-frame. That brings the net cost of the bill to $894 billion through 2019, CBO said.
House Democrats have seized on that net cost figure to claim that their bill is below President Barack Obama's upper limit which he set for health-care legislation of $900 billion.
The $1.055 trillion estimate also does not include $245 billion needed to stop Medicare payments to doctors from decreasing, which the House plans to address through separate legislation introduced Thursday.
The costs of the bill are fully offset by cuts to existing spending programs-- including the Medicare Advantage and other programs--saving $426 billion through 2019, and by tax increases raising $572 billion over that time, CBO said. In fact, the combined impact of provisions in the bill would be a net deficit reduction of $104 billion in the next decade, according to CBO.
CBO also said the House bill would not add to the deficit in the first decade beyond 2019--a key condition for support from fiscally conservative House Democrats.
CBO Director Doug Elmendorf, in a Thursday letter to House Democratic Chairmen, cautioned that his estimates are preliminary and "subject to substantial uncertainty."
House leaders capped weeks of internal negotiations among Democrats today by unveiling the sweeping legislation. They aim to bring the bill to a vote by the full House by the end of next week.
The bill would create exchanges where people who do not have access to health insurance from their employer could buy coverage. It would create a government- sponsored plan to compete with private plans.
The bill would reduce the number of uninsured in the U.S. by 36 million by 2019. By that time, 30 million people would be covered through the insurance exchanges, of which 6 million would be covered by the public option.
An expansion in eligibility rules for the Medicaid program would bring an additional 15 million enrollees to Medicaid by 2019, CBO said.
-By Martin Vaughan, Dow Jones Newswires; 202-862-9244; martin.vaughan@

Thursday, October 29, 2009

Constitutionality of health overhaul questioned

Donald Lambro

On top of all the other obstacles facing President Obama in his quest to pass health reform is this one: Does the U.S. Constitution allow the government to require uninsured Americans to buy medical insurance or impose a tax penalty if they refuse?
Congress has never before required citizens to purchase any good or service, but that is what both House and Senate health bills would mandate.
While this debate has been overshadowed by other issues involving the plan's nearly $1 trillion cost and its government-run option, the constitutional argument strikes at a pivotal part of the health care plan's finances. To make a government-run health care plan work, the nation's largely uninsured young adults would need to be covered to help subsidize medical care for older and typically less-healthy Americans, legislators say.
House Speaker Nancy Pelosi dismissed the complaint Thursday when she was asked by a reporter if the Democrats' health reform proposal was constitutional.
"Are you serious? Are you serious?" Mrs. Pelosi replied.
But House Minority Leader John A. Boehner said the argument could not be ignored.
"I'm not a lawyer, and I'm certainly not a constitutional lawyer, but I think it's wrong to mandate that the American people have to do anything," he told reporters at his own press briefing last week.
The question of the mandate's constitutionality "hasn't been part of the public debate, but the legal community has been debating it. It's been on all the legal blogs," said Michael Cannon, director of health-policy studies at the libertarian Cato Institute. He said "the Constitution does not grant Congress the power to force Americans to purchase health insurance."
In 1994, the nonpartisan Congressional Budget Office noted that a "mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action."
"The government has never required people to buy any good or service as a condition of lawful residence in the United States," the CBO said. The statement was part of an analysis of then-President Clinton's ill-fated health care reform plan, which also required that all Americans purchase health insurance plans.
The Constitution gives Congress the power "to regulate commerce ... among the several states" - a clause that has served as the foundation for broad economic regulatory and taxing powers claimed by the legislative branch.
But Randy Barnett, a professor at Georgetown University Law Center, asks, "Where in the [Constitution] is the power to mandate that individuals buy health insurance?" His answer: Nowhere.
"The business of providing health insurance is now an entirely intrastate activity" beyond the regulatory sway of the federal government, he said.
Washington lawyers David B. Rivkin Jr. and Lee A. Casey argued in an Aug. 22 column in The Washington Post that Congress has no constitutional power to tell people what they must buy.
"The Constitution assigns only limited, enumerated powers to Congress, and none, including the power to regulate interstate commerce or to impose taxes, would support a federal mandate requiring anyone who is otherwise without health insurance to buy it," they said.
But other legal scholars say that the Supreme Court has in recent decades taken a much broader view of Congress' commerce powers and would likely do the same in this case if the legislation's mandate is challenged in court.
"I would be willing to wager with Professor Barnett that the Supreme Court would uphold such a mandate, given the court's expansive reading of the Commerce Clause. In fact, I don't think the vote would be close," Washington and Lee University professor Timothy Stoltzfus Jost said.
Even some conservative legal analysts who oppose the health care reform think that in the end, if the legislation passes, Congress would win in the courts.
"In this case, the overall scheme would involve the regulation of 'commerce' as the Supreme Court has defined it for several decades, as it would involve the regulation of health care markets. And the success of such a regulatory scheme would depend upon requiring all to participate," writes Jonathan H. Adler, law professor at Case Western Reserve University School of Law.
House Majority Leader Steny H. Hoyer of Maryland was asked at a news conference recently whether Congress had "the power to mandate that somebody buy health insurance." He replied: "Promoting the general welfare in the Constitution obviously gives broad authority to Congress to effect that end. Clearly, this is within our constitutional responsibility."
The Senate Finance Committee, which recently approved one of the Senate's two main health care bills, "thoroughly explored the issue and believes that the policies put forward in our bill will fall within" the constitutional powers of Congress, a top aide said.
But the excise tax that would be imposed on anyone who did not purchase insurance and its enforcement "would invite [constitutional] scrutiny," said a paper presented to the Federalist Society for Law and Public Policy Studies by Peter Urbanowicz, a lawyer and health care management consultant, and Dennis G. Smith, senior research fellow in health care reform at the Heritage Foundation.
They cited Columbia University health policy professor Sherry Glied, named by Mr. Obama to a top policy job in the Department of Health and Human Services, who warned that "developing a system to promptly identify and penalize scofflaws will take effort and ingenuity, particularly in our diverse and mobile country."
"It may require a degree of intrusiveness and bureaucracy that some will find unpalatable."

Doctors on Health-Care Reform

'Government is in the process of duplicating everything that managed care did for the last 15 years that was reviled by everybody.'

Doctors from across the country were invited to the White House on Oct. 5, but the president did most of the talking. Medical professionals are being ignored or vilified more often than consulted in the current health-care reform debate. To broaden the discussion, the Committee to Reduce Infection Deaths invited 16 highly regarded physicians to convene at the Grand Hyatt in New York City on Oct. 19 to reflect on the current legislative proposals. Here's what they had to say on four key issues.
Government-Imposed Treatment Guidelines
Dr. Jeffrey Borer, cardiologist, named to Castle Connolly's "America's Top Doctors": "What's the impact of guidelines on the doctor-patient relationship? Guidelines step in between the doctor and the patient. If it's necessary to respond to guidelines rather than what you see, feel and hear when you're evaluating a person, then perhaps you're going to do something that isn't really the right thing. There really isn't an average patient. Every person that you see with a medical problem has some unusual or unique characteristic and this often has to be considered in dealing with the problem."
Dr. David Fields, obstetrician and gynecologist, Lenox Hill Hospital, New York: "They tend to forbid better-than-average medical care; guidelines are always average medical care . . . they tend to cramp the physician who can do better than average."
Dr. Borer: "One of the more common problems that people have as they get older is a disease called aortic stenosis. . . . [W]e can relieve that aortic stenosis with an operation with really very acceptable safety, low mortality rates . . . if that 85-year-old cannot walk down the street because he or she is too breathless to do so . . . or feels light-headed or could faint and break a hip . . . then there is really a very good justification for offering the therapy."
Dr. Richard Amerling, nephrologist, Beth Israel Medical Center, New York: "The example that you give of valve surgery in an 85-year-old is just not going to happen under [White House health care adviser] Ezekiel Emanuel. He's going to just say that that's a nonstarter. That person has outlived their useful years, no matter how long they could live beyond that."
Dr. Borer: "What we're hearing from the president's medical advisers is that what we have is good enough and we really shouldn't be wanting or expecting any more."
Dr. Seymour Cohen, oncologist, named to "America's Top Doctors": "When we went to medical school, people used to die at 66, 67 and 68. Medicare paid for two or three years. Social Security paid for two or three years. We're the bad guys. We're responsible for keeping people alive to 85. So we're now going to try to change health care because people are living too long. It just doesn't make very good sense to me."
Shifting Resources From Specialty to Primary Care
Dr. Cohen: "Let's talk about specialization for a moment. . . . We don't go to our general attorney when we have a patent problem, but they're telling us to do this now in medicine. We have different types of engineers, even journalists. There's a financial writer, there's a sportswriter . . . . Now in health care we're telling everybody, 'you just go to the guy who's your general doc. He's going to know everything and maybe we'll find a specialist for you if the panel decides maybe you're sick enough to need a specialist.' It really doesn't make sense at all."
Dr. Jeffrey Moses, interventional cardiologist, named to "America's Top Doctors": "If you have heart failure or heart attack or coronaries in general in the hospital you need to be treated by a cardiologist. Study after study shows that . . . when you have an illness and you want to have an accurate diagnosis and the most up-to-date and accurate treatment, you want a specialist."
Patient Privacy
Dr. Samuel Guillory, ophthalmologist, refractive and orbital surgery, named to Castle Connolly's "New York's Top Doctors": "We're being asked by the executive branch . . . to break the code with patients and deliver all their records into electronic medical records . . . ."
Cost-Cutting Methods
Dr. Fields: "Government is in the process of duplicating everything that managed care did for the last 15 years that was reviled by everybody and which we fought very hard to overcome, The courts finally said 'You can't have withholds, you can't pay people to deny care. You can't have gag rules.' The government is in the process of doing all that. Massachusetts is about to establish capitation [a fixed payment remitted at regular intervals to a medical provider] as the rule of the state. Capitation was the wort thing that ever happened to medical care."
Dr. Joel Kassimir, dermatologist, Mt. Sinai Hospital, New York: "We're now being told by physicians advising the president that we take the Hippocratic Oath too seriously."
Dr. Tracy Pfeifer, plastic surgeon, president, New York Regional Society of Plastic Surgeons: "When physicians graduate from medical school we take an oath, the Hippocratic Oath, to do no harm to our patients. It's a very important philosophy to us and we uphold it and hold it very dear to our hearts. Plato, another philosopher, used to say things like 'Those with a poor physical constitution should be allowed to die. The weak and the ill-constituted shall perish.' These government programs that are being proposed I think are very scary in the sense that physicians could be induced to violate the Hippocratic Oath.
"There's a limit to how much of a financial penalty each individual practitioner is going to be able to bear. . . . If the patient is sitting in the examination room with us and they're wondering, 'Is the doctor not ordering a test for me because he's going to get penalized if he does it?' This is a major, major problem for patients and physicians alike."
Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former Lt. Governor of New York State. For a complete transcript of the physicians' meetings, visit


Business Groups Push Hard Against the Senate Bill

Employers are blasting the Senate's plan to create a new public health-insurance program -- a sign of how businesses are becoming increasingly uneasy about Democrats' proposals to overhaul the health system.

WSJ's Janet Adamy explains why small businesses are against a government health plan, noting that what they save in upfront costs may end up costing them even more in taxes to pay for the overall plan.
Lobbyists for employers thought they had staved off a public plan in the Senate after the Finance Committee opted not to include the idea in its version of the health legislation. They were caught by surprise when the public plan resurfaced and Majority Leader Harry Reid (D., Nev.) said it would be in the bill brought to the Senate floor, albeit with an option for states not to participate.
President Barack Obama invited a group of small-business owners to meet with him at the White House Thursday. He will make the case that the health overhaul will give them the ability to control health costs.
The Business Roundtable, an association of company executives, is calling and visiting lawmakers to persuade them not to include the public plan in the legislation. The U.S. Chamber of Commerce on Wednesday began airing cable-television advertisements in seven states arguing that the public option will lead to higher taxes and increase the national debt.
"We cannot support a public plan," said Antonio Perez, chief executive of Eastman Kodak Co. and a member of the Roundtable. "That cost is going to come back to you one way or another."
The public plan is designed for those who buy insurance on their own as well as small businesses. Most people who work for midsize and large companies wouldn't be eligible.
Large employers are concerned that the plan will end up raising their health-insurance costs. They believe that if the government pays doctors and hospitals at lower rates than do private insurance companies, the health industry would try to pass the cost on to those with private insurance.
[Climbing Costs chart]
Small-business groups, for the most part, are against the public plan, despite the fact that Democrats say they engineered it with small business in mind. "We don't think that the public plan is needed to spur competition," said Susan Eckerly, senior vice president of public policy at the National Federation of Independent Business.
The group, which represents 350,000 small firms, said the overwhelming majority oppose the idea, in part because they are skeptical of large government programs. Small businesses pay higher prices for insurance than do large employers because they don't have as many people to spread out the risk of covering sick employees. Instead of a public plan, they say, proposals to create new health-insurance exchanges and prevent insurers from discriminating against people with pre-existing health conditions will more effectively bring down their costs.
Warren Hudak, who owns an accounting firm in New Cumberland, Pa., said only one insurance company will offer him an affordable policy to cover his six employees. His wife has multiple sclerosis, which has driven up the whole firm's insurance costs so that a high-deductible family policy costs $1,300 a month. But he wouldn't want to switch to a government plan. "My wife might not be able to take her drug that she's taking right now," said Mr. Hudak, who is one of the employers invited to the White House on Thursday.
Not all small-business groups oppose the public plan. At least one, the Small Business Majority -- which has less clout than the National Federation of Independent Business -- argues that businesses need a public option to give them an alternative in a consolidated insurance market. "It just doesn't provide small-business owners with much choice when we go to buy insurance," said John Arensmeyer, chief executive of the Small Business Majority.
Write to Janet Adamy at

Wednesday, October 28, 2009

Senate healthcare bill draws skeptics, opponents

By Donna Smith and John Whitesides
WASHINGTON (Reuters) - A healthcare reform bill with a government-run insurance option faced an uncertain future in the Senate on Tuesday, with many centrist Democrats uncommitted and Senator Joe Lieberman strongly opposed.
Senate Democratic leader Harry Reid's decision to include a government-run "public" option in the Senate bill failed to sway about a dozen moderates who said they wanted more details before making their decisions.
Democrats said Reid was still short of the 60 votes needed to overcome procedural hurdles and pass a bill with a public option, which has become one of the most contentious issues in the debate on President Barack Obama's top domestic priority.
The healthcare bills in the Senate and the House of Representatives aim to rein in costs, expand coverage to millions of uninsured and bar insurers from denying coverage for pre-existing conditions or dropping coverage for the sick.
Health insurer stocks rallied on skepticism that a government-run plan, seen as detrimental to the industry, would win passage. That view was fueled by Lieberman's comments.
Lieberman, an independent who caucuses with Democrats, said he would not join Republicans on a procedural vote to block the healthcare bill from coming up for debate, but would be willing to block a final vote on the plan if it remained unchanged.
"I don't support a government-operated health insurance company that will end up costing the taxpayers a lot of money," he told reporters.
Senator Olympia Snowe, the only Republican to support a healthcare bill in a congressional committee, opposes the public option and said she would vote with her fellow Republicans to block a motion to proceed to debate.
"Once you put in a motion to proceed, then it's very difficult to change it," she told reporters.
Democrats cannot afford to lose the support on healthcare of any of their members in the Senate where they control 60 votes. As a result, they must woo about a dozen uncommitted moderates.
"I'm skeptical about what Senator Reid has proposed. I have not been a supporter of a national government-run option, but I am going to stay open to principled compromise," said Democratic Senator Mary Landrieu of Louisiana.
After days of closed-door negotiations to merge two pending healthcare bills into one for floor debate, Reid said on Monday he would include a national government-run insurance option that would let states opt out of participation.
Reid, Obama and congressional liberals have backed a public option as a way to create choice and competition in the insurance market, but critics call it a government takeover that would hurt the private insurance industry.
"Every person has to decide for himself or herself how they are going to vote. For me, it is just too early," said Democratic Senator Ben Nelson. 
"This is just the next step, there are many more steps and many more opportunities to bring people together," said Democratic Senator Kent Conrad, whose proposal for nonprofit cooperatives to compete with insurers is included in the bill.
An NBC/Wall Street Journal poll released on Tuesday found 48 percent of Americans favor a public health plan administered by the federal government, compared with 42 percent who oppose it. In a September poll, 48 percent said they opposed the public option while 46 percent supported it.
Democratic Senator Tom Carper, who proposed a public option that would let states opt in on participation, said he still thought there was a chance a compromise plan could win approval.
"At the end of the day my hope is that we can come up with something that is not only good policy but can get 60 votes, Carper told reporters.
Reid's decision encouraged liberal Democrats in the House, who are negotiating a merger of three pending healthcare reform bills that all include a public option. They are still trying to compile the 218 votes necessary to pass the strongest version.
"Senator Reid's very welcome decision has really lifted us," said Representative Robert Andrews. "The consensus now is there will be a public option, the question is what it will look like."
House leaders said they hoped to unveil their bill in the next few days, with a floor debate possibly starting late next week.
The timetable in the Senate is even more unclear. Reid has sent the bill to the Congressional Budget Office for cost estimates, with a response not expected quickly.
The S&P Managed Health Care index of large U.S. health insurers rose 4.24 percent on Tuesday amid a slight decline for the broader market and following a 2.5 percent drop for the index on Monday.

Tuesday, October 27, 2009

Dem Moderates Challenge Reid on Health Care Plan

The Associated Press

Senate Majority Leader Harry Reid of Nev. gestures while speaking on health care reform during a news conference, Monday, Oct. 26, 2009, on Capitol Hill in Washington. (AP Photo/Haraz N. Ghanbari)
Senate Majority Leader Harry Reid of Nev. gestures while speaking on health care reform during a news conference, Monday, Oct. 26, 2009, on Capitol Hill in Washington. (AP Photo/Haraz N. Ghanbari)
Senate Majority Leader Harry Reid of Nev. gestures while speaking on health care reform during a news conference, Monday, Oct. 26, 2009, on Capitol Hill in Washington. (AP Photo/Haraz N. Ghanbari)
Senate Majority Leader Harry Reid of Nev. gestures while speaking on health care reform during a news conference, Monday, Oct. 26, 2009, on Capitol Hill in Washington. (AP Photo/Haraz N. Ghanbari)
Senate Majority Leader Harry Reid of Nev. gestures while speaking on health care reform during a news conference, Monday, Oct. 26, 2009, on Capitol Hill in Washington. (AP Photo/Haraz N. Ghanbari)
Senate Majority Leader Harry Reid of Nev. gestures while speaking on health care reform during a news conference, Monday, Oct. 26, 2009, on Capitol Hill in Washington. (AP Photo/Haraz N. Ghanbari)
Senate Majority Leader Harry Reid of Nev., center, speaks on Capitol Hill in Washington, Tuesday, Oct. 27, 2009. He is joined by, from left, Senate Finance Committee Chairman Sen. Max Baucus, D-Mont., Sen. Jeff Bingaman, D-N.M, Reid, Sen. Jay Rockefeller, D-W.Va., and Sen. Christopher Dodd, D-Conn.,  right. (AP Photo/Susan Walsh)
Senate Majority Leader Harry Reid of Nev., center, speaks on Capitol Hill in Washington, Tuesday, Oct. 27, 2009. He is joined by, from left, Senate Finance Committee Chairman Sen. Max Baucus, D-Mont., Sen. Jeff Bingaman, D-N.M, Reid, Sen. Jay Rockefeller, D-W.Va., and Sen. Christopher Dodd, D-Conn., right. (AP Photo/Susan Walsh)

WASHINGTON — Democratic moderates who control the balance of power on health care legislation balked Tuesday at a government-run insurance option for millions of Americans, underscoring the enormity of the challenge confronting Senate Majority Leader Harry Reid one day after he unveiled the plan as a consensus product.

Republican opposition stiffened, and party leaders announced they would attempt to strangle the bill before formal debate begins.

Despite the obvious obstacles, senior Democrats cast Reid's draft legislation as a turning point in the yearlong campaign to enact President Barack Obama's top domestic priority. Sen. Max Baucus, D-Mont., chairman ofthe Senate Finance Committee, said there is now a "sense of inevitability, the sense that, yes, we're going to pass health care reform, and it's going to lower costs, provide better health insurance coverage and cover ... and reform the health insurance market."
The proposed government insurance option long ago emerged as the biggest flashpoint in both the House and Senate as Democrats struggle to pass legislation that extends coverage to millions who lack it, bans insurance industry practices such as denying coverage on the basis of pre-existing medical conditions and slows the growth of health care spending nationally.
But before that issue can be joined on the Senate floor, Reid's first challenge is to gain 60 votes — the number needed to overcome a filibuster by Republicans — just to bring the bill up, a parliamentary maneuver so routine that a vote is rarely required.

Sen. Mitch McConnell of Kentucky, the Republican leader, announced that in this case, members of his party will treat it as though it were "a vote on the merits" of a bill he said would "cut Medicare, raise taxes and increase health insurance premiums." He suggested Democrats could expect campaign commercials next year on the basis of the vote, and recalled that Sen. John Kerry, D-Mass., was ridiculed in his 2004 presidential campaign for having once said he voted for a bill before he voted against it.

Tuesday's developments illustrated the difficulties facing the 69-year-old Reid, juggling at least three separate concerns: his role as head of the Democratic caucus, the desire to deliver on Obama's agenda and a 2010 re-election campaign in Nevada, where his approval ratings are low.
"This isn't over until I'm standing with President Obama and he's signing a bill into law that delivers what Nevadans are demanding — real health insurance reform," Reid wrote in an e-mail message to political supporters in his home state Monday night.
The decision to include a government insurance option in his legislation had obvious appeal for liberals who account for a strong majority inside the Senate Democratic caucus, and it is likely to please labor unions and party activists in Nevada.

But it has gained less-than-effusive support from Obama, who is eager to have at least a dollop of bipartisanship for his signature domestic issue. Sen. Olympia Snowe of Maine, the only Republican who has sided with Democrats in committee this year, has announced she will not support the bill Reid drafted.

Still, if Reid is pressed in coming weeks by moderates to fall back, he can explain to liberals that he was forced to do so because his preference — a government insurance option — proved to be unobtainable in the Senate.

Already, that pressure is evident.

Sen. Tom Carper, D-Del., said he may seek changes on the Senate floor, a move likely to be welcomed by moderates. He backs a government role in states where one or two insurers control the market and premiums are high, along the same lines as a plan supported by Snowe. Additionally, Carper has talked of allowing other states to invite the federal government in — the reverse of Reid's plan, in which states would have to opt out.
That general approach, in which a lack of competition in an individual's state would trigger a government insurance option, "is still alive," said Sen. Kent Conrad, D-N.D.

While Reid is expected eventually to secure all 60 Democratic votes on the critical first test to bring the bill to the Senate floor, Sens. Ben Nelson of Nebraska, Mary Landrieu of Louisiana, Evan Bayh of Indiana and Blanche Lincoln of Arkansas all declined to say on Tuesday how they would vote.
In an indication of the pressure Reid faces, Bayh said the majority leader had agreed to cut an earlier proposal for a $40 billion tax on medical devicemakers.

"He significantly modified that proposal in a way that I understand will not impact thousands of good-paying jobs," said Bayh, whose state is home to Guidant Corp., a maker of cardiovascular devices, among other major industry players. Numerous officials said Reid had agreed to reduce the new tax to $20 billion over a decade. The officials spoke on condition of anonymity because no announcement had been made.

Speaker Nancy Pelosi is in a similar position in the House. Efforts to draft a consensus health care bill for a vote have been stalled for more than two weeks. The principal stumbling block is an internal disagreement over terms for setting fees for doctors, hospitals and other health care providers treating patients with government-sold coverage.

Liberals want the government to set the rate unilaterally, pegged to the charges the government pays Medicare beneficiaries. Moderates want the government to negotiate with the providers in setting fees.
Pelosi favors the approach liberals want, but officials say she has all but concluded she cannot gain the necessary majority of 218 votes for it.

House Democrats also must resolve internal disagreements relating to abortion services and health care for immigrants before they can send the bill to the House floor for a vote.

Obamacare’s False Dawn

The public option is a recycled means of pretending away Obamacare’s costs.

By Rich Lowry

The public option is back. Its Lazarus act is hailed as a sign of how rosy the health-care debate looks for Democrats.

August is but a sepia-tinged memory. Passage of a sweeping bill is now considered a lock by the wisest and most conventional Beltway pundits. And legislation may even include the most shining prize of all, the public option that liberals — no matter what the talking points for public consumption — consider a way station to the Valhalla of a government-controlled system.

The flush on Obamacare’s cheeks, though, is not necessarily a sign of health. The return of the public option speaks to a key — perhaps decisive — substantive weakness in the legislation. It’s no accident that the public option came roaring back in the immediate aftermath of an insurance-industry-commissioned study arguing that Obamacare would increase premiums.

The study made Democrats yelp so loudly because it hit on such a sensitive spot. The Democrats must make people believe their inherently unbelievable promise of vast new public benefits for free. Since this defies common sense, the determinedly commonsensical American people don’t buy it. A Gallup Poll finds that 49 percent of people expect their costs to get worse under Obamacare, compared with 22 percent who say they will get better. The skeptics are right.

States such as Maine, Vermont, Massachusetts, and New Hampshire have imposed Obamacare-style regulations, and have seen premiums jump for everyone. If people can wait to get sick until they obtain insurance, fewer healthy people will carry insurance. The cost of an older and sicker insurance pool naturally increases. To prevent this spiral of “adverse selection,” Obamacare imposes a mandate requiring all adults to buy insurance. But Democrats in the Senate Finance Committee — sensitive to its politically unpalatable requirements and fines — watered it down. 

This only stokes the cost problem. According to the National Journal, MIT health economist Jonathan Gruber says that under this looser regime, the young and healthy will drop their insurance, and premiums will go up by 10 percent. Sarah Bianchi, the chief domestic-policy adviser for the Kerry and Gore presidential campaigns, fears the same dynamic. 

This is exactly the point made by the much-reviled insurers. How to address this concern and placate a restive Left? Revive the left-for-dead public option. Nancy Pelosi insists that the public option will achieve “the lowest cost for America’s working families,” who shouldn’t be left on their own “to negotiate with insurance companies.”

This is yet another chimera. To tamp down fears that a public option is a vehicle for a government takeover, the House bill has a relatively tepid version that will supposedly only attract 10 million people. If so, that won’t help the broader middle class much. If a more “robust” public option is designed to drastically undercut private insurance rates and pull in more people, the costs of the squeeze it puts on doctors and hospitals will be passed along to the private system. In this scenario, the public option will be like Medicare, a program beggaring the private system even as it grows out of control itself.

In short, the public option is a recycled means of pretending away Obamacare’s costs. When the Office of the Actuary at Health and Human Services said the House bill would increase system-wide costs, the Democrats had a ready response — the bill is already being changed. The perfect bill that will bring greater coverage coupled with miraculously declining costs is always just over the horizon, a shimmering mirage of wishful thinking and willful dishonesty.

Eventually, Democrats will have to settle on a final bill and won’t be able to sweep its weaknesses under the rug of the next drafting process. Whatever its final form, it will raise taxes, cut Medicare, and — in all likelihood — increase insurance premiums. If the past few months of polling are any guide, it will be under 50 percent approval. Its benefits, such as they are, won’t kick in until 2013, while the taxes will start immediately.

If this is inevitable, what’s a heavy lift?

Joe Lieberman: I'll block vote on Harry Reid's plan

A composite image of Joe Lieberman and Harry Reid.
Connecticut Sen. Joe Lieberman says he opposes any sort of public option, even one including an opt-out provision such as Harry Reid's bill. Photo: Composite image by POLITICO

Sen. Joe Lieberman (I-Conn.) said Tuesday that he’d back a GOP filibuster of Senate Majority Leader Harry Reid’s health care reform bill.

Lieberman, who caucuses with Democrats and is positioning himself as a fiscal hawk on the issue, said he opposes any health care bill that includes a government-run insurance program — even if it includes a provision allowing states to opt out of the program, as Reid has said the Senate bill will.

"We're trying to do too much at once," Lieberman said. “To put this government-created insurance company on top of everything else is just asking for trouble for the taxpayers, for the premium payers and for the national debt. I don’t think we need it now."

Lieberman added that he’d vote against a public option plan “even with an opt-out because it still creates a whole new government entitlement program for which taxpayers will be on the line."

His comments confirmed that Reid is short of the 60 votes needed to advance the bill out of the Senate, even after Reid included the opt-out provision. Several other moderate Democrats expressed skepticism at the proposal as well, but most of the wavering Democratic senators did not go as far as Lieberman Tuesday, saying they were waiting to see the details.

Lieberman did say he's "strongly inclined" to vote to proceed to the debate, but that he’ll ultimately vote to block a floor vote on the bill if it isn’t changed first.

"I've told Sen. Reid that if the bill stays as it is now I will vote against cloture,” he said.

“I can’t see a way in which I could vote for cloture on any bill that contained a creation of a government-operated-run insurance company,” Lieberman added. “It’s just asking for trouble – in the end, the taxpayers are going to pay and probably all people will have health insurance are going to see their premiums go up because there’s going to be cost shifting as there has been for Medicare and Medicaid.”

Lieberman said he “very much” wants to vote for health care reform but that he’s worried about stifling “the economic recovery we’re in” or adding to the federal debt.

“I feel this way about a national, government-created health insurance company – whether it’s a trigger or not,” he said. “My answer is – we’re – we have the opportunity to do some great reforms here. These exchanges that we’re talking about, I think, are going to drive competition and probably bring the cost of health insurance down or at least contain the cost increases for a lot of people. Let’s give that two or three years to see how it works to see how it works before we talk about creating another entitlement that will end up increasing the national debt and putting more of a burden on taxpayers.”

Mich. Democrat: Pelosi 'not happy with me'

ep. Bart Stupak said Speaker Pelosi is not pleased with his effort to change abortion-related provisions in the healthcare bill being crafted by the House.

During an interview on C-SPAN's "Washington Journal" show, Stupak (D-Mich.) said he is undeterred in trying to ensure that taxpayer dollars do not pay for abortions. Stupak, who opposes abortion rights, acknowledged that some in his party are upset with his public campaign to change the bill.

"The Speaker is not happy with me," Stupak said.

The Energy and Commerce subcommittee chairman said he has been working with Democratic leaders on a compromise, but they haven't been able to strike a deal. Stupak pointed out that he and Democratic leaders have a fundamental disagreement on whether health plans that receive subsidies from the government should be allowed to provide coverage options on abortions.

Stupak wants a vote on the House floor to strike the language, and predicts he would have the votes to pass such an amendment.

"This has been federal law since 1976," he said, noting that President Barack Obama has vowed not to allow healthcare reform to pay for abortions.

"We have to have a vote," he said.

If he doesn't get one, Stupak said he and as many as 39 other Democrats will vote no on a procedural motion to bring the health bill to the floor. A House vote on healthcare reform could be taken next week.

Stupak stressed he wants to vote for healthcare reform and is "still somewhat optimistic" that he will reach an accord with Democratic leaders.

However, the Michigan Democrat said he will not be backing down: "I'm comfortable with where I'm at. This is who I am. It's reflective of my district. If it costs me my seat, so be it."

A portion of the interview can be accessed here.The entire interview can be seen here.

The WSJ Guide to ObamaCare

A comprehensive collection of our editorials and op-eds. 


Review and Outlook

October 22: Temporary Beltway Sanity
October 21: The Doctor Fix Is In
October 20: Health Costs and History
October 19: ObamaCare's Tax on Work
October 19: Gag Order Admission
October 16: Cash for Oldsters
October 14: Your Massachusetts Future
October 10: The Stressed German Model
October 8: The Greatest Show on Earth
October 6: The War on Specialists
October 5: Opting Out of Medicare
September 30: Escape to Montana
September 29: Rhetorical Tax Evasion
September 28: Max's Mad Mandate
September 25: Unsafe at Any Speed
September 24: Medicare and Gag Orders
September 22: Baucus Bludgeons Humana
September 21: Obama's Nontax Tax
September 18: The Innovation Tax
September 17: Public Option Lite
September 16: Another Health-Care Invention
September 11: Medicare for Dummies
September 10: Obama Doubles Down
September 8: The Perils of BaucusCare
September 8: Whoa, Trigger
August 23: The Competition Cure
August 21: No Maine Miracle Cure
August 20: ObamaCare's Contradictions
August 18: Whole Foolishness
August 18: The Public Option Goes Over
August 14: Obama's Senior Moment
August 13: Billy and the Beanstalk
August 12: The Truth About Health Insurance
August 7: Drug Dealers
August 7: Health Reform and the Polls
August 6: ObamaCare's Real Price Tag
August 5: Dems vs. Dems
August 4: Teeing Up The Middle Class
August 1: The Fat of the Land
July 31: Repealing Erisa--II
July 30: Fannie Med
July 28: No Help for the Blue Dogs
July 26: Dr. Obama's Tonsillectomy
July 23: A Better Health Reform
July 22: Mr. Grassley's Choice
July 22: Bullying CBO
July 20: Repealing Erisa
July 20: What's Up, Docs?
July 18: Their Own Medicine
July 16: Big Pharma Gets Played
July 15: The Small Business Surtax
July 10: The Public Option Two-Step
July 7: Of NICE and Men
July 3: Everyday Low Politics
July 2: Why It's Easy to Steal from Medicare
June 29: Obama's Health Future
June 23: Government Health Care and Voters
June 19: ObamaCare Sticker Shock
June 17: Health Reform and Competitiveness
June 16: Obama's Malpractice Gesture
June 8: Obama's Health Cost Illusion
June 3: Why the Health Care Rush?
May 29: Taxing Health Care
May 19: How Washington Rations
May 13: Signing On to an Obama 'Dream'
May 11: Republicans and the 'Public Option'
May 5: Specter On Cancer
April 13: The End of Private Health Insurance
March 27: National Health Preview
March 21: Vindicating McCain
February 11: A Health-Tech Monopoly
January 21: The Latest Entitlement
December 29: Orszag's Health Warning
December 9: The Obama Health-Care Express
December 1: Messing with Malpractice Reform
November 20: The Obama Health Plan Emerges


October 26: Arthur C. Brooks: Why Government Health Care Keeps Falling in the Polls
October 22: David Brady and Daniel Kessler: Public Opinion and Health Reform
October 21: Scott Harrington: Competition and Health Insurance
October 20: William McGurn: What Singapore Can Teach the White House
October 19: Norbert Gleicher: 'Expert Panels' Won't Improve Health Care
October 16: Al From: Democrats Don't Need the Public Option
October 14: Douglas Holtz-Eakin: The Baucus Bill Is a Tax Bill
October 9: Wendy Williams: Paying the Health Tax in Massachusetts
October 8: Mary Landrieu: Health Costs Are Crushing Small Businesses
October 6: Peter Suderman: The Lesson of State Health-Care Reforms
October 6: Thomas Frank: Health Care and the 'Predator State'
October 5: Donald Palmisano, William Plested II and Daniel Johnson: What We Would Have Told Obama
October 2: Matt Miller: A Real Employee Free Choice Act
October 1: Scott Gottlieb: How the U.S. Government Rations Health Care
September 30: Holman Jenkins: Why Obama Bombed on Health Care
September 28: Philip K. Howard: Why Medical Malpractice Is Off Limits
September 28: William Winkenwerder: Health-Cops Aren't the Answer
September 27: Michael Leavitt, Al Hubbard and Keith Hennessey: Health 'Reform' Is Income Redistribution
September 26: John Fund: Congress Needs a 72-Hour Waiting Period
September 25: John F. Cogan, Glenn Hubbard, and Daniel Kessler: Doubling Down on a Flawed Insurance Model
September 24: Daniel Henninger: From Bismarck to Obama
September 24: Matt Alsante: The FDA Rejects Another Good Cancer Drug
September 22: Matt Blunt: How Missouri Cut Junk Lawsuits
September 18: Kim Strassel: Congress Veers Left on Health Care
September 18: David Rivkin and Lee Casey: Mandatory Insurance Is Unconstitutional
September 18: Deval Patrick: Massachusetts Is a Health-Reform Model
September 16: Rupert Darwall: Government Medicine vs. the Elderly
September 16: Max Baucus: The Senate Is Ready to Act on Health Care
September 15: Andrew Napolitano: Health-Care Reform and the Constitution
September 14: Scott Harrington: Fact-Checking the President on Health Insurance
September 12: William Healey: Heal for America
September 11: Grace-Marie Turner and Joseph Antos: Medicare Is No Model for Health Reform
September 11: Kim Strassel: The President's Tort Two-Step
September 10: Mark Mix: Read the Union Health-Care Label
September 9: Daniel Henninger: It's Still the Economy, Stupid
September 8: Sarah Palin: Obama and the Bureaucratization of Health Care
September 8: Holman Jenkins: A Bipartisan Plan to Wreck the System
September 4: John Shadegg and Pete Hoekstra: How to Insure Every American
September 3: Peggy Noonan: Coruscating on Thin Ice
September 2: Tom Daschle: Climbing the Hill on Health Care
September 1: Tom Coburn: What I Learned From the 'Mob'
August 31: Jerome Groopman and Pamela Hartzband: Sorting Fact From Fiction on Health Care
August 28: Gary Locke: Fixing Health Care Is Good for Business
August 27: Betsy McCaughey: Obama's Health Rationer-in-Chief
August 25: Thomas Frank: Health Care and the Democratic Soul
August 24: William McGurn: Saving the Obama Presidency
August 23: Fred Barnes: Republicans Have Obama Playing Defense
August 22: Kevin Ferris: Arlen Specter's Dilemma
August 20: Michael Leavitt: Health 'Co-ops' Are Government Care
August 20: Heather Richardson Higgins: No Compromise on Health 'Reform'
August 20: Daniel Henninger: In Government We Trust?
August 20: Peggy Noonan: Pull the Plug on ObamaCare
August 19: Scott Harrington: Health Co-ops: Slow Road to Government Care
August 19: Ronald Dworkin: An Anesthesiologist's Take on Health-Care Reform
August 18: Martin Feldstein: ObamaCare Is All About Rationing
August 18: Jim Towey: The Death Book for Veterans
August 18: William McGurn: Harry Reid's 'Evil' Moment
August 17: Andrew Klavan: The Panel
August 16: Craig Karpel: We Don't Spend Enough on Health Care
August 14: John Cochrane: What to Do About Pre-existing Conditions
August 12: Alan Miller: Medicare For All Isn't the Answer
August 11: John Mackey: The Whole Foods Alternative to ObamaCare
August 10: William McGurn: The Health-Care Grail
August 10: Dorothy Rabinowitz: Obama's Tone-Deaf Health Campaign
August 6: Daniel Henninger: Why Obama May Fail
August 6: Peggy Noonan: 'You Are Terrifying Us'
August 5: Arthur Laffer: How to Fix the Health-Care 'Wedge'
July 30: Myrna Ulfik: Health Reform and Cancer
July 28: Theodore Dalrymple: Is There a 'Right' to Health Care?
July 24: John Fund: Health Reform's Hidden Victims
July 24: Kim Strassel: How Obama Stumbled on Health Care
July 23: Betsy McCaughey: GovermentCare's Assault on Seniors
July 22: Michael Boskin: Obama Needs a Move to the Middle
July 22: Bobby Jindal: How to Make Health-Care Reform Bipartisan
July 17: Kim Strassel: The Grassley Test
July 15: Philip K. Howard: Health Reform Requires Lawsuit Reform
July 15: Thomas Szasz: Universal Health Care Isn't Worth Our Freedom
July 1: George Newman: Parsing the Health Reform Arguments
June 29: Scott Harrington: Reform Needs Healthy Life Incentives
June 26: John Calfee: The Dangers of Fannie Mae Health Care
June 25: Scott Gottlieb: Government Health Plans Always Ration Care
June 24: Robert Reich: Why We Need a Public Health-Care Plan
June 23: Mark Sklar: A Doctor's Reflections on Health-Care Reform
June 22: David Rivkin and Lee Casey: Is Government Health Care Constitutional?
June 19: Betsy McCaughey: Dissecting the Kennedy Health Bill
June 19: Kim Strassel: Mr. Burd Goes to Washington
June 18: Daniel Henninger: 'Public Option': Son of Medicaid
June 17: Holman Jenkins: The Death and Life of Health 'Reform'
June 15: Scott Harrington: The 'Public Plan' Would Be the Only Plan
June 12: Kim Strassel: Democrats and the Health Tax Taboo
Jun 12: Steven Burd: How Safeway is Cutting Health-Care Costs
June 9: David Gratzer: Canada's ObamaCare Precedent
June 5: Betsy McCaughey: Obama's Voodoo Health Economics
May 20: Grace-Marie Turner and Joseph R. Antos: The GOP's Health-Care Alternative
May 15: Peter Orszag: Health Costs are the Real Deficit Threat
May 14: John Lechleiter: Health-Care Reform and the 'Innovation Test'
May 12: Scott Gottlieb: How ObamaCare Will Affect Your Doctor
April 27: John E. Sununu: National Health Care With 51 Votes
April 17: Marc Siegel: When Doctors Opt Out
April 14: Kerry Weems and Benjamin Sasse: Is Government Health Insurance Cheap?
April 8: Jerome Groopman and Pamela Hartzband: Why 'Quality Care' Is Dangerous
March 14: Scott Gottlieb: Stem Cells and the Truth About Medical Innovation
March 12: Jerome Groopman and Pamela Harzband: Obama's $80 Billion Exaggeration
March 6: Sally Pipes: Health 'Reformers' Ignore Facts
February 26: Max Baucus and Edward Kennedy: We Cannot Delay Health-Care Reform
February 9: Nadeem Esmail: 'Too Old' for Hip Surgery
January 20, 2009: Scott Gottlieb: Congress Wants to Restrict Drug Access
January 8: Scott Gottlieb: What Medicaid Tells Us About Government Health Care
January 7: Tim Price: The GOP Should Fight Health-Care Rationing
December 30: Sally Pipes: Obama Will Ration Your Health Care
December 10: Ezekiel Emanuel and Ron Wyden: Why Tie Health Insurance to a Job?

Monday, October 26, 2009

The Inevitability Myth

Health care reform is not a fait accompli
by Matthew Continetti
11/02/2009, Volume 015, Issue 07

Did the Democrats become Calvinists when we weren't looking? Lately they've been talking an awful lot about predestination. They want to claim that Obamacare's victory is foreordained, that the health care debate is over and--surprise, surprise--the liberals won.
So: Paul Krugman wrote on his blog that an "aura of inevitability" surrounds Obamacare. The Washington Post's health care blogger wrote that this month's pro-Obama vote in the Senate Finance Committee "convinced many that health care reform was more of an inevitability than a possibility." A blogger for the Atlantic Monthly wrote that health care reform is a "fait accompli."
Pas encore. Yes, the chances of some sort of health bill passing, at some point, are by no means negligible--unfortunately. But there are many reasons to be skeptical of the future of Obamacare. Here are three:
The Landscape. "Our government rests in public opinion," Abraham Lincoln said in 1856. "Whoever can change public opinion, can change the government."
Public opinion is not on the Dem-ocrats' side. Most Americans remain satisfied with their health care. It's true that certain elements of the proposed reform, when isolated from others, poll well. But Congress isn't going to hold separate votes on each piece. Congress will be voting for the whole package. And the fact is that, ever since Congress began to assemble that package, more people have opposed the health care plan than favored it. The polls are striking. Since September 9, President Obama has campaigned strenuously for his plan, and it continues to lose support. And the Gallup poll
says that Obama's ratings plunge over the last three months is the largest quarterly drop for an elected president since 1953. In other words, a polarizing chief executive is asking Congress to enact a $1 trillion entitlement and tax hike against the public's wishes. Won't Democrats whose seats are up in 2010 think twice before acceding to his demands?
The Money. A glance at the polls reveals the alarm at our ballooning national debt. The Congressional Budget Office concluded that the Senate Finance Committee's health care bill would pay for itself in its first 10 years, but only by imposing taxes and cutting Medicare. There is no reason to believe that the reform that comes to a floor vote will resemble the Finance bill. This bill is far too stingy for liberals. They are ready to add to the debt in order to achieve their social vision. They want universal coverage. They want more generous subsidies.
But a left-liberal health care reform is a dicey proposition. Consider what happened last week in the Senate. Medicare is scheduled to reduce doctor's payments by more than 20 percent in 2010. The Democrats wanted to restore those cuts at a cost of $247 billion in unfunded liabilities. But, when Harry Reid tried to end debate on the measure last week, he failed. Joe Lieberman and 12 Democrats voted against the Senate Democratic leadership and for fiscal responsibility. Reid can't get 60 votes for a payoff to the American Medical Association. What makes the White House think he can get 60 for Obamacare?

The Calendar. Obama originally wanted a bill before summer's end. Didn't happen. Back in September, lawmakers expected Pelosi to hold a vote by the end of that month. No go. Then the deadline was the end of October. Another fantasy. Now we're told the vote won't come before early November.
But November features off-year gubernatorial elections that look favorable for Republicans. In Virginia, Republican Bob McDonnell holds a commanding lead over Democrat Creigh Deeds. When Obama won the state last year, the reigning opinion was that his coalition was strong enough to move the Old Dominion firmly into the Democratic column. A McDonnell victory would shatter this illusion. It would give pause to the center-right Democrats about to tie their fortunes to the president. It would show that the enthusiasm in American politics is all on the right. Southern and Western Democrats may begin to ask, What's the rush? And then the longer the health care debate goes on, the more the momentum for grand reform will fade. Big schemes will be abandoned.
The health-reform Calvinists are wrong. Politics isn't physics. Legislative logrolling isn't gravity. Nothing is inevitable.
--Matthew Continetti