Nancy Pelosi: No Health Care Deal This Year

Speaker Nancy Pelosi predicted Wednesday that job creation and deficit reduction will be the central Democratic themes for the coming year – and that public support for health care reform will rebound once a bill has been sent to President Barack Obama.

On the divisive issue of Afghanistan, the California Democrat ducked the question of how she would vote on increased war funding: “Let’s see what they request,” she said. But she has urged her party, including old allies on the anti-war left, to listen and give some “room” to Obama, recognizing that the president had been “dealt a very bad hand because there was no plan in Afghanistan for years.”

Pelosi made her comments at a year-end roundtable with reporters where she described herself as back in full “campaign mode” and confident House Democrats will retain “a strong majority” after the 2010 elections.

“He didn’t give me 72 hours notice,” she joked of Rep. Brian Baird’s surprise decision to not seek re-election in his swing district in Washington state. But Pelosi said her rule of politics was “don’t assume anything” and she wasn’t panicked by the recent spate of retirements in her ranks.

In the case of health care reform, Pelosi credited House Democrats with having saved Obama’s initiative after the onslaught of attacks during the August recess. And if the Senate can complete its bill this month, she will work to try to send a House-Senate compromise to the White House before the State of the Union.

“They will pass a bill and we will have a bill,” the speaker said, and once that happens, she predicted the focus will shift away from the differences among Democrats and more on what is in the package itself.

“We are in a define-or-be-defined occupation,” she said, and her adversaries have had the advantage of picking out single issues, such as abortion or the public option, to characterize the whole.

Matching the House bill against the still-evolving Senate package, she said she saw differences of affordability for families and the revenue-raisers that would have to be negotiated. But she downplayed differences over the public option for coverage, saying the emphasis had always been on giving consumers an insurance option, not that it be public or government run.

“We know that, between the two bills, we have the makings of a big difference for the American people,” Pelosi said. “When we have a bill . . . the discussion is no longer about the bishops or about the public options, and it’s about what’s in the bill for people.”

She plans to travel to Michigan for the Detroit auto show in January and is already pressing the Senate to respond quickly next month to a new job-creation package on the floor Wednesday. When a Michigan reporter asked her response to White House proposals about job-creating investments in environmental technologies, she bridled a bit: “We need no introduction to these subjects, and we’re thrilled that the White House is joining them.”

But in contrast with this past year, dominated by the Democrats aspirations for health care or climate change legislation, she said the grim federal debt now loomed over the agenda.
“There is a very, almost fierce determination to reduce the deficit,” she said, and repeatedly returned to her early years in Congress and budget battles under President Bill Clinton that contributed to the Democrats losing control of Congress in 1994.

“We’ve been here before,” she said. “We had to make very difficult decisions, and as you know, we paid a political price for it but we had to do it.”

Pelosi predicted in January ‘we’ll come to terms on a commission” such as those proposed to make recommendations to Congress on difficult deficit-reduction measures. But without mentioning Senate Budget Committee Chairman Kent Conrad (D-N.D.) by name, she seemed cool still toward his legislation, which would usurp the speaker’s power over legislation and dictate an up-or down-House vote -- without amendments -- on whatever the commission recommends.

“I said pass it in the Senate,” the speaker said. “Send it to me, I’ll have to face it.” But when Senate leaders told her that it was unclear still if the Conrad plan had the 60 votes needed for passage, her answer was: “Then let’s talk about what we can both pass rather than talk about what some people think should happen but doesn’t really have the votes.”

“This is not a completely whole new ball game because we had to do it when President Clinton made the determination that we would go forward,” the speaker said. “We know how to do it -- we’ll do it again.”

Nancy Pelosi seems determined to get her legislation passed. Photo: AP

The People Lose in Health Care Trainwreck

WASHINGTON -- This is what happens when the soaring promises of Hope and Change give way to old-style political prostitution on the Potomac.
President Obama won last year vowing to change the way Washington works.
Democrats clung to his coattails and won commanding control of Congress.
In less than 12 months, though, all the Democrats' promises of honesty, openness and common sense have sunken into the same old sordid sewer that has forever defined Washington as the loathsome, dishonest and wasteful place that it is.
The result is the health-care train wreck.

We must lower the skyrocketing costs, Dems said.
Now they are willing to spend any amount of your money it takes to get some kind of health-care legislation passed.
And they don't care how much their own accountants tell them the bill will actually raise the costs of health care.
We will usher in a new era of openness, they vowed.
Not anymore.
Openness and honesty were killing their health-care plans, so Democrats took it entirely behind closed doors.
The only way to provide health care for all Americans, they promised us, was if the government went into the insurance business.
Now they say states can opt out or opt in. Or you can join Medicare. Or, some people can join Medicare.
"Anything!" they are saying. "We just need a victory!"
This is what happens when politicians go from idealism to survivalism.
They no longer care what they promised voters. They don't care what the public wants. And they don't care about what is right.
All they care about is a victory so that they can claim to have accomplished something.
churt@nypost.com

Read more: http://www.nypost.com/p/news/national/just_win_baby_even_if_the_people_IZVxYEW51uvZQY0l6kW7JN#ixzz0ZpF5B3Lw

Sources: Medicare buy-in likely to be dropped from health care bill

Lieberman talks health care

STORY HIGHLIGHTS

• Plan to expand Medicare to those 55 and over will be dropped, sources say
• Move aims to win back support of Sen. Joe Lieberman, they say
• Senate Dems need 60 votes to close debate and bring health care bill to a vote
• Lieberman support is key to the 60 votes

Washington (CNN) -- Senate Democrats are preparing to drop a compromise health-care plan that would allow 55- to 64-year-olds to buy into Medicare because of opposition from Connecticut Sen. Joe Lieberman, two senior Democratic sources said Monday.
"It's what the White House wants, and there aren't many other options that allow us to finish by Christmas," said one source.
Lieberman, an independent who caucuses with the Democrats, has emerged as the majority party's main obstacle to its efforts to get a health care bill through the Senate before Christmas. He ratcheted up his public opposition to the bill Sunday by threatening to join a Republican filibuster if the legislation contains either a government-run public health insurance option or a proposed alternative that would expand Medicare to people as young as 55.
"I think the danger always is you try to add too much onto a bill," he told reporters Monday evening. He said he supports the "core" of the bill, including tighter regulations on private insurers, but he wants Democrats to "take off some of this stuff that runs the risk of creating federal debt, and moves toward a government takeover of insurance, which I think would be bad."

Unanimous Republican opposition so far means Senate Democrats need all 60 votes in their caucus to close debate on the sweeping health care bill. Final passage of the bill would then require only a simple majority of 51.
Lieberman supported letting older workers buy into Medicare in 2000, when he was the Democratic vice presidential candidate, and as recently as September in comments to a Connecticut newspaper. But he said Monday that the idea was "no longer necessary," since the Senate bill includes subsidies to help people 55 and older buy insurance coverage before they become eligible for Medicare.
"I was suggesting various ideas for health care reform that did not involve the public option, and that was the focus at that time," he said. "But the important thing is I'm for health care reform, and if we get together, we're going to deliver a health care reform bill that will provide the ability to get health insurance to 30 million people that don't have it now."
Lieberman spokesman Marshall Wittmann said that now, "We have a huge national deficit and a program that analysts indicate is in dire fiscal straits in 2009."
Senate Democrats held an emergency meeting Monday night to discuss the issue, which threatens to derail the Obama administration's push for a sweeping reform of U.S. health insurance. Although a final decision was not made at Monday night's meeting, a second Democratic source said a final decision could be made at a White House meeting Tuesday between the Senate's Democratic majority and President Obama.
"I think there is a fundamental understanding of the direction we're going in," said Sen. John Kerry, D-Massachusetts.
Before the meeting, liberal Democrats Tom Harkin of Iowa and Jay Rockefeller of West Virginia indicated that the Medicare buy-in would likely be dropped. While they didn't like the idea, they suggested they would support a health care bill anyway.
Democrats "may have to do what Mr. Lieberman wants," Harkin said.
The Medicare expansion was part of a package of provisions announced by Reid last week as an alternative to a government-run public health insurance program, which lacked enough support among Democrats to break a filibuster. Negotiated by a team of 10 Democratic senators -- five liberal and five moderate -- the compromise package was hailed by Reid, Obama and others as an important step forward in the health care debate.
The package also would allow private insurers to offer nonprofit health coverage overseen by the government. But many senators have reserved judgment on the compromise proposal until the non-partisan Congressional Budget Office provides its analysis of how much it costs.
Senate Majority Leader Harry Reid would discuss no specifics of a bill after Monday night's caucus, telling reporters he would wait until the CBO finished its estimate of a revised bill's cost. But he said the measure "saves lives, saves money and saves Medicare."
"I am confident that by next week we'll be on our way to forward this bill to the president," he said.
Most Democrats support the public option as a nonprofit competitor to private insurers that would expand coverage and bring down prices. Republicans and some moderate Democrats, along with the health insurance industry -- one of the major employers in Lieberman's home state -- oppose a public option, calling it a first step toward a government takeover of the U.S. health care system.
Lieberman first expressed possible opposition to the health care bill in late October, saying he would join a GOP filibuster if the measure contained the public option. Asked about Lieberman's position then, Reid said: "Joe Lieberman is the least of Harry Reid's problems."
Another potential obstacle for Reid is moderate Democrat Ben Nelson of Nebraska, who said Sunday he cannot support the Senate bill without tighter restrictions on federal funding for abortion. The Senate last week defeated an amendment proposed by Nelson and two other senators that would adopt tougher language on abortion funding contained in the House health care bill.
A compromise on the abortion language is possible, said Nelson, one of 10 Senate Democrats who negotiated in private last week on the public option compromise.
If the Senate eventually passes a health care bill, its version will have to be merged with the version the House of Representatives passed in November, which includes a public health insurance plan. The final bill would then need approval from both chambers before going to Obama to be signed into law.

Obama and Democratic leaders have said they want the bill completed this year. The Senate would need to finish its work this week to leave a realistic chance of meeting that schedule.

Dems against Dems in health care vote struggle

By DAVID ESPO, AP Special Correspondent David Espo, Ap Special Correspondent – Mon Dec 14, 6:24 pm ET

WASHINGTON – The end game in sight, Senate Democrats coped with stubborn internal differences as well as implacable Republican opposition on Monday in a struggle to pass health care legislation by Christmas.
A liberal-backed call to expand Medicare as part of the legislation drew strong opposition from Sen. Joe Lieberman, I-Conn. and quieter concerns from a dozen Democrats, raising significant doubts about its ability to survive.
Congressional officials said the administration was recommending the provision be jettisoned to clear the way for the most sweeping health care legislation in a half-century. In response, a top presidential aide, Dan Pfeiffer, said, "The White House is not pushing (Senate Majority Leader Harry) Reid in any direction, we are working hand in hand with the Senate leadership to work through the various issues and pass health reform as soon as possible."
Disputes over abortion and the importation of prescription drugs from Canada and other countries also flared.
In an attempt to generate support for the bill, Reid promised late in the day that any final compromise with the House would completely close a gap in Medicare prescription drug coverage generally known as a "doughnut hole." The Senate bill goes only part way toward that goal.
Democrats are "looking for 60 votes," said Dick Durbin of Illinois, the party's second-ranking Senate leader — a statement that has characterized their effort to overcome Republican opposition for months.
President Barack Obama, the fate of his top domestic priority in doubt, invited all Senate Democrats to a meeting at the White House complex on Tuesday — possibly the final day for an agreement if the legislation is to clear the Senate before Christmas.
In the interim, the president's Monday schedule included a meeting with Sen. Bob Casey, D-Pa., who has been trying to negotiate a compromise on the abortion issue with Sen. Ben Nelson of Nebraska. Both senators oppose abortions, but Nelson has been outspoken in demanding changes in the bill before he can vote for it.
The overall measure, costing nearly $1 trillion over a decade, is designed to expand coverage and ban the insurance industry practice of denying coverage on the basis of pre-existing medical conditions. Obama has also urged Congress to slow the rate of growth in health care spending nationally, and several days after Reid submitted a package of revisions, lawmakers awaited final word from the Congressional Budget Office on that point.
Additionally, a top administration economic adviser acknowledged Monday that the Democratic-backed health care measure would raise spending in the short run, but she said it would eventually generate more than enough savings to offset the expense of expanded coverage.
"Our bottom line is that the bills as they are coming through will genuinely slow the growth of health care spending, both public and private, by about 1 percentage point a year for an extended period," said Christina Romer, chair of the Council of Economic Advisers.
Sen. Byron Dorgan, D-N.D., led the effort to lift a long-standing ban on the importation of prescription drugs from Canada and elsewhere. Obama favored the plan as a senator, but the pharmaceutical industry is opposed, and the White House appeared anxious not to jeopardize a months-long alliance with drug makers who have been helpful in trying to pass the overhaul.
But the obstacle that loomed largest was a proposal to permit uninsured men and women to purchase Medicare coverage as early as age 55.
It emerged last week as part of a framework agreement between moderates and liberals struggling to define the role of government in the newly revised health care system. Additionally, the proposal calls for creation of nationwide plans run by private insurance companies under the supervision of the Office of Personnel Management, the agency that oversees the system through which federal employees and lawmakers obtain their own coverage.
The two provisions were seen as a replacement for Reid's initial call for a government-run insurance plan to compete with private industry.
Liberals have long wanted a government-run option, but moderates oppose it as an unwanted intrusion into the health care system. In announcing the agreement last week, Reid told reporters he could finally see the finish line for his effort to pass a health care bill.
Despite that optimism, opposition to the Medicare changes blossomed from doctors and hospitals, who are paid less to treat patients under Medicare than those covered by private insurance companies.
Lieberman announced his opposition over the weekend, but he was not the only critic.
"We appreciate the rationale underlying the proposed Medicare expansion but fear that provider shortages in states with low reimbursement rates such as ours will make such a program ineffective, or even worsen the problems states are experiencing," a dozen Democrats from across the political spectrum wrote Reid.
Democratic officials said late last week that efforts were under way to try and ease the concerns of doctors and hospitals, as well as defray the cost of buy-in coverage for consumers. Under some estimates, the price tag could reach $7,600 annually or more.
Lieberman said on Sunday he was opposed to the Medicare provision, threatening to deny Democrats his vote if it remained in the bill.
That set off an unusual round of finger-pointing, in which Senate aides anonymously accused him of having flip-flopped on the issue after privately indicating to Reid he was in favor of it.
In a pointed rebuttal, Lieberman's spokesman said, the Connecticut lawmaker had told Reid privately on Friday "that he had problems with the Medicare provision." Marshall Wittman, the spokesman, added, "This position was also told to negotiators earlier in the week. Consequently, Senator Lieberman's position came as no surprise to the Democratic leadership. Any contrary charge by aides who cowardly seek to hide under the cloak of anonymity is false and self-serving."
But Lieberman's consistency on the issue came under question within hours, when House Democrats circulated a videotape from September in which he spoke favorably of allowing men and women as young as 55 to purchase coverage under Medicare.
Wittman said those comments were made before the Senate health care bill, which includes health insurance subsidies, was finalized. He said Lieberman believes the government assistance makes a Medicare buy-in program redundant.
One other proposal to emerge from last week's negotiations appeared headed for oblivion.
The Congressional Budget Office said a requirement for insurance companies to spend 90 cents of every premium dollar on medical care would transform the industry into "an essentially governmental program" that would more properly belong in the federal budget.
Reid's bill now includes some limits on insurance company overhead, but Sen. Jay Rockefeller, D-W.Va., and other liberals advocate the 90 percent proposal.

Obama: One Last Scare

 

Mon Dec 14, 3:03 pm ET

WASHINGTON – President Barack Obama will meet with Senate Democrats at the White House Tuesday to press for action at a make-or-break moment for his health care overhaul.
All 60 members of the Democratic caucus have been invited, according to three Democratic officials. The officials spoke on condition of anonymity because the announcement was not yet public.
The meeting comes as Senate Majority Leader Harry Reid works to round up votes to get a sweeping health bill passed before Christmas. The outcome is uncertain with moderates in danger of defecting on issues including abortion and a proposed expansion of Medicare.

The 'Cost Control' Bill of Goods

How Peter Orszag and the White House sold a health-care illusion.

ObamaCare's core promise—better quality care for everyone at lower costs—is being exposed as an illusion as it degenerates into the raw exercise of political power. Naturally, the White House and its media booster club are working furiously to prop up this fiasco, especially on cost control.
As Obama budget director Peter Orszag put it at a revealing media breakfast earlier this month, the Senate bill does everything the experts recommend to "get at the underlying drivers of health-care costs." While he admitted that "we don't know enough" to produce results right away, the key is to encourage "continuous improvement" through pilot programs and demonstration projects. Cost containment will actually take "years to decades," Mr. Orszag conceded.
The torch was then passed to Ron Brownstein of the Atlantic Monthly, David Leonhardt of the New York Times and editorial writers for the New England Journal of Medicine, among others. Last week the New Yorker ran a 5,000-word apologia from Atul Gawande, who likewise owned up to the fact that there is "no master plan for dealing with the problem of soaring medical costs," only "a battery of small scale experiments." Keep in mind, this is an argument in favor of ObamaCare.
They might have piped up earlier: What they're finally admitting is that all the grandiose talk about "bending the curve" used for months to sell ObamaCare really comes down to their hope that bureaucratic improvisation will make a difference over the long term. Yet the liabilities of the greatest social spending program in American history will be added to the budget almost immediately, and what happens if Mr. Orszag's technocratic revolution doesn't work as promised? Or rather, when it doesn't?
Forgotten in ObamaCare's march-to-the-sea campaign is that during the transition and early on, the White House was divided on whether to pursue health reform at all. Opponents included Larry Summers, worried about the economy and deficits, and David Axelrod, worried about the politics. Another faction led by Tom Daschle preached from the conventional social-equity church of liberalism.
Mr. Orszag proposed another option, citing academic research observing that as much as 30% of health spending is "waste" that doesn't affect outcomes. He argued the country could save $700 billion a year without harming quality—more than enough to pay for universal coverage.

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Associated Press

Peter Orszag.

Thus cost control migrated from Orszag theory to free political lunch. Mr. Gawande wrote an influential New Yorker essay on the topic in June, and the theme shaped both the case for a new entitlement and especially the appeal to potential opponents in business.

But then Congressional Budget Office director Douglas Elmendorf testified in July that "the curve is being raised," given that ObamaCare lacks "the sort of fundamental changes" necessary to tamp down costs. Meanwhile, it became clear that Mr. Orszag's favored research was always more nuanced and qualified than his pose of papal infallibility. One of his main gurus, Jonathan Skinner, mused recently that "the key lesson" from a new study challenging some of his findings "is how little we know about the science of health-care delivery."
Well, sure. A field as dynamic and innovative as U.S. medicine, in which costs are largely driven by new technologies and better ways of caring for patients, is rife with complexities and uncertainties. But no one bothered to strike that note of caution when Washington was hopped up on a cost-control gambit that was too painless to be true.
The new cost-control apologists concede that there isn't any actual plan for controlling costs: Throw enough speculative policies against the wall, they say, and some breakthrough will stick. Yet Mr. Orszag's no-less-confident predecessors spent decades trying to pull down Medicare spending with little to no success. Technocracy rarely if ever works as intended. Mr. Gawande points to the case study of U.S. farm policy, and if politically sacrosanct agriculture subsidies and rural price-supports are the best to hope for, then what's the worst?
More relevant examples include Medicare's "relative value" payment scale, which was designed in 1985 by the Harvard economist William Hsiao to encourage more primary care. That's this year's rallying cry too. "Diagnosis-related groups" were introduced into Medicare in 1983 to alleviate hospital cost growth, and what a monumental success that turned out to be. With only brief periods of relatively slower growth, nominal Medicare spending has risen on average at an annual rate of 9.6% since 1980. Over the same period total Medicare spending has grown 13-fold, climbing from 1.2% of the economy to 3.2% today.
Congress lacks the stomach for serious cost control in any case. One policy Mr. Orszag favors—Medicare penalties for hospitals that re-admit certain patients—is limited to only three conditions in the Senate bill, and the penalties are trivial.
Another—a putatively independent commission that is supposed to enforce cost cutting—is barred from going after costs incurred by doctors and hospitals, which leaves out more than half of Medicare spending. Earlier this year Mr. Orszag got into a heated debate with Henry Waxman over such a commission at a dinner party hosted by Connecticut Rep. Rosa DeLauro, precisely because the House baron enjoys the political power that flows from controlling health spending.
Even if Mr. Orszag's Princeton and Yale Ph.D.s really do cook up some hope-and-a-prayer savings plan, it will invariably offend one constituency or another and Congress will block it. Thereupon the political class will do what it always does when costs run over: Tighten price controls across the board, before moving on to denying patient access to costly treatments that will be defined as "wasteful." That is, ration care.
"Basically everything that has been put forward in health policy discussions for a decade is in this bill," Mr. Orszag said on a conference call shortly before Thanksgiving. He then asked critics pointedly: "What specifically else would you do?"
Hmmm. One liberal sage noted in a 2007 paper that "four decades of empirical research" have shown that insulating people through third-party insurance coverage "from the full cost of health care has been responsible for anywhere from 10% to 50% of the large increase in health expenditures." Ultimately, he concluded, increasing cost-sharing would give individuals a direct stake in more prudent purchasing, as opposed to today's invisible health dollars that vanish as more expensive premiums, foregone wages and higher taxes.
Those are the words of Jason Furman, now the White House deputy economic director who seems to have been put into witness protection. Every serious health economist in the country recommends reforming the tax exclusion for employer-sponsored insurance, perhaps by converting it to a deduction or credit. Cost control will never stick unless it is extricated from politics and transferred to individuals to make their own trade-offs.
Such reforms were ruled out by union opposition, so the Senate gestures at them with a 40% excise tax on high-cost insurance plans, on the theory that two wrongs will make a right. But this untargeted tax will simply raise the cost of coverage for all workers in a given pool—it's too clever by 40%—while doing nothing to stem the distortions from first-dollar, third-party insurance.
No doubt there are efficiencies to be had in health care, and maybe Mr. Orszag has even identified some of them. But all of his bright ideas could be taken for a whirl without adding trillions of new liabilities to the federal balance sheet. And the bad faith of the White House and its acolytes is breathtaking.
The White House hawked a permanent entitlement expansion on flimsy and speculative theories that its own partisans now admit—albeit when it is nearly too late—aren't more substantive than the triumph of hope over experience, while simultaneously writing off the one policy that has been effective in the real world. The cost control mantra of ObamaCare was always a political bill of goods, and its result will be the opposite of its claims: poorer quality care at higher costs.

 

Harry Can't Find 60

By Eric Zimmermann - 12/13/09 11:15 AM ET



Two key senators criticized the most recent healthcare compromise Sunday, saying the policies replacing the public option are still unacceptable.

Sens. Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.) both said a Medicare "buy-in" option for those aged 55-64 was a deal breaker.

"I'm concerned that it's the forerunner of single payer, the ultimate single-payer plan, maybe even more directly than the public option," Nelson said on CBS's "Face the Nation."

Lieberman said Democrats should stop looking for a public option "compromise" and simply scrap the idea altogether.

"You've got to take out the Medicare buy-in. You've got to forget about the public option," he said.

If Democrats stick to relying primarily on the bill's subsidies, the legislation would pass easily and with bipartisan support, Lieberman argued.

Nelson's comments are somewhat surprising, considering he was one of the 10 Democrats tasked with putting together the compromise.

He said this morning that he participated simply "to be a friend of the process."

"What we've put together is something to get scored," he said.

Most Democrats still don't know what exactly the compromise entails. Majority Leader Harry Reid (D-Nev.) has sent the bill to the Congressional Budget Office but will not release the details until a score is final.

Lieberman said this morning that Reid fears the new compromise proposals would "get mauled" if they're released without a score to back them up.

Indeed, another senate centrist said this morning that her vote would be decided by the results of the CBO score.

Speaking on "Fox News Sunday," Sen. Claire McCaskill (D-Mo.) said she would not vote for any bill that doesn't reduce the deficit and bring down healthcare costs.

If those two criteria aren't met, "we'll have to go back to the drawing board," she said.

Meanwhile, Sen. Jay Rockefeller (D-W.Va.) remained optimistic, arguing that as a final vote nears senators will come around.

"The closer you get, the more you have to look at the whole bill, and you say, 'I have to do this for the nation,'" he said.