Obama Promised Eight Times During Campaign To Televise Health Hearings

Sestak puts blame on Democratic leaders for slipping support

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

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

Medicare and the Mayo Clinic

The famous hospital will no longer take some senior patients. 

President Obama last year praised the Mayo Clinic as a "classic example" of how a health-care provider can offer "better outcomes" at lower cost. Then what should Americans think about the famous Minnesota medical center's decision to take fewer Medicare patients?
Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.
Mayo says it lost $840 million last year treating Medicare patients, the result of the program's low reimbursement rates. Its hospital and four clinics in Arizona—including the Glendale facility—lost $120 million. Providers like Mayo swallow some of these Medicare losses, while also shifting the cost by charging more to private patients and insurers.
Of course, only governments can lose that much money and pretend they don't have to change. "Mayo Clinic loses a substantial amount of money every year due to the reimbursement schedule under Medicare," the institution said. "Decades of underfunding and paying for volume rather than value in Medicare have led us to this decision."

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Associated Press 

 

Mayo is probably a leading indicator of where other hospitals and doctors are headed. Physicians on average earn 20% to 30% less from Medicare than they do from private patients, and many are dropping out of the program. While about 92% of family physicians participate in Medicare, only about 73% of those are now accepting new patients. In some specialties—neurology, oncology, gynecology—in places like Manhattan and Washington, patients can struggle to find any doctor who'll accept Medicare.

The $500 billion in Medicare cuts planned as part of ObamaCare won't help this trend. The hospital industry agreed earlier this year to chip in $100 billion over the next decade in lower annual payment increases for Medicare. The chief Medicare actuary estimates that up to 20% of hospitals could become unprofitable as a result of the scheme.
The irony is that the Obama Administration has repeatedly praised Mayo as an example of the efficiency and lower cost that will spread everywhere if ObamaCare passes. And it's true that Mayo is a sterling example of the kind of health reform that many economists—notably White House budget chief Peter Orszag—extol.
Mayo's doctors are salaried and work in teams, which have become known more broadly as accountable care organizations, or ACOs. Mayo would prefer to receive a bundled payment for an episode of illness, rather than the Medicare practice of reimbursing for individual procedures. As it is now under Medicare, Mayo's less-is-more model means it can't make up its true costs on volume.
We have our differences with this ACO model. It essentially converts health-care providers into the equivalent of managed care in the 1990s. While HMOs did lead to less health spending for a time, patients and doctors rebelled. Congress threatened to intervene with a "patients bill of rights" until insurers backed off. The promoters of ACOs are saying that managed care will work better this time because the providers will be reducing costs at the behest of government, instead of insurance companies.
That may work for Mayo, which has spent decades building an institutional culture by trial and error. But it takes a special kind of hubris to believe that government can replicate such a culture nationwide. The ACO model still hides the cost of care from individuals, who thus have no incentive to reduce their utilization. Mayo also serves a more affluent population than most hospitals, which may make cost-saving easier.
The double irony is that earlier this year Mayo itself came out against the House health bill as offering too little cost-saving reform. And, six months later, the truth is that neither bill in Congress includes the kind of cost-saving innovations that would lead to more Mayos. Instead, the highly touted insurance "exchanges" will essentially import Medicare's rules. Mr. Orszag and the Obama whiz kids have settled for "pilot programs" and cost-saving quarter measures because Congress doesn't want to give up political control over government health payments.
In other words, the real Mayo story is that sclerotic Medicare is preventing more Mayos, and ObamaCare is paving the way for all of health care to operate like Medicare.

 

Why Drug 'Reimportation' Won't Die

The drug industry made a foolish bet in supporting health reform.

By GILBERT ROSS

As a threat to our nation's security, allowing imported drugs into our pharmacies ranks just below terrorism. Yet this idea refuses to die. Why is drug importation (and its twin the reimportation of American drugs from foreign countries) a bad idea? Aren't cheaper drugs good for low-income Americans?
The Food and Drug Administration's response—reasserted last month by FDA Commissioner Margaret Hamburg—is that imported and reimported drugs can't be guaranteed to be safe. Studies have shown that a significant percentage of drugs thought to be American-made and reimported are actually counterfeit, ineffective or even toxic. In one sting in 2003, for example, FDA and Customs officials found that 88% of the imported drug packages they inspected did not meet FDA safety standards.
But there is an even more important reason why importing drugs is dangerous. Importing foreign drugs or reimporting American-made drugs is a back-door way of introducing price controls in America. Many foreign countries, including Canada, impose price controls on drugs, which is why reimporting American-made drugs is cheaper than simply buying drugs that haven't left the country.

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Associated Press 

 

And allowing price controls into this country is a sure path to destroying our drug industry, which is now a prime driver in developing new and innovative pharmaceuticals. The drug industries in countries with price controls lag behind our drug industry in developing new, important drugs.

It is unfair that Americans underwrite the cost of developing new drugs for much of the rest of the world. But the solution to that disparity isn't to destroy our innovative drug industry. It would be much better to find ways to make the rest of the world pays its fair share.
So why has the idea of reimporting drugs continued to pop up? It seems that it is just too easy for populist lawmakers to depict cheaper imported drugs as a panacea for rising health-care costs. It is much harder to explain the negative impact importing drugs would have on our drug industry's ability to meet health-care needs.
Some advocates in favor of importing foreign drugs were disappointed in President Obama when he struck a deal with the drug-industry group PhRMA to keep importing drugs out of the health-care reform legislation moving in Congress. The president struck the deal to get the drug industry on board with his health-care reform initiative and succeeded at getting drug industry officials to agree to have their companies swallow about $80 billion in new costs (most negotiated price reductions for government health-care programs) in return for the understanding that no further demands would be made of them. Drug makers held up their end of the deal by paying for ads supporting health-care reform.
Imagine the drug makers' surprise, then, when almost immediately after the Senate passed its reform administration spokesmen said that importing cheap "foreign" drugs was back on the president's agenda. This despite the fact that Ms. Hamburg wrote to the Senate asserting that her agency continued to strongly oppose importing drugs, a position that is in line with positions held by every prior FDA head. The drug executives, far from getting a seat at the negotiating table were made into an entrée on the menu.
As a senator, Mr. Obama was an outspoken supporter of drug importation and remained so on the presidential campaign trail. Only when cajoling the drug industry into signing on to his reform did he suddenly turn away from that position. Now, however, he is reverting to his original position by separating importation from the actual reform bill.
The result is that the importation of possibly dangerous foreign drugs may soon be on their way to our drugstores and hospitals, and along with them will come dangerous price controls that will demolish drug innovation and condemn our children and grandchildren to cope with obsolete drugs from the dawn of the 21st century.
Dr. Ross is medical director of the American Council on Science and Health.

 

AP sources: Obama OKs taxing high-end health plans

By ERICA WERNER, Associated Press Writer Erica Werner, Associated Press Writer – 1 hr 29 mins ago

WASHINGTON – President Barack Obama signaled to House Democratic leaders Wednesday that they'll have to drop their opposition to taxing high-end health insurance plans to pay for health coverage for millions of uninsured Americans.
In a meeting at the White House, Obama expressed his preference for the insurance tax contained in the Senate's health overhaul bill, but largely opposed by House Democrats and organized labor, Democratic aides said. The aides spoke on condition of anonymity because the meeting was private.
House Democrats want to raise income taxes on high-income individuals instead and are reluctant to abandon that approach, while recognizing that they will have to bend on that and other issues so that Senate Majority Leader Harry Reid, D-Nev., can maintain his fragile 60-vote majority support for the bill.
Pelosi and four committee chairmen met with the president Wednesday as they scrambled to resolve differences between sweeping bills passed by the House and Senate. The aim is to finalize legislation revamping the nation's health care system in time for Obama's State of the Union address early last month.
Despite the dispute over the payment approach, Pelosi, D-Calif., emerged from the meeting expressing optimism.
"We've had a very intense couple of days," Pelosi said. "After our leadership meeting this morning, our staff engaged with the Senate and the administration staff to review the legislation, suggest legislative language. I think we're very close to reconciliation."
Congressional staff members stayed at the White House into the evening to continue work and a conference call of the full House Democratic caucus was scheduled for Thursday.

The Tom DeLay Democrats

So much for the President's pledge of C-Span transparency.

Rehabilitating Tom DeLay's reputation always seemed hopeless, or so we thought—but then again, President Obama ran on hope. Against the odds Democrats are making the former GOP Majority Leader look better by comparison as they bypass the ordinary institutions of deliberative democracy in the final sprint to pass ObamaCare.
Instead of appointing a formal conference committee to reconcile the House and Senate health bills, a handful of Democratic leaders will now negotiate in secret by themselves. Later this month, presumably white smoke will rise from the Capitol Dome, and then Nancy Pelosi, Harry Reid and the college of Democratic cardinals will unveil their miracle. The new bill will then be rushed through both chambers with little public scrutiny or even the chance for the Members to understand what they're passing.
Evading conference has become standard operating procedure in this Congress, though you might think they'd allow for the more open and thoughtful process on what Mr. Obama has called "the most important piece of social legislation since the Social Security Act passed in the 1930s and the most important reform of our health-care system since Medicare passed in the 1960s."
This black-ops mission ought to be a particular embarrassment for Mr. Obama, given that he campaigned on transparent government. At a January 2008 debate he said that a health-care overhaul would not be negotiated "behind closed doors, but bringing all parties together, and broadcasting those negotiations on C-Span so the American people can see what the choices are."
The C-Span pledge became a signature of his political pitch. During a riff at the San Francisco Chronicle about "accountability," he added that "I would not underestimate the degree to which shame is a healthy emotion and that you can shame Congress into doing the right thing if people know what's going on."
Apparently this Congress knows no shame. In a recent letter to Congressional leaders, C-Span president Brian Lamb committed his network to airing "all important negotiations," which if allowed would give "the public full access, through television, to legislation that will affect the lives of every single American." No word yet from the White House.
At a press conference in December, even Mrs. Pelosi said that "we would like to see a full conference." One reason she mentioned was that "there is a great deal of work involved in reviewing a bill and seeing what all the ramifications are of it," though her real motive at the time was that a conference seemed like a chance to drag the bill closer to the House version.
With public support collapsing, however, Democrats now think the right bill is any bill—and soon. Democrats know that a conference forces the majority party to cast votes on awkward motions and would give the Republicans who have been shut out for months a chance to participate. This sunlight, and the resulting public attention, might scare off wavering Democrats and defeat the bill. Ethics rules the Democrats passed in 2007 also make it harder to "airdrop" into conference reports the extra bribes they will no doubt add to grease the way for final passage.
Democrats howled at the strong-arm tactics Mr. DeLay used to pass Medicare drug coverage in 2003, and so did we. But they've managed to create an even more destructive bill, and their tactics are that much worse. We can't even begin to imagine the uproar if the Republicans had tried to privatize Social Security with such contempt for the democratic process and public opinion.

 

Nebraska gift needs returning

By John Suthers

Posted: 01/03/2010 01:00:00 AM MST

From the moment health care reform emerged as the issue of Congress' 2009 agenda, Republicans and Democrats have exchanged rhetorical volleys and parliamentary maneuvers aimed at passing, slowing or halting passage of a bill.
It's not my job as Colorado attorney general to immerse myself in the merits of the health care debate. But in an effort to secure 60 votes to pass a health-care overhaul, the U.S. Senate has crossed a line that should trouble Coloradans on both sides of the political divide.
The Senate bill, which must be reconciled with the House's take on reform, contains provisions that would dramatically expand Medicaid eligibility throughout the country and the amount various states must contribute to the expanded program. Colorado, for example, is likely to have to come up with an additional $1 billion over the next six years to fund the Medicaid expansion. To secure the 60th vote needed to pass a bill, Senate Majority Leader Harry Reid inserted a provision in the bill that effectively exempts Nebraska from any additional burden and requires that the other 49 states absorb the cost of covering any new Nebraska Medicaid recipients. The bill thus acquired the support of Sen. Ben Nelson and, in the eyes of several state attorneys general, a significant legal problem.
The U.S. Constitution and related case law bar Congress from arbitrarily funding or taxing the states differently. Any differences must have a rational basis. It is our opinion that the "Nebraska Compromise" has no rational basis. This sort of congressional action is not an expenditure promoting the general welfare of the United States. It is quite the opposite: an expenditure to the benefit of one state and the detriment of all others.
The Nebraska Medicaid amendment is substantially different from any other earmark in this or any other bill. Instead of being a one-time expense for a hospital expansion, highway resurfacing or other project, Nebraska is securing a perpetual benefit that taxpayers in every other state must bear.
To be sure, there can be rational taxing or funding discrepancies between the states. For example, the residents of one state might be poorer than Coloradans and, thus, qualify for more federal entitlements. That is an acceptable discrepancy. However, when one state is singled out for a benefit — being perpetually exempt from paying for any new Medicaid patients — for no other reason than securing a vote, it does not pass the smell test.
I have received dozens of calls and e-mails from Coloradans applauding me for my decision to explore the constitutionality of the Nebraska arrangement. The vast majority of these callers said they support me because they do not like the president's health care overhaul. My objections, however, have nothing to do with the merits of the Senate bill or the politics of Washington, D.C. My concerns are purely legal.
This is a matter of the U.S. Constitution and protecting Colorado and Colorado taxpayers' interests on the national stage.
Colorado's senators and congressional representatives should insist on removing the Nebraska Compromise from the bill as lawmakers reconcile the House and Senate proposals. In the meantime, several of my colleagues and I plan to continue to study this provision and our legal options.
John Suthers is Colorado's 37th attorney general.

Read more: http://www.denverpost.com/opinion/ci_14103533#ixzz0bcMihX3g