Obama's big idea: Digital health records

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Obama's big idea: Digital health records

President-elect wants to computerize the nation's health care records in five years. But the plan comes with a hefty price tag, and specialized labor is scarce.

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By David Goldman, CNNMoney.com staff writer
January 12, 2009: 4:05 AM ET

NEW YORK (CNNMoney.com) -- President-elect Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic.

Here's the audacious plan: Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline.

Sounds good. But it won't be easy.

In fact, many hurdles stand in the way. Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation. And some experts say that serious concerns about patient privacy must be addressed first. Finally, the country suffers a dearth of skilled workers necessary to build and implement the necessary technology.

"The hard part of this is that we can't just drop a computer on every doctor's desk," said Dr. David Brailer, former National Coordinator for Health Information Technology, who served as President Bush's health information czar from 2004 to 2006. "Getting electronic records up and running is a very technical task."

It also won't come cheap. Independent studies from Harvard, RAND and the Commonwealth Fund have shown that such a plan could cost at least $75 billion to $100 billion over the ten years they think the hospitals would need to implement program.

That's a huge amount of money -- since the total cost of the stimulus plan is estimated to cost about $800 billion, the health care initiative would be one of the priciest parts to the plan.

The biggest cost will be paying and training the labor force needed to create the network. Luis Castillo, senior vice president of Siemens Healthcare, a company that designs health care technology, said the laborers will have the extremely difficult task of designing a a system that "thinks like a physician."

"Doctors cannot spend hours and hours learning a new system," said Castillo. "It needs to be a ubiquitous, 'anytime, anywhere' solution that has easily accessible data in a simple-to-use Web-based application."

But highly skilled health information technology professionals are as rare as they come, and many IT workers will need to be trained as health technology experts.

Early government estimates showed about 212,000 jobs could be created from this program, but Brailer said there simply aren't that many Americans who are qualified.

Furthermore, ensuring the privacy of patients' records in a nationalized computer network will be tricky. There are obvious concerns about hackers and system failures. And new online health record systems, such as Google Health are not currently subject to the Health Insurance Portability and Accountability Act, the national health privacy law.

"HIPAA was never intended for the digital age, because the laws never anticipated the emergence of Web-based records," said Brailer. "Congress can pass one of numerous policy proposals for change, it's just a question if they have the will to do that."

Jobs and savings for the future

The Obama transition operation declined a request to elaborate on Obama's proposal. The president-elect said Thursday in a speech on the economy that the benefits of a modernized national health record system go beyond just cost savings.

"This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests," said Obama. "It just won't save billions of dollars and thousands of jobs -- it will save lives by reducing the deadly but preventable medical errors that pervade our health care system," he added.

Still, compared to the $2 trillion a year that the industry spends, the $100 billion experts say it may cost to implement Obama's plan is a drop in the bucket.

"We must reduce waste to become more efficient" said Brailer.

The savings of such a plan could be substantial. Brailer estimates that a fully computerized health record system could save the industry $200 billion to $300 billion a year.

That could ultimately slow the rapid rise of health care premiums, which have cut into Americans' paychecks. While wages are rising at a rate of around 3% a year, health care costs are growing at about three times that rate.

"Obama's support for electronic medical records is one of the key efforts of health reform that actually will deliver lower costs for hard-working American families," said Larry McNeely, a health care advocate at U.S. Public Interest Research Group. "Long-term savings can't happen unless we have 21st century health information technology."

Massachusetts has developed a plan to fully computerize records at its 14,000 physicians' offices by 2012 and its 63 hospitals by 2014. After a pilot program, the state legislature estimates it will cost about $340 million to build the statewide computer system, with a cost of about $2 million per hospital.

"[Obama's] timeframe is very ambitious, but there is a need to be able to track data on patients and talk across providers and health care systems," said Dr. JudyAnn Bigby, Secretary of Health and Human Services for Massachusetts. "The program will allow for greater patient safety."

Some say some of the hard work has begun. The Bush administration laid much of the groundwork for the program, leading to several pilot programs in a handful of states, as well as a standardization of medical records.

"The whole structure has already been developed," said Stephen Schoenbaum, executive director of The Commonwealth Fund's commission on a high performance health system. "It's feasible to at least make a lot of progress on this in the next five years."

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Microsoft Partners With Implantable RFID Chip Maker VeriChip

Users of VeriChip's VeriMed technology can now utilize a Microsoft HealthVault account to access and manage their personal health data stored in the VeriMed database.

By Beth Bacheldor

Dec. 2, 2008—Microsoft plans to make VeriChip's VeriMed Health Link system accessible through Microsoft's HealthVault platform, a secure, online repository that consumers can use for free to manage their health records. The VeriMed Health Link system includes implantable passive RFID tags used for human patient identification and medical records tracking, as well as a hosted database for storing electronic medical records. According to Sean Nolan, the chief architect for HealthVault, VeriChip is the first RFID company to partner with Microsoft on the online platform.

"We created the HealthVault platform to help jump-start innovation around health care," Nolan says. "Our belief was that if we did the hard plumbing work to make it easy for individuals to collect and share their health information, forward-looking companies would seize on the opportunity to provide new solutions to difficult health-care challenges. VeriChip's decision to integrate the VeriMed product with HealthVault is clear evidence that the market is responding."

Sean Nolan

Unveiled in 2007, HealthVault lets consumers set up their own private health-record repository so they can manage their health and wellness information online. To protect this personal data, the information is encrypted and users can also set up personal privacy controls, including a password, and determine which information is stored in the account, as well as who can access it (see Microsoft Seeks RFID Support for HealthVault).

Today, Nolan says, HealthVault is integrated with more than 40 applications and more than 50 devices, including glucometers, heart rate monitors, pedometers, weight scales and blood pressure monitors. These devices can be utilized to download data directly into a HealthVault account. "In addition," he adds, "we announced our device certification and logo program—devices that have been tested to ensure they meet certain standards for uploading data to HealthVault are eligible to display a 'Works with Microsoft HealthVault' logo on products, packaging and marketing material."

The VeriMed Health Link system is designed primarily to assist in emergency situations by providing nurses and doctors with vital patient information. Each VeriMed implantable tag (which operates at 134 kHz and is compliant with the ISO 11784 and 11785 standards) is encoded with a unique 16-digit ID number associated with the patient's medical records stored in the VeriChip-hosted database. When an unresponsive patient enters the hospital, the staff can employ an RFID interrogator to scan that individual's arm. If the patient has had a VeriMed chip embedded, the reader will indicate its unique ID number, which can then be inputted manually, or directed wirelessly to VeriChip's Web-based database. If the facility is an approved care provider, it can immediately access the patient's identification and health records.

Thanks to the VeriChip-Microsoft agreement, VeriMed Health Link customers can open a HealthVault account and use it to access and manage their personal health records and data that are stored in the VeriMed database. "VeriMed adds an exciting RFID-based option for HealthVault users trying to keep themselves and their families safe," Nolan says.

Despite the Microsoft partnership, the future of VeriChip—and its VeriMed Health Link business—is uncertain. In May 2008, VeriChip announced it had hired investment banking firm Kaufman Bros. to assist in the sale of the VeriMed Health Link business, as well as the possible sale of the entire company (see VeriChip to Place Implantable Division on Block). At that time, the firm also announced it was selling its Xmark division—which sells RFID-based products and services designed to help track infants in hospitals, as well as other patients and physical assets—to Stanley Works. That $45 million deal was finalized in July (see Stanley Bolsters RFID Portfolio With VeriChip's Ex-Subsidiary).

Last month, VeriChip announced that private investment and business consulting company R&R Consulting Partners, owned by VeriChip's former chairman and CEO, Scott R. Silverman, purchased 5.4 million shares of VeriChip common stock, held by Digital Angel Corp. Digital Angel manufactures RFID tags that are implanted in pets and wildlife for tracking purposes, as well as active transponders used as emergency location beacons to find people during search-and-rescue applications (see Personal Location Beacons Usage Grows). The deal provides Silverman, who had existing holdings of 861,000 shares, with control of 6.2 million shares—or 53 percent—of VeriChip.

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In a separate transaction, VeriChip also purchased from Digital Angel all patents related to an RFID-enabled sensor tag that could make it easier for diabetics to monitor their blood-sugar level. Digital Angel, VeriChip and Receptors had been working together on this tag (see VeriChip, Digital Angel Partner With Receptors LLC to Develop Glucose Sensor). Receptors is a company in the field of proteomics (the study of proteins) and the development of artificial receptors.

VeriChip's difficulties do not worry Nolan, however. "Innovation can be hard—and innovation in health care all the more so, especially given the nature of the economy today," he says. "We've created HealthVault as an open ecosystem so that the market can ultimately decide which new ideas will succeed, and which will not. VeriChip's business is all about new ideas, and we are excited they've chosen to work with HealthVault."

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Socialized medicine? Pfizer agrees to buy Wyeth for USD 68 bn: media reports

New York, Jan 26 (PTI) Pharmaceutical giant Pfizer is closing in on a USD 68-billion buyout deal with rival Wyeth, according to media reports.

Quoting people involved in the negotiations, the New York Times said that Pfizer has agreed 'in-principle' last night to acquire Wyeth for USD 68 billion.

On the funding of the deal, the Wall Street Journal said that Pfizer has secured USD 22.5 billion loan from banks and plans to use stock and its cash reserves to fund the rest of the transaction.

"Pfizer is expected to offer Wyeth shareholders USD 50.19 per share, paying USD 33 a share in cash and USD 0.985 a share in Pfizer stock," the Journal stated.

Quoting people familiar with the matter, the WSJ said: "A group of five banks -- Goldman Sachs Group, Bank of America, JP Morgan Chase, Barclays Capital and Citigroup -- have each agreed to provide USD 4.5 billion in financing." Pfizer's products include the anti-cholesterol drug Lipitor and the erectile stimulant Viagra.

The deal would make Pfizer, already the world's biggest drug maker by revenue, even bigger with a product line that includes everything from Advil pain medication to Centrum vitamins and Lipitor, a cholesterol drug, it added.

"The deal would not only create a pharmaceutical behemoth but would be a rarity in the current financial tumult: a big acquisition that is not a desperate merger of two banks orchestrated by the government," the NYT said.

The New York-based Pfizer employs 83,400 people, has slashed 15,000 jobs since January 2007 and is preparing to cut thousands more in the coming months. Wyeth, based in New Jersey, counts 46,000 employees. PTI

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Obama urges doctors to back his health care plans

CBS 2 Chicago – Obama In Chicago To Sell Public Insurance Plan

WASHINGTON – President Barack Obama, continuing to barnstorm for his health care proposals, will urge doctors gathered in Chicago to support wider insurance coverage and targeted federal spending cuts.

Obama planned to tell the American Medical Association's annual meeting in his hometown on Monday that overhaul cannot wait and that bringing down costs is the most important thing he can do to ensure the country's long-term fiscal health, a senior administration official said.

The official spoke on the condition of anonymity to discuss the president's remarks before they were delivered.

The nation's doctors, like many other groups, are divided over the president's proposals to reshape the health care delivery system. The White House anticipates heavy spending to cover the almost 50 million Americans who lack health insurance and has taken steps in recent days to outline just where that money could be found.

For instance, Obama wants to cut federal payments to hospitals by about $200 billion and cut $313 billion from Medicare and Medicaid. He also is proposing a $635 billion "down payment" in tax increases and spending cuts in the health care system.

To an audience of doctors Obama plans to say the United States spends too much on health care and gets too little in return. He says the health industry is crushing businesses and families and is leading to millions of Americans losing coverage, the administration official said.

Obama's turn before the 250,000-physician group in his latest effort to persuade skeptics that his goal to provide health care to all Americans is worth the $1 trillion price tag it is expected to run during its first decade.

The president plans to acknowledge the costs. But he also will tell the doctors it is not acceptable for the nation to leave so many without insurance, the official said.

Unified Republicans and some fiscally conservative Democrats on Capitol Hill have said they are nervous about how the administration plans to pay for Obama's ideas.

The New York Times reported Monday that Obama has been quietly making a case for reducing malpractice lawsuits to help control costs, long a goal of the AMA and Republicans. Obama has not endorsed capping jury awards

Former Senate Majority Leader Tom Daschle, D-S.D., said Monday that controlling the cost of malpractice insurance would have to be a part of the Obama administration's overhaul of the health care system.

Daschle, whose nomination for secretary of health and human resources was derailed because of questions about his personal finances, said much of the unnecessary annual health care cost can be attributed to doctors ordering extra tests and taking extra precautions to make sure "they aren't sued."

Obama has been speaking privately with lawmakers about his ideas and publicly with audiences, such as a town hall style meeting last week in Green Bay, Wis. Obama and his administration officials have blanketed the nation in support of his broad ideas, and Vice President Joe Biden on Sunday said it's up to Congress to pin down the details on how to pay for them.

"They're either going to have to agree with us, come up with an alternative or we're not going to have health care," Biden told NBC's "Meet the Press."

"And we're going to get health care."

In Chicago, the president's remarks are likely to focus on how his ideas might affect the medical profession.

His proposed cuts in federal payments would hit hospitals more directly than doctors, but physicians will be affected by virtually every change that Congress eventually agrees to. Many medical professionals are not yet convinced Obama's overhaul is the best for their care or their pocketbooks.

Broadly, the AMA supports a health care "reform" — a term that changes its definition based on who is speaking — although the specifics remain unclear.

In a statement welcoming Obama, AMA president Dr. Nancy Nielsen said the medical profession wants to "reduce unnecessary costs by focusing on quality improvements, such as developing best practices for care and improving medication reconciliation."

She also said doctors need greater protection from malpractice lawsuits and antitrust restrictions.

Many congressional Republicans, insurance groups and others oppose Obama's bid for a government-run health insurance program that would compete with private companies. On Sunday, Senate Minority Leader Mitch McConnell, R-Ky., described a government plan as a "nonstarter."

"There are a whole lot of other things we can agree to do on a bipartisan basis that will dramatically improve our system," he said.

To that end, lawmakers were considering a possible compromise that involved a cooperative program that would enjoy taxpayer support without direct governmental control. The concessions could be the smoothest way to deliver the bipartisan health care legislation the administration seeks by its self-imposed August deadline, officials said.

"There is no one-size-fits-all idea," Health and Human Services Secretary Kathleen Sebelius told CNN's "State of the Union" on Sunday.

"The president has said, 'These are the kinds of goals I'm after: lowering costs, covering all Americans, higher-quality care.' And around those goals, there are lots of ways to get there."

Momentum might be on Obama's side. Aaron Carroll, an Indiana University medical professor who has surveyed doctors' views on U.S. health care delivery, said 59 percent "favor government legislation to establish national health insurance," an increase over a previous poll's finding.

He noted that many doctors are not AMA members, and therefore the association's views should not be overrated.

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As a Medical Underwriter, it's not much of a big deal. Most all the records I read anymore are all digital anyway, all the big hospitals made that transition 5-10 years ago. Handwritten records get scanned and digitized by our Vendor and sent electronically also. Plus they're all transfered to me electronically over secure networks.

Seems to be a mountain out of a mole hill from what I experience every single workday.

I suppose standardization of formats and transfer protocol are behind the scene issues I don't see.

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Yes, by itself is benign.

The next battleground phase the socialist have planned is the take control over of our Health Care Sector.

Digitizing records is only one small (but necessary) ingredient in a broad landscape of Changes coming to morph our current system into Socialized Care.

[Toad]

Electronic records are simply a necessity for any effort to modernize the Health Care system, ideology aside. It's not a part of the socialist equasion in my book, because it's in every other equasion out there too.

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Better access to health insurance: $1 trillion

The Congressional Budget Office offers preliminary estimates of 2 key provisions in a bill from Democrats on the Senate health committee.

By Jeanne Sahadi, CNNMoney.com senior writer
Last Updated: June 16, 2009: 7:42 AM ET

FIXING HEALTH CARE

• The death of the corner pharmacy
• Better access to health insurance: $1 trillion
• Obama: Allow doctors to heal, not push paper
• Biden: Taxing health benefits 'not the way to go'
• Taxing health benefits may fall short
• Obama: We can afford health care reform

NEW YORK (CNNMoney.com) -- Two key proposals to improve access to health insurance could reduce the ranks of the uninsured but cost $1 trillion over 10 years, according to preliminary estimates released Monday by the Congressional Budget Office.

The estimates are the first in a series over the next few months that will attempt to quantify the costs and benefits of various health reform options. President Obama, citing the huge part health care spending plays in the economy, has made passing reform this year a top priority.

The report by CBO, an independent agency that scores legislative proposals for lawmakers, focuses on proposals to create health insurance exchanges and subsidize the cost of insurance for some households.

The agency estimated that the exchange and subsidies could reduce the number of uninsured people by roughly 16 million by 2015. It is estimated there would otherwise be 51 million uninsured that year.

The CBO estimates are based on parts of a health reform bill from Democrats on the Senate's Health, Education, Labor and Pension Committee, chaired by Sen. Ted Kennedy, D-Mass.

The committee will start debating and amending that bill on Wednesday.

Under the bill, the federal government would give grants to states to set up insurance exchanges that consumers could use to comparison shop for health insurance. And it would offer subsidies of varying levels to help families with incomes up to 500% of poverty level (roughly $110,000) to pay for coverage.

The federal government would also subsidize small businesses that offer health benefits but have workers with low wages.

The CBO stressed that its estimates are preliminary for several reasons:

• They only reflect analysis of one part of the health committee bill. So they aren't a comprehensive look at the potential costs and savings of all measures in that bill.
• They do not reflect the likely interactions that will occur with other elements of comprehensive health reform that may be included -- such as an expansion of Medicaid or the creation of a public insurance plan, which is the most controversial issue in the health reform debate.
• In addition, the CBO has not yet finished its analysis of all the bill's elements, such as a proposal to let parents cover their children as dependents until they're 27.

The health committee bill is hardly the last word on health reform. Other congressional committees have jurisdiction over other parts of health care reform.

One is the Senate Finance Committee, which will oversee the tax proposals intended to help pay for the overhaul of the health care system.

The finance panel's chairman, Sen. Max Baucus, D-Mont., is expected to release a draft of his health reform bill this week.

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Barack Obama: US will go broke if it doesn't overhaul health care system

America could go broke if it failed to overhaul its health care system, President Barack Obama said on Monday.

By Tom Leonard in New York
Published: 12:39AM BST 16 Jun 2009


President Barack Obama said America could go broke if it failed to overhaul its health care system Photo: GETTY

Mr Obama compared the country's crumbling health industry with a "ticking timebomb" and called on America's doctors - traditionally suspicious of government interference - to support his plans for sweeping reform.

"To say it as plainly as I can, health care is the single most important thing we can do for America's long-term fiscal health - that is a fact," he told the annual meeting of the American Medical Association (AMA) in Chicago.

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"If we do not fix our health care system, America may go the way of GM, paying more, getting less and going broke."

He dismissed criticism that he was bent on creating a "socialised" state-run system, instead promising to cut the cost of existing private health plans and make greater use of preventive medicine.

Mr Obama also made a moral case for reform, saying that, despite America's enormous wealth and a health care industry that cost $2.5 trillion a year, tens of millions of people had no health insurance at all.
"We are not a nation that accepts nearly 46 million uninsured men, women and children...we are a nation that cares for its citizens, we are a people who look out for one another," he said.

America's health care costs are rising quickly at a time when many employers and ordinary people are struggling to pay insurance bills.

The Obama administration is proposing a public programme that would compete with the private insurance plans held by many employees.

But many Republicans argue that the Obama reforms would drive private insurers out of business, erode the quality of health care and increase bureaucracy.

"Americans don't want a government-run system that puts bureaucrats between patients and doctors," said Mitch McConnell, a senior Republican senator.

"They certainly don't want the kind of government boards that exist in places like New Zealand and Great Britain that deny, delay and ration treatments that are currently available to Americans."

But J. James Rohack, the AMA president-elect, praised Mr Obama's support for investment in preventive medicine and he backed a general call for reform.

"I think the important signal is that we are at a watershed moment in our country," he said.

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White House Claim of 46 Million Uninsured 'Americans' Includes Almost 10 Million Foreigners
CNSNews ^ | June 16, 2009 | Matt Cover
Posted on Tuesday, June 16, 2009 11:14:37 AM by Mr. Mojo

(CNSNews.com) - The claim made by the White House this month that 46 million “Americans” lack health insurance is false because that number includes almost 10 million people who are not “Americans” but in fact citizens of foreign countries who happen to be present in the United States, according to data from the U.S. Census Bureau.

The claim was made repeatedly in a report published by the White House Council of Economic Advisers (CEA) on June 2 and again in an op-ed published the same day by Christina Romer, the chair of CEA.

The claim that there are 46 million uninsured “Americans” has also been used by members of Congress and news organizations.

At a townhall meeting in Green Bay, Wis., last Thursday, President Obama twice referred to “46 million” people who lack health insurance, although in neither case did he describe those “46 million” as “Americans”—in one instance referring to them as “46 million people who don't have health insurance” and in another instance as “46 million uninsured."

On June 2, the White House released “The Economic Case for Health Care Reform,” a report by the president’s Council of Economic Advisers.

In making the case for Obama’s health-care reform plan, this report repeatedly asserted that there are 46 million uninsured “Americans.”

That same day, CEA Chair Christina Romer published an op-ed on Yahoo! News asserting: “Health care expenditures in this country are currently 18 percent of GDP and, without change, will keep rising, until they account for nearly one-third of our total output by 2040. Even with this exorbitant bill, about 46 million Americans lack health insurance coverage today, and this number is predicted to rise to 72 million over the next three decades.”

“Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance,” said the CEA report itself. “CEA projections suggest that this number will rise to about 72 million in 2040 in the absence of reform.”

“In addition,” said the CEA report, “nearly 46 million Americans are currently without health insurance, and this number is projected to rise substantially.”

The CEA even used the claim of “46 million uninsured Americans” as a basis for some of its economic analysis, claiming that Americans could spend an estimated $46 billion per year less on health insurance if the 46 million uninsured Americans were covered.

“Some studies suggest that moving from the current system to an insurance exchange with widespread participation could bring down the price of health insurance by 20 percent, or roughly $1,000 per year for a typical uninsured individual,” said the report. “With 46 million uninsured Americans, this suggests an overall gap of about $46 billion per year, or more than 0.3 percent of GDP.”

Speaking on June 11 in Green Bay, President Obama said the fact that there are “46 million uninsured” demonstrates that the “free market fails.”

“What we're trying to explain is, is that all we’re trying to make sure of is that there is an option out there for people where the public--where the free market fails,” said Obama. “And we’ve got to admit that the free market has not worked perfectly when it comes to health care, because you've got a lot of people who are really getting hurt: 46 million uninsured.”

The CEA’s claim that there are “46 million uninsured Americans” is false because, according to the Census Bureau, 9.7 million of the approximately 46 million uninsured people in the United States are not American citizens. In other words, about 21 percent of the uninsured in this country are citizens of other nations who are living here.

According to “Income, Poverty, and Health Insurance Coverage in the United States,” a Census Bureau report published in August 2008, there were 45.6 million persons in the United States who did not have health insurance in 2007, the latest year for which figures are available.

However, the report states that 9.7 million of these uninsured persons were not U.S. citizens.

The Census Bureau does not ask whether someone is legally or illegally present in the United States, so it is unknown how many of the 9.7 million uninsured foreign nationals were legal permanent residents of the United States and how many were illegal aliens.

Interestingly, the majority of non-citizens residing in the United States did in fact have health insurance. Of the approximately 22.2 million non-citizens residing in the country in 2007, says the Census Bureau, 12.5 million had health insurance, with 9.4 million covered by private plans.

Of the 299 million people in the United States in 2007, 253.4 million had health insurance. The vast majority of those—202 million—had private health insurance, according to the Census Bureau.

In a June 7 editorial arguing that Congress should increase taxes to help pay for universal health insurance, The New York Times echoed the claim of the Obama White House that there were “46 million uninsured Americans.”

“But Congressional Democrats will almost certainly need to come up with a lot more money--and that is likely to mean new taxes,” said the Times’s editorial. “There are at least two easy ways to duck the problem should Congress choose to be imprudent. One way out would be to abandon the goal of universal coverage until after costs have been controlled. That would be unfair to the 46 million uninsured Americans, who often suffer health damage because they are reluctant to seek treatment until their plight becomes desperate.”

Senate Finance Chairman Max Baucus (D.-Mont.), who is overseeing the development of health-care legislation in the Senate, referred to “46 million Americans without health insurance” at a March 27 forum sponsored by the Center for American Progress, where he argued that all “Americans” should be mandated to get health insurance.

“An individual obligation to get health coverage is essential for several reasons,” said Baucus. “It is the only way to stop the cost shifting related to uncompensated care. Today the cost of care for 46 million Americans without health insurance are largely borne by those with insurance. Getting all Americans covered will also make insurance markets function properly.”

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Obama Is Pressed to Tax Health Benefits

Seeking GOP Votes, Democrats Split Over Plan for New Levy


Nicholas Albano sits outside New York's Memorial Hospital. President Obama's call for health reform could include a new tax on health benefits. (By Daniel Acker -- Bloomberg News)

By Lori Montgomery and Ceci Connolly
Washington Post Staff Writers
Monday, June 15, 2009

The White House is caught in a battle within its own party over how to finance a comprehensive overhaul of America's health-care system, as key Democrats advocate a tax plan that could require President Obama to break his campaign pledge not to raise taxes on the middle class.

Sensitive to voter anxiety about a soaring federal deficit, Obama and congressional leaders have vowed to pay for a sweeping expansion of the health-care system -- expected to cost more than $1 trillion over the next decade -- without additional borrowing.

Much of the money is likely to come from reining in spending on federal health programs for the elderly and the poor. Obama has proposed trimming more than $600 billion from Medicare and Medicaid by 2019 -- including more than $300 billion in cuts unveiled in his Saturday radio and Internet address -- which could fulfill the promise to curb the growth of federal health spending.

The rest of the cash will probably come from new taxes. But Democrats are deeply divided over which taxes to raise, and the issue has become a central stumbling block in the push to enact legislation by fall.

In recent days, Obama has revived a tax plan he first offered in February: limiting itemized deductions for the nation's 3 million highest earners. Polls show that the idea is popular -- it was Obama's biggest applause line last week at an event in Wisconsin -- and it would enable him to abide by a campaign pledge to pay for coverage for the uninsured with new taxes on the rich.

"He believes this is the most equitable way to do this," said senior White House strategist David Axelrod. "It places the burden on people who can most afford it."

But many Democrats, particularly in the Senate, have balked at the idea, saying they prefer a tax that has some hope of winning Republican support. In legislation that could be unveiled as early as this week, Senate Finance Committee Chairman Max Baucus (D-Mont.) is expected to propose a new tax on the health benefits that millions of Americans currently receive tax-free through employers.

Economists say taxing employer-sponsored benefits would help trim runaway health costs and force society to broadly share the burdens of reform. The idea also has bipartisan appeal. Former president George W. Bush and Sen. John McCain (Ariz.), the 2008 GOP presidential candidate, championed a form of the tax; so did Obama advisers Jason Furman and Ezekiel Emanuel before they joined the administration.

"The Democrats are trying to figure out whether they can do health-care reform by themselves without Republicans, or whether they need to adopt some Republican ideas to get a health-care plan," said Chris Edwards, director of tax policy at the libertarian Cato Institute. Taxing health benefits "could be the center of a bipartisan agreement," he said.
But political analysts say the idea is treacherous, especially for Obama.

Baucus is considering a tax on employer-sponsored premiums in excess of $15,000 a year, Senate aides said, a plan that would strike many of the very families Obama has vowed to protect from a tax increase. Yesterday, top administration officials pushed back forcefully against the tax, which Obama criticized during the campaign.

"The president starts with the premise that 180 million Americans have health coverage through their employer, that attacks on those benefits may dismantle that marketplace," Health and Human Services Secretary Kathleen Sebelius said on CNN.

Two-thirds of Americans under age 65 get coverage through an employer -- more than 158 million people, according to the Kaiser Family Foundation. In 2008, only about one in five employer-sponsored plans carried the high premiums likely to be hit by the tax.

But research shows that those people tend not to be wealthy highfliers with gold-plated insurance plans, as advocates assert, but those who have to pay high premiums just for basic coverage -- the old, the sick, women of childbearing age and residents of high-cost urban areas. Elise Gould, director of health policy research at the liberal Economic Policy Institute, found that a similar cap suggested by a 2005 tax reform panel would have raised taxes mainly on workers with family coverage, many of them in smaller firms with high concentrations of older, female or unionized workers.

Labor leaders, who have for years chosen better health benefits over higher wages in contract negotiations, call the tax a deal-killer. "It has the capacity to really undermine trust in a basic kind of way," said Gerald Shea, assistant to the president of the AFL-CIO. "If you say you really, really want to help out the middle class, what are you doing charging more for the health care that's already costing us an arm and a leg?"

It could also prove poisonous in the 2010 elections. In a recent survey for Health Care for America Now, a labor-backed reform advocacy group, Democratic pollster Celinda Lake found that 80 percent opposed a tax on benefits, compared with 63 percent support for limiting itemized deductions for high earners.

"Taxing benefits would be a disaster," Lake said. "You have no idea how strongly this is going to backfire if we do it."

Key lawmakers in the House don't particularly like either of the competing tax plans and may yet offer a third proposal. But in the Senate, the more important congressional battleground, taxing health premiums "has reached the level of a foregone conclusion," said Len Nichols, a health policy analyst at the nonpartisan New America Foundation.

Politics aside, the tax dwarfs all other current proposals as a potential cash cow. The tax-free treatment of employer-provided health insurance is the biggest loophole in the tax code and the second-largest federal health-care cost, after Medicare. Taxing half of all employer-sponsored premiums would generate nearly $1.2 trillion over the next decade, according to the nonpartisan Joint Committee on Taxation, compared with about $270 billion for new limits on itemized deductions for the rich.

Advocates say taxing benefits also makes good economic sense. The rewards of the current tax break fall heavily to the wealthy, and there is no similar tax break for workers who must buy insurance on their own. Many economists also dislike it because it encourages workers to take compensation in the form of health care instead of higher wages, pushing resources into the health system and increasing costs.

"Even in the absence of wanting the money, you'd want to do it," said MIT economist Jonathan Gruber.

Senate Democrats have been considering two options. The first would be to tax premiums above a certain level, such as the value of the standard family plan offered to federal employees, which will be about $15,000 in 2013, Senate aides said. That would raise about $420 billion over 10 years. The other option would be to apply the cap only to families earning more than $200,000 a year ($100,000 for individuals), which would raise about $160 billion over 10 years.

A senior Baucus aide said the committee is leaning toward the former option, which would do more to "bend the curve" of soaring health costs.

In either case, workers would see any insurance premiums in excess of the cap added to their wages and taxed as income. That could increase their tax bills by hundreds or thousands of dollars a year, said Paul Fronstin, director of health research at the nonprofit Employee Benefit Research Institute.

The Baucus aide stressed that the goal of reform is to lower premiums for everyone. But the White House is clearly not convinced.

"There is still a great deal of disagreement," Sebelius said, "on whether or not taxing benefits at any level of any kind really does put us a step forward or take us a step back."

Polling analyst Jennifer Agiesta contributed to this report.

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Obama strongly rejects 'socialised' healthcare fears

By Edward Luce in Washington
Published: June 16 2009 03:00 | Last updated: June 16 2009 03:00

Barack Obama yesterday weighed into the debate over healthcare reform by making his most impassioned case so far to extend universal healthcare coverage to the 47m US citizens who lack it.

Mr Obama's intervention, which came in a speech to the American Medical Association, whose opposition was critical in shooting down Bill Clinton's attempted reform in 1994, comes at a critical stage in the congressional debate which is set to dominate the legislative agenda for the rest of the year.

Mr Obama, who has said healthcare reform is his number one domestic priority, robustly defended his plan to include a public option among the competing healthcare plans. Opponents, including many doctors represented by the AMA as well as private health insurance companies, fear a public option would be a first step on the road to "socialised medicine".

Mr Obama strongly rejected this: "What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single payer system," he told the AMA in Chicago. "When you hear naysayers claim that I am trying to bring about government-run healthcare, know this: they are not telling the truth."

Mr Obama also sought to allay fears that the estimated $120bn-$150bn (€87bn-€109bn, £74bn-£92bn) annual costs of expanding coverage would add to the US's soaring fiscal deficits. He said his administration had already identified $95bn in annual savings and would produce more savings to ensure the reform was budget-neutral.

"Healthcare reform is the single most important thing we can do for America's long-term fiscal health. That is a fact," he said. "This is a test of whether we - Democrats and Republicans alike - are serious about holding the line on new spending and restoring fiscal discipline . . . If we fail to act, one out of every five dollars we earn will be spent on healthcare within a decade."

Mr Obama's speech was aimed at a number of targets - the lobby groups opposed to healthcare reform; the left, which is worried the president is rowing back on commitments to offer a public option for the uninsured; and centrist Democrats and Republicans who are concerned about fiscal discipline.

The US president argued that reform was a "necessity, not a luxury". While stressing that reform was in the long-term interests of the private sector, since continuing with the status quo would bankrupt the federal government and lead to change by fiat rather than consensus, Mr Obama issued a strong warning to the lobby groups lining up to oppose his plans.

In particular, he targeted the insurance companies and warned that their days of "cherry-picking" patients to maximise their profit margins were coming to a close. "What I refuse to do is simply to create a healthcare system where insurance companies have more customers on Uncle Sam's dime but still fail to meet their responsibilities," he said.

Mr Obama's speech is likely to be seen as a powerful intervention at a time when supporters of healthcare reform were fearing the White House was allowing ownership of the bill to slip out of its control. White House officials, however, have been at pains to consult as widely as possible on Capitol Hill to avoid alienating lawmakers - a strategic mistake made by the Clinton White House.

Later this week, possibly as soon as tomorrow, Max Baucus, chairman of the Senate finance committee, will unveil his own healthcare plan, which is likely to offer an important clue as to where the centre of gravity lies on Capitol Hill.

Copyright The Financial Times Limited 2009

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The president's Trojan horse

Michael O. Leavitt and Jeffrey H. Anderson


They're not telling the truth."

As the authors of "A Trojan Horse Plan" (Opinion, June 1), we are perhaps uniquely situated to respond. For our part, we're prepared to believe that the president honestly thinks his "public option" isn't a Trojan horse; that he honestly believes it won't lead to government control of our health care system. What we don't know is why he believes that.

The Lewin Group, a prominent consulting firm, estimates that, under a widespread, Medicare-like "public option," 118 million Americans would lose their private health insurance and be switched onto government-run care. To the best of our knowledge, the president hasn't cited any studies to the contrary. When you combine those 118 million with the 80 million people already covered by government health care, there wouldn't be much room left in which private insurance could operate.

Because he doesn't support a "single-payer" system, the president implies he doesn't support "government-run health care." But if, through payment policies, the government decides what doctors we use, what drugs we can take, and how much is charged, the system is government-run. So we can agree that Mr. Obama technically isn't supporting a single-payer system. But he is supporting a government-run system that may well lead to a single payer.

Mr. Obama says that the "public option" would merely provide Americans with a new choice for health insurance: "If you like what you're getting, keep it. Nobody is forcing you to shift." In truth, however, millions of employers would choose the "public option" - for their employees.

Given a choice between accepting the cost, risk and burden of continuing to provide insurance, or having the government take over that responsibility, millions of employers would bolt. And anyone who believes a public option plan wouldn't become a tax-subsidized plan hasn't been watching very closely for the past 50 years.

The president says his proposal will be "deficit-neutral in the next decade." Given its projected cost of $1.5 trillion over that decade - an amount greater than the annual gross domestic product (GDP) of Canada - this is quite a claim.

Keep in mind that we're already running higher deficits - even as a percentage of GDP - than during the Great Depression. Only 55 percent of 2009 federal spending ($2.2 of $4.0 trillion) comes from tax revenue; the rest is borrowed money. Yet the creation of a massive new Medicare-like program won't increase deficits?

The president says this unlikely result will be made possible through miscellaneous tax increases and Medicare spending reductions, but he never specifies the cuts. As secretary of health and human services, I took a budget to Capitol Hill containing half the reductions the president says Congress must make, and I was politically stoned by those in his party and many in mine. With all due respect, Mr. President, name the cuts. Show us the money.

Most of Mr. Obama's claims would be impossible to believe even if there weren't such a clear track record to support disbelief. In the 1960s, President Johnson and the Democratic Congress both projected that Medicare would cost $12 billion in 1990. Its actual cost was $111 billion - 9 times the original estimate. The Medicare Hospital Trust Fund is now projected to become insolvent in 2016, three years earlier than last year's estimate.

So, we're prepared to believe, as Mr. Obama watches Congress begin to build the "public option" Trojan horse, following the blueprint he has provided, that he honestly thinks this is merely a fine-looking gift for the American people, and not the vehicle through which government-run health care will pierce the gates, capture their wallets, and ration their health care. We're just not prepared to believe he's right.

Michael O. Leavitt, secretary of the U.S. Department of Health and Human Services from 2005-09, is a former director of the Environmental Protection Agency, and a three-term governor of Utah. Jeffrey H. Anderson is a senior fellow at the Pacific Research Institute.

http://www.washingtontimes.com/news/...-trojan-horse/

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Obama Says It's 'Not Logical' to Fear Government-Run Health Care

Wednesday, June 24, 2009
By Fred Lucas, Staff Writer



White House (CNSNews.com) - President Barack Obama said it is “not logical” to think that a government-run health care program competing with private health insurers would eventually drive the private firms out of business.

The concern expressed by many Republicans and some private insurers has been one of the leading arguments against the president’s plan to establish a “public option” health care program.

At a White House press conference on Tuesday, Obama said: “Why would it drive private insurance out of business? If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business? That's not logical.”

Obama also said there would be “some healthy debate in Congress” about how the “public option” plan would be implemented.

He further said: “I think there can be some legitimate concerns on the part of private insurers that if any public plan is simply being subsidized by taxpayers endlessly that, over time, they can't compete with the government just printing money, so there are going to be some – I think [there are] legitimate debates to be had about how this private plan takes shape.

“But just conceptually, the notion that all these insurance companies who say they're giving consumers the best possible deal, if they can't compete against a public plan as one option – with consumers making the decision [on] what's the best deal – that defies logic,” said Obama, “which is why I think you've seen in the polling data overwhelming support for a public plan.”

Obama also addressed a Congressional Budget Office report, which estimated the cost of a Senate health care reform plan sponsored by Sens. Ted Kennedy (D-Mass.) and Chris Dodd (D-Conn.) at $1 trillion over 10 years.

“So there's been a lot of talk about, well, a trillion-dollar price tag,” Obama said. “What I've said is, if we're going to spend that much money, then it's going to be largely funded through reallocating dollars that are already in the health care system, but aren't being spent well.”

House Minority Leader John Boehner (R-Ohio), in a statement released after the news conference, objected to Obama’s claim that the “public option” was not the first step toward a single payer system.

“Today, the president again claimed that the Democrats’ government takeover of health care would not force Americans off of their current plans, yet independent analysts have reported that at least 23 million Americans would lose their coverage under the bill drafted by Senate Democrats,” Boehner said.

“House Republicans have introduced a better alternative to make health care more affordable and accessible, ensure that Americans can keep their health plan, and keep doctors and patients, not government bureaucrats, in charge of critical and personal medical decisions,” he said.

Taking several questions, Obama insisted to reporters that the “public option” was not the beginning of an entirely government-owned health system. Rather, it would simply inject more competition into the system, he said.

“Now, the public plan, I think, is an important tool to discipline insurance companies,” the president said. “What we've said is, under our proposal, let's have a system – the same way that federal employees do, same way that members of Congress do – where we call it an exchange, but you can call it a marketplace where, essentially, you've got a whole bunch of different plans.”

“If you like your plan and you like your doctor, you won't have to do a thing. You keep your plan, you keep your doctor,” said Obama. “If your employer's providing you good health insurance, terrific. We're not going to mess with it.”

Obama continued: “But if you're a small-business person, if the insurance that's being offered is something you can't afford, if you want to shop for a better price, then you can go to this exchange, this marketplace, and you can – look, okay, this is how much this plan costs. This is how much that plan costs. This is what the coverage is like. This is what fits for my family.”

Asked whether the final bill would have to contain a public option, Obama said the only deal breaker would be a bill that did not keep costs down.

“We have not drawn lines in the sand, other than that reform has to control costs and that it has to provide relief to people who don't have health insurance or are under-insured,” Obama said. “You know, those are the broad parameters that we've discussed.”

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Did Obama Say We Should Kill the Old Folks to Save Money Last Night?

By Warner Todd Huston Thursday, June 25, 2009



I am wondering when the euthanasia folks are going to start touting this one? I mean, it sure seemed to me as if the most caring, most civil, most intelligent president evah just said that healthcare could be cheaper if we don’t give old folks and the infirm the full measure of care they now get. It appeared that Obama said we should just let them die or suffer because they aren’t worth the effort. Imagine if Bush had said something like this? The left wouldn’t have hesitated to call him any manner of names.

Obama said during the ABC Special on Wednesday night that a way to save healthcare costs is to abandon the sort of care that “evidence shows is not necessarily going to improve” the patient’s health. He went on to say that he had personal familiarity with such a situation when his grandmother broke her hip after she was diagnosed with terminal cancer.

Obama offered a question on the efficacy of further care for his grandmother saying, “and the question was, does she get hip replacement surgery, even though she was fragile enough they were not sure how long she would last?”

But who is it that will present the “evidence” that will “show” that further care is futile? Are we to believe that Obama expects individual doctors will make that decision in his bold new government controlled healthcare future? If he is trying to make that claim it is a flat out untruth and he knows it.

Does your homebuilder negotiate with your city hall over whether you get a building permit, or does the permit get levied no matter what? Does a cop decide if you really broke the law, or does he simply arrest you and let the courts hash it out? Does your tax preparer negotiate with the IRS or is he supposed to just calculate your tax bill on their terms and have you pay the required amount?

Government does not work by negotiation. Government does not work from the bottom up. It works from the top down. This singular fact means that no doctor will be deciding if you are too old or infirm to get medical care. It will be a medically untrained bureaucrat that sets a national rule that everyone will have to obey. There won’t be any room for your grandma to have a different outcome than anyone else’s.
Will our friends on the left now disown Obama the “murderer”?

So, what will it be then? Who will decide when medical care is just too expensive to bother with? Who will be left to perish because they just aren’t worth the lifesaving effort? Well, for sure it won’t be any members of Congress or anyone that works for the federal government because they won’t be expected to suffer under the nationally socialized plan. It also won’t be Obama’s buddies in the unions who are about to be similarly exempted from the national plan, at least if Senator Max Baucus has his way.

Ah, but we are told that Obama’s ideas on healthcare are “evolving,” dontcha know? During the recent campaign for president (that was only 7 months ago, if you’ll recall) Obama insisted that he would never tax your healthcare benefits from work. He even ridiculed McCain for proposing such a plan. Lately, however, he’s “evolved” toward saying that such a new tax is on the table. What about his stance against fining people and businesses that don’t join his UberPlan? He was against that sort of coerciveness before. Now he’s “evolved.”

Originally, he said it was “healthcare for all,” but as of Wednesday night, it seems he’s “evolved” to say that only those worth the bother should get healthcare. The rest should be left to died and/or suffer. If he does any more “evolving” we’ll all be finding just who is “worth” what as far as he and his Democrats are concerned. Somehow I’d guess that many of you reading this today won’t quite be worth as much as certain others!

Let’s hope none of us are ever in a position to find out if Obamacare deems our grandmothers worth saving.

And what ever happened to the left’s mantra that healthcare is a “right” and that money should never enter into a life or death decision? Now The One is saying it’s just too darn expensive to save the old and infirm? Will our friends on the left now disown Obama the “murderer”?

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June 25, 2009...10:44 am
Government Will Decide Who Lives and Who Dies

Obama’s syrupy rhetoric disguises a slow-drip poison intended to give government the power to decide whether you live or die.



A snippet from the transcript from yesterday’s full court propaganda push by state run media reveals the insidious hidden nature of Obama’s nationalization of the health care industry. A plan that will give the government the power to regulate what you eat, how you live and even how you vote if you want or need health care. The real truth is that everything related to healthcare is going to be decided and based on cost. If you are too fat, too old, too white, too rich or smoked, did drugs or ate meat – some government stooge is going to deny your ability to get care for whatever ails you.

Once the government gets control of deciding who gets health care – it can then be easily manipulated to make deciding factors for care reach the truly insidious proportions, such as “did you ever vote for anyone other than a Democrat”? If you did – that may decide whether or not you get the stamp of approval for that surgery you need to remove your gall bladder. After all, in many places – welfare already operates on such litmus test requirements for aid.

As Obama masterfully hinted last night without actually stating it plain; instead of a life saving surgery or pacemaker to extend your life – you will get pain pills instead. Decisions he says “we” will have to make. Understand that everywhere Obama uses the word “we”, he is talking about GOVERNMENT being the “we”.

One wonders if his amazing slight-of-tongue to mesmerize the masses under his spell of Marxism is again going to triumph here – or will he simply ramrod this takeover through by sheer force?

But what needs to be noticed – is how Obama skillfully hints at what he truly intends without making it obvious. His plan for you is one that if you are too old by government standards – you get a pill instead of life saving surgery.

From ABC News Full Trascript
SAWYER: And we have with us a couple of people who really represent the opposite ends on this spectrum too. I want to talk, if I can, to Jane Sturm.
Your mother, Hazel…

JANE STURM: Caregiver for 105-year-old mother: Yes.

SAWYER: Hazel Homer (ph), 100 years old and she wanted…

STURM: She’s 105 now. Over 105. But at 100 the doctor had said to her, I can’t do anything more unless you have a pacemaker. I said, go for it. She said, go for it. But the arrhythmia specialist said, no, it’s too old.

Her doctor said, I’m going to make an appointment, because a picture is worth a thousand words. And when the other arrhythmia specialist saw her, saw her joy of life and so on, he said, I’m going for it.

So that was over five years ago. My question to you is, outside the medical criteria for prolonging life for somebody elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life? Or is it just a medical cutoff at a certain age?

(snip)

….OBAMA: But, look, the first thing for all of us to understand is that we actually have some — some choices to make about how we want to deal with our own end-of-life care. And that’s one of the things I think that we can all promote, and this is not a big government program. This is something that each of us individually can do, is to draft and sign a living will so that we’re very clear with our doctors about how we want to approach the end of life.

First off this is the big lie of Obama. The entire full-court propaganda press is about conditioning the American people to swallow the biggest government program of all time. This whole push is about big government getting control of health care.

Obama: I don’t think that we can make judgments based on peoples’ spirit. That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people.

This is insidious. They will be making care decisions based on ALL KINDS of criteria based on cost, and notice how he suddenly thinks government can usurp the Hypocratic Oath doctors take – and create new rules and oaths to fit his new criteria for what constitutes ‘good’ quality care.

GIBSON: But the money may not have been there for her pacemaker or for your grandmother’s hip replacement.
OBAMA: Well, and — and that’s absolutely true. And end-of-life care is one of the most difficult sets of decisions that we’re going to have to make.

Oops – a little truth spilled out there. Obama admits that life and death decisions are things “WE” (Government) will have to make.

Obama: I don’t want bureaucracies making those decisions, but understand that those decisions are already being made in one way or another. If they’re not being made under Medicare and Medicaid, they’re being made by private insurers.

Another lie. The health care plan already circulating Congress expressly makes such decisions the province of a MASSIVE bureaucracy unlike mankind has ever seen. And I’d rather my own private insurer make decisions on what they will cover for my health care than some stupid government stooge making it for me. I can always shop for a different insurer. None of us can shop for a different bureaucrat if they get that kind of control.

Obama: We don’t always make those decisions explicitly. We often make those decisions by just letting people run out of money or making the deductibles so high or the out-of-pocket expenses so onerous that they just can’t afford the care.
And all we’re suggesting — and we’re not going to solve every difficult problem in terms of end-of-life care. A lot of that is going to have to be, we as a culture and as a society starting to make better decisions within our own families and for ourselves.

Your government culture and Marxist society has no authority to make such decisions for me and my family. Who the hell are you to tell us that we have to “start making better decisions’ – while at the same time, are demanding we accept a behemoth program that takes those decisions away and puts them in YOUR evil little hands??? I’m also sick of your veiled efforts to continually create demons for the people to hate, from corporate CEO’s to stockbrokers to doctors and health insurers. You are a demagogue.

Obama: But what we can do is make sure that at least some of the waste that exists in the system that’s not making anybody’s mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what?

Who decides what the waste is? YOU? Some Marxist bureaucracy you establish? The “waste” that exists is already largely in place as a result of both medicare and medicaid rules and as a result of the billions of dollars in frivolous medical malpractice suits that have created encyclopedias of rules and regs insurance companies demand regarding how your doctor must treat you. How about you get rid of the Trial lawyers? We will save billions.
But you are in their pocket – so no.

Obama: Maybe this isn’t going to help. Maybe you’re better off not having the surgery, but taking the painkiller.

And those kinds of decisions between doctors and patients, and making sure that our incentives are not preventing those good decision, and that — that doctors and hospitals all are aligned for patient care, that’s something we can achieve.

And here is the plain truth of how Obama’s health care is going to operate. HE will decide that you or your relatives are better off not having life saving surgery, but getting painkillers only – until you or your loved one dies.

Obama is pushing for government to decide if you live….or die.

And as usual, on the Kennedy plan circulating the halls of power, CONGRESS is exempted from being subject to the universal health care they are going to pass on the rest of us. They get to keep the plan they now have. Meanwhile, you and I will be forced to stand in line for a pain pill.

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Dems Propose to Raise Taxes on Rich to Fund Health Care Legislation

As discussed in the tax-writing House Ways and Means Committee, the surtax would apply to individuals with adjusted gross income of more than $200,000 and couples over $250,000, they added.

WASHINGTON -- An income tax surcharge on highly paid Americans emerged as the leading option Wednesday night as House Democrats sought ways to pay for health care legislation that President Obama favors, several officials said.

As discussed in the tax-writing House Ways and Means Committee, the surtax would apply to individuals with adjusted gross income of more than $200,000 and couples over $250,000, they added.

In addition, key lawmakers are expected to call for a tax or fee equal to a percentage of a worker's salary on employers who do not offer health benefits.

Rep. Shelley Berkley, D-Nev., a member of the panel, said the proposed surtax on high-income taxpayers appealed to her and others as a way to avoid a "nickel-and-dime" approach involving numerous smaller tax increases. She added that other earlier options had fallen away, including an increase in the payroll tax.

Berkley and others cautioned that no final decisions have been made, either by the tax-writing committee or by the Democratic leadership, which hopes to have legislation drafted by Friday and through the House by month's end.

Aside from Berkley, other officials discussed the private discussions only on condition of anonymity.

The developments stood in contrast to the Senate, where Democrats edged away from their goal of passing ambitious health care legislation by early August amid heightening partisan controversy over tax increases and a proposed new government role in providing insurance to consumers.

"I think the ultimate goal is to have a bill by the end of this year" that is signed into law by the president, Sen. Chuck Schumer, D-N.Y., said in an interview with The Associated Press. He said Democrats would make "every effort to stick to the timetable" that included initial Senate action by August.

Separately, Republicans who met with Senate Majority Leader Harry Reid, D-Nev., said he expressed flexibility on the timetable, indicating he was willing to allow more time before legislation is brought to the floor.

The evident slippage coincided with a formal announcement that the nation's hospitals had agreed to give up $155 billion in projected Medicare and Medicaid payments over the next decade, money than can help defray the cost of the legislation the administration wants.

"Folks, reform is coming. It is on track," Biden said at the White House, urging the Senate to enact legislation by the now-imperiled August goal.

Any failure to meet the goal would be a setback -- but not necessarily a fatal one -- for Obama's attempt to win legislation this year that both slows the growth in health care costs and extends coverage to nearly 50 million Americans who now lack it.

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Dems Introduce $1 Trillion Health Care Bill to Cover All Americans

Plan Would Require Wealthy to Pick Up the Cost; Republicans Vow to Oppose Bill

By JONATHAN KARL, AVERY MILLER and SADIE BASS
WASHINGTON, July 14, 2009




On Capitol Hill today, House Democrats unveiled their $1.04 trillion plan for health care reform, a sweeping plan that was quickly endorsed by President Barack Obama, who wants Congress to pass legislation before the August recess.


From left, House Speaker Nancy Pelosi, D-Calif., is joined by other House Democratic leaders, House...

From left, House Speaker Nancy Pelosi, D-Calif., is joined by other House Democratic leaders, House Majority Leader Steny Hoyer of Maryland, Pete Stark of California, Henry Waxman of California and Charles Rangel of New York, in a news conference, announcing the introduction of health care legislation on Capitol Hill, Tuesday, July 14, 2009, in Washington.

(Manuel Balce Ceneta/AP Photo)

"This legislation is landmark legislation, and this is a defining moment for our country," said House Energy and Commerce Committee Chairman Henry Waxman, D-Calif.

The sweeping changes to the health care system would cover 97 percent of Americans and include a mandate requiring all Americans to buy health insurance or pay a fine. Subsidies would be available to those with an income of less than $88,000.

The plan would also eliminate co-payments and deductibles for preventative care and there would be no denial of coverage for pre-existing conditions. Additionally, a government-run insurance program would be created to compete with private insurance.

To help pay for the new plan, the bill would slap a new surtax of up to 5.4 percent on those with incomes of more than $400,000 a year.
House Speaker Nancy Pelosi, D-Calif, praised the bill, calling the moment "historic and transformative."
"This bill is the starting point and a path to success," she said.

Republicans Oppose the Plan

Most Republicans are already vowing to oppose the plan.

"What we really have here is a bill that, without any question, will kill jobs, will limit access to health care, will raise taxes and will lead to a government takeover of health care," said Rep. Roy Blunt, R-Mo.

Some Republicans compared the new plan with the $775 billion stimulus bill that was passed a month after Obama took office.

The stimulus has yet to stop unemployment from rising, even though Democrats pushing for it to pass said it would bring quick relief to the troubled economy.

"Here we are a few weeks before the recess, and you get the impression they willing -- they want to pass just anything they can pass as rapidly as they can," said Rep. Mitch McConnell, R-Ky. "And the reason I was comparing that to the stimulus, we know that that, at least so far, is a failure. It, once again, was sold to us on the basis that we had to do it tomorrow in order to prevent catastrophe."

Senate Democrats are also considering a new tax on soft drinks of 3 to 10 cents per can and a 1.5 percent increase in capital gains and dividends taxes.

Democrats are scrambling to get bills passed in the House and Senate by August.

It will be an immense challenge, and even if they succeed, the tougher challenge will come in the fall, when they try to resolve fundamental differences between the House and Senate versions of the bill.

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House health care bill makes individual private medical insurance illegal

(Investors Business Daily) It didn't take long to run into an "uh-oh" moment when reading the House's "health care for all Americans" bill ...

It's Not An Option

By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 15, 2009 4:20 PM PT

Congress: It didn't take long to run into an "uh-oh" moment when reading the House's "health care for all Americans" bill. Right there on Page 16 is a provision making individual private medical insurance illegal.
IBD Exclusive Series: Government-Run Healthcare: A Prescription For Failure

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

From the beginning, opponents of the public option plan have warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither.

Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington's coverage.

The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, "fizzle out altogether."

What wasn't known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law.

The legislation is also likely to finish off health savings accounts, a goal that Democrats have had for years. They want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs.

With HSAs out of the way, a key obstacle to the left's expansion of the welfare state will be removed.

The public option won't be an option for many, but rather a mandate for buying government care. A free people should be outraged at this advance of soft tyranny.

Washington does not have the constitutional or moral authority to outlaw private markets in which parties voluntarily participate. It shouldn't be killing business opportunities, or limiting choices, or legislating major changes in Americans' lives.

It took just 16 pages of reading to find this naked attempt by the political powers to increase their reach. It's scary to think how many more breaches of liberty we'll come across in the final 1,002.

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DEM HEALTH RX A POI$ON PILL IN NY

TERRIFYING 57% TAX LOOMS FOR BIGGEST EARNERS

Congressional plans to fund a massive health-care overhaul could have a job-killing effect on New York, creating a tax rate of nearly 60 percent for the state's top earners and possibly pressuring small-business owners to shed workers.

New York's top income bracket could reach as high as 57 percent -- rates not seen in three decades -- to pay for the massive health coverage proposed by House Democrats this week.

The top rate in New York City, home to many of the state's wealthiest people, would be 58.68 percent, the Washington-based Tax Foundation said in a report yesterday.

That means New York's top earners, small-business owners and most dynamic entrepreneurs will be facing new fees and penalties.

The $544 billion tax hike would violate one of President Obama's ironclad campaign promises: No family will pay higher tax rates than they would have paid in the 1990s.

Under the bill, three new tax brackets would be created for high earners, with a top rate of 45 percent for families making more than $1 million. That would be the highest income-tax rate since 1986, when the top rate was 50 percent.

The legislation is especially onerous for business owners, in part because it penalizes employers with a payroll bigger than $400,000 some 8 percent of wages if they don't offer health care.

But the cost of the buy-in to the program may be so prohibitive that it will dissuade owners from growing their businesses -- a scary prospect in the midst of a recession.

Obama took to the airwaves yesterday with ads and TV interviews promoting the need to reform health care.

As a Senate health committee passed a different version of a health-care reform bill - a milestone for the issue - Obama said on NBC, "The American people have to realize that there's no such thing as a free lunch."

And in a Rose Garden speech, he said the "status quo" on health care is "threatening the financial stability of families, of businesses, and of government. It's unsustainable, and it has to change."

Asked if Obama supports the surtax on wealthiest Americans even though it would break a campaign pledge, White House spokesman Robert Gibbs said only, "It's a process that we're watching."

Republicans in Washington and small-business defenders in New York said the House legislation would effectively place a stranglehold on businesses while running off top earners.

"Placing a big tax burden on the small-business community would rob them of the resources they need to create the jobs that will lead us out of the recession," said Tom Donohue, president of the US Chamber of Commerce.

"If there's one sure way to kill the goose that lays the golden egg, this is it."

Richard Lipsky, a lobbyist for small stores and businesses in New York City, warned that "in the middle of a recession, it's a very strange way to legislate."

"According to what we've read, the House health-insurance plan would have a job-crippling impact on neighborhood stores and other small businesses because they put mandates on these businesses that would prevent them from hiring people because of the cost of the plan," Lipsky said.

Under the House plan, businesses with payrolls of $400,000 or more would pay an 8 percent penalty for uninsured workers, while companies with payrolls between $250,000 and $400,000 would pay slightly smaller penalties.

Adding to this burden, said Michael Moran of the State Business Council of New York, is that New York is already a high-tax state.

"Any additional taxes make New York even less competitive," he said.
New York would become the third-most-hostile place for top earners to live under the proposed new surtaxes supported by House Democrats and championed by Rep. Charles Rangel (D-NY).

Also hit would be individuals earning $280,000 annually and families making $350,000 a year.

The profits from small businesses would also be taxed on the back end.
Kathryn Wylde, president of the Partnership for New York City, an umbrella organization representing the city's major businesses, said that the estimated top marginal tax rate of 57 percent for New York actually underestimates the potential impact on businesses.

That's because it doesn't include the city's burdensome unincorporated-business tax, which snares many entrepreneurs.
"It could be between 62 and 63 percent," she said.

If the House plan passes, Wylde said, "There literally, at this point, is very strong reason to relocate your family and your business outside New York."

A lot of small businesses would be hit with the penalties for not insuring workers and get hit with the surtaxes, Moran warned.

"Many small businesses file their business taxes under personal income," he said. "That's the way the tax law is written. Small business, which is really where most of the job creation takes place, could be hit hard.

According to the city's Department for Small Business Services, there are some 220,000 small businesses in the five boroughs. The agency does not keep track of how many offer health insurance.

"It's something that's going to kill jobs. That's the result," said Stephanie Cathcart, spokeswoman for the National Federation of Independent Businesses.

Among the most egregious provisions of the House proposal, she said, is a requirement that businesses pay the cost of 72.4 percent of individual health plans and 65 percent of family plans.