Senate liberals and moderates have closed ranks, defeating many who hoped to use seniors’ fears of Medicare cuts to bury health care reform.
As the Assocociated Press (AP) reported: “Unflinching on a critical first test, Senate Democrats closed ranks Thursday behind $460 billion in politically risky Medicare cuts at the heart of health care legislation, thwarting a Republican attempt to doom President Barack Obama's sweeping overhaul.
“The bid by the bill's critics to reverse cuts to the popular Medicare program failed on a vote of 58-42, drawing the support of two Democratic defectors. Approval would have stripped out money needed to pay for expanding coverage to tens of millions of uninsured Americans. . ..”
Tuesday, I appeared on GRITtv with Laura Flanders and explained why conservatives who oppose health care reform were objecting to Medicare cuts—not because they wanted to protect Medicare patients, but because they wanted to protect the for-profit insurance industry.
You’ll find the roundtable discussion, which included TNR’s Jon Cohn, The Nation’s John Nichols and Pro Publica’s Olga Pierce here: Laura Flanders – http://lauraflanders.firedoglake.com/
This vote reinforces my belief that, in the end, we will wind up with legislation that resembles the House bill, and includes a strong public option.
I find it extremely ironic that the very republicans who opposed to formation of Medicare are the ones now proclaiming to protect it. Dems should spend energies to enlighten the seniors about Medicare’s history. Bob Dole and Newt Gingirch and several high ranking Repubs tried to kill benefits in various ways,Mccain proposed raising the age eligiblity to 67 ys just few yrs ago.
Maggie- I cannot thank you enough for your optimism.
The jobs/recession issue is looming so large it is great to hear health care is moving ahead.
Dr. Rick Lippin
Southampton,Pa
Just stumbled upon this blog. I hope your keep up the good work.
Just viewed the Grit TV segment; Maggie, you were great! Thanks so much for being out there speaking truth to power.
Too bad you didn’t get a chance to remind John Nichols from The Nation, and TV viewers, that Obama did indeed squarely rebut the disinformation about Medicare spending reforms in his speech to Congress. Obama stated that this reform absolutely “would NOT pull the plug on Grandma”. I sensed you had this in mind but chose instead to make another important point, that reform is bigger than Obama and he is smart to let Congress take ownership. I agree.
I learned some important details about the public option from Maggie’s comments about the imperative of it being “opt out” and not “opt in” (if opting any which way is going to be a part of the final bill). The photos from pro publica were kind of odd, but I guess it was an attempt to “put a human face on the issue”.
A few lines from various guests on the Grit TV segment were real keepers but I didn’t commit them to memory, so I encourage HealthBeat readers to watch it yourselves. Make sure to watch until the end to see a fun clip from The Daily Show. Heaven knows, we need to have some in this fight!!!
P.S. Lisa in TX, how are the MDM screenings going?
Rick, Ray, Degen, & Ann
Rick-
Thanks much. I think
that being optimistic is the most constructive thing that we can do at this point in time.
Harry Reid knows that he is all but certain to lose his next election.
But he decided it was more important to do the right thing. The bill he is pushing is far, far from perfect, but it’s a beginning. And he seems to realize that it is crucial to begin the process of reform now.
As Orszag said this week “Health care reform is a process” (I’ve heard that phrase somehwere) and going forward, Orszag said, even in the next year, we can strenghten the reform legislation.
John Nichols (from The Nation), who was on the Laura Flanders show with
me suggested (after the show) that Reid shouldn’t run for re-election Instead, he should retire and “become ambassador to
Tahiti or wherever.”
I agree. If I were Reid’s wife, I would tell him “Harry, in the future no one will remember whether you won another term as a Senator from Nevada. They will remember what you did in fighting for health care reform.”
And now you deserve a wonderful retirment.
Ray–
Yes, McCain, and all of the Republicans wanted to slash Medicare.
Now, they are the defenders of the elderly??
Degenerative Arhtrities–
Welcome to HealthBeat
Ann–
Thanks much.
I’m getting somewhat better at TV.
You’re right that I had several points I wanted to make at that juncture.
And , as you intuited, I thought it was most important to explain that Obama didn’t wimp out on healthcare reform. He was wise, I think, to insist on sharing responsibility with Congress.
And people like Pelosi & Reid have stepped up to the challenge.
I also wanted to point out that when people say that Obama came to office with huge support from the public, what they really mean is that those who supported him were extremely enthusiastic.
But the truth is that Obama got only 48% of the white vote.
African-Americans, Latinos and even Asian voters, tipped the balance.
Obama did not have the majority of the most affluent and powerful people in this country behind him.
On the Flanders show, I realized it looked as if John Nichols and I were clashing, but in fact, I liked him. We talked a bit before and after the show.
We basically agree on the larger, most impt. points.
When Nichols was provocative, he was saying something that he knew perfectly well would cause me to bounce right out of my chair. That’s good TV.
(I don’t like “Shout TV,” but passion keeps people awake,and reminds them that there is something important at stake.)
I am concerned about a possible trigger compromise. Was there a (never to be implemented) trigger attached to the Pt. D legislation? I had heard a comment from someone that there was such a trigger. If so, not a good omen.
Maggie, I also want to say how much I appreciate your optimism. As for Democratic Senate Majority Leader Harry Reids chances at re-election, I believe that he’ll have a good chance if he gets this health reform bill through the Senate with the public option and without making too many concessions. There are a lot of union people around Las Vegas. I can see him getting defeated if he fails to get health reform passed.
Greg:
The only trigger legislation I am aware of is that when general revenuues consume more than 45% of Medicare’s estimated funding for, something like, 3 of the next 7 years, the trigger is “enforced.”
This means that Congress is supposed to take a good hard look at Medicare’s fiscal sustainability.
Although Medicare’s premiums are earmarked, all taxes go into the Treasury’s general fund.
Thus, all governmental expenditures come from general revenues.
In fact, Medicare benefits can be paid whether there are FICA taxes or not.
This is because benefits are directly related to earnings history, not contributions.
Don Levit
we seem to be getting into the weeds on medicare funding rules here. as I understand it, if there isn’t adequate money in a fund, whether it is medicare or social security, then promised benefits cannot be paid. this is why we’ve seen emergency transfers from time to time when some funds were temporarily exhausted. so short answer is if medicare part a fund didn’t have money, benefits wouldn’t be paid, notwithstanding positive government balances in other accounts. that’s only part a. part b is basically self-funded with 75% appropriated and premium levels set to provide the remainder.
Ironically, a proven EHR system already exists. It’s called VistA (no, thankfully not Microsoft’s product of the same name)and the beauty is that it is predicated on an open source code. The development of this open source EHR occurred from 1994 to 1999, when Dr. Kenneth W. Kizer, MD, MPH served as the Undersecretary for Health in the U.S. Department of Veterans Affairs (VA). In this role, Dr. Kizer was the Chief Executive Officer of the VA healthcare system, the largest provider of healthcare in the nation, managing an annual budget of more than $20 billion, approximately 200,000 employees, and more than 1,300 sites of care. He was the chief architect and driving force behind the radical transformation of VA healthcare that occurred between 1995 and 1999. Dr. Kizer led the largest EHR implementation in United States history while serving in this capacity and pioneered several major IT innovations during his tenure. If you’d like to know more about it visit him at http://www.Medsphere.com And notice who just entered into an agreement with Medsphere: Kaiser Permanente to take advantage of VistA. My guess is that they exercised wisdom to avoid re-inventing the wheel. Other companies touting their stand alone EHR products only, are after one thing: stimulus money rather than the greater good of U.S. healthcare. And while your looking up http://www.Medsphere.com, take a stroll over to another company that has a component that bridges the gap in healthcare IT: drugindexsafetysystems.com
The bottom line Washington, if anyone is listening, is do your due diligence and check out VistA, Medsphere and Drug Index Safety System before you open the floodgates of more stimulus monies flowing to a problem that has already been solved.
NEWSFLASH- Push is in high gear see http://tinyurl.com/ya6r65b
Rick Lippin
To Doug,
Are you mostly a spam commentor? EHR seems a bit off-topic on this thread albeit it is a component of health system reform. But is your real agenda pushing “drug safety products” as is also mentioned in your comment? As a nurse I’m extremely committed to reducing medication errors.
You lost credibility with me when I read the upper right banner in your touted drug safety product. It reads “Improving healthcare while not harming pharmaceutical companies”.
We’re not stupid around here.
I would be interested to know from someone else about the EHR VistA product, since the VA has indeed achieved some really good things in health care system reforms.
Maggie,
Interesting to hear your “behind the scenes” perspective on Nichols and doing TV. Makes sense to me. Thanks a million and then some for all you are doing. I’m trying not to get totally exhausted and discouraged by it all and you’re helping to keep me engaged and somewhat enthused. Maybe when the semester’s over I’ll rev up again… I really believe that Money-Driven Medicine will be a powerful tool to keep forward momentum in this “process” of health care reform 🙂
I remain perplexed at the enthusiasm for the public option. With Medicare on railroad tracks to bankruptcy, and the Medicaid system breaking the backs of state government, how is a third entitlement the panacea to the healthcare problem? A prudent road would be to fix one at a time – noone knows what will happen with the 2000 pages of regulation, entitlement, subsidies and taxes. Not even the smart guys at CBO.
The $460 billion cut to Medicare is a Paul Bunyan approach, which will have significant implications to the provider system and quality of care. It will also crush the private system as cost shifting accelerates.
This bill is a go for broke strategy that has tremendous risk of a third out of control entitlement. Hang on!
In a comparison of public and private insurance and cancer rates, a study of European cancer rates published in the November 30 Annals of Oncology showed marked parity with very similarly constructed reports from the American Cancer Society.
Despite the endless rhetoric from United States politicians the results indicate private and government sponsored health programs have achieved extremely similar results in the reduction of cancer.
Cancer mortality in Europe, 2000-2004, and an overview of trends since 1975. Annals of Oncology. doi:10.1093/annonc/mdp530
http://annonc.oxfordjournals.org/cgi/reprint/mdp530
http://www.cancer.org/downloads/STT/Global_Facts_and_Figures_2007_rev2.pdf
http://www.cancer.org/docroot/stt/stt_0.asp?from=fast
Maggie,
In the broadcast you commented that an advantage of the House bill over the Senate bill was that it included federal regulation of insurance companies. I have been puzzled that since the debate began in earnest this year, Republicans have advocated allowing insurance companies to sell their products across state lines, which to me sounded like a good idea that Democrats opposed. Charles Shumer explained that states with weaker rules would then be selling inadequate policies in states with higher standards. I never heard a Democrat argue that the problem might be solved by the federal government taking over the regulation, and everybody would be happy. Of course states’ rights conservatives would oppose this, but perhaps they should agree since it is the logical way to sell insurance across state lines. Can you explain how this issue is addressed in the legislation, or reference an explanation? Thanks.
Bill:
I share your concerns about the fiscal sustainability of our social insurance prigrams.
We are not alone, for the American Academy of Actuaries has similar concerns.
On page 5 of their May 2009 Issue Brief it states “Medicare and Social Security expenditures are even more striking when considered relative to total federal revenues. Total federal revenues have historically averaged about 18% of GDP. Using this average, nearly 50% of all federal revenues in 2009 will be used to pay Medicare and Social Security benefits. If no changes are made to either program and federal revenues remain at 18% of GDP, this share is expected to increase to about 80% in 2050, and by 2080, Medicare and Social Security spending would equal over 90% of total federal revenues.”
Go to:
http://www.actuary.org/pdf/medicare/trustees_09.pdf.
On the other hand, maybe we shouldn’t be that concerned, Bill.
Even if Social Security and Medicare consume 100% of federal revenues, we still have the deficit to fund other governmental expenses.
Don Levit
Liberals and Moderates is like drama movie, they defeat for the power
Don, Richard,Walter, Jim & Don, Doug, Ann, Bill, Gregory
Don– Social Secruity is not in trouble. A fairly minor fix will take care of it.
The Century Foundation has done much work on Social Secruity– see http://www.tcf.org
Anyone who says otherwise is simply a conservative ideologue who wants to get rid of social security.
As for Medicare, as I have said repeatedly, we over-pay for too many unnecessary tests and treatmetns. MedPAC has very good ideas for how to realign financial incentives and squeeze out out the waste. Most of these ideas are in the reform legislation.
Richard–
The original Senate bill gave authority to regulate insurers to the states.
The new “compromise” gives power to the Office of Personnell management (that administrers FEderal Employees’ insurance– a menu of private sector plans) to oversee the insurance that would be available to Americans under 55 int he Exchanges.
How much regulation would it do? Probably not much.
OPM isn’t that big, and in negotations with insuerers providing coverage for federal employees, it has not been tough.
We don’t want insurers selling insurance across state lines because they will sell cheap Swiss Cheese policies (filled with holes) in progressive states that won’t let their own insurers sell these policies.
Up until now the legislation had insisted that policies be very comprehensive–now, I’m not sure what will happen.
Very likely, there will be many policies with deductibles of $10,000 and high co-pays. They’ll be cheap–because people won’t be able to afford to use them. (There are many high-deductible Federal Employees plans.)
Walter– I wonder how the union people in Nevada are feeling about Reid now?
JIm & Don– ON Medicare funding and payment of benefits, Jim is right.
Doug– We’ve written about Vista on health beat. It works very well for the VA–difficult to assess how expensive it would be to revamp it for others, but there is certainly an argument to be made that we don’t need to start from scratch in inventing IT.
Ann: I agree with you “Improving Healthcare without harming pharmaceutical companies” raises a red flag.
Health Care Reform has just one goal– better care for patients at a more affordable price.
Pharma, with its 16% profit margins, stands in the way of that goal. We
are over-paying for a great many drugs.
Bill–
The original House and SEnate legislation made it clear– Medicare would be changing waht it pays for, and how it pays for it over the next 3 or 4 years–before the public option
became a reality.
Medicare also would be redesigning financial incentives, to change the way care is deliveredd.
The Public plan woudl incorporate those reforms– reforms that would lift qualitiy and reduce costs, squeezing waste out of the s system.
MedPAC has written about all of these reforms for the past few years. Presdient Bush wouldn’t let Medicare begin implementing them becuase he had one goal: privatizie Medicare (turn it over to private insurers.)
The Medicare cuts that the administration is calling for is NOT a Paul Bunyan approach,
It is not about slashing fees across the board.
IT is about making very intelligent cuts–reducing fees for specialists who perform very lucrative servcies that provide little or no benefit to the patient while raising fees for primary care, geriatric care etc.
Medicare also would begin to refuse rewarding inefficient hospitals for inefficiency and errors.
This is how you lift quality and reduce costs.
Now, these reforms could take place–if Congress decides to let Medicare follow through.
Gregory–
This for the comparative cancer stats.