(How Opponents Tried to Use the Mayo Clinic to Undermine the President)

What I find most troubling about the Senate’s decision to delay the healthcare reform bill until September is the fact that some believe that if they manage to slow the process, this could be President Obama’s undoing.

As Steven Benen writes over at the Washington Monthly’s “Political Animal,”:

Benen is referring to the statement that Sen. Jim DeMint  (R, South Carolina’s)  made on television last week, saying he’d  like to see  the  push for healthcare reform slow down. Friday, he elaborated on what he meant in a "Conservatives for Patients Rights" conference call: "If we're able to stop Obama on this, it will be his Waterloo. It will break him, adding “If we’re able to top Obama on this, it will be his Waterloo. It will break  him.” 

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This afternoon Senate Majority Leader Harry Reid  told reporters that the Finance Committee will act on its portion of the bill before Congress' month-long break. Then Sen. Reid will merge that bill with separate legislation already passed by the Senate Health, Education, Labor and Pensions Committee. The Nevada Democrat says the decision to delay a vote was made Wednesday night in the hopes of getting a final bipartisan bill.

As I have suggested in the past, the odds of getting a “bipartisan bill” that would truly reform healthcare, providing sustainable, affordable care for everyone are slim to none.  Most Republicans do not want true health care reform; certainly they do not want changes that cut into the profits of the for-profit healthcare industry.  Polls show that Republicans see covering everyone as a secondary  goal. Meanwhile less than 20 percent of all Americans now identify themselves as Republicans. So the Senate’s futile quest for a bipartisan solution would seem to be putting the interests of a minority ahead of the hopes of the majority of Americans who would like the security of healthcare reform as soon as possible.

As President Obama pointed out Wednesday night, the longer we delay, the higher health care costs rise –while more and more Americans lose their health insurance. 

Nevertheless, the Washington Post  continues to take a skeptical view of  the reform process:

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That was the headline on a memo prepared by the staff of the House Education and Labor Committee and released by House Speaker Nancy Pelosi’s office yesterday evening. The amount of misinformation circulating out there about the House bill is growing—I’ll be writing another post about this soon.

Clearly, the conservatives are running scared. It’s not surprising when a Wall Street Journal editorial offers a unique interpretation of what is happening in Washington. The paper’s editorialists are known for their distinct perspective on American politics. But now, they are resorting to outright lies. Below, the text of the memo:

"The Wall Street Journal ran an editorial today [Tuesday, July 21] that advanced false and misleading information regarding the House’s health reform bill, America’s Affordable Health Choices Act  (H.R. 3200).

While most Americans are satisfied with their health insurance coverage now, most Americans are concerned that they will either lose their insurance or face staggering increases in premiums, co-pays or other costs. The America’s Affordable Health Choices Act is about giving all American families more choices of quality, affordable health care and the peace of mind that they will be covered with quality, affordable care no matter of their job or economic situation. 

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As always, Princeton economics professor Uwe Reinhardt brings a provocative perspective to a sensitive subject: physician pay.

Turning to Adam Smith’s An Inquiry Into the Nature and Causes of the Wealth of Nations (1776), Reinhardt focuses on Chapter 10 of Book 1, titled “Wages and Profit in the different Employments of Labour and Stock” as the text for an Op-ed published in Friday’s New York Times. 

Reinhardt observes that, when it comes to physicians and lawyers, Smith “appeared to lean on the medieval doctrine of ‘just price.’ Thus he wrote:”

“We trust our health to the physician: our fortune and sometimes our life and reputation to the lawyer and attorney. Such confidence could not safely be reposed in people of a very mean or low condition. Their reward must be such, therefore, as may give them that rank in the society which so important a trust requires. The long time and the great expense which must be laid out in their education, when combined with this circumstance, necessarily enhance still further the price of their labour.”

Reinhardt, who is a health-care economist declares that he finds “Adam Smith’s perspective persuasive. But,” he asks, “what income would give physicians ‘that rank in the society which so important a trust requires’?”

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Include the tab for expanding Medicaid, and the proposal for health care reform that the Senate Health, Education, Labor, and Pensions (HELP) Committee approved last week will probably cost $1.6 trillion, report the Urban Institute’s Linda J. Blumberg and John J. Holahan in a brief titled: “Beyond the $1.6 trillion sticker shock.”

This “is clearly a considerable sum,” acknowledge the researchers, who were funded by the Robert Wood Johnson Foundation. They note that when the Congressional Budget Office (CBO) announced that it guessed the Senate Committee’s health plan could cost that much, “the estimate caused the committee to stop its deliberations,” and set a new goal: “a plan that would cost closer to $1.0 trillion.”

But perhaps Finance Committee Chairman Senator Max Baucus didn’t need to panic. As Blumberg and Holahan point out: “The $1.6 trillion is a 10-year number,” measuring how much reform is expected to cost the nation between 2010 and 2019. Meanwhile, over that same span the Congressional Budget Office (CBO) projects that total GDP will “equal $187 trillion.” 

Thus, they observe, “the estimated gross costs of health reform are less than 1 percent of the GDP over ten years.”

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Recently, I’ve become a member of a Washington Post health care panel that answers a weekly questions  about health care reform. This week’s query, “Should We Tax the Rich to Cover the Uninsured? refers to the House proposal, released earlier this week, which would tax the wealthy to help finance reform.“

Below, my answer, plus some additional thoughts:

Sometimes a picture is worth a million words. This graph, from the Center on Budget and Policy Priorities   tells you why it makes sense to tax the very rich to fund reform.

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Today, the the Senate Health, Education, Labor, and Pensions (HELP) Committee passed its reform bill on a party-line vote, thirteen to ten. Yesterday, the three House committees writing healthcare legislation released the final text of their bill. Left behind in the dust, the Senate Finance Committee remains bogged down as Committee Chairman Senator Max Baucus vainly struggles to engineer a “bi-partisan bill.” (And yes, I mean “vainly” in both sense of the word.) 

I suspect Senator Baucus is about to discover that he is not as important as he thought he was. As I have been suggesting in recent weeks, in the end he will not be the ultimate architect of health care reform. That job belongs to President Barack Obama.

What’s most interesting about the two pieces of legislation put forward by HELP and House Democrats this week is what they tell us about President Obama’s priorities.

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When the White House announced that President Obama had named Dr. Francis Collins to head the NIH, many applauded the choice. “But praise for Dr. Collins was not universal or entirely enthusiastic,” declared The New York Times.  “Dr. Georges C. Benjamin, executive director of the American Public Health Association, called Dr. Collins’s selection a ‘reasonable choice.’ Others privately expressed unease.”

In what seemed a strained effort to find a second side to the story, the Times zeroed in on the

“two basic objections to Dr. Collins. The first is his very public embrace of religion.” While in medical school, Collins converted to Christianity.  “Religion and genetic research have long had a fraught relationship, and some in the field complain about what they see as Dr. Collins’s evangelism,” the Times commented. But in fact, Collins religious belief did not stand in his way when leading the Human Genome Project. And no one has pointed to a single instance when religion has in any way interfered with Collins work as scientist. Was the Times suggesting the the only suitable candidate to head the NIH would be an agnostic? This seems to me just as discriminatory as the bias against agnostics so common in other corners of the mainstream media.

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Some observers have suggested that if we tax the gold-plated insurance that some employers offer to their employees, insurance that encourages over-utilization of health care would begin to disappear. To avoid the tax, employees would settle for more basic, less expensive plans. Others propose giving consumers a larger menu of plans to choose from, so that they have an opportunity to pick more modest plans that don’t cover so many unnecessary treatments.

Both ideas suffer from two problems. First, they assume that less expensive insurance plans cover effective care—and eschew unnecessary care. Second, they’re  proposing a crude across-the-board solution to a complicated problem. As I have said in the past, the waste and “fat” in our health care system is not hanging out around the edges of the steak. It is marbled through the meat. Eliminating it means using a scalpel to discourage use of specific tests, treatments and products that provide no benefit for patients who fit a particular profile. Simply taking a whack at expensive insurance plans does not do the trick.

Granted, the idea of taxing pricey employer-based health insurance has a certain appeal. Today health benefits are not taxed as income. Since more affluent Americans are most likely to enjoy the most valuable benefits, this seems to be a “regressive tax break”—one that favors the rich.

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I’m now part of a Washington Post panel responding to a health-care reform question each week. Click here to find the panel.

This week’s question:  “Is the Individual Mandate Necessary?”

You’ll find my reply here.

Let me add that while I think we need an individual mandate, I am concerned that the House version of health care reform lets insurers charge older customers twice as much as younger customers. At this point, the Senate Finance Committee also allows insurers to discriminate by age. This could make it very hard for 50-somethings who don’t qualify for subsidies to afford a family plan. Under the House bill, a couple with joint income of $75,000, before taxes, would not receive a subsidy. And if they are self-employed, and receive no help from an employer, the premiums that they would be expected to pay could easily run as high as $13,000 a year. After taxes, if they live in a high-tax state, they might take home $65,000 a year—or less. This means that health care premiums would eat 20 percent of their income—or more.

I don’t think it makes sense to suggest that a young couple, earning $150,000, jointly, shouldn’t pool their resources with a 50-something couple earning $75,000.  Don’t younger Americans want to help pay for the health insurance that their parents need? These days, as more 50-somethings become unemployed, it’s not that unusual for college-educated 20-somethings and 30-somethings living in two-income households to earn  significantly more than their middle-class parents.

Both Social Security and Medicare ask all Americans to pay the same percentage of their paychecks into the system, regardless of  age. When they grow older, younger taxpayers will benefit from a system that expects all of us to pull together.  Universal health care should follow the same model: everyone in, no one out of the pool.