President Barack Obama maintained in his speech on Wednesday and in a letter to Capitol Hill (see PDF) his intention to reach out across party lines, a token effort to make his health care legislation more bipartisan before ramming it through reconciliation, by adding four ideas of note from last week’s summit at Blair House. A closer look at the actual details of these ideas, however, shows that the White House has done very little indeed – and while it would be nice to say otherwise, the reality is that what President Obama is offering to Republicans is not an olive branch, but a rather insulting joke. And in the case of one additional topic, both he and Speaker Nancy Pelosi continue to repeat a clear and verifiable falsehood.
Here’s what President Obama wrote in his letter – keep in mind that we have yet to see legislative language on these reconciliation-based “fixes” to the Senate bill, so we have only his own words to go on:
1. Undercover waste/fraud/abuse investigations: “Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.”
2. Additional grants to states for tort reform: “I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants.”
3. Increasing Medicaid reimbursement rates: “At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states…I’m open to exploring ways to address this issue in a fiscally responsible manner.”
4. Strengthen high deductible provisions: “I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear.”
If you’re keeping count, one of these four proposals is relatively insignificant; one is already in the bill; one is undercut by other parts of the bill; and the other is something impossible for the federal government to do. As a whole, these four points do not in any way change the direction of this overarching tax-laden government-run package.
1. Everyone agrees that we should reduce waste, fraud, and abuse – well, everyone except the ripoff artists. But while Senator Tom Coburn’s (R-OK) idea of sending “secret shopper” patients in to evaluate suspected offices is an innovative idea, it is one that is strongly opposed by the AMA, as well as libertarians like the Galen Institute’s Grace Marie-Turner and the Cato Institute because of concerns about the effect on good doctors. In any case, a program of this nature cannot be considered significant, nor will it be able to prevent the upwards of $90 billion in fraud and abuse paid for by taxpayers every single year.
2. We don’t need more demonstration projects on medical malpractice reform. We already have one: it’s called Texas. Since 2003, the state has seen the astounding business and health insurance benefits of reasonable, straightforward tort reform. The Congressional Budget Office has said that serious federal liability reform could save taxpayers $54 billion over 10 years. The president’s proposal doesn’t even come close, and what’s more, the Senate bill already contained $23 million in these token grants – he’s just tacked on some more money, and nothing that will offend the John Edwards’ of the future.
3. The president agreed with Senator Chuck Grassley (R-IA) that raising reimbursement rates in Medicaid ought to be considered to prompt more doctors to participate in the program. But states set those reimbursement rates, not the federal government. The statement Sen. Grassley made was in the context of pointing out that the Senate bill adds another 15 million people into Medicaid, a program that is already a strain on state budgets. As Congressman Paul Ryan (R-WI) pointed out during the summit, Medicaid is already on the path to insolvency, growing at a rate of 21% each year. Raising reimbursement rates, even if the president could do it, doesn’t do anything to solve the cost problem or bend the curve in the right direction.
4. Perhaps the one legitimate offer from President Obama was an indication that he’s open to including health savings accounts coupled with high-deductible health plans as choices in the government-run insurance exchanges within the Senate package. That’s certainly a good thing, since those are the plans that appeal overwhelmingly to young, healthy Americans who currently choose not to buy insurance. But the coverage requirements set for participating in those exchanges under the Senate health care bill are so burdensome, independent observers agree the premiums for such plans would likely be far too high for the young people who want them. In other words, President Obama’s own legislation will do away with the whole reason for high-deductible plans in the first place.
As a senior Republican Capitol Hill staffer told me last night: “It’s laughable that the president considers adding these proposals including real substantive Republican ideas when they’re nothing more than lip-service or half-measures. The bottom line is, as Leader McConnell said this morning, tacking a few good ideas onto a bill that reshapes one-sixth of the economy, vastly expands the role of government, and which raises taxes and cuts Medicare to pay for it all, is not what Americans want. They’ve been abundantly clear that we should scrap this bill and start over.”
Set aside these four ideas for a moment, and let’s get to the outright lie, which is, I should add, not a predictive falsehood. It’s wrong to say that President Obama’s repeated claims about you being able to keep your own coverage, that costs will come down, that the bill will have a positive effect on the deficit, etc. are lies – perhaps the president believes those statements to be true, even though they are at odds with what is predicted by the CBO, the president’s own chief Medicare actuary, and any number of other independent observers. No, I’m speaking of what the president said last week and what Speaker Nancy Pelosi (D-CA) said today: both maintain that this legislation does not change America’s longstanding policy on using taxpayer funds for abortions.
“Let me say this: This is not about abortion! This is a bill about providing quality, affordable health care for all Americans,” [Pelosi] said, more eager than ever to stay on message as her legacy becomes increasingly tied to what happens in the next few weeks…
“I will not have it turned into a debate on (abortion),” she said, when asked a follow-up question about Stupak. “Let me say it clearly: we all agree on the three following things. … One is there is no federal funding for abortion. That is the law of the land. It is not changed in this bill. There is no change in the access to abortion. No more or no less: It is abortion neutral in terms of access or diminution of access. And, third, we want to pass a health care bill.”
Yet anyone who actually bothers to read the legislation will find that, as Democratic Rep. Bart Stupak of Michigan points out, the Senate language is essentially a shell game with funding, with none of the protections passed by the House last year. As many as 12 Democrat House members who previously voted in favor of health care legislation in the House would be ready to switch according to Stupak.
“If that is the one [the Senate health bill] they are presenting in reconciliation to the members of the House of Representatives, I’ll bet you that won’t even come close to passing,” Stupak said yesterday.
Again and again, the differences between what the White House claims about this bill and the reality of the legislative language is just jarring. Over at National Review, the editors liked the sound of the bill Obama was talking about. If only it actually resembled what’s on the page.
Crossposted at Health Care News.