Of all weekends to be busy and traveling, of course my own schedule absolutely explodes on the very weekend that the year-long health care reform debate will finally come to a head with a scheduled vote in the House of Representatives on Sunday. Unbelievable. Between a job interview today, move-related planning obligations tomorrow, and driving home to Philadelphia from Charleston all day on Sunday, I don’t know where time for America’s Right is going to fit in, but in case I have a few minutes here or there, I’m going to keep this piece open for comments from readers and additions from me.
That being said, here’s what has been on my mind as we move closer and closer to zero hour on the House floor:
Cornhusker Kickback Out, Other Incentives In
It just seemed right to start with a little good news. Thankfully, the $100 million Medicaid deal given to Sen. Ben Nelson’s state of Nebraska in exchange for his “yes” vote on the Senate health care bill has been excised from the health care bill, presumably in the reconciliation-driven “fixer” legislation being put together by Democrats. I applaud them. However, where the so-called “Cornhusker Kickback” has been removed, other sweetheart deals have been included.
“Bye bye, Cornhusker Kickback. Hello, special treatment for Tennessee and North Dakota.” That’s how a surprisingly snarky assessment from the Associated Press begins, the piece going on to describe how the 153 pages of new additions included “extra money for hospitals in Tennessee that serve large numbers of low-income patients” and a particularly sugary-sweet deal for North Dakota, as the state-owned Bank of North Dakota will be the only other lender in the nation–other that the federal government–permitted to issue student loans pursuant to the terms of the complete overhaul of the student aid industry also contained in the health care legislation.
To his credit, though, North Dakota Democrat Kent Conrad asked that the latter provision be removed, fearing backlash in what he called an “overly heated partisan environment.” Well, of course. And, folks, his fear of that “overly heated partisan environment” should be proof positive that what we do here at America’s Right and what is done in points beyond do indeed make a difference — the education of the American electorate is the root of such appropriate pressure. Thomas Jefferson once wrote that an educated populace is the “ultimate repository” for freedom and liberty, and this is what he meant.
From the Associated Press piece, here’s a pretty good round-up of some of the changes made:
Also eliminated from the Senate measure was a provision allowing about 800,000 elderly Floridians to keep enhanced Medicare benefits that are being cut for residents of other states.
The changes also include an additional $99 million in 2012 and 2013 for Tennessee hospitals that treat many poor people.
Retiring Rep. Bart Gordon, D-Tenn., has fought for the funds for years to bring the state’s aid up to par with the rest of the country, spokeswoman Emily Phelps said. She said their inclusion had nothing to do with his announcement Thursday that he will vote for the final health legislation after opposing an earlier version in November.
The new package also promises new aid for colleges serving minority students, using money the government is supposed to save by no longer paying banks to make student loans. Included are annual payments of $100 million for schools with large numbers of Hispanic students, the same amount for colleges with many black students, and millions more for schools with large numbers of native Americans and other minorities.
Based on Thursday’s changes, the health legislation also:
- Retains $300 million in extra Medicaid aid for Louisiana, which had helped win support for the Senate health bill from Sen. Mary Landrieu, D-La. The state is still struggling to recover from Hurricane Katrina.
- Keeps $100 million included in the Senate bill that is expected to go for a public hospital in Connecticut sought by Dodd, who is retiring.
- Preserves language won by Baucus permitting many of the 2,900 residents of Libby, Mont., to qualify for Medicare benefits. Some of them have asbestos-related diseases from a now-shuttered mine.
- Provides an additional $8.5 billion over the next decade for 11 states and the District of Columbia to help them pay for the more generous Medicaid assistance they have been providing low-income residents. These states are Arizona, Delaware, Hawaii, Maine, Massachusetts, Minnesota, New York, Pennsylvania, Vermont, Washington and Wisconsin.
- Maintains a Senate-approved provision giving extra money for hospitals and doctors in North and South Dakota, Montana and Wyoming.
Obviously, while some things change, others–like the “Louisiana Purchase” and the legislative equivalent of a gold watch celebrating Christopher Dodd’s forced retirement–stay the same. Interestingly enough, as far as I know, Section 1412(c) of the Senate bill remains unchanged. Why is that significant? Well, for all of the time spent by Democrats demonizing those heartless, money-hungry insurance companies, Section 1412(c) provides $436 in federal subsidies–read: taxpayer money–to insurance companies slated to provide coverage on the proposed insurance exchange.
Of course, the public flogging and private embrace of the insurance industry is nothing new. After all, while Barack Obama scolded Anthem Blue Cross of California and Michigan Blue Cross and Blue Shield for greedily raising rates at levels he insisted were excessive, the Senate health care bill specifically exempted the latter from brand spanking new taxes to be thrust upon private insurers. How positively consistent of him.
In the meantime, in case anyone was wondering whether lawmakers from the great state of Tennessee will insist that any special treatment in the bill be stricken like North Dakota’s Kent Conrad admirably did, this next section–well, the first part of it, at least–is for you.
If the administration did not think it had enough votes to pass the Senate bill through the House, there would be no vote scheduled for this weekend. It just wouldn’t happen. Now, how do they know, anyway, that they have garnered enough “yes” votes? Simple … they paid for them.
According to Human Events.com, two retiring congressional democrats from Tennessee who voted against the House health care reform bill in November are now moving on to greener pastures, and to cushy government jobs provided by the very administration looking for their votes.
That’s right. Rep. Bart Gordon, previously a “no” vote and up until recently one of the democrats holding out for some sort of kickback, deal or phone-it-in desk job, has been promised a position as NASA Administrator in exchange for a “yes” vote this weekend, while Rep. John Tanner, who also put the “no” in “November,” was promised an impressive appointment as U.S. Ambassador to NATO in exchange for a “yes” on Sunday.
This, of course, comes less than a month after President Barack Obama nominated Scott M. Matheson, Jr. to the bench at the Tenth Circuit Court of Appeals. Now, judging from his resume, Scott Matheson is eminently qualified for the job on the federal bench, but the timing was certainly suspect — Scott’s brother, Jim, voted against the health care reform bill in the House in November, and he was one of ten such democrats who met with the president privately in the White House on March 3.
Also among the “ten such democrats”: Pennsylvania’s Jason Altmire, Florida’s Allen Boyd, Lincoln Davis of Tennessee, South Dakota’s Stephanie Herseth-Sandlin, Frank Kratovil of Maryland, Betsy Markey of Colorado, New York’s Scott Murphy, Heath Shuler of North Carolina, and John Tanner of Tennessee. Tanner, as mentioned before, will be our newest Ambassador to NATO after he serves out the rest of his term; we’ll just have to watch the rest of them for the sudden onset of political or professional success.
Meanwhile, there’s word now that two previously “undecided” California democrats, Reps. Dennis Cardoza and Jim Costa, could very well be moving toward the affirmative for this weekend’s vote after being bought off with increased water allocations for the water-starved and unemployment-heavy Central Valley. The March allocation, according to a press release from the U.S. Department of the Interior, was “moved up … at the urging of Senators [Dianne] Feinstein and [Barbara] Boxer, and Congressmen Costa and Cardoza.”
Massive Expansion of IRS Power
If there is anything normal, everyday Americans can all agree to dislike, it’s the IRS. And yet, should the Democrats’ proposed health care reform pass, there will be a massive expansion of Internal Revenue Service power. Released yesterday by the Ways and Means Republicans, there’s this little bag of fun:
Washington, DC – Today, Ways and Means Republicans released a new report detailing how the Democrats’ health care bill vastly expands the responsibilities of the Internal Revenue Service (IRS) and strengthens the heavy hand of the IRS in dealing with taxpayers.
“If the Democrats’ health care bill becomes law, the IRS could have to hire more than 16,000 additional agents, auditors and other workers just to enforce all the new taxes and penalties,” said Ways and Means Ranking Member Dave Camp (R-MI). “It is a dangerous expansion of the IRS’s power and reach into the lives of virtually every American.”
Highlights of report, which is entitled “The Wrong Prescription: Democrats’ Health Overhaul Dangerously Expands IRS Authority,” include:
- IRS agents verify if you have “acceptable” health care coverage;
- IRS has the authority to fine you up to $2,250 or 2 percent of your income (whichever is greater) for failure to prove that you have purchased “minimum essential coverage;”
- IRS can confiscate your tax refund;
- IRS audits are likely to increase;
- IRS will need up to $10 billion to administer the new health care program this decade;
- IRS may need to hire as many as 16,500 additional auditors, agents and other employees to investigate and collect billions in new taxes from Americans; and
- Nearly half of all these new individual mandate taxes will be paid by Americans earning less than 300 percent of poverty ($66,150 for a family of four.)
The Republicans noted that despite all these new mandates on Americans, the Democrats prohibit the IRS from imposing these same taxes and penalties on illegal immigrants.
The full report can be viewed HERE.
Okay, first of all, it is extremely important to understand that this is a report released by the Ways and Means Republicans. Again, this report has been released by Republicans. That being said, the language is either in the bill or it is not.
Now, some of the bullet points are, frankly, obvious attempts at fear-mongering. First, there are provisions already in the Internal Revenue Code which provide the IRS with authority in certain situations to reclaim your tax refund, so unless there is some sort of health care reform-specific language in the bill which provides that coverage deemed sub-standard or that non-compliance with an [unconstitutional] mandate can lead to a refund being reclaimed, the news that the “IRS can confiscate your tax refund” seems a little ho-hum to me. Second, the idea that audits are likely to increase seems on its face to be an overt attempt at ginning up further opposition — after all, nobody enjoys an audit, but the idea that an Internal Revenue Service already stretched to the limit by the tax-related burdens of health care reform can muster the resources to increase audits just doesn’t make sense to me.
All that being said, it is obvious that the bureaucratic consequences of this legislation, should it be passed and signed into law, will be felt like an earthquake throughout each nook and cranny of the federal government. There just isn’t the infrastructure in place ready to deal with a massive entitlement like this, and that’s why the quality of care will suffer and why the size of the federal government will absolutely explode should this darned thing happen. Remember, in the House bill, more than 110 new commissions, boards, committees and bureaucracies were created — all that government has to fit somewhere.
So Much For The “Final Number”
On March 11, House Speaker Nancy Pelosi told reporters that she and other House Democrats “were briefed by the Rules Committee as to the action they need to take to put the reconciliation bill on the table, and they can’t do that, of course, until we have a final number from the CBO.” She then proceeded to reiterate that “our clock starts ticking when we get the final CBO report,” but cautioned that “we don’t have the final [report] yet.”
Well, as the reconciliation “fixer” bill moves forward, and as liberal democrats from coast to coast remind their Republican and conservative friends and neighbors that the CBO scored the health bill at “only” $940 billion over the next decade, with what it says will be significant deficit reduction (yeah? how?), it is important to remember that Pelosi does not have a “final CBO report” as she contended was needed by the Rules Committee. Consider this, from the CBO report released yesterday (emphasis mine):
Although CBO completed a preliminary review of legislative language prior to its release, the agency has not thoroughly examined the reconciliation proposal to verify its consistency with the previous draft. This estimate is therefore preliminary, pending a review of the language of the reconciliation proposal, as well as further review and refinement of the budgetary projections.
When I heard yesterday that Nancy Pelosi had released the CBO score, I knew immediately that she figured it to be acceptable. (As if $940 billion is acceptable.) If it hadn’t been acceptable, she would have released it either on Wednesday to minimize any disruption of whatever momentum Democrats had built up, or during the late afternoon today as part of the Democrats’ new favorite practice — the Friday afternoon news dump.
Any way you look at it, though, the CBO cannot truly score a bill unless it has the legislative language in front of it. In this case, it does not.
Furthermore, when it comes to matters of scores and costs, it’s important to remember what I wrote here at America’s Right in response to Barack Obama’s September 8, 2009 speech to a joint session of Congress. (In fact, that entire piece is chock-full of good information just dismantling the Democrats’ health care reform proposals and arguments, so check it out.):
When has the federal government ever slowed the growth of costs in any industry it has injected itself into, either constitutionally or unconstitutionally?
When Medicare was first brought about in 1966, the entire program cost $3 billion. At the time, the House Ways and Means Committee estimated that it would only cost $12 billion by 1991, including an allowance for inflation. Whoops — they were only $95 billion off! In 1991, Medicare cost American taxpayers $107 billion. Last year, the budget for Medicare was $444 billion. So much for the government promises when it comes to slowing the growth of health care costs.
More Fun With the CBO
From the folks at the House Republican Conference, some great insight as to the “Highlights of CBO’s Preliminary Analysis of the Reconciliation Act of 2010.” (emphasis mine):
SPENDING: According to the CBO’s preliminary score of H.R. 3590 and the reconciliation amendment, the legislation would spend nearly $1 trillion over its first ten years. More specifically, CBO estimates that the bill would spend $940 billion to finance coverage expansions-$434 billion for the Medicaid expansions, $466 billion for “low-income” subsidies, and $40 billion for small business tax credits. The spending on coverage expansions does not even consider additional federal spending included in the legislation-including $60 to $70 billion in discretionary spending which CBO recently estimated-and other spending which may fall outside the coverage subsidies. When combined with the cost of the coverage expansions, total spending under the bill almost certainly exceeds $1 trillion.
BUDGETARY GIMMICKS: While the CBO score claims H.R. 3590 and the Reconciliation Act of 2010 would reduce the deficit by $138 billion in its first ten years, Democrats achieved that “deficit-neutral” in part by excluding the cost of reforming the Sustainable Growth Rate (SGR) mechanism for Medicare physician payments-the total cost of which stands at well over $250 billion over ten years, according to CBO-from this bill, and including it instead in separate legislation (H.R. 3961; S. 1776) that is not paid for. While Members may support reform of the SGR mechanism paid for in a fiscally responsible manner, many may view any legislation that presumes a more than 21 percent cut in Medicare payments to physicians in the applicable budget window as an inherent gimmick designed solely to hide the apparent cost of health “reform.”
OUT-YEAR EFFECTS: According to CBO’s estimate, the legislation would reduce deficits relative to the current baseline between FY 2020 and FY 2029 by a broad range, roughly between zero and one-half percent of GDP over the ten year span, depending on what legislation were to be enacted-not by any dollar amount, such as $1.2 trillion, as Democrats have asserted. However, CBO admits that these long term estimates are “rough” and that, “The imprecision of that calculation reflects the even greater degree of uncertainty that attends to it, compared with CBO’s 10-year budget estimates.”
TAXES: Offsetting taxes include $17 billion in taxes on individuals not complying with the mandate to purchase coverage, $32 billion from the “Cadillac tax” on high-premium insurance plans, $52 billion in payments by businesses associated with the employer “free rider” penalty, and $44 billion in associated other revenue interactions. In total, provisions in the reconciliation bill increase taxes by $155.8 billion over the next ten years, above and beyond the tax increases contained in the Senate-passed bill.
STUDENT LOAN PROVISIONS: The legislation includes a reconciliation provision to alter federal student loan programs by eliminating the Federal Family Education Loan program and shifting all student loans to a government-run and taxpayer financed system under the Direct Loan program. While this legislation has nothing to do with the government takeover of health care, the provision is scored as a deficit reduction of $19.4 billion which is used as an offset against the $1 trillion cost of the legislation. However, CBO has also noted that current budget scoring rules do not include the cost to the government stemming from the risk that the cash flows may be less than the amount projected (that is, that defaults could be higher than projected).
Now, I’m just a regular guy. I don’t know what the “SGR mechanism” is. What I do see, however, is a group of legislators purposefully fudging numbers when it comes to costs and revenues, all in order to force the American people to invest their hard-earned money in a program they simply do not want. Where I come from, that’s fraud. If the officers and directors of a company play with the balance sheet and misrepresent revenues and expenses in order to portray a different financial condition and induce investment, they’ve earned themselves a trip to federal court. With regard to our fine representatives, we should only be so lucky.
A. Fraud; B. Malpractice; C. All Of The Above
Obviously, I say it’s fraud. But in a commentary written yesterday for Yahoo! News, Oklahoma Republican Sen. (and practicing physician) Tom Coburn insists that it is malpractice. He does an excellent job of breaking the bill down into understandable segments. Part of it:
The Senate bill will put 15 million Americans in the Medicaid program, which is bankrupting states and denying care to millions of American. Forty percent of doctors restrict access to Medicaid patients because reimbursement rates are so low. The rest of America will be funneled into the insurance industry the White House has been demonizing.
Supporters argue that the bill will save taxpayers $100 billion over 10 years, but this estimate is a sham. The numbers Congress gave to the Congressional Budget Office include 10 years of tax increases but only six years of benefits at the back end. This is unjust and deceptive Enron-style accounting. No homeowner would allow a bank to tell them they have to make mortgage payments for four years before they can move into their new home. Yet that is precisely what Congress is telling the American people.
The bill will also cause health care costs and premiums to increase, not decrease. According to CBO, premiums for families could rise 10 to 13 percent beyond current estimates. The president’s own actuary also estimated that health care costs will increase, not decrease, under the Senate bill.
Proponents are not only wrong about cost containment but patient choice as well. The fact is the Senate bill takes unprecedented steps to put government bureaucrats between patients and doctors. For instance, the Senate bill creates new comparative effectiveness research (CER) panels that have been used as rationing commissions in other countries such as the U.K., where 15,000 cancer patients die prematurely every year according to the National Cancer Intelligence Network.
The Senate bill also depends on the recommendations of the U.S. Preventive Services Task Force in no fewer than 14 places. This task force was responsible for advising women under 50 to not undergo annual mammograms. Proponents claim the task force recommendations do not carry the force of law, but the Senate bill itself contradicts that claim by declaring health insurance plans “shall provide coverage for” services approved by the task force.
I’ve treated patients in my own practice who would have had their lives cut short had a government panel been allowed to tell me which treatments I could and could not prescribe. These and other provisions have caused physicians to turn against this bill. For instance, a recent poll conducted by Sermo.com, an online community of more than 110,000 physicians, found that only 1 in 10 physicians said Congress should push the current bills through, while nearly two-thirds of physicians said Congress should start over and work on targeted, step-by-step solutions.
One of the things that Coburn did not mention, however, is the alternative bill put together by the House GOP. That piece of legislation was roughly 250 pages long to Nancy Pelosi’s 2000-plus page long counterpart. It relied on risk pools, on interstate competition and on tort reform, and it was scored by the Congressional Budget Office at a price of $61 billion over ten years. Even better, it would decrease insurance premiums. So, for $61 billion over ten years, we have decreased health insurance costs, while increased premiums will cost the country more than $1 trillion over that same period.
Democrats to Contact
If you are looking to get in touch with a few congressional democrats who might just provide salvation in all of this, here is a list, with contact information linked at each name:
- Rep. Jason Altmire (PA)
- Rep. Michael Arcuri (NY)
- Rep. John Boccieri (OH)
- Rep. Jim Costa (CA)
- Rep. Brad Ellsworth (IN)
- Rep. Gabby Giffords (AZ)
- Rep. Suzanne Kosmas (FL)
- Rep. Betsy Markey (CO)
- Rep. Scott Murphy (NY)
- Rep. John Tanner (TN)
Obviously, a few of those–Tanner and Costa, for example–look as though the president has already gotten to them. Still, if you’re looking to make some phone calls (and I hope you are), these are the folks to call. These people hold the future of health care for 300 million Americans in their hands. For one reason or another, they hesitated to follow party line before — let’s implore them to do the right thing this weekend.
A Few Closing Words (for now, at least)
I received an e-mail yesterday evening from John Feeny. It’s safe to say that neither he nor I are as optimistic as is Congressman Mike Pence, despite a wonderful wrap-up to some fantastic remarks on the House floor yesterday.
“I tell you what, big guy,” Feeny wrote. “Everything I’m seeing tells me that this thing passes. Jay Severin, a talk show host here in Boston who has worked his entire life in politics says that Obama wouldn’t call for a vote unless he had the votes, and two Massachusetts congressmen flipping to “no” votes indicates that they’ve been given permission to vote in their own self-interest.”
He continued, saying that he was about ready to throw in the towel. “There’s nobody up there that gives a damn about what we think,” he wrote. “Not that I didn’t know that already, but all these guys flipping to “yes” just makes this sense of their self-imposed separation from their own people and their complete and utter disregard for their own country seem absolutely real. I find it shockingly disheartening and appalling; I think we’re wasting our time.”
I couldn’t help but hang my head. I’m only now beginning to get to know John well, but to me he sure doesn’t seem like a guy who gives up easily. But, by God, I understood where he was coming from, and I still do. All I could do was write him back and express my agreement in part. To be completely honest, I do get the feeling that the House bill will pass on Sunday. Unless there are some “no” votes masquerading as “yes” votes in order to force Pelosi’s hand and force a vote, only to turn around and bury this abomination for good, I simply cannot see how a vote would be scheduled unless the president and the Democratic Party leadership was confident that it would pass. After all, they’ve had no problem pushing past deadline after deadline before, and even now were prepared to wait until Easter.
But as much as my gut–which, unfortunately, is ample–agrees with John’s assessment that health care reform will pass the House of Representatives, with every fiber of my being I wholeheartedly disagree with his assertion that we are somehow wasting our time.
In 1976, after a beleaguered Ronald Reagan lost a nasty primary battle with Gerald Ford, he told his staffers and supporters not to get cynical. “Look at yourselves and what you were willing to do,” he said, “and recognize that there are millions and millions of Americans out there that want what you want, that want it to be as we do, who want it to be that Shining City on a Hill.”
Look at what we have done, people. Look at it! Look at the number of ordinary, everyday Americans who care. Look at the ordinary, everyday small business owners who took time away from their livelihood to march on Washington, D.C. on September 12 of last year, and look at how they’ll do the same on Saturday to unite in opposition to this bill. Look at the ordinary, everyday housewives and retirees who, for the first time in their lives, have been paying rapt attention to the actual legislative process. By God, for the past week we’ve been openly discussing, at office water coolers and supermarket checkout lines and little munchkin play-dates, parliamentary procedures which even the likes of Karl Rove have difficulty explaining.
It has happened. The American people have awakened and, regardless of what happens on Sunday afternoon, Mike Pence is absolutely right — A minority in Congress plus the American people equals a majority.
And while we may not win this battle this weekend, we should not forget the words of Leonidas, a man who knew a thing or two about fighting against extraordinary odds: “I will lay me down and bleed a while. Though I am wounded, I am not slain. I shall rise and fight again.”
What has happened in the United States of America is far greater than anything Nancy Pelosi or Harry Reid or Barack Obama can bring. The American people have risen. We are watching. We are listening. We are learning. We are ready to fight. And fight we will.
219 to 212. Watching the votes come in was like watching the nation I love so much bleed to death from a paper cut.
I’m in a Fredericksburg, VA hotel room with my family now, writing and updating this from my smartphone. We’re in two beds, an unfortunate necessity because I’ve got a bitch of a headcold, and in the bed to my left is my wife and my three-year-old daughter.
My wife is snoring lightly; my daughter is still awake, quietly singing to herself and playing with her stuffed Aubie doll. She doesn’t know yet the burden which has been placed on her little shoulders tonight. She doesn’t understand that the Democrats are cheering while they dance on the Constitution.
To be honest, I’m in no mood to write. Long having run out of tissues for my Kennedy-red nose, I have hotel toilet paper jammed up there to stop things up. It’s not attractive and, frankly, I just need sleep.
Still, the television is on C-SPAN. Callers calling into the network are talking about this as a “great victory for social justice.” I’ve just about had enough. Why don’t people understand? Why can’t they comprehend the difference between a right and a privilege? Why can’t they see that this is blatantly unconstitutional?
On the bright side of it all, much of the so-called “benefits” of the legislation will not come into place for years–the unconstitutional mandates, for example, will not be enforced until the end of 2013–and the Republican Party I see now is the most cohesive I’ve ever seen. So long as they stay firm in the corner of limited government, we can pare this bill down and rid it of its most objectionable provisions.
In the meantime, we must pay attention as the reconciliation process takes place. The amendments proposed by the Republicans will shed further light on the shortcomings of what was just passed, and it is vitally important that this issue stays alive, that the American people know what the Democrats have forced through.
We will be home tomorrow, and there will be fresh material up here at AR probably by mid-afternoon. In the meantime, follow America’s Right on Twitter for any interesting links or spur-of-the-moment thoughts or insight.
Now, if you’ll excuse me, I need sleep.