When All Else Fails, Bring Up Acorn

It was inevitable. The right wing is has resorted to using scare stories about Acorn to protest the health care reform bill. By tomorrow Rush will be claiming that the bill puts Acorn in charge of running the death panels.

AMA Backs Senate Health Care Bill

The American Medical Association has announced their support for passage of the Senate bill:

The American Medical Association (AMA) today announced its support for passage of the amended Senate health reform bill (H.R. 3590).  Passage of the Patient Protection and Affordable Care Act by the Senate will bring our nation close to the finish line on health reform.

“All Americans deserve affordable, high-quality health coverage so they can get the medical care they need – and this bill advances many of our priority issues for achieving the vision of a health system that works for patients and physicians,” said AMA President-elect Cecil B. Wilson, M.D.

The Senate bill includes a number of key benefits for meaningful reform. It will improve choice and access to affordable health insurance coverage and eliminate denials based on pre-existing conditions. The bill will increase coverage for preventive and wellness care that can lead to better disease prevention and management, and further the development of comparative effectiveness research that can help patients and physicians make informed treatment decisions.  “Lifetime limits on health coverage will be a thing of the past – as will higher premiums based on medical conditions or gender,” said Dr. Wilson.  “These are important benefits for those who have insurance now – and those who want it but have been unable to get it.”

“The AMA communicated closely with the Senate about items it supported and items of concern in the prior version of the Senate bill,” said Dr. Wilson.  “We are pleased that the manager’s amendment addresses several issues of concern to AMA.  It increases payments to primary care physicians and general surgeons in underserved areas while no longer cutting payments to other physicians.  It eliminates the tax on physician services for cosmetic surgery and drops the proposed physician enrollment fee for Medicare.”

While important improvements have been made to the bill, there is still work to be done, and AMA will continue its advocacy on behalf of patients and physicians through the conference process.  Important issues that need to be resolved in the House-Senate conference committee include the creation of a Medicare payment board, quality improvement and Medicare data release initiatives.  Separate action is needed early next year to permanently repeal the current Medicare physician payment formula to provide a stable payment system to preserve access to care for America’s seniors, baby boomers and military families.

“The AMA will stay engaged in the process to ensure that the final bill that goes to President Obama for his signature will improve the health care system for patients and physicians,” said Dr. Wilson.

Unfortunately the manager’s amendment also has some negatives which are not mentioned here, but hopefully the final bill will be improved further when reconciled with the House bill. The Senate took the same approach as the House in voting for a two month freeze in physician reimbursement to allow time for a more permanent fix the the flawed physician payment formula. It did make more sense to remove this from the Senate bill in the manager’s amendment and avoid including this long term problem in the cost projections for this plan. One unfortunate change in the manager’s amendments was to strengthen the penalties under the individual mandate. Multiple economists have issued a statement in support of the cost-cutting measures in the amendments.

The AMA previously endorsed the House bill.

The Senate bill is far from perfect, but it is now the target of misinformation from the left as well as from the right. The Wonk Room provides corrections to some of the criticism.

Obama and The Health Care Legislation

Until Barack Obama’s election I do not recall a president who received so much criticism for doing what he said he would do during the campaign. It is one thing, and perfectly legitimate, to criticize Obama when one disagrees with him. Having said he would do something as a candidate does not make him immune to criticism for his policies once elected. It is a different thing, as some on the left are doing, to claim that Obama sold them out or act shocked by his current policies.

Barack Obama campaigned as a centrist, pragmatic politician who planned to try to consider the views of the opposing party. While campaigning he said he would remain in Afghanistan, and it was clear he would not concentrate on prosecuting Bush administration officials for their acts in office. As Ezra Klein points out, he also campaigned on a health care plan (pdf here)  similar to the one being considered in Congress:

…the basic structure of the proposal is remarkably similar. Here’s how it was described in the campaign’s white paper:

“The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.”

We don’t know what the employer mandate will look like once the House and the Senate merge their bills, and the exchanges look likelier to be run by states or regions than by the government (though there will also be a national exchange overseen by the Office of Personnel Management), but those are really the only differences. And it’s not even clear they’re differences.

Going through the legislative process has led to some changes. A key difference is the individual mandate. While I wish Obama had stuck with his opposition, the change is understandable. Ezra Klein, whose understanding of  the realities of health care in the real world is far weaker than his study of legislation, believes this is because his plan would not work without mandates. The real reason Obama gave in is more likely that this was a compromise which was necessary to get a bill passed. He first tried to make a deal with the insurance industry by agreeing to their demands for a mandate in return for ending the restrictions based upon pre-existing conditions. Once this issue was taken up in Congress, leaders from both parties supported the individual mandate, making it futile for Obama to fight it.

The other big change, and the one which has disappointed the left the most, is the elimination of the public plan in the Senate bill. Obama’s strategy has certainly been one of getting a bill passed even if compromise is necessary, but he does not deserve the amount of blame he has been receiving for the elimination of the mandate. It was Joe Lieberman who killed the mandate, yet surprisingly many on the left are accepting the word of Lieberman (as well as Howard Dean, who has his own axe to grind with the Obama administration) on this.  Joe Lieberman’s argument comes down to telling the left not to blame him for opposing the public option because Obama didn’t try hard enough to twist his arm.

Tom Harkin has a different take on the public option, disagreeing with the claims that this failed because of Obama. Harkin also says that the public option will be revisited. Even if it doesn’t make it into the final bill during reconciliation with the House bill, it is possible to bring up the public option again as a separate bill in the future. Considering the degree of public support for the public option, it might even make more sense to have a separate battle over this during an election year, or even in 2011.

I will not attempt to say whether the bill should be passed until the final legislation is available. The Senate bill has many faults, but passage is the only way to go to conference with the House and attempt to improve it. The bill must be judged not against our ideas of a perfect plan, but against the status quo, where the individual market might not survive much longer unless one is young and health or has lots of money to burn. Any final bill must be considered on its merits and not be judged based upon litmus tests such as whether there is a public option. Even Jacob S. Hacker, who devised the idea of a public plan, is arguing in favor of passage of the current Senate plan. Whatever the details are in the final plan, it does not appear that it will be radically different from the plan discussed when Obama was campaigning.

Cynthia Nixon Protesting Stupak Amendment

While everyone has been concentrating on the positive and negative aspects of the Senate health care bill, the big problem with the House bill has almost been forgotten. Cynthia Nixon has been speaking out against the Stupak amendment:

It’s been a little more than a week since Cynthia Nixon flew back from filming “Sex and the City 2” in Morocco, and she’s already diving headfirst into the debate surrounding abortion and health care reform.

Nixon, a longtime abortion rights activist, says she can’t keep quiet about the recent health care bill amendments that would limit insurance coverage for abortions.

“It’s a very basic female right that we need to protect,” Nixon said. “What’s so frightening about this Stupak ban is that he’s found a backdoor way to basically not cover abortion for the vast majority of American women.”

The Stupak-Pitts amendment, written by Democratic Rep. Bart Stupak of Michigan and Republican Rep. Joseph R. Pitts of Pennsylvania, is a point of contention in the House health care bill. The amendment would limit funds in the health care bill, preventing subsidies from directly paying for abortions and also from paying for any insurance plan that covers abortions.

The prohibition excludes cases of rape, incest or when the mother’s life is in danger.

CNN interviewed Nixon about her protests of the Stupak amendment:

CNN: You’ve been very outspoken in the past few years about LGBT issues and rights, but not as much about reproductive health. When did you start becoming vocal about being pro-choice?

Cynthia Nixon: I’ve been involved since I was 15, so we’re talking almost 30 years now.

My mother had an illegal abortion pre-1973, and it’s something that I would never want to face or want my daughter to be facing or any of her friends. Abortion is a right I feel must not go away, and I feel like people aren’t mobilizing so much because it’s so complicated and it’s difficult to understand.

CNN: But some say that all the Stupak-Pitt amendment does is essentially hold up the current law that restricts federal funding from providing abortions.

Nixon: That’s patently false. The new people coming in would be people making less than $88,000 a year in a family of four and would be getting their insurance in the form of tax credit. That credit is coming through the federal government.

[For] the majority of women who have health insurance now, abortion is covered as a complete given. Once these new people come in, we’re looking at adding 36 million people to these tax credits, and they will not have abortion offered as an option on their health insurance. That’s a really large chunk of people, but the thing is also how it will affect the marketplace. …

They’re saying you could buy [a rider] additionally, but for how much? It’s going to be exorbitantly expensive, and it’s not a thing people are going to do.

By the very nature of abortion, nobody intends to have one. Nobody intends to get pregnant by mistake, nobody intends to be raped, nobody intends to be [a victim of incest], and no one intends, in the course of a wanted pregnancy, to have a catastrophic event that requires an abortion.

I Hope Newt Gingrich Was Joking

Newt Gingrich on Twitter:

As callista and i watched what dc weather says will be 12 to 22 inches of snow i wondered if God was sending a message about copenhagen

He very well could have been joking, but between Republican ideas on climate change and religion it is sure hard to tell. Many who deny global warming have confused short term variations in weather with long term climate change. There have also been far too many comments from Republicans, including Sarah Palin and George Bush, suggesting God is involved in our politics. It is possible that this intellectual leader of the Republicans really does look for signs from god in determining policy issues.

In another tweet, Gingrich showed that he takes the bogus claims of “climategate” seriously even though the hacked email failed to show anything to alter the scientific consensus on climate change.

While again I’m not sure how serious he is, Erick Erickson of Red State also suggests that the storm is a sign of God’s objection to the health care bill, even raising the bogus claims of “death panels.”

Lie of the Year

There were a lot of lies told by politicians, but one really stands out. PoliFact has chosen the lie of the year: Sarah Palin’s claims the health care reform proposals would lead to the government setting up “death panels.” It also says something about politics today that this lie was started by Sarah Palin on her Facebook page.

Two Big Votes, And The Words of the Day

There were two big votes Sunday night. (Ok, one is more meaningful than the other. For now I’m primarily posting to note the more entertaining one, and will get to the more important one after I get more of a chance to wade through all the amendments which were voted upon.)  The Democrats got sixty on the big cloture vote and being nice turned out to be more important than being the dominant player on the Survivor finale. Thanks to Shambo, the words for the day are feckless and the c-word (coattail). In this case choosing the right coattails was the winning move for Natalie.

Update: Since blog aggregators are picking this up along with real posts on health care reform I should at least mention something on the Senate vote (although this post was primarily a quick response to Survivor as opposed to anything really serious). As with everything going on in the Senate, the amendments look like a combination of good and bad items. The most disappointing is an increase in the penalties for the rather weak mandate in the Senate bill. The fix to the Medicare payment formula was removed, but it would be better to deal with this separately rather than add this cost, which has been with us for years, to the scoring of the Senate bill.

Reconciliation with the House version will sure be interesting considering the vast differences between the two bills, with both having good and bad aspects (with the House version being preferable). Hopefully we will wind up with the best portions of both bills, but there is also the very real danger that in order to obtain enough votes for narrow passage we could wind up with bad aspects from both surviving.