The Wonk Room

NRCC Luring Doctors To Oppose Reform By Pretending To ‘Honor’ Them

The National Republican Congressional Committee (NRCC) is engaged in a misleading campaign to trick physicians into opposing health care reform. The Wonk Room has learned that the Committee has been placing calls and sending “hand-written” faxes to physicians across the country to ostensibly recognize physicians for their “invaluable experience” and ask recipients to call a toll-free number and approve a press release “to honor the achievements of you and other concerned physicians like you.”

The missive invites doctors to “represent” their state “as a consultant on Rep. Tom Price’s (R-GA) ‘Physicians’ Council for Responsible Reform,’” but a call to the “Council” suggests that the NRCC’s real goal is to scare physicians and add legitimacy to Republican efforts to stall reform. (Download a copy of the letter HERE).

According to one account provided to the Wonk Room, once a physician dials the number at the bottom of the fax, a staffer who identifies herself as a “someone who works for Congressman Price” answers the phone and informs the caller that her name was on a list “of leaders” “compiled” by Rep. Price. The staffer stresses that the doctor has been selected to serve as a “senior adviser” on the Council and that her input is “vital” to the reform process.

But rather than seeking “critical input” or “guidance” from doctors “who are respected by their peers”, the staffer– who at no point asks the doctor for her views on health care reform — plays a message from Price warning about the “very real threat of Washington interfering even more with doctor’s efforts to provide the best possible care for their patients.” (Listen to a recording of Price’s message HERE). Then, the operator explains, what the physicians on the Council have already agreed to:

CALLER: What do you stand for?

OPERATOR: Well, the thing is, we want, I think what we want is a free market type thing. You know, fine, you know, if we can upgrade Medicare or something so that those that aren’t covered will be covered, but we think what they’re proposing now can really be deleterious to patients and their doctors and we’re afraid that a lot of people will be left uncovered or waiting in line to get appointments or procedures or anything like that. We don’t want to end up being like England or what Canada has.

Listen to the call:

Before ending the call, the operator explains that the call was “paid for by the NRCC” and directs the caller to the organization’s website, “NRCC.org” where “there are some issues on there that talk about the socialized medicine.” After the caller asks for the Council’s website, the operator explains, “it’s physicianscouncil.org, there is not a whole lot on there yet, we are just starting it. Something brand new for us, which is why we don’t have a whole lot of details for you.”

Republicans Introduce Another Health Care Alternative, What Was Wrong With The Other Four?

In today’s POLITICO, Rep. Tom Price (R-GA) celebrates the 44th anniversary of Medicare by arguing that “nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare.” Price joins a long-line of Republicans who have historically opposed a program that has dramatically improved “the health of the elderly population,” increased “life expectancy,” and improved the financial security of millions of seniors.

A recent Commonwealth Fund study found that “compared to people with private insurance, Medicare enrollees have greater access to care [and] fewer problems with medical bills.” Their report adds that this finding is significant, considering that those Americans on Medicare represent a demographic that is more likely to be in poor health and to have lower incomes. Elderly Medicare beneficiaries also reported “greater overall satisfaction with their health coverage” and Medicare is so popular that most Americans support expanding its coverage to individuals aged 55 to 64.

But Price reaches deeper into the reactionary rhetoric of the 1960s, to argue that “the proposal before the House would hand over to Washington nearly every decision that should be made by patients and their physicians” before proposing yet another Republican alternative to the Democratic initiative. The new “Empower Patients First Act” is almost identical to the The Patient’s Choice Act, Commonsense Health Care Reform to Lower Costs and Increase Access and Quality at a Price Our Country Can Afford, Improving Health Care for All Americans Act and Health Care Freedom — which begs the question: What was wrong with the other four bills?

Like it’s predecessors, this legislation would break-up employer-based coverage, endanger the coverage of Americans with pre-existing conditions, and drive-up health care spending:

- “Creating tax incentives for consumers to purchase insurance on the individual market, encouraging states to assist consumers with pre-existing conditions”: This proposal breaks up the employer-pool by encouraging younger workers (who can find cheaper coverage in the individual market) to opt out of their current coverage and purchase insurance elsewhere. The departure of healthy workers from employer insurance pools would drive up average health costs for employer based plans and force workers to opt out entirely. This unravels employer health insurance for Americans who prefer it. Younger, healthier people could find cut-rate insurance on the individual market – as long as they stay young and healthy! Since the bill lacks any adequate consumer protections — like requiring insurers to offer coverage to Americans with pre-existing conditions — insurance companies operating in the unregulated individual market would continue rescinding or denying coverage and increasing premium rates.

- “In order to provide coverage for Americans who have pre-existing conditions, the Republican plan proposes giving states incentives…to establish high-risk insurance pools”: Nationwide, high-risk pools cover fewer than 200,000 people. Often, enrollees face high premiums and are denied benefits for treatments related to their preexisting conditions— the very thing the plan will help. Because these pools will be full of only sick people, covering all high-risk Americans through these pools is likely to be prohibitively expensive. According to the Tax Policy Center, using high-risk pools “to prevent large losses in insurance coverage among the sick and needy could …[cost] on the order of $1 trillion over ten years given projected health care pay-costs.”

- “Republicans are also proposing to expand the individual market by creating pooling mechanisms such as association health plans and individual membership accounts”: In theory, Association Health Plans (AHP) are intended to implement a laudable goal: allow small employers to pool their risk nationally so they can get the same economies of scale and negotiating power as large employers. But in reality, Association health care arrangements would allow businesses with healthier employees to pool risk, while excluding firms with sicker employees.

- “Consumers would also be able to shop for insurance across state lines”: Allowing insurers to sell policies across state lines would allow companies to avoid state consumer-protection laws and solvency requirements. Insurance companies “would have little incentive to continue doing business” under certain state rules which “require that companies issue coverage to all new customers and not set higher rates for people who are already sick.” Companies will charter in states with scarce regulations, and will no longer have to provide mental health parity, cancer screenings, or abide by regulations that “limit the rates that can be charged to higher-cost consumers and that limit who can be excluded for a health plan.

- “The Republican plan also proposes reforming Medicaid and the State Children’s Health Insurance Program (SCHIP) by giving beneficiaries the option of getting a voucher to purchase private insurance”: Republicans would take some beneficiaries out of Medicare and CHIP and leave them in the hands of private insurers (in the individual market). But how would this swap control costs? Legislators had proposed “premium payment” support back in the 90s — that is, subsiding the purchase of private coverage — and analysts have concluded that the only way to control costs is to provide a “premium payment” that depreciates every successive year. In other words, the voucher may start at “100% of the Medicare benefits on average” in 2009, but it will diminish as health care costs increase. According an analysis by the National Academy of Social Insurance of the Breaux/Thomas premium support proposal, federal subsidies would not keep up with growing insurance premiums and could relegate “lower-income beneficiaries to lower-cost and possibly lower-quality plans.”

- “Our legislation is paid for. By requiring a 1 percent annual step-down in discretionary spending, plus other efficiencies”: The Republicans had proposed this “cost saving” measure in their alternative budget. As Pat Garofalo explained, an across the board cut would allow inflation to eat away at vital funding for programs like Head Start, Pell Grants and the entire public health infrastructure, and make cuts without any regard to merit.

- “The Republican plan also addresses the issue of medical liabilities that doctors face”: While medical malpractice reform is an important issue, malpractice costs represent only 0.46 percent of total health care expenditures. Republicans attempt to group the larger problem of practicing too much defensive medicine with liability reform, but as Kate Steadman explains, “the research that has been conducted indicates, for the most part, that defensive medicine has little effect overall and that states with tort reform only have slightly lower rates of spending than those without.” For instance, after Texas passed its landmark tort reform legislation in September 2003, the state continued to grapple with the highest uninsured rate in the nation. As the Houston Chronicle points out, “malpractice issues are a small scab on Texas’ ailing health care system. The cancer is the number of uninsured. Increasing the number of doctors and specialties only does so much good when many Texans can’t afford to make an appointment.”

GOP Health Plan Is Modeled on Banking Deregulation

Apparently incapable of coming up with a single new idea, House Republicans plan to release a health plan today which is plagiarized almost entirely from the McCain-Palin health plan that voters soundly rejected last November.  Amazingly, the “new” GOP plan even lifts McCain’s widely-panned proposal to deregulate the health insurance industry in exactly the same way the banking industry was deregulated over the last several decades.  As McCain promised during the 2008 campaign:

I would also allow individuals to choose to purchase health insurance across state lines. . . .  Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.

Here’s how this “new” plan works:  Once upon a time, banks were governed by something known as “usury laws,” state laws which prohibited lenders from charging excessive interest to homeowners and other borrowers.  In 1978, however, the Supreme Court held that banks are only required to follow the usury laws of the state where they are “located,” effectively immunizing banks from the interest rate caps in each of the other 49 states.

The result was a race to the bottom where states competed to enact the least protective usury laws in order to coax the banking industry into relocating within their borders.  Eventually, South Dakota “won” this race by repealing its usury laws altogether, and Citibank rewarded South Dakota by moving its lending offices to that state.  The rest of the industry soon followed suit, immunizing itself from interest rate caps altogether by locating in places like South Dakota.

At a time when Americans are terrified of being denied care because of a preexisting condition, or even having their health insurance provider pull coverage the minute they get sick, the McCain-Palin/House GOP health plan calls for health insurers to have even greater latitude to deny coverage; and it does so by fully adopting the banking model’s approach to state regulation.  If the House Republicans are successful in enacting their plan, a short list of laws that would effectively cease to exist includes:

• Women’s Health: 49 states and the District of Columbia require health plans to cover reconstructive surgery after breast cancer, mammograms, and maternity stays;
• Fair Appeals: 44 states and the District of Columbia allow patients to appeal denials of coverage to an external review board;
• Preexisting Conditions: 38 states and the District of Columbia restrict how far into the past a insurance company can “look-back” to determine whether a patient is disqualified because of a preexisting condition;
• Healthy Children: 31 states require health plans to cover well child care.

The choice is clear.  President Obama has promised to cut health care costs, expand coverage and eliminate discrimination against Americans with preexisting conditions.  Conservatives have a very different vision.  They think that insurers “don’t need to be ‘kept honest’ by the government,” and they plan to dismantle many of the existing laws which Americans rely on to ensure that their medical conditions are covered.  We have already seen the cost of bank deregulation on the nation’s economy; it is truly mind boggling that conservatives want to do the same thing to health care.

What Does The Blue Dog Compromise On Health Care Say About The Blue Dogs?

After arguing that the House health care bill did not do enough to lower long term health care spending, Blue Dog Democrats hijacked the House Energy and Commerce Committee and promised to vote down the bill unless Chairman Henry Waxman (D-CA) heeded their concerns.

Today, the Dogs and the Dems reached a compromise:

- Reimbursement rates for public plan should be no higher than market rates: Rather than reimbursing at five percent above Medicare rates, the new public option will now directly negotiate rates with providers.

- States can offer an insurance co-op alongside public plan: Presumably this state-based cooperative would act like any other not-for-profit insurer and will lack the market clout to drive bargains and lower costs.

- Premium cap goes from 11% of income to 12%: Loosening the affordability measures is certainly one way to bring down the cost of health reform, but it does little to help families purchase coverage.

- States must pay 7% of cost of additional Medicaid enrollments: States are already worried that the plan to expand Medicaid would leave them on the hook for financing the expansion after the five year grace period (for the first five years, the federal government funds the expansion, after that, the states would gradually assume half the cost.) This will likely stoke their concerns.

- Small business exemption for payroll up to $500,000; phases out at $750,000: The original language exempt businesses with a payroll of less than $250,000 and charged a penalty on a sliding scale.

- Cost of bill must come in at under $1 trillion: Most health reform advocates believe that is nearly impossible to provide everyone with affordable health care coverage under $1 trillion.

On the whole, these tweaks are rather minor. Most observers interpreted the hoopla surrounding the negotiations as a sign of serious trouble. If the outline above is correct, then the dogs came back with their tail somewhat between their legs.

Secondly, the agreement only reinforces the notion that Blue Dogs are more interested in ideological politics than lowering long-term health care spending. After all, if they really wanted to lower costs, they would support reform that includes a robust public option and generous affordability measures so that every American is part of the health care system and has access to needed care. After all, if the public plan pays bloated market rates (as this agreement states) it will fail to offer lower premiums within the Exchange, and would cause the government to spend more money on subsidies. Unfortunately, the Blue Dogs are trying to lower the costs by making insurance less affordable and undercutting a meaningful public option.

Conservatives Fabricate ‘Mandatory’ End-Of-Life Consultations In House Bill »

Yesterday, during President Obama’s AARP town hall, a caller stated that she had “heard lots of rumors going around about this new plan…I have been told there is a policy there that everyone that Medicare age will be visited and told to decide how they wish to die.” This “rumor” which may have been started by infamous health care provocateur Betsy McCaughey has made its way into the standard conservative critique of the Democrats’ reforms:

- Laura Ingraham: Old people could be visited in their homes and essentially be told ” all right, sweetie, you’ve had a good life...I don’t want a government bureaucrat telling him what kind of treatment he should consider to be a good citizen. That’s frightening.

- Rep. Virginia Foxx (R-NC): [Americans will be] put to death by their government.

- Rush Limbaugh: The bureaucratic going to make the decisions. You aren’t. And it’s in the House bill. Once you reach, I don’t know what the age is, every five years, it’s in the sixties, every five years some counselor shows up.

- Sean Hannity: In other words, they would mandate that those who get government care literally could be pushed to refuse care.

Watch a compilation:

To substantiate their claims, conservatives point to SEC. 1233 of the House Tri Committee bill, a section titled “ADVANCE CARE PLANNING CONSULTATION.” But while the language allows Medicare to reimburse providers for consulting with patients about end-of-life issues, nothing in the section mandates a consultation. On page 429, the bill specifically states that seniors “may” consult with medical professionals — not government bureaucrats:

The bill aims to provide seniors with information about drafting a living will or the options surround end of life care, information Americans have been asking for. A recent report by ThirdWay found that “although 75% of Americans feel advance directives are a good idea, only 40% of Medicare patients say they have one.” Given the lack of clear information, “many patients sign documents that don’t offer clear instructions. Family members may have conflicting feelings about the care they wish to see a patient receive…For elderly patients, their end-of-life wishes regarding care are often unknown or ignored.” The new optional Medicare service seeks to reverse that trend and help patients make more informed end-of-life decisions.

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