Reid has promised to give Senators at least 72 hours to review the legislation, and debate isn’t expected to begin before Friday, November 17th. Sixty senators will have to vote on a measure to begin what could be six weeks of debate, and 60 votes will stop it.

Before the Senate begins its marathon session — which could last many weeks and weekends — here is a summary timeline of some of how far reform has come, and how far it has to go:

June 2009: Health, Education, Labor, and Pensions Committee Releases ‘Affordable Health Choices Act’ and begins considering the legislation in committee.

June 2009: The Senate Finance Committee’s “nothing-burger” proposal is leaked. The legislation does not include a public health insurance option or a requirement that large employers provide coverage.

June 19, 2009: House releases the first draft of its Tri-Committee proposal. The legislation includes a robust public option, a requirement that all large employers provide health insurance coverage, and a surtax on wealthy Americans.

July 13, 2009: After 13 days and more than 60 hours of debate the HELP Committee passed health care reform. Not a single Republican votes for the bill. Instead, they lie about it.

July 31, 2009: All relevant House Committees mark-up and pass the House health care bill by this date.

August, 2009: Republicans misrepresent the consequences of reform in town halls across America.

September 9, 2009: Obama pushes for health care reform before a joint session of Congress.

September 2009: Sen. Max Baucus (D-MT) releases the Senate Finance Committee health care bill after 6 months of bipartisan negotiations. The bill is attacked from the left and the right. The Committee begins marking up the proposal.

October 13, 2009: The Senate Finance Committee passes the health care bill 14-9. Sen. Olympia Snowe (R-ME) becomes the only Republican to vote for health care reform.

October 26, 2009: Majority Leader Harry Reid (D-NV) announces that the final health care bill will include a national public health insurance option, but gives states the option to opt-out of the plan.

October 29, 2009: House Speaker Nancy Pelosi (D-CA) unveils the merged House health care bill.

November 7, 2009: In a 220-215 vote, the House passes bipartisan health care reform legislation. Rep. Joseph Cao (R-LA) becomes the second Republican to vote for health care reform.

November 17, 2009: Reid will unveil the merged health care bill and the Congressional Budget Office’s analysis. Will promise to bring the bill to the floor on Friday.

November 20, 2009: At least 60 senators vote to begin debate on the health care reform bill. Minority Leader Mitch McConnell (R-KY) predicts that the legislation “will be on the floor for quite a long time.” “I think it ought to be on the floor at least as long as it’s been in Harry Reid’s office,” he said on Sunday.

December 21-23, 2009: The Senate passes health care reform bill.

January 2010: The Conference committee merges the Senate and House bills. Will it keep the Stupak language? What will happen to the public option and the employer mandate? How will the conference finance reform? Will it keep the Senate’s excise tax or opt for the House’s surtax on wealthy Americans?

February 2010: The House and will Senate vote on the final conference report.

February/March 2010: President Obama signs health care reform into law.

Here are the five key sets of questions they have to confront, both in the Roosevelt Room and in their consultations with Congress:

1 – What is “death with dignity” for the public option? Is it better for the president to sacrifice it himself? Or convince Democratic leaders behind closed doors to come to him? Some will argue for taking the public option issue to the floor, passing it through the House and sacrificing it in conference – but once you’ve gone that far, it may be impossible for House Democrats to back down. So, giving it up on the front end in some fashion is likely the preferred option.

While the politics of the public option are obviously complex, the conventional Washington wisdom surrounding the process and means for achieving health reform is infuriating. Here, Stephanopoulos strategizes the different ways in which Democrats could abandon the President’s signature campaign issue, the most popular and one of the more important element of health care reform and the one “sliver” that has energized the President’s liberal base.

Stephanopoulos believes that rather than fight and defend good policy from the lies and smears of the right and find ways to push the option through, the administration should just give up and move to the center. After all, pleasing American “moderates” and conservatives, and of course the very actors — private health insurers — who have made reform so necessary in the first place, is the key to good politics.

This is Washington centrism at its finest and it mostly applies to Democrats.

The Constitution assigns only limited, enumerated powers to Congress and none, including the power to regulate interstate commerce or to impose taxes, would support a federal mandate requiring anyone who is otherwise without health insurance to buy it. [...]

Significantly, in two key cases, United States v. Lopez (1995) and United States v. Morrison (2000), the Supreme Court specifically rejected the proposition that the commerce clause allowed Congress to regulate noneconomic activities merely because, through a chain of causal effects, they might have an economic impact. These decisions reflect judicial recognition that the commerce clause is not infinitely elastic and that, by enumerating its powers, the framers denied Congress the type of general police power that is freely exercised by the states.

For starters, the Post showed exceptionally poor judgment by choosing to publish the authors of this op-ed, right-wing attorneys David Rivkin and Lee Casey. The same duo labeled Amnesty International “un-American” after it criticized widespread human rights abuses at Guantanamo Bay, and they recently claimed that Bush-era DOJ memos authorizing the use of torture “prove we didn’t torture.”  Rivkin once claimed that President Bush had unilateral authority to use weapons of mass destruction on Russia. 

Saturday’s op-ed, however, is weak even even by Rivkin and Casey’s low standards.

In essence, the duo argue that Congress does not have the power to enact an individual mandate because such a mandate is “noneconomic” in nature.  Yet while they are correct that the Supreme Court has held Congress’ power to be more limited when it regulates outside of the economic sphere, their claim that insurance regulation is not “economic” is frankly absurd.

The provision Rivkin and Casey take aim at would require most uninsured Americans to buy a product — health insurance coverage — which pools thousands of people’s premiums together and pays those people’s medical costs as they become ill.  As Rivkin and Casey admit, the individual mandate would lower premiums nationwide by requiring more healthy individuals to buy into the system; while reducing the risk of catestrophic financial loss should a person who was previously uninsured experience catestrophic illness.  It is difficult to imagine a law which has a more obvious economic impact than a requirement that all Americans be insured.

Neither the Lopez nor the Morrison case, which Rivkin and Casey point to in their op-ed, support their claim that insurance reform is not economic in nature.  Lopez struck down a federal ban on guns in school zones; Morrison struck down a law providing federal remedies to the victims of violence against women.  Thus,  both cases involved activity that is far less economic in nature than the purchase of health insurance.  Neither carrying a gun nor committing an act of violence involve a sale, a market, or an exchange of something of value.  No employer hires workers simply to carry a gun into a schoolhouse; and there is little marketplace for cowardly acts of violence.

Simply put, Rivkin and Casey’s attack on health care reform has no basis in reality–and no grounding in the Constitution.  Even right-wing legal academics have dismissed it as entirely without merit.  Hopefully, next time these discredited attorneys submit a piece to the Washington Post, its editors will have the good sense to point them to a more appropriate publication.

It is not within our power as members of Congress, it’s not within the enumerated powers of the Constitution, for us to design and create a national takeover of health care. Nor is it within our ability to be able to delegate that responsibility to the executive.

Watch it:

Bachmann, however, is wrong about both the contents of the health care plan and the requirements of the Constitution. There is nothing in any of the health care bills under consideration which resembles a “national takeover of health care.” Conservatives like to use this language when referring to the public health option. Like other insurers, the public option would collect premiums from people who choose to buy into it, and then spend those premiums to insure these participants.

Had Bachmann bothered to read Article I of the Constitution before going on Fox, she would have learned that Congress has the power to “lay and collect taxes, duties, imposts and excises” and to “provide for….the general welfare of the United States.” Rather than itemizing specific subject matters, such as health care, which Congress is allowed to spend money on, the framers chose instead to give Congress a broad mandate to spend money in ways that promote the “general welfare.”

It’s unclear what the basis is for Bachmann’s claim that the public option is an unconstitutional delegation of power to the Executive. There is a 74 year-old decision — decided by the same right-wing Supreme Court which believed most of the New Deal to be unconstitutional — which holds that Congress could not simply grant President Roosevelt nearly limitless authority to do whatever he wanted in order to prevent “unfair competition.” But no one has proposed giving President Obama similarly unchecked authority over health care. Rather, pages 116-128 of the House bill that Bachmann will vote on provide extremely detailed instructions explaining how the Executive Branch must manage a public health plan.

It’s important to note just how radical Bachmann’s theory of the Constitution is. If Congress does not have the power to create a modest public option which competes with private health plans in the marketplace, then it certainly does not have the authority to create Medicare. Similarly, Congress’ power to spend money to benefit the general welfare is the basis for Social Security, federal education funding, Medicaid, and veterans benefits such as the VA health system and the GI Bill. All of these programs would cease to exist in Michele Bachmann’s America.

Cross-posted on ThinkProgress.

In recent weeks, the Obama administration has refocused its campaign on current insurance market practices as the cause of rising costs.

Attempting to shift the blame to doctors’ fees, Karen Ignagni and America’s Health Insurance Plans (AHIP) released a report yesterday on out-of-network physician billing. “No politician has asked how much is being charged,” Ignagni said. HR 3200 requires disclosure on out-of-network costs, reduces overpayments, and changes Medicare payment rates to doctors and hospitals.

The study compared out-of-network billing rates to Medicare rates. Out-of-network physicians are free to charge non-negotiated, often times higher rates. The study attempts to show the arbitrary nature of procedure pricing or as Dr. Uwe Reinhardt calls it, “lunacy”:

“Some out-of-network providers are charging exorbitant prices – several hundred or even over a thousand percent of the Medicare reimbursement for the same service in the same area. Recent examples: … $40,000 for a total hip replacement when Medicare would have paid $1,558.”

While physician fees are a part of the cost problem, this study does not show the role of private insurers in the billing process and fails to address in-network private insurance billing rates, which make up over 90% of claims. Including these lower in-network rates would undoubtedly prove that a vast majority of billing rates are lower than the excessive out-of-network rates.

Moreover, the procedures by the insurance industry are not comparable across Medicare and private insurers. Procedures such as hip replacement, coronary bypass, and cataract surgery are more common in the +65 year old population and oftentimes involve more expensive conditions in younger patients.

Highlighting Medicare as a comparison is deliberative. Back on the offensive, AHIP is resorting to their previous cost shift argument that the government reimburses too low forcing insurers to pick up the cost.

The commission approved the draft language by a vote of 4-2, with two abstentions. Two Republicans and two independents voted for it, two Democrats voted against it, and two Republicans abstained. The letter needs to be approved again before being sent.

Once upon a time, the Commission played an essential role in enacting landmark civil rights legislation, visiting communities ravaged by segregation and Jim Crow to document widespread discrimination.  Today, however, it is little more than a dumping ground for opponents of civil rights from right-wing policy shops.

Although only four of the Commission’s eight members are presidential appointees chosen by George W. Bush, three quarters of its membership is controlled by the far right.  Indeed, the Commission’s two “independent” members–both chosen by Republicans in Congress–may be its most ideologically conservative.  They include Todd Gaziano, director of the right-wing Heritage Foundation’s legal policy shop, and Gail Hariot, who co-chairs one of the right-wing Federalist Society’s practice groups and who spearheaded the effort to pass California’s Proposition 209, a far-reaching ban on race-conscious laws in California.

And Gaziano and Hariot are hardly the only representatives from the right-wing policy community.  The Commission’s Bush-appointed Vice-Chair is Abigail Thernstrom, a leading opponent of civil rights laws who is a “scholar” with the American Enterprise Institute, a former Senior Fellow with the Manhattan Institute, and who serves on the board of the Institute for Justice, a radical libertarian law firm.  The Commission’s Staff Director, it’s most senior full-time staffer, is Martin Dannenfelser, a former vice-president with the Family Research Council–a virulently anti-gay organization which once claimed that gay men and lesbians view “pedophiles as the ‘prophets’ of a new sexual order.”

So the Washington Times’ big “exclusive” is that senior staffers at right-wing think tanks oppose health care reform.  Maybe next week, they’ll notice that the sky is blue.

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.

She can afford to pay higher taxes.

One of the many options that the committee reportedly has on the table for covering a portion of the $1.5 trillion cost is applying a 1.45 percent Medicare tax to capital-gains and other non-wage income:

The proposal, modeled after a plan released this week by Citizens for Tax Justice, would force people living off investments to contribute taxes to the health-care system, said Steve Wamhoff, legislative director for the Washington research group…“If the only income Paris Hilton gets is capital gains, stock dividends, interest and other types of investment income, currently she is completely exempt from the one big tax we have right now that is dedicated to health care,” Wamhoff said. “We’re saying that probably doesn’t make sense.”

Estimates show that the measure would raise $100 billion over 10 years, but “the proposal is sure to draw fire from Republicans.” “Any proposal that increases the tax on capital income will ignite supply-side conservatives in opposition, as capital gains taxes are enemy number one,” said said Alex Brill, an economist at the American Enterprise Institute. “This is a tax increase that is easy for Republicans to attack.”

It might be an easy tax increase for Republicans to attack, but it should be an easier one for Democrats to defend. The Medicare payroll tax is the “one important tax we already have that is dedicated to funding health care, but it completely exempts wealthy investors whose income takes the form of capital gains, stock dividends, and interest.” Plus, dividends and long-term capital gains are currently taxed at a far lower rate than income earned by other means, with taxpayers in the 25, 28, 33, and 35 percent income tax brackets paying 15 percent. Before the Bush tax cuts of 2003, the capital gains and dividends rate for people in these brackets was 20 percent.

According to an analysis by Citizens for Tax Justice, if this change occurred, “most Americans would either see no tax increase at all or would see a tax increase of less than $100 a year.” More than 64 percent of the increase would be paid by the richest one percent of Americans, and more than 80 percent would be paid by the richest five percent. And for the tax to not unfairly hit moderate income seniors who live off of investment, some sort of senior exemption would need to be included.

CIS’ “findings” were also featured in Jerome Corsi’s Red Alert newsletter. Corsi is already well known for authoring two error-ridden anti-Obama books. His “controversial and often bizarre views,” include xenophobic government conspiracy theories as expressed in his book, “The Late Great USA: The Coming Merger With Mexico and Canada.” Stephen Camarota, Director of CIS Research, told Corsi, “It is not too much to say that the nation’s problem with those lacking health care insurance is being driven by the nation’s immigration policy.” Krikorian is also quoted as saying, “We don’t have an uninsured crisis…We have an immigration crisis.”

What Corsi, Krikorian, and Camarota all conveniently fail to mention is that there were years during the post-1989 period during which the number of uninsured native-born citizens dropped dramatically. By leaving out this significant piece of information, anti-immigrant zealots are able to make it look as if immigrants were a larger share of the total increase in the uninsured than is really the case.

In a personal email correspondence, Dr. Walter Ewing, Senior Researcher at the Immigration Policy Center (IPC) further criticizes CIS for muddying the national health care debate with their anti-immigrant agenda. “Given that nearly 80 percent of the uninsured adults and children in this country are U.S. citizens, it is difficult to fathom how Mark Krikorian can treat this as an immigration issue,” says Ewing.

Ezra Klein has pointed out that excluding immigrants from a national health care system, as groups like CIS advocate, could do more harm than good as unskilled or semi-skilled insured native workers are left to compete with cheaper uninsured undocumented immigrants. As CIS and their anti-immigrant allies exploit the health care issue to make the case against immigration, some have gone as far to argue that immigration reform which includes a legalization program for undocumented immigrants could actually solve labor cost disparities and pave the way for health care reform:

“Most immigrants—legal and illegal—to this country are hard-working, young, and in relatively good physical shape (especially compared to native-born Americans). They make far fewer demands on the public purse than, for example, the average retiring baby boomer. If placed on a pathway to citizenship, they comprise a potentially huge new block of taxpayers—taxpayers that could be critical to balancing the long-term ledger for health care, social security, and other entitlements.”

– The “Hot Air Tour” promoting global warming skepticism and attacking environmental regulations.
– “Free Our Energy,” a group promoting increased domestic drilling.
– The “Save My Ballot Tour,” a group that pays Joe the Plumber to travel around the country smearing the Employee Free Choice Act.
– “No Climate Tax,” a group dedicated to the defeat of Clean Energy Economy legislation.
– “No Stimulus,” a group launched to try to stop the passage of the Recovery Act.

Notably, AFP was also instrumental in orchestrating the anti-Obama, anti-tax tea party protests in April.

With nearly 70 Republican operatives and former oil industry spokesmen working behind the scenes of AFP’s various fronts and disclosures that point to ever increasing oil and corporate donations to the group, one must wonder, who is guiding this massive front group factory? The answer is Tim Phillips, the President of AFP who has built a long career of inventing fake grassroots causes. In Phillips’ official biography, there appears to be over a 10 year gap — but that period was when Phillips developed his very first astroturf groups to do everything from smearing his opponents with anti-Semitic attacks to laundering money for criminal lobbyists.

Click More To Read The WonkRoom’s Investigation Of AFP’s Tim Phillips

As a Virginia-based political consultant, Phillips got his first big break managing the campaign of Rep. Bob Goodlatte (R-VA). After serving as Goodlatte’s chief of staff for four years, Phillips joined former Christian Coalition director Ralph Reed in 1997 to create an astroturf lobbying and campaign consulting operation called Century Strategies. The firm promised to mount “grassroots lobbying drives” and explained its strategy as “it matters less who has the best arguments and more who gets heard — and by whom.”

After being recommended by Karl Rove, Century Strategies signed its first major corporate client – Enron. Phillips and Reed were paid $380,000 to mobilize “religious leaders and pro-family groups” to push energy deregulation in Congress and on the state level, a policy shift that led to the energy crisis and economic meltdown of 2001. The Washington Post reported that the pair informed Enron that they had leveraged their relationships with members of Congress and “placed” articles in prominent papers like the New York Times.

Part of Phillip’s role at Century Strategies was to manage the firm’s direct mail subsidiary, Millennium Marketing. In 1998, now disgraced lobbyist Jack Abramoff hired Phillips’ firm to pressure members of Congress to vote against legislation that would have made the U.S. commonwealth of Northern Mariana Islands subject to federal wage and worker safety laws. A federal report “found that Chinese women were subject to forced abortions and that women and children were subject to forced prostitution in the local sex-tourism industry.” Nonetheless, Phillips sent out mailers claiming Chinese workers “are exposed to the teachings of Jesus Christ” while on the islands, and many “are converted to the Christian faith and return to China with Bibles in hand.” The mailers then encouraged the recipients to contact lawmakers and ask them to oppose the Marianas labor reform legislation.

The Marianas stealth lobbying effort was not the only time Phillips worked with Abramoff. Reed and Phillips conspired to generate conservative Christian outrage towards gambling at Indian casinos in a cynical plot to encourage those same tribes to hire Abramoff to lobby on their behalf. In some cases, Phillips’ anti-gambling crusade would simply be part of an effort to kill off competition to Abramoff’s clients. And while Phillips and Reed postured to be motivated by anti-gambling Christian values, the pair helped launder lobbying money from an Abramoff Internet gambling client called eLottery.

Though Phillips and Reed are best known in the campaign consulting world for engineering the dual victories of Sen. Saxby Chambliss (R-GA) and Republican Gov. Sonnie Perdue in Georgia (by associating images of Osama bin Laden with the incumbent Democratic senator), the pair can also be credited with the most below the belt tactics ever seen in modern Republican primaries. The duo “spearheaded” the telemarketing and direct mail efforts for George Bush against John McCain in the 2000 primaries. It is widely believed that Century Strategies executed the mass mailers and robo-calls which accused McCain of fathering an illegitimate child with a black woman, using the image of McCain’s adopted daughter from Bangladesh.

Phillips’ brass knuckled hits on fellow Republicans almost prevented the only Jewish Congressman in the GOP caucus from ever being elected. Phillips set up a 527 called “The Faith and Family Alliance,” a group supposedly designed to support conservative and Christian causes. But like his other front groups, Phillips used the Family Alliance to simply slime his political opponents with an organization that appeared to represent a grassroots community. The Richmond Times Dispatch reported that Phillips was hired by State Sen. Stephen Martin to manage his direct mail campaign against State Del. Eric Cantor in the 2000 Republican primary for the Congressional seat being vacated by Rep. Tom Bliley (R-VA). Phillips used his Family Alliance to blast robo-calls and mass mailers claiming Cantor did not represent “Virginia values” and that his opponent was the “only Christian in the contest.”

Larry Sabato, a political analyst and the director of University of Virginia’s Center for Politics, noted:

A despicable, underground campaign that was unquestionably anti-Semitic nearly beat Cantor in the GOP primary for U.S. House to succeed Tom Bliley in June 2000. Cantor had been heavily favored over state Sen. Steve Martin, but in the end he won by a couple hundred votes. Now the national and state GOP appears grateful for its lone Jewish House member — but the Republican base and some Christian groups almost insured his defeat. I’m amazed that Democrats and even Republicans haven’t raised this matter.

Indeed, after the Phillips’ anti-Semitic attacks, Cantor went from being high in the polls to barely winning the primary by a mere 264 votes. Phillips still holds rallies – under the umbrella of AFP – to boost his old client Sen. Martin.

Phillips managed to escape most of the controversy that eventually embroiled his partners Reed and Abramoff. Working under the slush fund provided by oil baron David Koch – with a salary approaching $300,000 a year and at least a $7 million annual budget – Phillips continues to lead AFP in building front group after front group to advance his radical right wing agenda.

Those who oppose health reform are choosing to maintain this status quo.

A new paper from the Center for American Progress, “America Without Health Reform,” points out that, absent reform, average premiums (the cost of health insurance to families and businesses) are projected to rise more than 70 percent from 2010-2018, according to the Congressional Budget Office.

Read it here.

This cost growth will have cascading effects across the economy as businesses trim benefits and workers lose their coverage.

According to researchers at Harvard University, a mere 20 percent increase in premiums costs 3.5 million workers their jobs, causes millions more to move from full-time to part-time work, and cuts the average income by approximately $1,700. CBO predicts that this 20 percent increase will occur over the next four years.

Today, more than 51 million Americans under age 65 do not have health insurance as of January 2009, and millions more drift in and out of coverage as their employment and financial situation changes. Approximately 87 million Americans under 65—nearly one in three—went without health insurance for some period in 2007 or 2008.

Even as the economy recovers over the coming years, swelling health care costs could cause businesses to continue cutting back on health care, dropping more of their employees into the ranks of the uninsured. A recent survey by Hewitt Associates found that approximately 20 percent of employers were planning to stop offering health benefits in the next three to five years, up from just 4 percent of employers in the 2008 survey.

Without reform, our broken health care system will continue to squeeze families, businesses, doctors, the federal budget, and the economy. Every day, the status quo is increasingly indefensible.

Read the full report here.

As doctors, we see the effects of our broken health system on our patients every single day. We have seen what happens when our patients are denied the care they need, or when they lack access to preventive care, or when they cannot afford their medicines. Doctors know what’s wrong with our health care system — and have ideas about how to fix it. And yet, when it comes to health reform, doctors voices have not been heard.

Doctors for America is working to change that. We are a grassroots organization that seeks to engage physicians in healthcare reform and give them a voice. Our current membership includes over 11,000 physicians from all 50 states, with more and more members every day. Our goal is to convey the ideas and experiences of physicians to achieve healthcare reform based on four key pillars:

1) affordable coverage
2) expanded access to care
3) high quality care
4) practice environments that allow physicians to focus on patient care.

Incorporating the experiences and perspectives of individual physicians is critical to fashioning a solution to our current healthcare crisis. Right now, we’re in the midst of a nationwide campaign to make physicians’ voices heard on health reform: Voices of Physicians. Over the past two weeks, more than 1,000 physicians have added their names to a national map to share their concerns about the healthcare system. As lawmakers put together health reform legislation, it is imperative that they know physicians’ priorities for reform. Voices of Physicians allows physicians from all across the country – the individuals who see our broken healthcare system firsthand each and every day –- to tell Congress and the public what concerns us most about the current healthcare system, and what can be done to allow us to take better care of our patients.

At Doctors for America, we believe that physicians must continue to make our voices heard on critical issues in health reform. Over the next six weeks, we will launch a series of one-week campaigns, each focused on a specific issue of relevance to the health reform effort. The goal will be to educate physicians and the public about these issues and allow the opinions of physicians to be conveyed to Congress and the media. Together, we will continue to build a strong coalition of physicians and patient and professional organizations committed to health care reform.

Ask your doctor how he or she would fix our health care system — and tell them to add their voice to the map. And please visit us at www.drsforamerica.org for more information or to get involved.

Watch it:

These ads attempt to conflate the current health care reform proposals before Congress with the government-run health care systems in other parts of the world. This is wrong.

Current reform proposals would let families keep their current doctor and insurance plan, let them choose a public insurance plan if they prefer, give doctors and patients better information to make healthy choices, bring down the costs that are burdening businesses and family budgets, and increase access to insurance for the 52 million Americans without coverage.

Since the beginning of the recession, over 730,000 workers have lost the insurance they once had through their jobs. In many, when they lose coverage, their spouses and children lose coverage also. People who have a history of medical conditions are turned away from private health insurance plans, or face higher co-pays and deductibles.

Rick Scott’s only answer to this spiraling crisis is to block reform and distort the solutions offered by others.

BRALEY: Have you published any peer reviewed treatises in a journal of economics on health care policy?
PIPES: Yes.

BRALEY: Can you give us some examples?

PIPES: I’ve done some things in Health Affairs over the past and –

BRALEY: But can you just identify the scholarly journal that’s a peer reviewed journal of economics?

PIPES: Well, Health Affairs is, I think. I don’t know whether you would say it is.

UNINDENTIFIED: It’s peer reviewed.

Listen:

Searching ‘Pipes’ in the author field of the Health Affairs website yields one result — a Letter to the Editor titled ‘Piping A Different Tune.’ In the letter, Pipes responds to what she describes as a “hostile” book review of Who Killed Health Care: America’s $2 Trillion Medical Problem–and the Consumer Driven Cure:

The author of the review responds to Pipes, highlighting her not-so-academic approach to policy: “Sally Pipes’ riposte to my review of Regina Herzlinger’s book, Who Killed Health Care, offers rhetoric and faith-based posturing but little evidence. Whilst it can be intellectual fun and politically advantageous to repeat the principles of bottom-up, makret oriented health care, the practice is usually inflationary, inefficient, and inequitable.”

That is not in the President’s budget…it does not include this provision. This appears to be coming from the administration and representatives of the administration who went to Congress and said we are open to all ideas to pass health care reform…there are some people in Congress who are pushing for this, but that is not the President’s idea….he is open to all ideas. He said, let’s put all ideas on the table. That is not the president’s idea. It is not in his health care plan, it is not in his budget.

Watch it:

The press has argued that the “proposal is politically problematic for President Obama,” since it is similar to one he denounced in the presidential campaign as ‘the largest middle-class tax increase in history.” But in reality, the the consequences of Obama’s proposal are quite different.

The problem was never the tax exclusion itself. Rather, progressives were concerned about what would happen to individuals who lost their employer-sponsored health coverage once the tax code changed. McCain proposed replacing the employee deduction with a one-size-fits-all tax credit without reforming the health insurance market or expanding access to group coverage. Under his plan, Americans who lost their employer coverage would have had to fend for themselves in an unregulated individual health insurance market; Americans with pre-existing conditions would have joined the ranks of the uninsured.

Obama is using the measure as a means to finance comprehensive reform. Should someone lose their employer-based coverage, they will be able to purchase affordable insurance through a regulated exchange that cannot deny coverage to Americans with pre-existing conditions.

The theory behind capping the health exclusion rests on the assumption that the tax-preferred status of employment-based health coverage leads workers to over-insure and use more health care services than they otherwise would. Overuse of insurance drives up insurance premiums and makes coverage less affordable for lower-income workers.

The Congressional Budget Office (CBO) estimates that the exclusion of employer paid health insurance from income taxes costs the government about $145 billion and the exclusion from payroll taxes costs $100 billion. And the savings only increase over time. As CBO chief Douglas Elmendorf explained during a recent Senate Budget Committee hearing:

All tax provisions grow to some extent over time because the economy grows and prices rise, but this — the value of this exclusion grows with health-care spending over time. So, our estimate of the value of this provision, I think more specifically the way the Joint Tax Committee estimated some of these options has growing over time with health care spending because whatever employers end up putting into health insurance does not count as taxable income.

In fact, Elmendorf argued that “the cleanest and strongest level that you have about private health care is the tax exclusion. As I said in my testimony, I think many analysts would agree that adjusting that exclusion can be very beneficial for health insurance coverage and for ensuring a more efficient health-care system.”

The approach, which would allow Obama to finance a large portion of health care reform with money that’s already in the system and please conservative Democrats and some Republicans who don’t want to pump new money into health care, isn’t without its problems. A Employee Benefit Research Institute Brief concluded that capping the tax exclusion for employment based health coverage could become “a complicated and administratively costly burden” for self-insured employers and warned that workers would “face a variety of equity issues if the tax exclusions of health coverage were capped.”

At yesterday’s forum in Dearborn, Michigan, for instance, representatives from insurance companies, labor unions, “workers and retirees; and nursing professors, among other stakeholders in the health care overhaul debate” agreed “on the need for health care reform” and urged the president to “emphasize preventive, wellness and primary care, and to better utilize health information technology.”

Here is one account from the Detroit Free Press:

Being insured doesn’t always mean you’ll get the help you want. At 22, Adrian Campbell-Montgomery said, she learned she had cervical cancer. Seemingly covered under her family’s General Motors employee insurance, she was rushed into surgery. Blue Cross Blue Shield of Michigan denied payment, saying the surgery was only recommended for women 26 and older. She was in graduate school, had a small child and was now $8,000 in debt. “When does it end?” she asked during the forum. “You have to stop denying people.”

Obama’s approach serves a political purpose. Public opinion polls already indicate that the public supports comprehensive health care reform. But this kind of outreach weeds out the personal stories of insurance company malfeasance and hardships of families facing rising health care costs, and ultimately provide the administration with the same kind of emotional narrative about the need for reform that the Right often finds in the waiting lines of Canada or Great Britain.

It’s political, but it’s smart. These regional summits keep the issue in the local news — long after the national media has moved on to exploring the root cause of Anna Nicole Smith’s death — familiarize the public with progressive proposals, and allow the President and Congressional Democrats to shroud themselves in the flag of public opinion once the health care debate really heats up this summer.

For more on the White House’s regional health summits, click here.

SCARBOROUGH: Where does it go? That’s my question. Retool how? I’m not being pushy. I just keep hearing “We gotta spend that money.” What do we spend it on?

ROBINSON: Well, you know. Hopefully more than computerized electronic medical records, which I don’t think should cost as much as the administration says it should cost. You know, I don’t know. I’m not an expert in health care. I’m not.

Watch it:

Robinson may not be a health care expert, but it doesn’t take a masters in health policy to push back against pundits and policymakers who argue that investing in the system won’t lower costs or improve health outcomes.

For one, half of the money in Obama’s $634 billion health care fund actually comes from re-investing money already in the health care system, just as Gregg, Conrad and Scarborough suggest. But most reform advocates also believe that to really lower health care costs and improve health quality, $634 billion is a good start, but it’s certainly not enough. One must first invest in the system to see long-term cost savings:

- Expanding Access To Contain Costs: Expanding coverage to the 45.7 million uninsured and treading their chronic conditions won’t come cheap, but it’s necessary if we want to manage chronic diseases and offer preventive services that will treat conditions before they develop into costly medical emergencies. By extending coverage to all, you can achieve efficiencies and end cost shifting.

- Investing In Preventive Measures To Contain Costs: While the United States spent $132 billion in 2002 treating Americans with diabetes, just $70 billion went to the prevention of all diseases. It can be difficult to quantify the possible savings from expanded prevention efforts, but experts estimate that just ensuring that every child receives every routine vaccination could reduce direct and indirect health care costs by up to $40 billion over time.

- Investing In Information On Effective Treatments To Contain Costs: Today, Americans are likely to receive the appropriate care just half of the time, and approximately one-third of individuals seeking care are likely to experience a medical error such as a medication mistake or the wrong lab results. Improving quality could help save lives and contain costs. Estimates of savings go as high as 150,000 lives and $100 billion every year.

- Using Health IT To Contain Costs: Fewer than 25 percent of hospitals, and fewer than 20 percent of doctor’s offices, employ health information technology systems. Estimates vary, and real-life experience is limited, but one group of researchers finds that implementing health IT would result in mean annual savings of $40 billion over a 15-year period.

Recently, PhRMA, SEIU, the U.S. Chamber of Commerce, AARP, Aetna, AFL-CIO, and AHIP signed a letter urging Congress to suspend pay-go rules when considering health care reform: “While the cost savings from improving the efficiency and quality of health care will be significant, many of the anticipated savings will be realized in the long term, and may thus not be evident in a ten year budget window…Requiring spending or revenue offsets for the entire cost of health reform within a ten year budget window, as required under a traditional pay-as-you-go rule, will significantly reduce the likelihood of enacting legislation to achieve essential reforms for long-term savings.”

Transcript:

CONRAD: I think it’s also critically important that we recognize over the longer term we’re on an unsustainable course and it’s absolutely essential that we return to a more fiscally prudent path in the future. We’re already spending one in every six dollars in this economy on health care. We’ve had testimony before this committee that as much as 30 percent of that is being wasted. So some of us have real pause about the notion of putting substantially more money into the health care system when we’ve already got a bloated system.

ROBINSON: The idea is that you do have to spend a bit more on health care now — not a bit — a lot more on health care now — to lay the groundwork for reforms that ultimately will save you money. We have to save money on health care. We have to stop spending so much more than other [inaudible] or we bankrupt the country.

SCARBOROUGH: What is that $635 billion spent for as a down payment when our biggest problem is that it’s a bloated system? Is that for TV commercials explaining [rationing] to people?

ROBINSON: Do you need to spend $634 billion? Could it be $500 billion? Do you really need to spend 800? I confess I don’t know what the number is. But it make sense that you need to invest to retool.

SCARBOROUGH: Where does it go? That’s my question. Retool how? I’m not being pushy. I just keep hearing “We gotta spend that money.” What do we spend it on?

ROBINSON: Well, you know. Hopefully more than computerized electronic medical records, which I don’t think should cost as much as the administration says it should cost. You know, I don’t know. I’m not an expert in health care. I’m not.

[laughter]

SCARBOROUGH: Hey, you know what though? You know what — an A+ for honesty. Because nobody knows what all of these numbers are for.

We’re all familiar with the numbers. General Motors spends $71 per worker per hour on health care, while Toyota spends only $47. Health care costs add $1,525 to the price of every GM vehicle, and the company spent $5.2 billion on health care benefits in 2004. It spends more on health care than on steel, and Starbucks pays more for benefits than coffee beans.

But while Pipes’ argument is counterintuitive, it’s not entirely wrong. At least not according to the Congressional Budget Office (CBO), the agency responsible for scoring Congressional proposals. Last week, while testifying before the Senate Finance Committee, CBO director Douglas Elmendorf explained that “for employers, health care is merely a part of total compensation“:

Although U.S. employers may appear to pay most of the costs of their workers’ health insurance, economists generally agree that workers ultimately bear those costs. That is, when firms provide health insurance, wages and other forms of compensation are lower (by a corresponding amount) than they otherwise would be. As a result, the costs of providing health insurance to their workers are not a competitive disadvantage for U.S.-based firms.

But this doesn’t tell the whole story. Health care costs are soaring faster than inflation, and instead of cutting worker’s wages, businesses are struggling to keep up with costs and are scaling back coverage. The National Federation of Independent Businesses reports that “58 percent of all small-business owners” are having a “hard time keeping up with the cost of health care.”

Consequently, “in 2010, 49% of employers will reduce their health benefit plan offerings. Forty percent of employers will increase adoption on consumer-driven health plans and two-thirds of employers will move more costs to employees.

Meanwhile, the business groups are clamoring for health reform, arguing that they can’t sustain growing health care costs:

- NFIB: NFIB agrees that the current growth in healthcare costs is unsustainable for the government and for small businesses alike.

- Business Roundtable: Rising health care costs affect all American workers, employers and the government. Rising costs impact job creation, diminish the nation’s competitiveness and reduce Americans’ ability to save for retirement

- Chamber of Commerce: A healthy workforce is the backbone of a strong economy, but spiraling health care costs curb the competitiveness of U.S. businesses and constrain tight family budgets.

The CBO’s analysis, while economically and theoretically sound, is completely divorced from reality. While wages may pay for health care costs in the long run, workers won’t accept smaller paychecks every time premiums increase. As Sen. Max Baucus (D-MT) pointed out at the hearing with Elmendorf, when considering the costs and consequences of health care reform proposals, Congress should not be “in the old situation where whatever CBO says is God.” “In my judgment you’re not God,” he said.

- She has had a close personal and financial association with the nation’s most infamous abortion doctor, George Tiller, who specializes in late-term abortions.” [Family Research Council]

- Sebelius honored Tiller and his entire abortion clinic staff at the Governor’s mansion in April 2007. Tiller has contributed thousands of dollars to Sebelius and to her PAC. [The Liberty Council]

- With Obama’s appointment of Gov. Sebelius to the Department of Health and Human Services, he might as well be appointing George Tiller. [Operation Rescue]

- Sebelius, governor of Kansas – the late-term abortion capital of the world – is a threat to the health and well-being of our country and her appointment must be stopped. [American Life League]

While Sebelius vetoed legislation that would have allowed a woman’s relatives to sue an abortion provider, and bills that violated women’s privacy, she has “worked to reduce the number of abortions by supporting expanded prenatal care and adoption incentives.” As Catholics United points out, “the governor has had disagreements over public policy with leaders in her Church. Yet their disagreement has never been over the morality of abortion, but over what prudential policy is best in dealing with abortion in Kansas.”

Indeed, abortion rates declined 10 percent during Sebelius’ first three years as governor and Americans United for Life has even ranked Kansas as the 14th best state for Defending Life in 2009. As for her George Tiller connections, those too are overstated. Tiller and his staff won a dinner with Sebelius “in a fund raising auction.” Sebelius “has not taken financial contributions from Tiller as a gubernatorial candidate or as governor” and even appointed the Attorney General who is looking into allegations that Tiller did not properly fill out abortion paperwork.

None of this is an issue, and it shouldn’t be a big concern during confirmation. It’s just a fund raising tactic for the Right.

- Health, Education, Labor and Pensions Committee ranking member Mike Enzi (R-WY): “The president said repeatedly during his campaign that Americans who like the health insurance they have would keep their existing plans in his administration,” adding, “His budget proposal undercuts that promise.”

- America’s Health Insurance Plans President Karen Ignagni: “Unfortunately, this proposal would force seniors enrolled in Medicare Advantage to fund a disproportionate share of the costs to reform the health care system,” adding, “A cut of this scale would jeopardize the health security of more than 10 million seniors enrolled in Medicare Advantage and would turn back the clock on innovative payment incentives to improve the quality of care that patients receive.”

Obama’s campaigned to re-establish parity between traditional Medicare fee-for-service and Medicare Advantage plans, and for good reason. When lawmakers approved the Medicare Modernization Act, they offered an extra subsidy to Medicare Advantage plans (MA). The deal was this: Medicare would pay about 13 to 17 percent more for beneficiaries enrolled in MA Plans, and the plans would, in turn, use the increased payments to offer more benefits, reduce beneficiary cost sharing, and “expand into geographic areas where previously plan options had been very limited.”

It was supposed to be a win-win, or so proponents of MA argued. But in recent months, a trickle of government reports and independent estimates have dampened the rationale for subsidizing MA plans. The extra federal dollars don’t improve health outcomes. They pad insurers’ bottom lines, raise costs for beneficiaries in the traditional Medicare program, squeeze both Medicare and the federal budget, and drain resources from more productive uses.

Three studies published in Health Affairs, concluded that private plans “have increased the cost and complexity of the program without any evidence of improving care” and a Government Accountability Office (GAO) report found that Medicare Advantage Private-Fee-For-Service Plans (PFFS) — which are responsible for nearly half of the recent growth in MA enrollment — have exposed beneficiaries to serious financial risks. At least two different GAO reports released just in June and December also concluded private plans participating in Medicare Advantage earned greater profits and spent less on benefits.

So for the insurance groups, this is really a problem of diminishing profits. Obama wants to open up the process to competitive bidding that rewards efficiency and truly focuses on quality care. The insurance companies want to hold on to the government subsidy without really investing in preventive care, care-coordination or better care for patients.

In other words, if these plans really could provide care that is based on quality and not quantity then a competitive bidding process should compliment business models that help seniors navigate a complicated system, rather than drive them to fear monger about reforms.