Tuesday, December 22, 2009

How Deals are Made in DC: Concessions.

The AP reports on some of the concessions given to Democratic senators who held out long enough on their votes on the health care bill:

Here's a look at some of the concessions lawmakers and interest groups won in the latest version of the Senate's health care overhaul bill:



SEN. BEN NELSON, D-NEB., who provided the critical 60th vote that Senate Majority Leader Harry Reid needed, received numerous benefits for Nebraska, along with tighter curbs on abortion. Among the Nebraska-specific provisions:

_The federal government will pick up the full cost of a proposed expansion of Medicaid, at an estimated cost of $100 million over 10 years.

_Blue Cross Blue Shield of Nebraska will be exempted from an annual fee on insurers; the exemption could also apply to nonprofit insurers in other states, possibly including Blue Cross Blue Shield of Michigan.

_Supplemental "Medigap" policies such as those sold by Mutual of Omaha are exempted from the annual fee on insurers, something that would help other companies selling such policies.

_A physician-owned hospital being built in Bellevue, Neb., could get referrals from doctors who own it, avoiding a new ban in the Senate bill that will apply to hospitals built in the future. Without mentioning Nebraska or other states by name, the Senate bill pushes back some legal deadlines by several months, in effect making a few hospitals near completion eligible to continue receiving referrals from the doctors who own them.

SEN. MAX BAUCUS, D-MONT., chairman of the Finance Committee and a key architect of the legislation, put in a provision to help the 2,900 residents of Libby, Mont., many of whom have asbestos-related illnesses from a now-defunct mineral mine. Under Baucus' provision, which never mentions Libby by name, sickened residents could sign up for Medicare benefits.

SEN. CHRISTOPHER DODD, D-CONN., who is facing a difficult re-election next year, added an item making $100 million available for construction of a hospital at a public university. The measure leaves it up to the Health and Human Services Department to decide where to spend the money. Dodd says more than a dozen sites could be eligible, but he hopes the University of Connecticut will be the beneficiary.

SEN. PATRICK LEAHY, D-VT., negotiated $600 million in additional Medicaid benefits for his state over 10 years. He said Vermont is due the additional benefits because the state already has acted to expand Medicaid eligibility to the levels now contemplated by the federal government. Vermont would be unfairly penalized if other states are now being helped with that expansion, he said. Massachusetts is getting $500 million in Medicaid help for similar reasons.

SEN. MARY LANDRIEU, D-LA., a key moderate, withheld her support from the legislation until she was able to procure Medicaid help worth at least $100 million in 2011 from the federal government.

SEN. BERNIE SANDERS, I-VT., who was angered after a new government-run health plan was dropped from the legislation to win over moderates like Nelson and Landrieu, held out on backing the bill until Reid, D-Nev., agreed to a $10 billion increase in support for community health centers.

SEN. BILL NELSON, D-FLA., pushed a provision he said will let about 800,000 Florida seniors enrolled in private Medicare Advantage plans keep their extra benefits. It also helps seniors in a handful of other states. Elsewhere, Medicare Advantage patients risk losing benefits because the private plans are a major target of planned cuts to Medicare.



_Doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming will get paid more than providers in other states under formulas in the bill designed to help the so-called Frontier States.



_Longshoremen were added to the list of high-risk professions shielded from the full impact of a new tax on high-value health insurance plans. Electrical linemen were already shielded, along with policemen, firefighters, emergency first responders and workers in construction, mining, forestry, fishing and certain agriculture jobs. Sen. Jeff Merkley, D-Ore., took the lead in pushing for the longshoremen carve-out.

_Merkley also pushed for language that will exclude all but the very smallest construction industry companies from the bill's small business exemption. In general, the exemption says that companies with fewer than 50 workers aren't subject to penalties if they don't ensure their employees. In the construction business, under Merkley's change, only firms with fewer than five workers and a payroll under $250,000 would be exempt. Merkley's spokeswoman said the change was needed to ensure that construction contractors, which are overwhelmingly small businesses, provide insurance for their workers.

_Gun rights lobbyists pushed for language to ban collection of data on gun ownership in the bill.

_The American Medical Association announced its coveted endorsement Monday after Reid made a series of change to please doctors, including eliminating a 5 percent tax on elective cosmetic surgery procedures, replacing it with a 10 percent tax on indoor tanning services; eliminating payment cuts to specialty and other physicians that were to be used to pay for bonuses to primary care physicians and general surgeons in underserved areas (the bonuses remain); and dropping a proposed $300 fee (to be used to fight fraud) on physicians who participate in Medicare.

_Makers of brand-name biotech drugs — expensive pharmaceuticals made from living cells — won 12 years of protection against would-be generic competitors.

_Drugmakers fended off proposals to allow importation of cheaper drugs from Canada and other countries, and to let the government negotiate drug prices for Medicare recipients.

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The USCCBs Bully Position on Patients' Rights.

Religion Clause reports on the continued criticisms lobbed by the USCCB against the Senate version of health care reform. While I am happy to see them raise coverage for the poor and immigrants to the level of their discriminatory stance on women's rights and conscience protections for doctors, I find this extended tantrum by such a powerful organization as the Catholic Church (provider of health care via more than 620 hospitals across the country, according to their religious doctrines, despite federal funding and tax-exempt status) to be a sad departure from Christian values.

The church has despicably used its colossal role in the delivery of health care (garnered over decades of making Catholic health care it's "mission") it's excessive claims of charity and care for the poor, it's paternalistic justification for moral superiority, and false representation of it's parishioners (who predominantly support women's rights) to further the discriminatory agenda of enforcing women's role in society. They have done everything possible to stymy reform, despite their stated claims of tolerance for plurality and concern for the "least of these."

If the church has rallied Americans to oppose further expansion of abortion via health care reform because they oppose "taking from my pockets to kill the unborn," so too do I oppose the breach of church and state separation and the taking of my tax dollars for support of their "mission."

While the U.S. Senate appears poised to finally pass a health care reform bill before Christmas, the U.S. Conference of Catholic Bishops remains opposed to the Senate version on the ground that its limits on abortion funding do not go far enough. According to statements issued last Friday and Saturday by the Bishops, the Manager's Amendment (full text) to H.R. 3590 "does not seem to allow purchasers who exercise freedom of choice or of conscience to 'opt out' of abortion coverage in federally subsidized health plans that include such coverage. Instead it will require purchasers of such plans to pay a distinct fee or surcharge which is extracted solely to help pay for other people's abortions." The Bishops stressed that their criteria for acceptable health care reform includes three moral criteria: "respect for life and conscience; affordability for the poor; and access to much-needed basic health care for immigrants." According to The Boston Pilotyesterday, the Bishops applauded amendments that expanded adoption tax credits and assistance for pregnant women, but the abortion language apparently remains the block to obtaining their support.

At issue is nine pages of language (pp. 38-46 of Manager's Amendment) on how abortion coverage will be handled. It provides (1) any state may elect to bar abortion coverage in policies offered through the Exchange in that state; (2) elsewhere each insurance company may decide whether or not its plans will cover abortion services; (3) if a plan does cover abortions, no federal subsidy may be used to pay for that coverage; (4) instead the insurer must collect a separate payment from the insured for that coverage and segregate those funds for use for abortion services.

The Bishops' concern seems to be that under this arrangement, abortion coverage will still be in some policies that receive government subsidies, so long as a separate check is written for the part of the premium applicable to that coverage. Instead, according to a
Dec. 14 letter from the Bishops, they want language in the House bill that was proposed as an amendment by Sen. Ben Nelson, but was defeated by the Senate. That language provides that no federal funds could be used "to cover any part of the costs of any health plan that includes abortion coverage." After that loss, Sen. Nelson negotiated the language in the Manager's Amendment and according to AP argued that the differences were "about a staple." By that he means that the disagreement is over whether abortion coverage-- which would be paid for separately in either case-- would be a part of the subsidized policy (not acceptable to the Bishops) or in a separate rider stapled to it (acceptable to the Bishops).

As an aside, the U.S. is not the only country struggling with the abortion issue.
Interfax reported yesterday that Russian President Dmitry Medvedev has signed amendments to the country's Federal Advertising Law banning the advertising of abortions in a wide variety of media and locations. Many of the restrictions seem to be aimed at preventing advertising of abortions to minors.

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Persecuted Doctors and Government Regulation of Health Care.

This cartoon image accompanies a post at Monty Pelerin's World of a 2000 article by a doctor about the "poor doctors" who are being unjustly subjected to government regulation. Of course the article is written by a doctor, a member of a profession which has for decades used its wealth, clout, authority, and professional associations to deny patients' rights and an overhaul of the medical industry. Doctor's gains of greater autonomy have been patients' loss, as is clear when the current state of care is assessed. Using doctors' authority to determine how the government should proceed in regulating delivery of medicine is like relying on the banking industry to look out for the public's financial needs. It doesn't work.

There's a lot of talk lately, spurred by the failed attempt by the Obama administration to reform the medical - and particularly the insurance - industry and regulate quality, affordable, accessible medicine for all, that doctors will be damaged by any regulation of "their" industry and practices. What has resulted from this tussle between patients' rights advocates, the medical industry, the church and the state is a failed bill that rewards the insurance industry with mandated payments for care. We're going the wrong way, progressive rightly claim. Yet another industry has been given a pass to discriminate, control, and financially thrive on the restrictions it exerts to the detriment of patients, particularly women, the poor, the elderly and the gay community.

What doctors claim is an entirely different thing. Despite the AMA's belated support for the plan - and why shouldn't they support a reform plan that essentially makes no reforms and brings more patients into their closed system - the association has historically worked to prevent any regulation of medicine delivery. As can be expected, their role is to advocate for doctors' rights, not patients'. Unfortunately, theirs is a position respected by the state and often the church.

A recent ad campaign by conservative doctors claims that health care reform will create a shortage of doctors, yet the AMA has long determined how doctors are trained - and how many. Any shortage of doctors will be in the general practitioner category because the association has protected and encouraged medical specialization. That's where the money is, where the prestige is. These new claims that reform or "socialization" in the form of government regulation will create a shortage is disingenuous from an industry that has worked to limit general practitioners. If you're a supplier, you want to keep your costs up by limiting access to your service. Since the advent of Medicare, the industry has kicked and screamed against further extending their reach in favor of specialization.

So these are the two prongs that the AMA has successfully worked in their fight against greater access for all citizens: prevent government regulation; and control the number of doctors available and in what discipline. It's a power play, pure and simple, which leaves patients' rights out of the equation.

Two weeks ago, I had the opportunity to communicate with the former chair of the AMA's Council on Ethical and Judicial Affairs. According to this doctor, patients had no rights because mandating such would infringe on doctor's rights. In other words, the doctor was the individual who should be left to decide what a patients receives. He actually likened a woman's need for a tubal ligation, unmet by providers in her area, to the challenges a consumer may have in finding collard greens for Thanksgiving or a new coat only sold at a department store the next city over.

This position, that care is not a right but a commodity, is abetted by religious cries for strict conscience clauses in health care reform. While I of course believe that individuals should be left to determine their own conscientious guidelines for their work, I do not think that such a decision should be allowed to institutions which receive government funding and are responsible to the entirety of society. You staff a doctor who won't inform, perform or refer a woman for abortions? You are discriminating against that woman's rights unless you provide a manner in which she can get the care she needs. Anything short of giving a woman a full range of options should never be allowed or funded by the government, to hell with institutional conscience, association ethics, government funding, church demands. If we are to develop a medical system that serves patients, we must do so without reserve or discrimination.

Our failed attempt to reform health care this year is yet another sad chapter in the demonstration of monopoly of medicine by the industry itself, left alone to regulate it's own responsibilities without the interference of government on behalf of the needs of patients.

Screaming that doctors will be forced out of medicine, that the AMA and doctors are being discriminated against, that government regulation of delivery of what should be considered a human right, is all unjustified claim of persecution. The "poor doctors" have been doing just fine for themselves. It's time to address the needs of the poor patients, as doctors' oath to the profession demands.

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Methodist Leadership and the Manhattan Declaration.

Looks like the United Methodist is staying far away from the Manhattan Declaration, choosing to focus on other priorities. Methodist Thinker quotes a letter from Riley B. Case of the Confessing Movement Within the United Methodist Church:

The declaration has been widely reported and discussed in the secular and mostChristian media. However, acknowledgment of the declaration among United Methodist institutional leaders is conspicuous by its absence. United Methodist News Service has carried no articles on the declaration. The United Methodist Reporter printed one small paragraph acknowledging the declaration and commenting that the declaration called for the possibility of civil disobedience. This is disappointing.

The declaration basically is a reflection of traditional Christianity. It would be supported by the vast majority of United Methodists in the pews. It has been supported by many United Methodist pastors and laypersons (at least among those who know about it).

More importantly, it is basically in agreement with the Social Principles of the United Methodist Church. Not only do our Social Principles and our Book of Resolutions support almost every issue raised by the declaration, they would not be in conflict even with the more controversial ones, including the dignity of human marriage as the conjugal union of a man and a woman, the importance of the family, and the sanctity of human life.

However, the Manhattan Declaration obviously is an expression of traditional and evangelical Christianity and, as one seminary person related to me once, “We choose not to be identified with that form of Christianity.”…

So, if mainline leaders are not interested in declarations like the Manhattan Declaration what are they interested in? Well, for one, the bishops issued a statement on “God’s Renewed Creation: Call to Hope and Action.” This statement, which was to be read aloud in every United Methodist Church, would direct the church’s energy toward reversing global warming and concern for carbon footprints.

Following this there is a commitment of church resources toward seeking to influence the events at the United Nations Climate Change Conference in Copenhagen. The World Council of Churches wanted churches to sound bells, drums, gongs, or other instruments on Dec. 13, to call attention to the importance of this event. At this moment United Methodist apportionment money is paying the way of at least six and probably more UM agency staff and board members to go to Copenhagen and lobby or demonstrate or do whatever at the conference….

Whatever is occupying the time and energies of church leaders it does not seem to be on issues relating to marriage, family, dignity of the individual, and religious liberty. These are the issues addressed by the Manhattan Declaration.

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Christians are Being Persecuted by Marxist Christmas Haters.

I say forget the constitution. If the state can use federal funds to pay for religious memorials, schools, and social programs, I say let the state provide all citizens with access to unbiased medicine. (That's my screed.)

Read below for Missourian Mike Hall's screed on how our society is working to remove Christianity from our lives. But beware, it's a horror story of the war on Christmas, perpetrated by the Marxist state of Oregon, heathens and those disgusting liberals.

The First Amendment to the Constitution reads, in part, that "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof." The First Amendment explicitly applies to "Congress," but through a series of liberal Supreme Court rulings, it has wrongly been extended to the executive and judicial branches of government as well. It was clearly intended to keep the government from establishing a state-run religion, or favoring one religion over another.

Nowhere in the Constitution do the words "separation of church and state" appear. These words are from a letter that Thomas Jefferson wrote 15 years later to the Danbury Baptists in 1802, regarding their fears that Connecticut's constitution lacked protections concerning their religious practices. Jefferson agreed with them and wrote that states should "make no laws respecting an establishment of religion or prohibiting the free exercise thereof, thus building a wall of separation between church and state." Justice William Rehnquist stated that the "Establishment Clause" as it's commonly known, was intended to protect local establishments of religion from federal interference."

Because of liberal misinterpretations of the First Amendment there is no prayer in schools, no Ten Commandments on government property (except for historical references) and more and more often, none of those horribly evil "Christmas breaks." This brings me to the perfect example of liberalism's "freedom from religion" campaign, the WWI War Memorial in the Mojave Desert in California. This memorial was built in 1934 on private land and has a plaque that reads "In memory of the dead of all wars." It was eventually purchased by the National Parks Department. It's a simple cross built high on a hilltop overlooking the desert. Then one day Frank Bruno decided it "offended" him on his drives back to the Marxist state of Oregon. Bruno sued in district court to have it torn down. Of course, the ACLU was only too glad to help, and Bruno won the case, and the subsequent appeals. The Republican-controlled Congress then sold one acre of land the memorial sits on, to the VFW, meaning government no longer owned the property.

However, this didn't stop the ACLU. The 9th Circuit court of Appeals disallowed the sale, saying that carving out a tiny parcel of land "will do nothing to minimize the impermissible governmental endorsement" of religion. Ironically, the 9th circuit used the same Constitution to order the memorial's destruction, as the men who died fought for. The case was heard by the United States Supreme Court this fall, with a ruling expected early next year.

This cross doesn't establish a religion, it's a war memorial. What's next? Renaming Corpus Christi, Texas (body of Christ); Las Cruces, N.M. (the crosses); and Sacramento, Calif. (the Sacraments)? The Navy better do away with all those Los Angeles Class nuclear powered submarines. And Arlington Cemetery has to go, too. Welcome to your world if liberals ever run it.

While I'm still allowed to say it, "Merry Christmas" to all!

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Health Care Reform Is A Loaded Gun With Six Bullets.

From Dr. Jeff Mirus at Catholic Culture, another attempt to paint reform as perhaps necessary but only if it discriminates against minorities that the Catholic Right wishes to ignore.

I posted something from Mirus a few days ago because it so graphically displays conservative Catholic demonization of women, the elderly, and gays. His six bullets in the health reform gun, which he says should not be included in health care reform and which he says prove that Catholics must stand strong against actors for the "culture of death" (a menace to society hellbent on killing), are nothing more than cold discrimination.

The framing of choice advocates as death proponents is nothing new but it prevents the Catholic Right and other conservative actors from, as Dr. Mirus shows, objectively understanding the challenges faced by those he demonizes.

Instead of discussing how to best address the rights of women, elders and the gay community, he discounts any attempt at reform that includes them, working himself, on behalf of the "pro-life" movement into a position of persecution. Essentially, the provision of rights to others has become an argument that the religious right is persecuted.

It's a dishonest, immoral frame and one that, particularly in the US, indulges the privilege of one minority group, in this case "pro-life" Christians, over the needs of the entire community. Judging from the successes of this powerful, organized, well-funded and manipulative group to limit women's access to choice of health services and doctor-patient privacy, the state and the medical industry have given preference to loud "pro-life" activists over those who are being denied rights.

The resulting self-righteousness and claims of persecution from those like Dr. Mirus are alarming to me. And instructive if we want to understand what challenges we face as a nation to providing equal care to all of society's members. The blocks which continue to be put up against reform - and let me be clear, there is no reform in this administration's health care bill! - are predominantly from the religious and "fiscal conservative" segment of society.

Ideology has allowed our country to neglect millions of citizens. Forty thousand die each year without health care coverage. This is an epidemic that we fail to end because our courts and our legislature continue to honor industry profits, discrimination in patient care, to deny that unbiased health care is a right. Within our borders, social and economic minorities are - to use Mirus violent analogy - sacrificed (left to die) for the sake of prejudice.

If science can package and deliver Dr. Mirus food, can cure his disease, can deliver his drinking water, swell his national pride of American achievement, and even, as our medical industry now does, prolong death, how can he deny the use of that science to better meet the needs of those he has chosen to condemn simply because he personally opposes their lifestyle, ignores their lack of his same privilege, and denies the same financial benefits he holds.

It is discrimination and hatred, plainly on display in his writing. His lack of this understanding, his determination to paint the Christian right as morally just and even superior, and his claims of persecution are not only shameful, they are fatal. But this isn't about Dr. Mirus conscience in any way. He holds a place in society where he can choose how to address his own medical needs. This is about subjecting a needy segment of our population to his ideas of morality. When he takes seriously the hatred and suffering inflicted on women, gays and elders, by this sort of myopic selfishness, I will try to take his protestations more seriously.

I’m sorry, but I refuse to be blamed for the deliberate insertion of false ideas about the value of human life, including support for abortion, into the very packages and programs which should have a proper respect for life at their core—and which, in fact, lose their very meaning as “health care” without that fundamental respect for the life, rights and dignity of each person. I will not be backed into that corner. I will not stand accused of indifference to those less financially fortunate because I balk when somebody presses an ideological gun to my temple and calls it “concern for the poor.”

In that gun there are at least six bullets: Abortion, euthanasia, assisted suicide, harvesting of human embryonic materials, gender-change procedures, and medical rationing by those who serve an anti-life ethic. None of the major issues which are being debated, including the astronomically high cost of these Federal proposals, has very much to do with insuring the poor. There are far cheaper ways to get that done which do not carry all this ideological baggage. To my way of thinking, those who insist that the culture of death be injected into every health discussion are the ones who are showing a callous disregard of the poor.

They are, in fact, allowing their ideological passion to impede the process of helping the poor and (as Phil notes today in The abortion distortion) they are intent upon setting up a system that must be dismantled as soon as less ideological heads prevail. Look: With 85% of Americans already insured, and some portion of the remainder capable of, but opposed to, insuring themselves (for many young and healthy people choose not to use their income in this way), we find ourselves within striking distance of full coverage even through existing mechanisms. That striking distance is so close that it would apparently cost considerably less simply to insure the poor through existing carriers than to approve any of the sweeping Federal proposals to date. Tax incentives and other pressures and inducements could bring this about even more cheaply.

The Catholic Medical Association thinks the Federal government needs to start over, and to quit ignoring both life ethics and the benefits of subsidiarity. So let’s not kill any more poor people than necessary to get this done, shall we? And let’s stop calling a spade a heart, and a heart a spade.

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