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Pundits watching the current political campaigns note many advantages that Republicans have going into November: the President’s party usually loses seats in its first mid-term, the Democrat’s majority is so larger that there are many vulnerable members, and Obama voters who were so enthusiastic in 2008 are almost inevitably disappointed and less likely to mobilize to vote.
Yet the biggest advantage of all is with the issues. As National Review’s Ramesh Ponnuru highlights, a new survey shows that voters, including a majority of Independent voters, lean toward the conservative position on key issues. He writes:
By a five-point margin, they [voters surveyed] think that the government is trying to do too many things. They are extremely concerned about federal spending. Asked whether the government should spend more to boost the economy or less to reduce the deficit, voters break 59–34 for less spending. By a slightly smaller margin, they think that the stimulus was a waste of money. In both cases, Democratic voters are out of step with a Republican-and-independent consensus.
Fifty-three percent of independents join 89 percent of Republicans in opposing “the health care reform plan that Congress passed recently.” Much of that opposition is intense: 42 percent of independents and 81 percent of Republicans called themselves “strongly opposed.” Voters expect the legislation to raise taxes, premiums, and the deficit; a plurality also expects it to reduce the quality of care. Given three options — leave the legislation in place, amend and modify it, or replace and repeal it — voters split 22–37–35.
On some emerging economic issues, however, a conservative consensus includes a plurality of Democrats. Asked whether they think it is good or bad that federal pay exceeds private-sector pay, 62 percent of voters said it was a bad thing and only 19 percent a good one. A new value-added tax was unpopular across the board: Voters panned it by a 67–21 percent margin, with only 31 percent of Democrats approving.
Another poll, highlighted in this post on Bankrupting America, found that while Americans are concerned about rising government debt, they don’t believe that tax hikes are the answer. As Bankrupting America writes:
According to the survey, less than one in five voters is willing to pay more taxes to lower the federal budget deficit. That’s probably because two-thirds of Americans believe that the country is already over-taxed, and more than eight in ten believe that the federal deficit is the result of politicians overspending, not a lack of tax revenue.
Americans are also skeptical that politicians will really pay down the debt if they get additional tax revenue. Rasmussen reports that 58 percent of voters think that even if the president and Congress raise taxes to reduce the deficit, Washington is more likely to spend the money on new government programs than to actual pay down the debt.
This is the real asset Republicans have going into November. Democrats will be trying to refashion their record so that they can plausibly claim to be fiscally responsible or even conservative. Few voters will buy it. Republicans on the other hand can stick to core conservative principles and know that good policy will also be good politics.
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Oops. The Health and Human Services, Medicare Office of Actuary has just released a report that shows that one of the major talking points for the Administration when they were selling the health care overhaul—that the bill will reduce overall health care costs—is dead wrong.
Here’s how the Associated Press sums up the findings:
… the analysis also found that the law falls short of the president’s twin goal of controlling runaway costs, raising projected spending by about 1 percent over 10 years. That increase could get bigger, since Medicare cuts in the law may be unrealistic and unsustainable, the report warned.
It’s a worrisome assessment for Democrats.
In particular, concerns about Medicare could become a major political liability in the midterm elections. The report projected that Medicare cuts could drive about 15 percent of hospitals and other institutional providers into the red, “possibly jeopardizing access” to care for seniors….
The report acknowledged that some of the cost-control measures in the bill — Medicare cuts, a tax on high-cost insurance and a commission to seek ongoing Medicare savings — could help reduce the rate of cost increases beyond 2020. But it held out little hope for progress in the first decade.
“During 2010-2019, however, these effects would be outweighed by the increased costs associated with the expansions of health insurance coverage,” wrote Richard S. Foster, Medicare’s chief actuary. “Also, the longer-term viability of the Medicare … reductions is doubtful.” Foster’s office is responsible for long-range costs estimates.
In other words, the finding that health care spending will increase by just one percent is almost certainly a big under-estimate. Costs will most likely be higher. Much higher. And there was more bad news for Medicare:
In addition to flagging provider cuts as potentially unsustainable, the report projected that reductions in payments to private Medicare Advantage plans would trigger an exodus from the popular alternative. Enrollment would plummet by about 50 percent. Seniors leaving the private plans would still have health insurance under traditional Medicare, but many might face higher out-of-pocket costs.
In another flashing yellow light, the report warned that a new voluntary long-term care insurance program created under the law faces “a very serious risk” of insolvency.
Americans intuitively knew that the claim that this massive bill, which expands health care to some 34 million people, would somehow reduce health spending was bogus. My question is why did this report just come out now? Isn’t this analysis that the American people and their Representatives deserved to have before the legislation became law?
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Writing in the Phoenix Business Journal, Dr. Eric Novack warns readers about the many ways that they will end up paying for the new health care law. Fewer jobs and higher costs are just a few of the law’s unwelcome consequences. As we approach Tax Day, it’s also worth considering how the IRS gains in power as a result of the health care bill:
The new health care law makes it mandatory that every American buy health insurance. The enforcer of this provision is the Internal Revenue Service, which will add 17,000 new auditors and accountants — all the better to function as a collection agency for private insurance companies. Individuals without “adequate” health insurance — a term that will be redefined yearly — will be subject to fines that will reach 2.5 percent of income by 2016.
Fortunately for the feds, it won’t be hard to collect those fines. The new law allows the IRS to seize your tax refund as payment.
It’s not just individuals that face new mandates and potential penalties from IRS enforcers. Businesses are also underfire, and as a result many will be looking for ways to avoid exposure, including reducing the number of employees. As Dr. Novack writes:
In those companies [that employ 51 people or more], if even one employee qualifies for subsidies as a result of “inadequate” company benefits, the business will be subject to a $2,000 fine for every employee working at the company, with an exemption for the first 30.
Penalties for other violations will be predicated on factors such as employees’ income and family size. Because of this, employers will have incentives to avoid certain kinds of applicants — single mothers, for example — since those employees could put the entire business at risk for significant fines.
To be safe, businesses likely will respond by moving more employees into part-time jobs to avoid having them “in the count.” Others may find it easier to shift to a contract work force, which will require more costly advice to comply with regulations cracking down on “1099 employees.”
Yes, fellow taxpayers, keep this in mind as you finish up the mind-boggling process of filing your taxes. It is only going to get worse—much worse—as a result of this new health care law.
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The President’s still trying to convince the American people that they should be happy that the legislation remaking the health care system (which the public overwhelming opposed) was rammed through Congress and signed into law. That’s a tough job when people are also hearing doctors’ complaints and concerns about what the law will do to their practice and medicine in general.
Consider this article in Investor’s Business Daily, which tells the story of one woman, a primary care physician from New Jersey, who has decided to drop out of medicine, in part because Obamacare threatens to make existing problems with the medical system worse.
Most of the article focuses on how too low reimbursement rates threaten to make medicine simply unprofitable, forcing doctors to close up shop. But doctors are also concerned about the over-regulation of medicine and how bureaucrats will end up meddling in the patient-doctor relationship. Here are some interesting survey findings highlighted in that article:
Reimbursement issues were rated “most unsatisfying” by more than 54% of doctors surveyed in 2008 by the Physicians Foundation. Managed care issues and Medicare/gov’t regulations were not far behind, with 51.6% and 45.8%, respectively.
Seventy-nine percent of doctors said ObamaCare makes them less optimistic about the practice of medicine, according to a survey by Sermo and AthenaHealth (ATHN). Two-thirds said they would consider dropping all government insurance programs.
Two-thirds of doctors may stop serving Medicare and Medicaid patients? This is the kind of information that people are going to be getting about this new health care law, and it is only going to make them like it less.
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Americans horrified by the new health care laws are all asking the same question: what do we do now? On one level, the answer is obvious: we need to elect people committed to repealing the health care bill, and then embracing an entirely different approach to improving our health care system by returning power to the people. That election process really does begin today, culminating in November, and then again in November 2012 when the stakes go even higher for the Presidential election.
Yet Thomas Miller of AEI has a few additional ideas of what can be done even before the November elections:
(1) Stop the reconciliation bill coming up in the Senate this week. Several successful “Byrd rule” procedural challenges could strip key provisions out of the bill—although an initial ruling by the Senate parliamentarian late Monday night on the deal to delay the effects of a “Cadillac” tax on very high-cost insurance plans suggests the process remains wired for the majority. The Senate Republicans still hope to sink the rest of the bill by removing portions of its net budget savings and other House-favored changes. A host of Republican amendments also could stretch out this latest war of attrition and (if we want to be optimistic) result later in a House-Senate stalemate in a conference committee before the promise of a quick fix is abandoned.
(2) Challenge and slow down early stages of the final law’s implementation at various chokepoints. The health legislation remains fundamentally unworkable. Forcing it to run a multi-year gauntlet of critical comments and questions in the rulemaking process, rigorous administrative procedure requirements, and a tsunami of legal challenges to its statutory provisions should start the hemorrhaging.
The legal aspects of this will be particularly interesting. While it will be an uphill battle, as Nicole Kurowara writes on IWF’s blog, there is hope that the judiciary will reclaim its proper role as the true defender of individual liberty and enforcer of the concept of limited government.
Perhaps the most important thing that anyone can do is to remain engaged. One big battle was lost, but the war over health care is far from over.
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Today Drudge reports that Walgreens drugstores in Washington State will no longer accept new patients under Medicaid. Walgreens explains that reimbursement rates under Medicaid are simply too low: the stores are losing money by serving this population.
Welcome to the brave new world of government-run medicine.
As governments try to squeeze savings, providers will exit this system. This won’t just happen with pharmacists. An Investor’s Business Daily survey which was conducted last fall found that 45 percent of doctors say they will consider leaving medicine if this health care legislation passes. Another survey conducted in December had similar findings. Undoubtedly many of these doctors, already sick of spending so much of their time complying with the existing bureaucracy and paperwork, worry that increased government involvement will mean even more red tape. Too low government reimbursement rates are surely also part of the problem.
An exodus of medical professionals will lead to longer wait times; those wait times will be even worse since more widely available health insurance will mean a greater consumption of medical care. So we will have more patients and fewer doctors. It’s no wonder that our recent poll found that a majority of voters from swing states believe that the health care system will be made worse by this legislation.
Members, are you listening?
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Speaker Pelosi is reportedly meeting with female Members of Congress today. No doubt the intent of the meeting is to twist arms and threaten any Member who might be wavering about which way to vote.
Before meeting with the Speaker, those female Members should do a little reading. First, they should check out IWV’s new poll, which shows that despite what the Speaker might say, voters emphatically want them to vote against this health care monstrosity. They also might be surprised to learn that eight in ten women disagree with the statement “It is the responsibility of the federal government to mandate that everyone have government-approved health insurance and to be penalized if they do not.”
Female Members should also be sure to read this article by Grace-Marie Turner in the Wall Street Journal which examines Massachusetts experiment with mandatory health insurance. Here’s some highlights:
While Massachusetts’ uninsured rate has dropped to around 3%, 68% of the newly insured since 2006 receive coverage that is heavily or completely subsidized by taxpayers. While Mr. Romney insisted that everyone should pay something for coverage, that is not the way his plan has turned out. More than half of the 408,000 newly insured residents pay nothing, according to a February 2010 report by the Massachusetts Health Connector, the state’s insurance exchange….
Mr. Romney’s promise that getting everyone covered would force costs down also is far from being realized. One third of state residents polled by Harvard researchers in a study published in “Health Affairs” in 2008 said that their health costs had gone up as a result of the 2006 reforms. A typical family of four today faces total annual health costs of nearly $13,788, the highest in the country. Per capita spending is 27% higher than the national average. …
Further, insurance companies are required to sell “just-in-time” policies even if people wait until they are sick to buy coverage. That’s just like the Obama plan. There is growing evidence that many people are gaming the system by purchasing health insurance when they need surgery or other expensive medical care, then dropping it a few months later. …
The Bay State is also suffering from what the Massachusetts Medical Society calls a “critical shortage” of primary-care physicians. As one would expect, expanded insurance has caused an increase in demand for medical services. But there hasn’t been a corresponding increase in the number of doctors. As a result, many patients are insured in name only: They have health coverage but can’t find a doctor.
Fifty-six percent of Massachusetts internal medicine physicians no longer are accepting new patients, according to a 2009 physician work-force study conducted by the Massachusetts Medical Society. For new patients who do get an appointment with a primary-care doctor, the average waiting time is 44 days, the Medical Society found….
The difficulties in getting primary care have led to an increasing number of patients who rely on emergency rooms for basic medical services. Emergency room visits jumped 7% between 2005 and 2007. Officials have determined that half of those added ER visits didn’t actually require immediate treatment and could have been dealt with at a doctor’s office—if patients could have found one.
Finally, Members should remember that voting against this version of health care reform isn’t a vote for the status quo. There are plenty of ways that Congress can and should change the health care system to make the system work better for everyone—and particularly for women.
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National Review Online has several good round ups of where the Democrats are in terms of vote counts. Daniel Foster recounts estimates that Democrats are still 10 away:
In a press conference on Capitol Hill today, Rep. David Dreier (R., Calif.), ranking Republican on the House Rules Committee, said the word around the House is that Democrats are still about 10 votes away from securing the 216 they will need to pass changes to the health-care bill. Dreier added that that number might be moving in the wrong direction for Democrats.
And Jeffery Anderson details the hurdles that Democrats face:
If Obamacare’s opponents keep up the pressure on wavering House Democrats, victory is within our grasp. Obamacare faces three major hurdles to passage. You might reasonably assume that these are as follows: It’s a colossally bad bill; it’s an extremely unpopular bill; and members of Congress — despite what President Obama apparently thinks — do care about getting reelected. While you’d be right on all three counts, I’m talking about more specific hurdles related to the concrete numbers in the House.
Things have changed. The Democrats need every member of their caucus who voted “yes” last time to vote “yes” again — or, for every defection, they need to convert a prior “no” vote to their side. They don’t have a single vote to spare…
They need two-thirds of our 40. Andy Wickersham and I have listed the 40 Democrats we think are the most key to passage or defeat. Assuming that all other Democratic members vote the same way as last time — and that all Republicans vote “no” (as they will) — the Democrats need 27 of these 40 to vote “yes” in order to pass the bill. This is a high bar when you consider that 35 of these 40 reside in Republican territory — many of them solidly so — and 24 supported the Stupak Amendment.
Early returns aren’t good for Obamacare supporters….
Other Democrats are more likely to swing against Obamacare than for it. Beyond these 40, the Democrats are far more likely to lose additional members who voted “yes” last time than they are to convert additional members who previously voted “no.”
Hopefully those wavering Democrats have also seen IWV’s new poll that gives them many more reasons to vote against this bad bill.
No one should fool themselves though that the fight is over. Undoubtedly Pelosi and company are trying everything they can to get the numbers they need, so no one in the opposition can afford to let up.
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The Daily Caller
By: Carrie Lukas, Fellow, Independent Women’s Voice
Members undecided about how to vote on health care face intense pressure. The president is calling. Their leadership is badgering. Unions are threatening to back primary challengers and withhold support. Yet wavering Members be warned: Your constituents can’t twist your arm or make creative threats, but they will be voting in November. And if you vote for this health care legislation, chances are they’ll be voting against you.
That’s the message of a recent poll commissioned by the Independent Women’s Voice and conducted by the polling company, inc/ Woman Trend. The poll focused on voters in 35 Congressional districts in which Members are considered critical votes in the health care debate.
Forty percent of those surveyed want Congress to start from scratch on health care legislation, and another 20 percent think Congress should completely give up working on this issue this year. Far from gathering momentum, new information coming out about the legislation is making voters oppose it more strongly. When asked about how the information they’ve heard during the past 10 days affected their opinion, almost twice as many (55 percent) responded that they were less supportive than responded they have become more supportive (29 percent). Forty-two percent said they became much less supportive.
Instead of clamoring for health care reform, the public wants Congress to move on. Nearly 7 in 10 voters feel health care is distracting Congress from bigger priorities, like jobs. By a 2-to-1 margin, those surveyed agreed with the statement that “Even if it means health care reform is not passed this year, I would prefer that my Member of Congress vote against the current legislation.” More people said they would be “relieved” (45 percent) and “pleased” (21 percent) if health care reform didn’t pass this year, than said they would be “disappointed” (20percent), “frustrated” (19 percent), “angry” (14 percent), or “anxious” (10 percent).
People have good reasons for wanting the legislation to fail: more than half (53 percent) believe that they and their loved ones would be worse off under proposed changes. A majority also think the economy (54 percent) and U.S. health care system (55 percent) would suffer. Many see the health care legislation as an inappropriate federal power grab: 76 percent of respondents (and 80 percent of women) reject the statement that “It is the responsibility of the federal government to mandate that everyone have government-approved health insurance and to be penalized if they do not.”
A margin of nearly 2-to-1 agreed that “the current legislation gives government too big a role in the healthcare system” (63 percent agree [53 percent strongly] vs. 32% disagree). A majority were also very concerned about cost, with 64 percent agreeing (52 percent strongly) that “We as a nation can’t afford to pay for the current healthcare legislation right now.”
Not surprisingly, health care will be a top consideration when voters decide whom to support in November. More than 80 percent of those surveyed said that health care would be among the top three issues they’ll consider. And health care voters overwhelmingly oppose the current legislation.
Overall, 60 percent of voters surveyed said they would vote for the candidate who opposes the proposed health care legislation—that’s nearly twice (32 percent) those who would reward a health care supporter with their vote. Intensity was again on the side of those rejecting current legislation: 38 percent definitely will vote for a candidate opposed to the bill compared to 22 percent who will definitely vote for a health care legislation supporter.
Here’s one finding that’s particularly important for those Members wavering about how to vote this week: if you voted against health care reform in November, your constituents want you to vote against it again. If you voted for it in November, you can help yourself by switching your vote this time around. Sixty-one percent will be less supportive (compared to 29 percent who will be more supportive) of a Member who switched from voting against the bill to voting for the health care bill. In contrast, nearly half (49 percent) will be more supportive (compared to 40 percent who will be less supportive) of a Member who switches from voting for the bill to voting against it.
There are many reasons for Members to vote against this bill: from the policy to the process that has been used to advance it. Yet perhaps the most compelling reason is that Members are elected to represent their constituents—and it is overwhelmingly clear how their constituents would vote on health care if they truly had a voice in Congress.
Carrie Lukas is a fellow at Independent Women’s Voice [1].
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Today Robert Samuelson describes how the recent health care debate hasn’t informed Americans—it’s misinformed them, and the solutions being peddled by the President and Democrats in Congress would exacerbate existing problems with the health care system. He writes:
One job of presidents is to educate Americans about crucial national problems. On health care, Barack Obama has failed. Almost everything you think you know about health care is probably wrong or, at least, half wrong. Great simplicities and distortions have been peddled in the name of achieving “universal health coverage.” The miseducation has worsened as the debate approaches its climax.
There’s a parallel here: housing. Most Americans favor homeownership, but uncritical pro-homeownership policies (lax lending standards, puny down payments, hefty housing subsidies) helped cause the financial crisis. The same thing is happening with health care. The appeal of universal insurance — who, by the way, wants to be uninsured? — justifies half-truths and dubious policies. That the process is repeating itself suggests that our political leaders don’t learn even from proximate calamities.
How often, for example, have you heard the emergency-room argument? The uninsured, it’s said, use emergency rooms for primary care. That’s expensive and ineffective. Once they’re insured, they’ll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument. Unfortunately, it’s untrue.
A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency room use remained higher than the national average, reports an Urban Institute study. More than two-fifths of visits represented non-emergencies. Adult respondents to a survey said it was “more convenient” to go to the emergency room or they couldn’t “get (a doctor’s) appointment as soon as needed.” If universal coverage makes appointments harder to get, emergency room use may increase. …
Though it seems compelling, covering the uninsured is not the health care system’s major problem. The big problem is uncontrolled spending, which prices people out of the market and burdens government budgets. Obama claims his proposal checks spending. Just the opposite. When people get insurance, they use more health services. Spending rises. By the government’s latest forecast, health spending goes from 17 percent of the economy in 2009 to 19 percent in 2019. Health “reform” would likely increase that.
Samuelson argues that the key to reforming health care to control costs is to change incentives. Rep. Paul Ryan makes a similar argument in his oped in the Washington Post. He highlights the many ways the Democrats proposal fell to address the systems most fundamental problems (and would create new problems with new job-killing mandates and by driving costs higher), and makes the case for an alternative approach. He describes alternative legislation that he and other Members have introduced:
The Patients’ Choice Act takes on the discriminatory and inflationary tax exclusion, delinking the tax benefit from employers and attaching it to individuals through universal tax credits. The tax exclusion for employer-provided health coverage subsidizes insurance instead of health care, hides the true cost of coverage and disproportionately favors the wealthy at the expense of the self-employed, the unemployed and small businesses. Health-care economists across the political spectrum and reform-minded Democrats such as Sen. Ron Wyden identify the backward tax treatment of health care as a problem that must be addressed….
This year I re-introduced my own proposals to tackle our entitlement crisis head-on. My plan, “A Roadmap for America’s Future,” fulfills the mission of health and retirement security, lifts our crushing burden of debt, and spurs economic growth and job creation. In stark contrast to the vision being pushed by the majority in Congress, my plan unapologetically seeks to apply our nation’s timeless principles — our Founders’ commitment to individual liberty, limited government and free enterprise — to today’s challenges. It does so in a way that honors our historic commitment to strengthening the social safety net for those who need it most.
If this debate had actually been about health care, we could have worked together to get a grip on costs, make quality care more accessible, address exclusions for preexisting conditions and realign the incentives of insurance companies with those of patients and doctors. Yet this process — including its embarrassing conclusion — demonstrates that the debate has never been about health-care policy but, instead, paternalistic ideology.
This is the debate that Americans need, and deserve, to have about our health care system. Will Members listen to their constituents and scrap this big-government power-grab so they can actual consider ways to make our health system better? We will find out this week.
