FoxNews, “Obama: Health Care Reform Will ‘Absolutely’ Be Passed By End of Year“:

President Obama said Wednesday he “absolutely” believes health care reform will be passed by the end of the year, arguing the country will be “worse off” without a dramatic overhaul of the nation’s system.

“We’re going to get it done,” Obama said in an interview aired Wednesday on ABC’s “Good Morning America.”

That, of course, was June 24, 2009.

Which is to say, nothing’s inevitable.

The Congressional health care debate reaches its climacteric week, and The Washington Post op-ed page offers two good columns on the topic.

Robert Samuelson, “Obama’s illusions of cost-control“:

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 probably increase that.

Unless we change the fee-for-service system, costs will remain hard to control because providers are paid more for doing more. Obama might have attempted that by proposing health-care vouchers (limited amounts to be spent on insurance), which would force a restructuring of delivery systems to compete on quality and cost. Doctors, hospitals and drug companies would have to reorganize care. Obama refrained from that fight and instead cast insurance companies as the villains.

Rep. Paul Ryan (R-WI), “Rep. Paul Ryan on what real health reform should look like“:

Through any analytical lens, the legislation will not address the central problem of skyrocketing health-care costs. The Congressional Budget Office estimates that families’ premiums could rise 10 to 13 percent; private-sector actuarial estimates top these already high numbers. The higher costs are driven by federalizing the regulation of insurance, narrowing consumers’ options and reducing competition among providers. The health-care market would be dominated by government programs and the largest insurance companies, operating as de facto government utilities.

Rather than tackle the drivers of health inflation, the legislation chases the ever-increasing premiums with huge new subsidies. Already, Washington has no idea how to pay for the unfunded promises in Medicare, Medicaid and Social Security — and creating this new entitlement would accelerate our path to fiscal ruin.

The National Association of Manufacturers is a member of the Start Over! business coalition, which outlined its principles and priorities for health care reform in a Feb. 22 letter to President Obama. Cost control and global competitiveness figured prominently:

Central to the discussion among summit attendees must be how reform ideas affect the ability of
our nation’s economy to recover and businesses to create jobs. Even in ideal economic times
imposing costly regulations and taxes on business is a bad idea. A competitive global
environment and an already burdensome tax and regulatory structure offer enough challenges for
businesses of all sizes to invest and create jobs. We should be looking for ways to streamline
and modernize these structures, rather than layering additional costs on job creators. Moreover,
the dismal state of our nation’s fiscal house requires that proposals be weighed against the threat
that large-scale spending poses to long-term economic stability and competitiveness.

News coverage of the new ad campaign by Employers for a Healthy Economy — to which the National Association of Manufacturers belongs — used lots of combative terminology to describe the effort. Assault on Congress?

Well, OK. But judge yourself. Here are the ads, and here’s the text.

“Afford”
Americans still losing jobs… more businesses struggling…

We thought Washington understood.

But this week Congress is trying to use special rules…

to ram through their same trillion dollar health care bill.

Billions in new taxes… more mandates on businesses.

Health care costs will go even higher, making a tough economy… worse.

Washington’s not getting the message.

Tell Congress. Stop this health care bill we can’t afford to pay.

The business alliance issued a news release Tuesday, Business Coalition Releases New Television Ad on Health Care Legislation.”

• Washington Times, “Business groups target lawmakers“
• Roll Call, “Groups Aim One Last Time at Reform Bill“
• Seattle Times, “Businesses to fight health bill with huge ad campaign“

The Washington Post’s Dan Eggen has a pretty good blog summary of a conference call conducted by members of Employers for a Healthy Economy, a business coalition to which the National Association of Manufacturers belongs. The group is running ads critical of President Obama’s health care plan, or, as the headine writer puts it, ”Business groups plan TV assault on Obama health-care plan.”

It’s not “Force 10 from Navaronne,” you know. They’re just cable ads.

Eggen reports:

A coalition of major business groups said Tuesday that it will spend as much as $10 million on television ads over the next 10 days attacking President Obama’s health-care reform plans, arguing that legislation under debate in Congress will be too costly for small employers and will kill jobs at a time of economic distress.

He also quotes the NAM’s point person on the issue.

Jeri Kubicki, vice president of human resources policy at the NAM, said the legislation does not go far enough in controlling costs and will burdening small businesses with additional taxes and regulations. “Unfortunately, our members think the core of this debate has centered on expanding access as opposed to controlling costs,” Kubicki said. “We want to start over.”

That’s right.

Unfortunately, the White House’s communications director, Dan Pfeiffer, does not engage those points in a blog post he put this afternoon, “Putting American Workers and Small Businesses in Charge of Their Own Health Care Coverage.” His argument is that those who disagree with the legislation are bad actors in league with the greedy insurance industry.

[The] Chamber of Commerce, which we already know has also run anti-reform ads funded by the insurance industry, is holding a conference call today with executives from a handful of industries to lay out to discuss their plans to try to block reform.

Over the coming days, you’ll hear a lot of noise from opponents of reform who are desperately trying to protect a system that earns billions in profits while rates climb so high that many Americans can’t afford coverage.

The NAM doesn’t really care about the insurance industry. Our member companies have been hammered by rising health care costs, often double-digit increases in premiums every year, and believe the current health care bills being considered by Congress do too little to control costs.

Here is the statement issued by NAM President John Engler on Feb. 22 when the President released his latest version of the health care bill. It’s not noise, but rather a clear statement of why the legislation is flawed. The issues warrant a more serious response than a campaign-style attack. 

We are disappointed that the President’s proposal includes hundreds of billions in new taxes and fees but does nothing to contain costs for America’s manufacturers and job creators. Health care reform needs to be first and foremost about reducing costs, not adding burdensome new costs and taxes on employers. Manufacturers want the health care debate to move forward, but with a focus on long-term savings that will make health care more affordable for everyone.

The President’s proposal appears to largely embrace the Senate legislation which includes significant tax increases on America’s job creators. Manufacturers believe health care reform should focus instead on reducing costs, improving access and preserving what is working in the current system.

We are disappointed with the President’s approach to health-care reform he laid out today, both on process and substance. While the President included a few ideas intended to reduce costs (allowing medical providers to participate in fraud/abuse investigations) and to improve access (allowing health care plans with health savings accounts to be included in health exchanges), the proposal builds on a flawed foundation that increases costs for manufacturers. It does not address our key concern — long-term health care cost savings.

Further, the President’s comment on an “up and down” vote indicates that health care reform will not be completed in a bipartisan fashion — an approach the NAM has endorsed and recommended since the beginning of this effort. Manufacturers want health-care reform that includes the best ideas from both Democrats and Republicans. We believe health-care reform should protect what currently works in the health system, focus on long-term and sustainable reduction in health-care costs, and achieve more affordable health options.

Jeri Kubicki is NAM’s vice president for human resources policy.

President Obama will unveil the next version of the Administration’s proposal for health care legislation early this afternoon. [1:45 p.m., East Room] Judging by the medical liability section he previewed in a letter to Congressional leadership Tuesday, the differences in the proposals between versions pre- and post-Blair House meeting will be slight.

In September 2009, the President announced a $25 million grant program from Health and Human Services to fund state demonstration programs for “alternatives to the current medical liability system,” paid for by existing agency funds. As written by the Agency for Healthcare Research and Quality, the demonstration projects must address patient safety and risk management AND medical liability. Requiring both elements effectively screens out any serious proposal to cap damages.

In his letter to Congressional leaders, the President said he was open to more, adopting other provisions proposed by Republicans. No. 2 on his list was medical liability reform:

My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.

Majority Leader Harry Reid’s manager’s amendment version of the health care legislation includes $250 million over five years for the demonstrations. (The section starts on page 344.)

In comparison, in their proposed substitute amendment House Republicans had offered multipoint proposal on liability reform, including:

DIVISION C–ENACTING REAL MEDICAL LIABILITY REFORM
Sec. 301. Encouraging speedy resolution of claims.
Sec. 302. Compensating patient injury.
Sec. 303. Maximizing patient recovery.
Sec. 304. Additional health benefits.
Sec. 305. Punitive damages.
Sec. 306. Authorization of payment of future damages to claimants in health
care lawsuits.

Thus, the President’s “compromise” on medical liability is to ignore any substantive liability reforms and instead adopt the Senate Democratic majority’s very limited proposal for state demonstration grants. The new element is the President’s state willingness to appropriate money for the program. And that’s it.

With the President expected to release an updated version of the Administration’s health care policy proposal, it’s a good time to excerpt a recent interview with John Engler, president of the National Association of Manufacturers. On Feb. 22, he appeared via phone on the Frank Beckmann program on WJR radio in Detroit. Health care was among the topics, and the transcribed portion of the interview is below.

Engler: The manufacturers early in the health care debate said, look, we’re for reform. Of course we ought to get some of these costs down while fixing some of the problems, such as some pre-existing condition that needs to be covered.

We’ve watched in horror, I guess, as the approach has been to have the federal government take control of the health care system. There’s just a story today, and the President’s using this, Frank, about the idea that maybe we need federal government control of the rates because they’re gong up in California.

You know what I say? Let other people sell inside California. Tear down that barrier and let the competitors in, and then we’ll see what rates are going up.

Beckmann: Well, doesn’t competition drive rates down, drive prices down? Isn’t that Business 101?

Engler: Absolutely. And it does. That’s one of the problems frankly for business, or for manufacturing, is that we’ve got so much competition from other parts of the world, that costs matter, whether those costs are your costs of your energy, the costs of your labor, the costs of your taxes. Today, every penny matter because you’re competing so vigorously, and I say, don’t let health insurance be immune from that competition. We’ve long supported letting competition range across state borders, letting groups like, say, the National Association of Manufacturers have a health-care offering for our members. That would be a great thing, and I’ll bet we can come up with a pretty good deal. But we can’t do that today.

Beckman: There’s also a portion of the President’s proposal -and this is his first health-care proposal - that will fine employers who don’t provide a certain level of health insurance to their employees.

Engler: Well, one of the problems with that… I represent an organization where virtually every company that’s a member here already provides health insurance.

As America waits to learn if President Obama’s latest health care proposal makes any move toward  liability reform, we offer these words from another President from Illinois.

Never stir up litigation. A worse man can scarcely be found than one who does this. Who can be more nearly a fiend than he who habitually overhauls the register of deeds in search of defects in titles, whereon to stir up strife, and put money in his pocket? A moral tone ought to be infused into the profession which should drive such men out of it.

Discourage litigation. Persuade your neighbors to compromise whenever you can. Point out to them how the nominal winner is often a real loser — in fees, expenses, and waste of time. As a peacemaker the lawyer has a superior opportunity of being a good man. There will still be business enough.

From “Notes for a Law Lecture,” Abraham Lincoln, circa 1850.

(Hat tip, Texans for Lawsuit Reform.)

In a post this morning, we noted the failure of the Center for Public Integrity to include trial lawyers in its list of interests lobbying on health care issues. If you’re going to be querulous about groups exercising their First Amendment rights to influence health care legislation, you have to wring your hands about the American Association of Justice (AAJ) and its allies, too.

Not just lobbying, but campaign contributions also provoked fretting today in the goo-goo-sphere. The National Journal picked up a news release from Citizens for Responsibility and Ethics (CREW) in Washington that tallied up the campaign contributions that went to the attendees of the President’s Blair House health care meeting. From “CREW’s study of health care contributions to summit participants“:

A review of campaign finance records shows the health care establishment has invested heavily in the campaigns of the members of Congress invited to the meeting. In total, these 21
lawmakers have taken nearly $28 million in campaign donations from health care interests since
2005. These donations include contributions from health professionals (including physicians,
pharmacists, nurses, and others providing health care services) and their trade associations, as
well as the employees and political action committees (PACs) of hospitals and nursing homes;
pharmaceutical and health product companies; health services firms; HMOs; health and accident
insurers; and miscellaneous health care interests (such as research groups).

“Invested heavily in” is the sneering way of saying, “contributed to.” Shocking in a representative democracy, we know.

Strangely, CREW omits from its list contributions made by trial lawyers and labor unions. (At least the Center for Public Integrity included the unions.) Are the trial lawyers NOT a health care interest?

Well, of course they are, and they prominently contribute to campaigns, too. The Manhattan Institute’s latest edition in its “Trial Lawyers, Inc.” series reports, “In the last decade, lawyers and law firms—excluding lobbyists—have injected $780 million into federal campaigns, on top of $725 million donated to state races.”
Legal Newline, a legal reform-oriented publication backed by the U.S. Chamber of Commerce, today reported on the litigation industry’s campaign contributions to Sen. Richard Durbin (D-IL), “Durbin gets big bucks from trial lawyers.” At today’s health care meeting, the Senator argued impassionedly for the necessity of lawsuits in achieving recompense for injured patients. Sen. Durbin’s argument is an important point of view, and it absolutely deserved to be heard at today’s health care event.

But to omit trial lawyers and their campaign contributions from any accounting of health care interests is ridiculous on its face. CREW’s political selectiveness belies its claim to the moral high ground on “responsibility and ethics” in Washington. Or anywhere else.

The Center for Public Integrity, one of the hordes of goo-goo groups that pullulate across Washington, posted an article at its website, “Lobbyists Swarm Capitol To Influence Health Reform.” Well, it’s a nice change of pace from “Descend upon Capitol,” but the authors still managed to load up on phrases like, “a boom year for influence peddling.”

Eliminate the usual rhetoric and you get a good cross-section of the various public and shareholder interests that are using their First Amendment rights to influence the Congressional health care debate. The NAM is mentioned.

Kelly Johnston, vice president for government affairs at Campbell Soup, said the company channeled its lobbying efforts through groups like the American Benefits Council and the National Association of Manufacturers. The public insurance option was Campbell Soup’s biggest target. Johnson said the company feared a public plan would lure small and medium sized businesses to dump their private insurance plans, resulting in higher rates for larger companies.

“We want to create more incentive, not less incentive, for smaller businesses to get into private insurance,” he said.

Darn right. It’s an excellent argument about health care costs and access, and the NAM is proud to represent that point of view.

The activists who are offended by the exercise of constitutional rights usually concentrate their bemoaning on business, but we give the Center for Public Integrity credit. Its authors also addressed organized labor’s lobbying, which makes sense, given that the unions have influenced the White House’s health care plan more than has business.

Missing, however, is any mention of the trial lawyer lobby, the American Association for Justice and their various allies, associates and funding recipients. The AAJ’s fourth quarter 2009 lobbying report lists 10 lobbyists, including former congressional staffers, who worked on health care-related issues. The AAJ reported spending $4.6 million total on lobbying in 2009, and has celebrated its ability to block medical liability reform. If you’re going to be serious about examining lobbying activities on health care, you can’t ignore the trial lawyers.