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Healthcare Reform

The real deficit hawks

Critics decry the healthcare bill as fiscally irresponsible. Where's the outrage over the defense budget?
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Let's say you're a congressperson or "tea party" leader looking to champion deficit reduction -- a cause 38 percent of Americans tell pollsters they support. And let's say you're deciding whether to back two pieces of imminent legislation.

According to the nonpartisan Congressional Budget Office, the first bill's spending provisions cost $100 billion annually and its tax and budget-cutting provisions recoup $111 billion annually, thus reducing total federal expenditures by $11 billion each year. The second bill proposes $636 billion in annual spending and recoups nothing. Over 10 years, the first bill would spend $1 trillion and recover $1.11 trillion -- a fantastic return on taxpayer investment. Meanwhile, the second bill puts us on a path to spend $6.3 trillion in the same time.

Save $110 billion, or spend $6.3 trillion? If you're explicitly claiming the mantle of fiscal prudence, this should be a no-brainer: You support the first bill and oppose the second one.

Yet, in recent months, the opposite happened.

When the House considered a healthcare expansion proposal that the CBO says will reduce the deficit by $11 billion a year, tea party protesters and Congress' self-described "fiscal conservatives" opposed it on cost grounds. At the same time, almost none of them objected when Congress passed a White House-backed bill to spend $636 billion on defense in 2010.

The hypocrisy is stunning -- lots of "budget hawk" complaints about health legislation reducing the deficit and few ”budget hawk” complaints about defense initiatives that, according to Government Executive magazine, "puts the president on track to spend more on defense, in real dollars, than any other president has in one term of office since World War II." And that estimate doesn't even count additional spending on the Iraq and Afghanistan wars.

So, as Bob Dole might ask, where's the public outrage at the contradiction? It's nowhere. Well, why not?

One clear answer is values -- or lack thereof. In our militaristic culture, we are taught to prioritize Pentagon spending over everything else.

Another less obvious answer is ignorance sown by skewed reporting.

The health bill's expenditures are typically described by reporters in 10-year, $1 trillion terms while defense spending is described -- if at all -- as a one-year, $636 billion outlay. That can lead citizens to think the healthcare bill will cost more than defense -- when, in fact, the 10-year comparison pits a $1 trillion healthcare bill against $6.3 trillion in projected defense spending.

But even that's not apples to apples. Political headlines of late have all been some version of Dow Jones newswire's recent screamer: "CBO Puts Health Bill Cost At $1 Trillion." That's as true as an Enron press release touting only one side of the company's ledger. Though the bill's expenditures do total $1 trillion, the CBO confirms its other provisions recover more than that, meaning headlines should read "CBO Says Health Bill Saves $110 Billion."

Not surprisingly, the media distortions are being trumpeted by the same congressional hypocrites simultaneously backing bigger Pentagon budgets and opposing health reform. Their dishonest arguments were summed up by Sen. Joe Lieberman in a Fox News interview last week. Ignoring CBO data about the health bill and the deficit, the Connecticut lawmaker (who voted for the bloated defense bill) insisted health legislation must be stopped because it will rack up "debt (that) can break America."

Only professional liars could cite concern about debt as reason to oppose a healthcare bill reducing the debt -- and then vote for debt-expanding defense budgets. Unfortunately, professional liars are the norm in today's politics, not the exception -- and they're leading America off the fiscal cliff.

© 2009 Creators.com

New health advice hurting women?

Loosened guidelines on breast and cervical cancer screenings spark fears -- some unfounded

Immediately after reading about the new cervical cancer screening guidelines, which recommend delaying pap smears and having them less often, a friend sent me an e-mail reading: "I mean, should this month's headlines be summed up as, 'New medical guidelines recommend that women get a lot less health care than they used to?'" Indeed, this advice comes on the heels of the U.S. Preventive Services Task Force's controversial new guidelines that bump the suggested age for mammograms up to 50. The American College of Obstetricians and Gynecologists, which issued the new pap smear guidelines, says the proximity of both news items is strictly coincidental and that its new position has has been in development for quite some time.

Some skepticism on women's part about these relaxed standards makes sense after years of repeatedly being pinned with pink ribbons, lectured about the importance of yearly paps and hit over the head with pamphlets about the life-saving HPV vaccine. That's especially true for those of us who know women -- some in their 20s and 30s -- with breast or cervical cancer. As my friend wrote, it feels a bit like the overarching message is: "Chill out, chicks! It's just cancer!" Yeah, and it'll just kill you!

That these new guidelines come amid a contentious healthcare debate have also raised paranoia that this is part of an effort to lower healthcare costs -- at the expense of women's health. The impossible-to-avoid Sarah Palin took to Facebook late Thursday to air her worries about this shift in the wisdom about pap smears: "There are many questions unanswered for me, but one which immediately comes to mind is whether costs have anything to do with these recommendations," she wrote. "The current health care debate elicits great concern because of its introduction of socialized medicine in America and the inevitable rationed care." Many other Republicans have jumped on the "rationing" bandwagon as well. (Yeah now they care about women's healthcare!) Judy Norsigian, executive director of the Boston Women's Health Book Collective (a.k.a. Our Bodies Ourselves), told me that "we have a discourse at the moment that is dominated by right wing rhetoric that the Democrats are all about denying healthcare services."

The truth is that Kathleen Sebelius, secretary of health and human services, insists that the breast cancer screening guidelines will not change "what services are covered by the federal government." (Also, insurance companies claim they won't change mammogram coverage and, as David Dayen points out on FireDogLake, "the procedure is mandated at [age 40] in 49 of the 50 states.") The Obama administration has yet to address the new standards for cervical cancer screening -- but medical opinion on the benefits and risks of pap smears is far less contentious than when it comes to the mammogram debate (which has been going on for decades).

Cindy Pearson, executive director of the National Women's Health Network, an independent consumer-advocacy group, told me that the suggested pap smear routine "is not at all about cost-cutting," but instead "improving women's health." Most women's bodies are able to fight off the virus that causes cervical cancer -- but, when a doctor does detect infection through a test for the virus or the appearance of "disturbed cells" on the surface of the cervix, they typically provide treatment that very well might be unnecessary. This isn't just an issue of experiencing bothersome "cramping, discomfort and missing some work" after having the abnormal cells removed, she says -- "what's actually happening is it's weakening the cervix in some women so that they can't support a pregnancy full-term."

My question for her was why doctors haven't instead adjusted their response to the discovery of the virus' presence -- was it in the interest of avoiding malpractice suits? She explained that the medical community operates under the mantra of "if you see it, you treat it." Essentially, the new cervical cancer screening guidelines reduce the likelihood of a doctor seeing it, so as to avoid their treating something likely to clear up on it's own. "Sometimes there are cases when you say, 'Watch and wait,'" she says, "but almost no one does it."

It just goes to show that you have to be your own advocate when it comes to navigating the healthcare system. As Mary Elizabeth Williams wrote earlier this week about the new mammogram standards, "what’s optional for one woman may be the difference between life and death for another." She also added that "blanket guidelines are just that -- they're fine for covering the many, and they are not laws we have to follow." A woman and her doctor still have to take into account her individual history and particular risk factors. That has always been the case and continues to be so. As Norsigian from Our Bodies Our Selves said: "You give women the scientific evidence and let them make their own choices."

Nelson off the fence on healthcare vote, Lincoln not

Key Democratic senators are being closely watched as the first test of the Senate reform bill approaches

Senate Majority Leader Harry Reid can rest at least a little bit easier tonight. As he heads into the first vote in his chamber on Democrats' healthcare reform bill, he knows he has at least one senator who was wavering on his side.

Sen. Ben Nelson, D-Neb., said Friday that he will vote with his fellow Democrats Saturday night on a cloture motion that will allow the Senate to begin debating the legislation.

"Throughout my Senate career I have consistently rejected efforts to obstruct," Nelson said in a statement. "That's what the vote on the motion to proceed is all about. It is not for or against the new Senate health care bill released Wednesday .... If you don't like a bill why block your own opportunity to amend it?"

Another key vote, though, remains uncommitted. Majority Whip Dick Durbin had said Friday that Sen. Blanche Lincoln, D-Ark., had told Reid how she'll vote, implying that she, too, was a yes. He's since walked that back, however, and Lincoln remains publicly uncommitted. So does Sen. Mary Landrieu, D-La.

Elsewhere on Salon today, there's a great piece from Joe Conason on Lincoln and her vote. You can read it here.

A wobbly Democrat's moment of truth

Pressured from both sides, will a poll-wary Sen. Blanche Lincoln help the GOP sink healthcare reform?
AP
Sen. Blanche Lincoln, D-Ark.

On the very same day that Blanche Lambert Lincoln will finally vote on whether to allow healthcare reform to reach the Senate floor, thousands of the dithering Arkansas Democrat's uninsured constituents will be lining up to see doctors at a free medical clinic in Little Rock. Anticipating this remarkable coincidence, Lincoln may even realize that conservative ideologues and insurance lobbyists are not the only voices that should command her attention during this debate.

Among the handful of Democratic senators who have threatened to support a Republican filibuster, Lincoln is alone in facing reelection next year. Her weakness in recent polls, which suggest that well under half of her home state's voters approve of her performance, has clearly frightened her and emboldened nearly a dozen Republican candidates who want to run against her. Despite careful pandering to right-wing opinion, she has inevitably become a prime target of the National Republican Senatorial Committee, which has vowed to punish her for voting with her party on healthcare.

But as that fateful tally approaches, Lincoln is at last feeling serious pressure from Democrats as well. The man who brought the free clinic to Little Rock -- along with "Countdown" host Keith Olbermann -- is Lt. Gov. Bill Halter, who could be encouraged to enter a primary against her should she uphold the Republican filibuster. A former Clinton administration official and Rhodes scholar, Halter raised his profile by establishing a popular statewide lottery, with proceeds dedicated to education.

When Halter was asked on "Countdown" whether he might run for Lincoln's seat, he didn't say no. No doubt he knows that the activists who belong to Moveon.org and Democrats for America have vowed to raise millions of dollars to support a primary opponent for Lincoln unless she votes for cloture.

Lincoln's position is especially perilous at the moment because no matter what she says or does, her ratings seem to decline. Back in July, she wrote an Op-Ed essay on healthcare reform for the Arkansas Democrat-Gazette, the state's largest daily newspaper, indicating that she supported "real" reform, including either "a quality, affordable public plan or non-profit plan that can accomplish the same goals as those of a public plan." In that same essay she went on to berate "the opponents of reform, who have no real plan for improving health care," for reviving the "tired arguments of the past," with their warnings about "a Washington takeover of health care which will raise your taxes, get between you and your doctor, and eliminate private insurance." She warned Arkansans not to be misled by those who would use such "misinformation" to stimulate fear and block change.

But as her poll numbers plummeted and her position shifted sharply to the right, Lincoln herself quickly became a purveyor of misinformation, particularly concerning the public option. In a September speech at the University of Arkansas medical school, the senator described a bill that does not exist. "For some in my caucus, when they talk about a public option they're talking about another entitlement program, and we can't afford that right now as a nation," she said. "I'm not going to vote for a bill that's not deficit-neutral, and I'm not going to vote for a bill that doesn't do something about curbing the cost in the out years, because it would be pointless ... I would not support a solely government-funded public option."

As Lincoln certainly knows by now, because she claims to have read every page of the pending bills, the public option is neither an entitlement nor solely government-funded, but is to be financed with premiums from its beneficiaries. As for the cost of reform, she also knows that the Senate bill saves hundreds of billions of dollars over the next two decades, according to Congressional Budget Office scoring.

Running away from reform, Lincoln looked weak rather than thoughtful, and cowardly rather than centrist. Her numbers have not improved, and the Republicans are mocking her as a flip-flopper. The damage to her standing among Democrats could make the difference on Election Day, because many voters who pulled the lever for her in 2004 will simply fail to show up. A Democratic state senator who has supported Lincoln in the past told me that she recently sent a message to Lincoln's office: Healthcare is a "line in the sand," not just another issue.

It was Bill Clinton who uttered the most pungent criticism of Lincoln in recent days, however, although he didn't mention her by name. Speaking at a luncheon to celebrate the fifth anniversary of the opening of his presidential library in Little Rock on Wednesday afternoon, he berated the opponents of reform for preserving a system that spends far more than other developed countries for worse care -- at least $900 billion annually, according to his back-of-the-envelope calculations.

Clinton asked his audience, which included hundreds of Democratic donors and activists, to imagine a scenario in which he could somehow run for a third term as president (which drew enthusiastic applause). Then he asked them to consider what would happen if he offered the following campaign promise:

"If you elect me again, the first thing I'm going to do is put a $900 billion tax on you ... I'm going to have the government print the money, and put it on elevated flatbeds, and display it along the national mall. And we're going to broadcast this ceremony on national television. And then I'm going to motor myself from one end of that $900 billion to the other, sprinkling Kerosene on it, and then I'm going to set it afire and watch it burn.

"How many people do you think would vote for me?" he demanded. "If you don't want to reform healthcare, that is your position. That is what you are advocating."

Lincoln wasn't there, but she could have heard the roaring laughter all the way back in Washington.

More GOP lies about healthcare reform

Republicans who know better falsely claim that the panel recommending fewer mammograms is a Dem plan for rationing

The Senate will vote Saturday on whether to open debate on the healthcare reform bill, or make it easy for Republicans to filibuster. The only action is in the Democratic caucus, including the independents who caucus with them. (Sen. Joe Lieberman, I-Aetna, has threatened to back a Republican filibuster; let's hope Democrats find a peaceful solution.)

And really, why would anyone block debate? There's plenty that's controversial about both the Senate and House bills -- things to dislike for both the right and the left. There could be a great historic reckoning about it all. Sadly, Republicans seem to want to ignore the real issues and make up lies about the Democratic bills. I saw that firsthand on Thursday when Wyoming Sen. John Barrasso, who happens to be a doctor, blatantly lied to MSNBC's Ed Schultz about the Democratic reform bill.

Like other Republicans in the last couple of days, Barrasso tried to pretend that the recent decision by the U.S. Preventive Services Task Force, recommending that women start routine mammograms at 50 and not 40, was related to the Democrats' push for insurance reform. Even Sarah Palin has had to admit there are no "death panels" in the Democrats' bills; so now we have "breast panels," where Republicans claim bureaucrats will deny mammograms to women under 50 thanks to Obama's push for reform.

It's an enormous lie. Various government advisory panels have been trying to ratchet up the age for women to begin routine mammograms (from 40 to 50) going back to the Clinton administration through the George W. Bush administration and now, again, in the Obama administration. I'm not sure which side is right; I know doctors and breast cancer advocates on both sides of the issue. All I know is that the recent recommendations have nothing to do with so-called Obamacare. But I watched Barrasso, who clearly knows better, lie to Schultz about it all on Thursday. Here's what he said:

"You see what happened now with this rationing of care, with this preventive task force, they're preventing services for women, with mammograms. That's really a preview into what may happen with healthcare in America, when you get the government standing in between a patient and their doctor….Washington says it knows best, it says 'No, don't do mammograms to age 50, stop after age 75. 'You know what that's gonna do? That's gonna cost lives."

Thanks to Ed Schultz for giving me the chance to answer Barrasso, and explain how badly he distorted the facts about the panel's origins and power, and how well he represented the Republican position: say absolutely anything to stop healthcare reform. Lie, if you have to. Of course, the preventive services panel has no standing to change policy, and both Health and Human Services Secretary Kathleen Sebelius and the American Cancer Society came out against the panel's recommendations. And Barrasso knows that.

That's what I said on "The Ed Show." One post-show correction: It's not the very same panel issuing these mammogram-restricting guidelines over the years; earlier it was the National Institute of Health's Consensus Development Conference that recommended that mammograms begin at 50. The point is that various federal panels under various presidents have suggested raising the age at which women start mammography, and three presidents in both parties over the last 20 years have had to decide what to do. Clearly it's a medical debate, not a political one, and Republicans are dishonest and fear-mongering to pretend otherwise. 

Lieberman to liberals: Bite me

The senator laughs off suggestions of retribution if he votes down healthcare reform legislation

Sen. Joe Lieberman, I-Conn., isn't worried about Democrats getting angry if he votes with Republicans to filibuster healthcare reform legislation. But the reason for his lack of concern that he gave Politico this week may make some liberals even madder:

After what I went through in 2006, there’s nothing much more that anybody [who] disagrees with me can try to do.

Ouch.

Welcome to abortion's middle ground

The Senate's proposed healthcare bill may not be perfect, but it sure looks good after Stupak-Pitts

Ah, compromise! There's nothing like an extreme assault on women's reproductive rights to make you truly appreciate moderation. On Wednesday night, Senate Majority Leader Harry Reid introduced the proposed Senate healthcare bill, which trades the House's stringent Stupak-Pitts language in favor of a limited ban on federal funding of abortions. Essentially, the bill applies the restrictions found in the Hyde amendment to the healthcare bill. Stupak supporters may claim their amendment accomplishes the same thing -- but, as we've repeatedly written in Broadsheet, it goes much farther.

The key details of the Senate bill are as follows: Both public and private plans are allowed to offer abortion coverage. It empowers consumers to use government subsidies to purchase insurance that covers abortion, but requires that their premiums (and not federal funds) pay for the actual procedures. The Health and Human Services Secretary is charged with evaluating plans to ensure that taxpayers do not pay for abortions. And, while the bill requires at least one plan in each state to cover abortion, it also includes a conscience clause stating that healthcare providers cannot "be discriminated against because of a willingness or an unwillingness ... to provide, pay for, provide coverage of, or refer for abortions."

It's a true compromise bill. Meaning, it seems, that now both sides have something to be unhappy about. Doug Johnson, the National Right to Life Committee's legislative director, issued the following statement last night: "Reid has sought to please the militant minority that demands funding of abortion through federal programs, even though substantial majorities of Americans believe that abortion should be excluded from government-funded and government-sponsored health programs." Along similar lines, anti-choice Sen. Ben Nelson told The Hill: "I think you need to have it eminently clear that no dollars that are federal tax dollars, directly or indirectly, are used to pay for abortions and it needs to be totally clear." Presumably, "eminently clear" means Stupak-Pitts.

On the other side of the divide, a press release from NARAL Pro-Choice America said President Nancy Keenan is "encouraged that the Senate bill does not include the extreme new anti-choice restrictions adopted by the U.S. House" but notes that "the legislation includes a compromise that continues existing laws that unfairly single out abortion care, including a ban on federal funding." Nancy Northup, president of the Center for Reproductive Rights, was more supportive of the bill: "It is absolutely critical that the compromise language in the Senate bill prevail in any health reform legislation," she said in a statement. Lest you think she's perfectly happy with the new bill, Northup added, "Women have compromised their needs substantially to pass the bill, and Senator Reid's merged bill contains even more stringent segregation of funds and other requirements to ensure that no federal money will pay for abortion services. Enough is enough, and there can be no further weakening of protections for women and their healthcare needs." Now that's a choice -- ehem -- note to end on.

Update: More pro-choice organizations have weighed in on the Senate bill. Consistent with the comments above, Cecile Richards, president of Planned Parenthood, just issued the following statement:

The Senate bill ensures that no federal funds will pay for abortion, which is in keeping with the 33-year consensus based on the passage of the Hyde amendment in 1976. While we don’t agree with Hyde or approve of the fact that the Senate bill singles out abortion from all other medical procedures, we believe that the Senate bill respects the Hyde consensus, while allowing women with private health insurance the choice of plan, coverage, and providers.

Terry O'Neill, president of the National Organization for Women, however, took a more aggressive stance. "The Senate version of the health care bill, released last night, purports to be less harsh, but make no mistake: the anti-abortion provisions of this bill are harmful to women. What's worse, we know there will be an attempt to amend the Senate bill to go all the way with a provision mirroring the House's Stupak-Pitts Amendment," she said in a statement. "Anti-abortion measures have no place in health care reform!"

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