Obama's team weighs in on healthcare overhaul

Reporting from Washington — The Obama administration delivered to Congress its first detailed proposal for a piece of the healthcare overhaul today, suggesting that a new independent board make the decisions on how Medicare pays hospitals and doctors.

Until now, the president has carefully deferred to lawmakers developing healthcare legislation, in part because many believe that the Clinton administration's decision to write its own healthcare bill 15 years ago alienated Congress and contributed to that initiative's failure.

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2009/2010: OBAMA STUMPING FOR CORZINE

CongressDaily’s McPike notes all the Republicans running for rematches in 2010. 

"The shape of the 2010 battleground remains largely in flux 17 months away from Election Day, but House Democrats continued to reap the benefits of their majority status by posting strong second-quarter fundraising numbers this week," Roll Call writes. "In 40 targeted districts featuring incumbents, newly-filed fundraising reports showed that 10 of 30 Democrats had raised $300,000 or more, and three more incumbents falling just short of that mark."

DELAWARE: Rep. Mike Castle, who voted for the Democrats' energy bill, says he wasn't whipped by GOP House leadership; Republicans dispute that. The Hill sees it as the "latest indication that Castle, who is mulling a Senate bid, is unlikely to run for a 10th term in the lower chamber."

NEW JERSEY: President Obama made his first appearance on the campaign trail since he won the presidency. Stumping with Democratic Gov. Jon Corzine yesterday, Obama said, “I want you to know I’m proud to stand with a man who wakes up every day thinking of your future and the future of Jersey.” Corzine, trying to link his own beleaguered campaign to Obama’s presidency, noted, “Now, with a partner in the White House, there is no limit to what we can accomplish.” But Monmouth University polling director Patrick Murray said Obama’s appearance “would have no effect on [Jerseyans’] vote.” Some, in fact, came only to hear Obama. Chris Monroe of Roselle said, “This is a good gimmick to get us to listen to Corzine.” Some voters, like Sarah Tofighbakash, see Corzine as the lesser of two evils. “I’m iffy on Corzine, but I find Christie pretty repulsive,” she said.  

A new video from Republican candidate Chris Christie’s campaign, “I voted for Obama,” “highlights New Jerseyans from around the state who supported President Obama in 2008 and who will be voting for Chris Christie for Governor in 2009.”

VIRGINIA: Vice President Joe Biden made a stop at a private home in support of gubernatorial candidate Creigh Deeds last night. “The visit to Virginia signals a commitment by both the White House and Deeds campaign to weave their fortunes together, with Deeds banking on the mellowing but still strong popularity of Barack Obama.” 

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Black America's New Reality

President Obama's speech Thursday marking the 100th anniversary of the NAACP's founding was widely reported as a "tough love" message directed at black America. "I've noticed that when I talk about personal responsibility in the African American community, that gets highlighted," Obama said in an interview Friday. "But then the whole other half of the speech, where I talked about government's responsibility . . . that somehow doesn't make news."

Fair enough, but he misses the point. The real news wasn't in the content but the visuals: the nation's leading black civil rights organization being addressed by the nation's first black president. Obama could have read nursery rhymes and the event still would have been noteworthy.
In his six months in office, Obama has taken few occasions to confront the issue of race head-on. This moment was inescapable. But his words about the deficits that still plague black America were delivered to a room full of NAACP convention delegates who are, by and large, highly educated and comfortably affluent -- men and women who already have high expectations for their children and know how to hold their elected officials accountable. Missing was the too-large segment of the black community that has been left behind.
"Don't underestimate the degree to which a speech like the one I gave yesterday gets magnified throughout the African American community," Obama told me in the Oval Office, where a bust of the Rev. Martin Luther King Jr. surveys the room in silent admonition. "Folks on Friday go in and get their hair cut, they're getting ready for the weekend, they're sitting in the barber's chair, and somebody said, 'Did you see what Obama said yesterday?' It sparks a conversation. . . . And part of what my goal is here is to make sure that I'm giving a lot of folks permission to talk about things that maybe they've talked about around the kitchen table but don't get fully aired in public."
A century ago, when the NAACP was founded, black America was under siege -- lynchings were common, race riots had rocked major cities and Jim Crow segregation was being codified throughout the South. Today, all of that is fast-receding history. Some critics have wondered whether there is still a role for an organization like the NAACP. Obama says there is -- not just in advocacy but also in local-level efforts to mentor children and improve underperforming schools.
Obama embodies two trends that have made the African American community increasingly diverse. He is the son of a Kenyan immigrant -- at a time when highly educated people from Africa and the Caribbean are coming to this country in record numbers. And he is biracial -- the product of a kind of relationship that long was illegal in many states.
"I think that I would add a third element . . . which is a generational shift," Obama said. "If we haven't already reached this point, we're getting close to reaching it, where there are going to be more African Americans in this country who never experienced anything remotely close to Jim Crow than those who lived under Jim Crow. That, obviously, changes perspectives."
One impact of these changes, I believe, has been to make it all but impossible to identify a single "black agenda" or see a clear path toward future progress, the way the NAACP's founders saw the way forward. But we have to accept this new reality, because I can't argue with Obama when he says that black America's growing diversity is "all for the good."
"One of the ways that I think that the civil rights movement . . . weakened itself was by enforcing a single way of being black -- being authentically black. And, as a consequence, there were a whole bunch of young black people -- and I fell prey to this for a time when I was a teenager -- who thought that if you were really 'down' you had to be a certain way. And oftentimes that was anti-something. You defined yourself by being against things as opposed to what you were for. And I think now young people realize, you know what, being African American can mean a whole range of things. There's a whole bunch of possibilities out there for how you want to live your life, what values you want to express, who you choose to interact with."
No one could argue against possibility. But there was a time when no one had to ask what the NAACP was supposed to do -- when black Americans, living with the common constraints of overt discrimination, had an obvious and urgent common purpose.
Said Obama: "I do think it is important for the African American community, in its diversity, to stay true to one core aspect of the African American experience, which is we know what it's like to be on the outside.
"If we ever lose that, then I think we're in trouble. Then I think we've lost our way." 

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Obama Says Health-Care Reform Essential to Repairing Economy

President Obama urged Congress today to push past growing doubts and pass comprehensive health-care reform package this year, saying that a better opportunity to remake the nation's health care system may not arise for generations.

The president urged lawmakers Friday to take bolder steps to achieve health-care reform, and today in his weekly radio and Internet address, Obama called reform essential not only to expanding health care coverage to the 46 million Americans who lack it but also to restoring the nation's economic stability.

"This is an issue that affects the health and financial well-being of every single American and the stability of our entire economy," Obama said.

With the cost of health-care coverage rising at three times the rate of wages in recent decades, Obama called the status quo in health care unsustainable.

That fast-increasing cost of health insurance is crippling businesses, which are finding it difficult to afford to provide coverage. It is also placing a difficult burden on state and federal governments, who find increasing shares of their budgets consumed by Medicaid and Medicare costs. In addition, individuals who lack coverage frequently find themselves at risk of being thrown deep into debt by just one medical emergency.

As bills to expand health-care coverage take shape in both houses of Congress, criticism has intensified because of their potential costs. The Congressional Budget Office has said that the proposals fall short of Obama's promise to slow the increase in health-care costs, leading critics to charge that those bills would only add to the nation's already soaring budget deficits.

"That's simply not true," Obama said today.

Reform is expected to cost at least $1 trillion over the next decade, and Obama has pledged to pay for the changes without adding to the deficit. In fact, he says, the savings accrued by adjusting health-care incentives will eventually reduce medical costs and help bring the nation's budget deficits under control.

"By helping improve quality and efficiency, the reforms we make will help bring our deficits under control in the long-term," Obama said.

Rather than shy away from reform because of the difficulty, Obama urged, Congress should grab hold of the moment.

"This is what the debate in Congress is all about," he said. "Whether we'll keep talking and tinkering and letting this problem fester as more families and businesses go under, and more Americans lose their coverage. Or whether we'll seize this opportunity - one we might not have again for generations -- and finally pass health insurance reform this year, in 2009."

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Obama Urges Bolder Action to Shrink Costs

President Obama sought to reassure jittery Democrats that health-care reform was within reach, although he urged his party to take bolder steps to address long-term cost concerns.

Democratic defections on two House committees yesterday underscored divisions among the party's rank-and-file over the scope of reform, along with its massive price tag. The latest rebellion stirred among newly elected Democrats who are wary of the surtax on wealthy households that the House bill would impose -- a cudgel for Republicans, who portray the tax as a killer for small businesses.

Despite the warning signs, Obama asserted yesterday afternoon from the White House, "We are going to get this done. We will reform health care. It will happen this year. I'm absolutely convinced of that."

With every new brush fire, Obama faces growing pressure to relent on his midsummer deadline for House and Senate passage. That marker was established to keep momentum going, but with two weeks remaining on the House calendar and three in the Senate before they recess, the timetable appears all but unattainable.

Yet so far, the president has refused to yield. "I realize that the last few miles of any race are the hardest to run, but I have to say now is not the time to slow down, and now is certainly not the time to lose heart," Obama said.

The Senate Finance Committee appeared yesterday to be making slow, but steady progress on its legislation, the one version of health-care reform expected to gain bipartisan support. At a meeting late Thursday, negotiators identified about a dozen remaining areas of disagreement, including a revenue gap of about $100 billion. Senate sources said committee aides would work through the weekend on outstanding questions, with the goal of producing a draft bill by Tuesday.

Congressional Budget Office Director Douglas Elmendorf sent shock waves through the Capitol on Thursday when he declared that proposals already on the table from the House and the Senate health committee would fail to achieve "the sort of fundamental changes" necessary to rein in the skyrocketing cost of government health programs, particularly Medicare.

Last night, Elmendorf had more bad news. Hours after Obama vowed that health reform would not expand the deficit over the next decade, the CBO reported that the House bill would increase the deficit by about $240 billion by 2019. A plan to expand insurance coverage to 37 million Americans would cost the government about $1.04 trillion, the CBO said. That would be partially offset by reductions in existing federal programs worth $219 billion and tax increases -- including a surtax on the wealthy -- worth about $583 billion.

The resulting deficit reflects a decision by House leaders to cancel a scheduled 21 percent reduction in Medicare payments to physicians. Maintaining doctor reimbursements would cost about $245 billion over the next decade, the CBO said, accounting for the entire gap in the House bill.

The CBO report left unclear the overall cost of the House proposal, which Democrats have estimated at about $1.2 trillion -- the cost of the coverage plan plus the Medicare adjustments for doctors.

Along with closing the uninsured gap, restraining cost growth is a primary goal of the reform effort. But Democrats have yet to agree to controversial measures needed to "bend the cost curve."

Obama announced yesterday that he would back one such step, a proposal requiring Congress to surrender authority over Medicare reform and reimbursement rates to an independent group of medical experts. Lawmakers cherish their power to adjust payments to local doctors, hospitals and other providers, and as a rule, they ignore warnings from the Medicare Payment Advisory Commission, established by Congress in 1997, to adopt drastic changes to save the program from collapse.

"What we want to do is force the Congress to make sure that they are acting on these recommendations to bend the cost curve each and every year, so that we're constantly adjusting and making changes," Obama said yesterday.

 House Speaker Nancy Pelosi (D-Calif.) acknowledged concerns about the proposal, but said they could be overcome "under certain circumstances."

Senate negotiators, meanwhile, are pressing Obama to retreat from his campaign opposition to a health-insurance benefits tax that Elmendorf and other experts regard as a vital cost-containment tool. Senate tax aides are examining ways to close the tax loophole so it does not harm middle-class workers, including police officers and firefighters, who receive lucrative benefits packages.

One possible compromise would be to tax insurance companies, rather than beneficiaries, on large policies, an idea floated years ago by former senator Bill Bradley (D-N.J.). Senate aides who have studied the proposal said it could achieve the same aim of discouraging overuse of health care, but without the direct hit to beneficiaries that Obama is determined to avoid. Some Senate Democrats said they are increasingly hopeful that the White House will sign off on the idea -- especially if Congress embraces the independent commission.

Despite Obama's pep talk, new concerns arose in both chambers that underscore the legislation's complexities and the many pitfalls that negotiators will continue to encounter.

In the House, 22 freshmen and sophomore Democrats wrote to Pelosi to protest the surtax on wealthy households that the House would adopt to fund nearly half of its estimated $1.2 trillion, 10-year bill. Under the plan, a 1 percent tax would kick in at $350,000 in annual household income and rise to 5.4 percent on incomes more than $1 million, but the group expressed concern that small businesses would be hit as well.

Two signatories, freshmen Reps. Jared Polis (Colo.) and Dina Titus (Nev.), were among the three Democrats to oppose the revenue-raising portion of the House bill, approved 23 to 18 by the Ways and Means Committee early yesterday. In the Education and Labor Committee, three other Democrats voted no on a separate section of the bill, which was approved 26 to 22.

Meanwhile, in the Senate, a bipartisan group of six centrists that includes Republicans  Olympia J. Snowe and  Susan Collins, both of Maine and crucial swing votes on health care, appealed yesterday to Senate leaders to "resist timelines" in a debate that could impact more than one-sixth of the nation's economy.

"We support the efforts of Finance Committee members to produce a bipartisan bill," the centrists wrote to  Senate Majority Leader Harry M. Reid (D-Nev.) and  Minority Leader Mitch McConnell (R-Ky.). 

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Obama urges Congress to stay vigilant on healthcare

WASHINGTON - President Obama sought to reassure jittery Democrats yesterday that healthcare legislation was within reach, although he urged his party to take bolder steps to address long-term cost concerns.

Democratic defections on two House committees yesterday underscored divisions among the party’s rank-and-file over the scope of the bill, along with its massive price tag. The latest rebellion stirred among newly elected Democrats who are wary of the surtax on wealthy households that the House bill would impose - a cudgel for Republicans, who portray the tax as a killer for small businesses.

Despite the warning signs, Obama asserted from the White House, “We are going to get this done. We will reform healthcare. It will happen this year. I’m absolutely convinced of that.’’

With every new brush fire, Obama faces growing pressure to relent on his midsummer deadline for House and Senate passage. That marker was established to keep momentum going, but with two weeks remaining on the House calendar and three in the Senate before lawmakers recess, the timetable appears all but unattainable.

Yet so far, the president has refused to yield. “I realize that the last few miles of any race are the hardest to run, but I have to say now is not the time to slow down, and now is certainly not the time to lose heart,’’ Obama said. “We’re going to be putting in a lot more hours, there are going to be a lot more sleepless nights, but eventually this is going to happen.’’

Obama, who also plans a primetime news conference Wednesday and a healthcare event in Cleveland Thursday, did not mention the August recess.

Instead, he urged lawmakers and the public to look past the daily ups and downs and focus on the “unprecedented progress’’ toward overhauling healthcare: hospitals and drug companies have pledged givebacks to help pay for the bill, the American Medical Association and American Nurses Association endorsed legislation this week, and broad agreement on major elements of the bill.

The Senate Finance Committee appeared yesterday to be making slow, but steady progress on its legislation, the one version of healthcare changes expected to gain bipartisan support. At a meeting late Thursday, negotiators identified about a dozen remaining areas of disagreement, including a revenue gap of about $100 billion. Senate sources said committee aides would work through the weekend on outstanding questions, with the goal of producing a draft bill by Tuesday.

Douglas Elmendorf, director of the Congressional Budget Office, sent shock waves through the Capitol Thursday when he declared that proposals already on the table from the House and the Senate Health Committee would fail to achieve “the sort of fundamental changes’’ necessary to rein in the skyrocketing cost of government health programs, particularly Medicare.

Along with closing the uninsured gap, restraining cost growth is a primary goal of the reform effort. But Democrats have yet to agree to controversial measures needed to “bend the cost curve.’’

Obama announced yesterday that he would back one such step, a proposal requiring Congress to surrender authority over Medicare changes and reimbursement rates to an independent group of medical experts. Lawmakers cherish their power to adjust payments to local doctors, hospitals, and other providers, and as a rule, they ignore warnings from the Medicare Payment Advisory Commission, established by Congress in 1997, to adopt drastic changes to save the program from collapse.

“What we want to do is force the Congress to make sure that they are acting on these recommendations to bend the cost curve each and every year, so that we’re constantly adjusting and making changes,’’ Obama said yesterday.

House Speaker Nancy Pelosi acknowledged concerns about the proposal, but said they could be overcome “under certain circumstances.’’

Senate negotiators, meanwhile, are pressing Obama to retreat from his campaign opposition to a health-insurance benefits tax that Elmendorf and other analysts regard as a vital cost-containment tool. Senate tax aides are examining ways to close the tax loophole so it does not harm middle-class workers.

One possible compromise would be to tax insurance companies, rather than beneficiaries, on large policies, an idea floated years ago by Bill Bradley, the former New Jersey senator. Senate aides who have studied the proposal said it could achieve the same aim of discouraging overuse of healthcare, but without the direct hit to beneficiaries that Obama is determined to avoid. Some Senate Democrats said they are increasingly hopeful that the White House will sign off on the idea - especially if Congress embraces the independent commission

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Obama advisor Lawrence H. Summers defends $787-billion stimulus plan

Reporting from Washington — President Obama's chief economic advisor, former Treasury Secretary Lawrence H. Summers, defended the administration's massive program for fighting the recession, saying it was on track and beginning to show results despite continuing bad news on unemployment.

"If we were at the brink of catastrophe at the beginning of the year, we have walked some substantial distance back from the abyss," Summers said Friday in remarks at the Peterson Institute for International Economics, a Washington think tank.

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Bush-era intelligence issues trip up Obama

Barely six months old, the Obama administration faces a political problem caused by how the CIA handled a secret counter-terrorism program. Though President Obama has insisted he wants to look forward and push an ambitious domestic agenda, a series of intelligence-related issues has the administration and Congress looking back at the George W. Bush years. Here is a primer of what we know.

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Obama's historic all-female Marine One crew

It was another first in presidential history.

When President Obama left the White House on Thursday for Andrews Air Force Base, the Marine One helicopter that lifted off from the South Lawn was piloted by the first female helicopter aircraft commander in Marine One history. Maj. Jennifer Grieves of Glendale, Ariz., flew her first Marine One mission in May 2008, and had flown Obama and then-President George W. Bush.

In honor of Grieves' last day in the rotation, the Marines assigned two other female officers -- Maj. Jennifer L. Marino, of Palisade, Colo., and Sgt. Rachael A. Sherman, of Traverse City, Mich. -- to complete the crew. And that all-female crew was another first.

Marines say Grieves is off to Command and Staff College in Quantico, Va.

When the president boarded Marine One en route to try to salvage Gov. Jon Corzine's reelection bid in New Jersey and to address the NAACP in New York, he stopped to talk to Grieves and shook her hand.

Of course Obama is accustomed to being surrounded by women. At the White House he lives with First Lady Michelle Obama; their daughters, Malia and Sasha; and his mother-in-law, Marian Robinson.

Still, it was a singular moment in girl power when the chopper lifted off.

Perhaps CNN put it best when it called Grieves "the woman that shattered Marine One's glass rotors."

-- Johanna Neuman

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Defying President Obama, House Takes What Critic Calls "Hardcore Bipartisan NIMBY" Action on Chrysler and GM Auto Dealers

The Democratic-controlled House yesterday spurned the strong recommendations of President Obama and voted to undo the shuttering of more than 2,000 Chrysler and General Motors dealers closed as part of the restructuring of those two companies.

A source involved in the auto restructuring called the vote "hardcore bipartisan NIMBY," using the acronym for "Not In My Back Yard," a derisive term for politicians who take the most parochial views of issues, defying the "greater good."

As part of the auto companies' restructuring, Chrysler shut down 789 dealerships and General Motors informed roughly 1,300 dealerships that their franchise deals wouldn’t be renewed in 2010.

The legislation, drafted by Rep. Steve LaTourette, R-Ohio, and added in the Appropriations to the $24 billion Treasury Department funding bill, would stop those dealership closings and require Chrysler and GM to pursue any future closings in court.

“I don’t think Chrysler or GM has been able to demonstrate there is a savings associated with fewer dealers, since the dealers themselves bear the costs of operating their dealerships with little help from the manufacturers,” LaTourette said. “I think the closing of these dealerships was punitive and secretive, and it’s the most un-American thing for the government to help force you out of business and deprive you of the American dream.”

The larger bill was approved last night by the House by a vote of 219 to 208.

While not issuing a veto threat -- the bill has yet to go through the Senate, where the support of Senate Majority Leader Harry Reid, D-Nev., is less than assured -- the White House earlier this week said that President Obama's administration "strongly opposes the language in the bill that attempts to restore prior Chrysler and General Motors (GM) franchise agreements."

Arguing that the Small Business Administration on July 1 "implemented a new program to provide guaranteed floor plan financing loans" for dealers hurt by the restructuring, the administration said that "the decision by Chrysler and GM to rationalize their dealer networks was a critical part of their overall restructuring to achieve long-term viability in order to save jobs in the long run, and to improve the prospects for the companies’ repayment of the substantial taxpayer investments. Without the significant steps these automakers have taken to revamp their operations, the companies would have failed – imperiling every GM and Chrysler dealer in the country."

The move by Congress, the Obama administration said, "would set a dangerous precedent, potentially raising legal concerns, to intervene into a closed Judicial bankruptcy proceeding on behalf of one particular group at this point."

Last Fall, Sen. Bob Corker, R-Tenn., said that U.S. automakers "have all kinds of legacy issues they have not been able to deal with. Let me point out one. General Motors has 7,000 dealers. They probably need about 1,500 dealers. What the dealers did years ago is, they went around and got states to pass laws that said that GM could not do away with their dealerships. We have had the strong dealers actually calling our office and telling us they actually have hurt themselves by putting these state laws in place, because there are so many dealers that each of them is having trouble making a profit. It would be a tremendous disservice for us to grant money to these companies without causing them to reorganize."

But earlier this week the House Appropriations Committee approved LaTourette's amendment. House Appropriations Chairman David Obey, D-Wisc., agreed with LaTourette, saying he'd heard "legitimate concerns from a doggone good" auto dealer from his congressional district.

“Dealerships across Wisconsin and the 7th district have received notices that they are to close affecting places like Antigo, Chippewa Falls, St. Croix Falls, Phillips, Medford, Marshfield, Wisconsin Rapids, Wittenberg, Cornell, Cumberland and many others," Obey said at the beginning of June. "The loss of dealerships in many of these communities will present a real hardship."

But Rep. John Dingell, D-Mich., a longtime supporter (some might say enabler) of the US auto industry, disagreed.

“This is a very fragile industry and its survival even without that amendment is not necessarily assured,” Dingell said. “The amendment could be a burden that the industry simply cannot carry.”

This argument was repeated by the automakers.

“Chrysler has had many conversations with members of Congress to explain the critical importance of an effective dealer network,” said a Chrysler spokesman.

Said a GM spokesman: "this legislation seeks to overturn the bankruptcy court’s decision after the fact to protect a single stakeholder among so many that have been called to sacrifice.”

- jpt

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“Back from the Abyss”: Obama Adviser Touts Economic Rescue

ABCNews' Matthew Jaffe reports:

The nation’s economy has been rescued from the brink of collapse, President Obama’s top economic adviser believes.

In excerpts released by the White House, National Economic Council director Larry Summers touts the progress made by the administration in averting a financial meltdown.

“We were at the brink of catastrophe at the beginning of the year, but we have walked some substantial distance back from the abyss,” Summers plans to say this morning at the Peterson Institute in Washington. “Substantial progress has been made in rescuing the economy from the risk of economic collapse that looked all too real six months ago.”

When the administration entered office back in January, Summers recalls, “the economy was in free-fall at the start of the year with no apparent limit on how much worse things could get…fear was widespread and confidence was scarce.”

But thanks to President Obama’s two-tiered approach of addressing the immediate crisis and building for long-term growth, Summers says, “the distance we have traveled these past six months is remarkable.”

“First, the most immediate priority was to rescue the economy by restoring confidence and breaking the vicious cycle of economic contraction and financial failure,” outlines Summers. “Second, the recovery from this crisis would be built not on the flimsy foundation of asset bubbles but on the firm foundation of productive investment and long-term growth.”

In recent weeks, the administration has sent their sweeping financial regulatory reform proposals down Pennsylvania Avenue to Congress. Going forward, Summers calls for an economy that is more export-oriented and more balanced in terms of income distribution. While acknowledging that the administration’s agenda is “ambitious”, Summers believes it will “lay a foundation for future prosperity and for the confidence on which the current recovery depends.”

-Matthew Jaffe

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My Interview With President Obama

CBS)  I met President Obama yesterday. I interviewed him at the White House about his proposals for health care reform. But naturally, as we greeted each other, I asked about his throwing out the first ball at the All Star Game the night before.

"Were you nervous about bouncing the ball?" I asked. He grinned. "I will say it’s actually nerve-wracking," he said. "When they hand you the ball, there are just a lot of things that can go wrong." I found that to be a perfect metaphor for his assuming the Presidency of the United States and attempting to overhaul the health care system.

The biggest news from yesterday’s interview: President Obama has changed his position from the campaign trail and now believes that health care insurance should be mandated for all Americans, with a hardship exemption.

Dr. LaPook: Ultimately, philosophically, do you believe that each individual American should be required to have health insurance?

President Obama: I have come to that conclusion. During the campaign, I was opposed to this idea because my general attitude was the reason people don't have health insurance is not because they don't want it, but because they can't afford it. And if you make it affordable, then they will come. I've been persuaded that there are enough young uninsured people who are cheap to cover, but are opting out. To make sure that those folks are part of the overall pool is the best way to make sure that all of our premiums go down. I am now in favor of some sort of individual mandate as long as there's a hardship exemption. If somebody truly just can't afford health insurance even with the subsidies that the government is now providing, we don't want to double penalize them. We want to phase this in, in a way that we have time to make sure that coverage is actually affordable before we're saying to people "go out and get it."

The interview went very smoothly and fairly predictably until we reached the following exchange:

Dr. LaPook: You've said that if doctors have the information, they'll do the right thing. And generally, I like to -- I'm a physician and practicing -- I think that's true. But actually, there are a lot of times when that's not the case. For example, angioplasties -- elective angioplasties, where you open up a clogged artery in the heart. It turns out that about 30 percent of them are unnecessary, that they're done and you try to open up an artery of the heart, but really it's no better than medication, and doctors know this, but they still order them.

President Obama: Why are they still ordering them, do you think?

I will admit that he took me by surprise by turning the question on me. Suddenly I was not in a one-way interview, I was in a conversation. Politics aside, it was clear to me that he was listening and he was curious.

Dr. LaPook: I think that because they believe -- there's this thing about -- if an artery's closed. It's got to be better if it's open, and it turns out that's not true. So they have on the one side their intuition as a physician, in their bellies, and then there's the evidence-based medicine that we talk about, and they clash a lot at times, so how do you make that doctor do the right thing or give him the right incentives?

President Obama: I have enormous faith in doctors. I think they always want to do the right thing for patients. But I also think, if we're honest, doctors, right now, have disincentives to making the better choices in the situations you talked about. If you are getting paid more for the angioplasty, then that subconsciously even might make you think the angioplasty is the better route to take. And so if we're reimbursing the physician not on the basis of how many procedures you're performing but rather how are you caring for the patient overall - what are the outcomes - then I think you start seeing some different choices. And at the very least, you're not taking money out of physicians' pockets for making the better choice. So it’s a combination of better information and then, I think, a different system of reimbursement that says, "let’s look at the overall quality of the care of the patient."

My conversation with President Obama illustrates a crucial focus of the current health care debate: figuring out if the American people are getting their bang for the buck when doctors order tests, perform procedures, and prescribe medications. The current buzzwords among doctors and politicians are "evidence-based medicine" (is there proof that something works?) and "comparative effectiveness" (if there’s more than one way to do something, what works best?). An Institute of Medicine workshop about evidence-based medicine began today in Washington, with the following listed as “issues prompting the discussion”:

"Health costs in the United States this year will be about $2.5 trillion-nearly 17 percent of the economy.

The United States spends far more on health care than any other nation, 50 percent more than the second highest spender and about twice as high as the average for other developed countries.

Overall health outcomes in the United States lag behind those achieved in other countries.

Consistent with the per capita figures, many researchers studying the nature of U.S. health expenditures feel that 20 percent of our expenditures do not contribute to better health."

Expert groups are currently trying to establish guidelines for reimbursing health expenses based on clear results from well-designed clinical studies. The problem is that for many medical issues, there is no definitive, evidence-based approach. Clinical medicine is often based on inexact, immeasurable tools such as intuition and experience. As doctors, we don’t have the luxury of waiting for the twenty-year study to be completed. We have to treat the patient now, as best we can, without perfect information.

In the absence of definitive data, we will need to account for clinical judgment in an overhauled health care system. What will happen when the doctor suggests something the insurance company says is not indicated? Opponents of a public option for insurance warn about the danger of having a bureaucrat in between the patient and the physician. But that threat already exists in the current system every time an insurance company decides whether to approve a claim. Wendell Potter, former head of Public Relations for Cigna, recently told Bill Moyers about Cigna’s decision to deny a liver transplant to a 17-year-old girl, Nataline Sarkisyan, even though her doctors at UCLA had recommended the procedure.

A public-relations uproar forced Cigna to reverse its decision; the company subsequently explained its reversal as an exception, saying the surgery was approved “despite the lack of medical evidence regarding the effectiveness of such treatment.” Ms. Sarkisyan died hours after Cigna’s decision, without having received the transplant.

A critical flaw in the current system - and one that must be addressed in any overhaul - is that the same people who refuse to pay for a recommended course of action are the ones who consider the appeal of that decision. And, lo and behold, they usually end up agreeing with themselves! In more than two decades of medical practice, I have spent countless hours trying to get various services covered by payors. One encounter - when I tried unsuccessfully to get a stomach-acid lowering pill approved for a patient who needed it -ended up as an example of twentieth-century frustration in Letters of the Century.

Yes, our current health care system is not sustainable and we do need an overhaul. But there is no "exactly how" and we cannot afford to wait for one. There are so many nuances to the moving target of health care and so many unknowns that it is impossible to create a perfect solution on paper. I’ll settle for an imperfect solution that addresses the most important problems first and represents the best efforts of our most thoughtful experts. But it should not be set in stone. It must include provisions to mature gracefully into versions 2.0 and beyond. 

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No escape from Guantanamo for Obama

(CNN) -- There are more than 200 men behind bars in the U.S. prison at Guantanamo Bay, Cuba. In a way, U.S. President Barack Obama is trapped there too.

How we deal with those situations," he said in an interview with the Associated Press earlier this month, "is going to be one of the biggest challenges of my administration."

The detention center for suspected terrorists is one of the most infamous prisons in the world. On his first full day as president, Obama promised to shut it within a year.

On Tuesday he'll be at the half-way point and he's still struggling to close it.

The president says there are three kinds of prisoners at Gitmo. First, there are those who'll be put on trial. Military courts have already heard some cases and civilian court proceedings are under way as well.

There are prisoners who are expected to be released or transferred somewhere else. Since Gitmo was established in 2002, hundreds have been sent to their home countries or other places willing to accept them.

Finally, there are those the U.S. can't prosecute but doesn't want to let go.

All the cases are complicated but that third category is the most controversial: prisoners whom the administration still considers a threat, but doesn't expect to be able to convict in court using evidence judges will accept.

Lawyers within the Obama administration are considering jailing those prisoners indefinitely even after Guantanamo Bay is closed down. Should Barack Obama deliver on his pledge to shut down Guantanamo Bay? Sound Off below

"We don't have a tradition of detaining people without trial," Obama said. "It gives me huge pause, which is why we're going to proceed carefully."

The rights of the prisoners and the demands of U.S. law are part of the problem. There's also politics: widespread opposition to releasing or even jailing any Gitmo prisoners on U.S. soil.

Already, Congress refused to allow government money to be used to close Guantanamo Bay until there are clear plans for its inmates. So the president has to decide.

For now, Obama is caught between the prison he inherited and the promise he made, without any easy 

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Obama To NAACP: More Work Ahead

The first African-American U.S. President has told the nation's largest civil rights organization he has benefited from the sacrifices of America's civil rights pioneers.  President Barack Obama spoke Thursday before the National Association for the Advancement of Colored People, marking its 100th anniversary.

President Obama told the NAACP convention in New York there has never been less discrimination in America than today, but the pain of discrimination is still felt.

"By African-American women paid less for doing the same work as colleagues of a different color and gender," said President Obama. "By Latinos made to feel unwelcome in their country.  By Muslim Americans viewed with suspicion for simply kneeling down to pray.  By our gay brothers and sisters, still taunted, still attacked, still denied their rights."

The president said more progress is also needed on reforming education, health care and employment equality.  He said although extraordinary progress has been made, African-Americans are still disproportionately affected by unemployment and poor health care.  And the president said a black child is about five times as likely as a white child to eventually be sent to jail.

Mr. Obama honored civil rights leaders throughout U.S. history, from NAACP founder W.E.B. DuBois to Thurgood Marshall, the first African-American Supreme Court justice, for paving the way for his election as president.

Mr. Obama called on today's Americans to honor those pioneers' spirit and break down the remaining racial barriers.

"If three civil rights workers in Mississippi-black, white, Christian and Jew, city-born and country-bred-could lay down their lives in freedom's cause, I know we can come together to face down the challenges of our own time," said Mr. Obama. "We can fix our schools, heal our sick, and rescue our youth from violence and despair."

The president emphasized the importance of improving education in fighting America's remaining racial disparities.  He said there is no stronger weapon against inequality and no better path to opportunity than a good education.

Mr. Obama challenged the audience to take greater responsibility for their children's education, and for the quality of schools in their communities.  He also urged parents to encourage their children to have aspirations beyond sports and music.

"Our kids cannot all aspire to be [basketball star] LeBron [James] or [rapper] Li'l Wayne," said President Obama. "I want them aspiring to be scientists and engineers, doctors and teachers, not just ballers and rappers.  I want them aspiring to be a Supreme Court justice.  I want them aspiring to be President of the United States."

The president's address before the NAACP is his first speech directly tackling the issue of race since he took office in January.

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Snowe Dampens President Obama’s Timeline on Health Care ReformSnowe Dampens President Obama’s Timeline on Health Care Reform

Sen. Olympia Snowe, R-Maine,  a key member of the Senate Finance Committee, emerged from a meeting with President Obama Thursday afternoon sticking to her guns that health care reform legislation should not be voted upon before Senators break for recess on August 7, despite a strong push from the president that the bill be completed by then.

“We shouldn’t be restrained by an artificially compressed timeline,” said the Maine moderate, pointing out that with estimated costs of $2.4 trillion, health care comprises 17% of the US gross domestic product, so reforming health care is a “Herculean challenge.”

“It’s important to us to take time to work through these issues,” Snowe said.

President Obama needs Snowe’s support in order to be able to claim that the legislation is bipartisan and also, possibly, in order to even proceed to a vote on the floor of the senate given the illnesses of Sens. Ted Kennedy, D-Mass., and Robert Byrd, D-WV.

“We’d like to get a bipartisan package,” Snowe said, to make the legislation more likely to pass but also to “engender confidence with the American people.”

Snowe said she showed the president a draft outline of the bill the Senate Finance Committee members and staffers have been working on for weeks, including weekends, to assure the president  that “we’re working diligently.”

But she suggested a slower timeline than the “overly ambitious” one the president has urged, Snowe said.

In her view, the bill could be voted on in the Senate Finance Committee before August 7, she said. During the August recess, the Senate Finance Committee bill could be “fused” with the one from the Senate Health Education Labor and Pensions Committee, giving senators and the American people time to review them both.  In September, the legislative process can continue when the Senate reconvenes, she said.

President Obama, Snowe reported after their roughly 45-minute-long meeting, disagrees.

“Understandably the president would like to complete this process…before the August recess,” she said. “He’s concerned about returning in Fall and getting this done.” The president told her, she said, that “’this is our window of opportunity.’ I don’t disagree,” she said, but she wants to “make sure we have the best initiative and the best product going forward.”

After all, she said, “this is a costly endeavor” never before undertaken by Congress.

“It’s important to get it right,” she said, noting that the Finance Committee has yet to hear from the Congressional Budget Office regarding cost estimates.

-jpt

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New Jersery Gov. Corzine calls on Obama to boost campaign efforts

President Obama heads to New Jersey today to bolster the political chances of Gov. Jon Corzine, the Wall Street rich Democrat (and no-seat-belt-wearing car accident survivor) who is up for reelection this year.
The latest Quinnipiac University poll this week shows Republican challenger Chris Christie pulling away, with a 53% to 41% lead over Corzine -- up from a 10-point lead in last month's survey. One possible reason: Corzine recently signed a $2- billion budget that increased taxes and cut tax rebates.
Christie, mindful of Obama's popularity in the state, welcomed the president in a video ad that makes no mention of the governor
While Obama tries to raise money and votes for Corzine, Vice President Joe Biden is stumping in Virginia, the other bellwether gubernatorial election this year. Attending a fundraiser in Richmond for Democrat Creigh Deeds, who is running behind Republican Bob McDonnell in the latest Rasmussen Poll, Biden hopes to sway red-state-turning-blue Virginia to remain in the Democratic column.
Politicos are watching both races. As MSNBC's First Read noted this morning, if Republicans win both, it would dim Obama's luster and give the GOP an opening for a political comeback. If the Democrats win both, of course, it would increase Obama's reputation as a commander in chief with long political coattails.
And if it's a split decision? Look for both to claim moral victory.
-- Johanna Neuman
Ticket goes online several times a day with updates from the political world. Click here for Twitter alerts of each Ticket item or follow us @latimestot

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Why Obama wants healthcare bill by August -- think 2010 elections

The White House drumbeat is unrelenting: President Obama wants comprehensive healthcare reform -- with a public option -- on his desk before Congress leaves town for its summer recess Aug. 7.

"Don't bet against us. We are going to make this thing happen," Obama said this week during a Rose Garden appearance with his new surgeon general, Dr. Regina Benjamin.

Just back from a weeklong trip to Russia, Italy and Africa, the president said he did not want Congress to think he'd forgotten the issue. "I just want to put everybody on notice, because there was a lot of chatter during the week that I was gone," Obama said. "Inaction is not an option."

Republican critics have been quick to question why the rush, especially on a bill that could end up costing taxpayers $1.5 trillion over the next 10 years. And one of the doubters is Maine Republican Olympia J. Snowe, a moderate invited to the White House today in hopes Obama can sway her to support the plan.

"I don’t know why there’s this insistence on getting it done yesterday," Snowe told reporters last night.  "If you use President Johnson’s model on Medicare, for example, it took a year and a half, for good reason.”

So why is the White House rushing? In part, it's a calculus that Obama's still-high approval ratings are likely to soften as his term lengthens. So, use your political chits while you have them.

But another compelling reason is that the 2010 elections loom. Already, Blue Dog Democrats -- those moderates from Southern and rural parts of the country -- are balking at supporting a bill they say costs too much and saves too little. As Democrats in other swing districts get closer to reelection campaigns, they too could have qualms about backing a bill that will mandate that every American get health insurance and will pay for it with sizable tax increases on the wealthiest of their constituents.

"Very soon we'll be in the gravitational pull of the midterm elections, and it seems clear that Republicans . . . will run on tax cuts, deficit reduction and a much more scaled-down and privatized healthcare plan," former Clinton Labor Secretary Robert Reich told the Washington Post recently. "If the public begins to lose patience by election day, Democrats could have some real problems. And those problems of course could possibly extend through 2012."

-- Johanna Neuman

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Obama to NAACP: Progress made but much still to accomplish

CNN) -- President Obama commended the progress of African-Americans in a speech on the 100th anniversary of the NAACP, but said there was still much work to be done.

President Obama addresses the NAACP in New York Thursday night on the group's 100th anniversary.

Speaking at the organization's annual convention in New York, the city where the organization was founded, Obama evoked symbols of the civil rights movement to describe the NAACP's influence on race relations in the United States.

"What we celebrate tonight is not simply the journey the NAACP has traveled, but the journey that we, as Americans, have traveled over the past 100 years," Obama told a star-studded crowd that included music producer Sean "Diddy" Combs and poet Maya Angelou, to name a few.

But Obama said "the pain of discrimination is still felt in America" among African-Americans, Latinos and Muslim-Americans.

"Even as we inherit extraordinary progress that cannot be denied; even as we marvel at the courage and determination of so many plain folks -- we know that too many barriers still remain," he said. Watch Obama's speech to the NAACP

"What is required to overcome today's barriers is the same as was needed then. The same commitment. The same sense of urgency. The same sense of sacrifice. The same willingness to do our part for ourselves and one another that has always defined America at its best."

The "steepest" barriers are not prejudice and discrimination, he said, but the "structural inequalities that our nation's legacy of discrimination has left behind."

Obama highlighted some of his administration's policies as examples of how the government is attempting to break down the barriers of inequity.

"These are barriers we are beginning to tear down by rewarding work with an expanded tax credit; making housing more affordable; and giving ex-offenders a second chance. These are barriers that we are targeting through our White House Office on Urban Affairs, and through Promise Neighborhoods that build on Geoffrey Canada's success with the Harlem Children's Zone," he said.

"When it comes to higher education, we are making college and advanced training more affordable, and strengthening community colleges that are a gateway to so many with an initiative that will prepare students not only to earn a degree but find a job when they graduate; an initiative that will help us meet the goal I have set of leading the world in college degrees by 2020," he said.

Obama said the economy has made progress difficult, but assured the audience that his administration was working to "lay a new foundation for growth and prosperity" for future generations.

"One pillar of this new foundation is health insurance reform that cuts costs, makes quality health coverage affordable for all, and closes health care disparities in the process. Another pillar is energy reform that makes clean energy profitable, freeing America from the grip of foreign oil, putting people to work upgrading low-income homes, and creating jobs that cannot be outsourced," he said.

The president also talked about the need "to recapture the same sense of responsibility in Washington and in our own lives" that propelled the civil rights movement.

"In particular, when it comes to education, we need better standards in our schools, excellent teachers in our classrooms, and parents doing their part to ensure that all our children can succeed, no matter what their race, faith or station in life," a senior administration official said.

He urged families to help children with their homework, to put away the Xbox and encourage them to be more than "ballers and rappers"

"We have to say to our children, yes, if you're African-American, the odds of growing up amid crime and gangs are higher. Yes, if you live in a poor neighborhood, you will face challenges that someone in a wealthy suburb does not. But that's not a reason to get bad grades, that's not a reason to cut class, that's not a reason to give up on your education and drop out of school," he said, eliciting applause from the audience.

"No one has written your destiny for you. Your destiny is in your hands -- and don't you forget that," he said.

The excitement over Obama was in stark contrast to the reception of former President Bush, who had a strained relationship with the NAACP and declined the group's invitations for five years.

Bush spoke before the NAACP in 2000, during his first run for the presidency, but he did not make another appearance until 2006.

But now, even though there's a new president and a new dynamic, there are still some questions as to whether the NAACP and Obama share the same approach.

"I think his big challenge now is going to be in talking to them about issues that have concerned him in the past, like problems with teen pregnancy and black-on-black crime, that the NAACP hasn't been that eager to deal with," said Clarence Page, a columnist for the Chicago Tribune editorial board.

Earlier this week, Michael Steele, the first African-American chair of the Republican National Committee, addressed the NAACP and urged its members to take another look at the Republican Party.

Steele on Thursday reiterated that message, telling CNN, "There's a historic and inextricable link between the GOP and African-Americans. In fact, Republicans helped found the NAACP back in 1909."

The Republican Party, however, has not received more than 11 percent of the African-American vote since 1996. Obama received 95 percent of the black vote in the 2008 election.

According to a national poll conducted in May, African-Americans really like Obama, but more and more feel that race relations have not gotten better since he took office.

In December, 51 percent of African-Americans said Obama's election marks the start of a new era of better race relations, according to a CNN/Essence Magazine/Opinion Research Corp. poll.

In May, that number dropped to 44 percent. 

The historic election of the first African-American president in the United States highlights the NAACP's role in fighting for equality and opportunity. NAACP President Ben Jealous said that while Obama's presidency is a big milestone, it's just the next step on a long road.

"This is a big step that we've taken, having a black family in the White House, ending that 233-year-old color barrier, but there's a lot more work that needs to be done," he said. 

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Obama Comes to Corzine's Aid, as Polls Show Him Struggling in N.J. Governor's Race

In the middle of making a hard push for health care reform before the August recess, President Obama is taking a time out to drum up support for New Jersey Gov. Jon Corzine in his race for re-election, where the Democratic incumbent has been consistently trailing his Republican opponent. 

The latest Quinnipiac University poll this week showed challenger Chris Christie pulling away, with a 53-41 percent lead over Corzine -- up from a 10-point lead in last month's survey. 

While the president is devoting most of his time to keeping comprehensive health care legislation alive on Capitol Hill, Corzine's flagging candidacy apparently could not be ignored. 

Obama attended a Corzine fundraiser Thursday afternoon, to be followed by a rally at the PNC Bank Arts Center in Holmdel. And not a moment too soon for the governor. 

The Quinnipiac poll showed 60 percent of registered Jersey voters disapprove of the job Corzine is doing -- his lowest rating ever. 

Corzine recently signed a $29 billion budget that increased taxes and cut tax rebates, and New Jersey political insiders say that has many voters wanting to vote for change this fall. 

"Governor Corzine is in serious trouble in New Jersey at this point. He has about one-third of Democrats defecting from him," said Cliff Zukin, director of the public policy program at Rutgers University. "He's really gone through four years and people have said they wouldn't want to have another four years."

But can the campaigner-in-chief turn the tide? While Obama is popular in the Garden State with a 60 percent approval rating, recent surveys suggest his popularity may have little impact on the governor's race. 

According to a Monmouth University/Gannett New Jersey Poll released Thursday, 76 percent of New Jersey voters said their vote in the governor's race will be based solely on state and local issues. And 70 percent in the Monmouth University poll said having Obama actively campaign for Corzine would have no impact on their vote in the race. 

The way the Obama rally has been handled has also left New Jersey political analysts scratching their heads. 

The event was originally scheduled to be held at Rutgers University in New Brunswick, and 52,000 people signed up online to attend. But the rally was then moved to the 18,000-seat PNC Arts Center -- the Corzine campaign is promising sidelined supporters there will be other opportunities to "partake in an event with the president, the first lady and others in the Obama administration and the governor as we move forward." 

Obama is set to address the rally at 4:25 p.m ET. After his stops in New Jersey, Obama will cross the Hudson River to speak at the 100th NAACP Convention Dinner in New York City, and then attend a Democratic National Committee fundraiser. 

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Poll: Obama approval tied to stimulus, economic outlook

President Obama and Congressional Democrats' economic stimulus package is arguably the “New Deal” of the 21^st century. Both ambitious and controversial the plan continues to generate passionate debate from wildly opposing view points on the social and political spectrum.

A new CBS poll indicates that while support for the stimulus may have slipped over time as our country continues to struggle out of its economic rut, the package is still viewed positively by a majority of Americans. The poll oddity here is the weight given to independents. 39.6% of the responders claimed to be independent, a figure that is much higher than national registration totals would suggest. However the gap between Democrats and Republicans surveyed by the poll is just over 6%, reflecting a fairly accurate depiction. Recent partisan samples from Rasmussen Reports find Democrats with an advantage of slightly under 7% for instance.

Taking our queue from this particular CBS poll support for the stimulus package seems tied to the view that voters hold of President Obama’s overall job performance. Both have slipped in recent weeks but continue to win over a majority of Americans. Solid economic news from the past couple of days could inspire more confidence in the effectiveness of both, although persistently strong data has proven fleeting thus far in 2009. Simply put, the source of falling support for Obama and the stimulus can be summed up by the saying, “it’s the economy, stupid!”

The CBS poll finds a 48-44% approval to disapproval split in terms of how President Obama is handling the economy. The four-point margin is down from a substantial 22-point divide from just last month. 57% of Americans now approve of Obama’s job performance. While that is down six points after a rocky month of June the decline in support comes from Democrats and independents, not Republicans. An additional 50% expect at least two more years of recession meanwhile. Democratic support for the President has dipped from 92% to 82% over the last month. It seems quite plausible however that a number of disenfranchised Dems may get back on the Obama-Express if and when Judge Sotomayor is confirmed to the Supreme Court. 

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