Conservative Democrats Push Health Bill Changes

WASHINGTON — Fiscally conservative House Democrats forced leaders of their party on Tuesday to slow the pace of work on major health care legislation so Congress and President Obama could address their concerns about the cost of the bill, its impact on small businesses and the shape of a proposed new government health insurance plan.

The fiscal conservatives, members of the House Blue Dog Coalition, made their case for major changes in the bill at a White House meeting with Mr. Obama.

The chairman of the House Energy and Commerce Committee, Representative Henry A. Waxman, Democrat of California, canceled sessions of the panel scheduled for Tuesday and Wednesday so he could meet with Blue Dogs. They hold seven seats on the committee, a potentially decisive number, since the panel has 36 Democrats and 23 Republicans.

“The seven of us cannot support the current House bill,” said Representative Mike Ross, Democrat of Arkansas, who is the point man on health care for the Blue Dogs. “Whether it requires a new bill or whether this bill can be amended, those are decisions, I guess, for the parliamentarians to help us make.”

“We don’t need to box ourselves in with any artificial deadline,” Mr. Ross added.

The Blue Dogs said they had won agreement from Mr. Waxman to help rein in Medicare spending by giving the executive branch new power to set annual payment rates for doctors, hospitals and other health care providers, based on recommendations from an independent advisory council. Rates are now set by statutory formulas, and Congress is besieged by lobbyists pleading for bigger increases each year.

It was unclear when the energy committee sessions would resume, but even the two-day delay was a setback for House Democratic leaders, who had hoped to pass the bill before their summer recess, scheduled to begin at the end of next week.

If the committee finishes its work in the next few days, the House could still vote on the legislation next week and thus meet a goal set by Mr. Obama. The House Democratic leader, Representative Steny H. Hoyer of Maryland, said he saw no point in staying in session longer to grapple with health care.

“If we get consensus, we’ll move on it” next week, Mr. Hoyer said. “If we don’t get consensus, I don’t think staying in session is necessarily necessary.”

In an e-mail message, David L. Cavicke, chief of the Republican staff at the energy committee, declared “a victory.”

“The majority obviously does not have the votes, even with a 13-vote advantage in committee, to move this trillion-dollar socialization of American heath care,” Mr. Cavicke said, and he thanked Republicans for sticking together.

The chairman of the Senate Finance Committee, Senator Max Baucus, Democrat of Montana, met throughout the day with a handful of members of his panel and said they were making slow but steady progress toward a bipartisan proposal.

But some Republicans, like the House minority leader, Representative John A. Boehner of Ohio, said the president’s plan was a bad foundation on which to build because it would kill jobs by imposing new costs on employers, requiring them to provide or help pay for insurance for their workers. “It’s time to scrap this bill,” Mr. Boehner said.

Mr. Obama tried again to whip up public support for the legislation, which is his top domestic priority.

“I understand that some will try to delay action until the special interests can kill it, while others will simply focus on scoring political points,” Mr. Obama said before television cameras in the Rose Garden of the White House. “We’ve done that before.”

Alternatively, “we can choose action over inaction,” he said. “We can choose progress over the politics of the moment. We can build on the extraordinary common ground that’s been forged.”

The White House, which has been wooing interest groups from the health care industry, began to see Tuesday how difficult it would be to keep a united front.

Dr. J. James Rohack, president of the American Medical Association, issued a video message supporting the House bill.

“The status quo is unacceptable,” Dr. Rohack said in the video, posted on YouTube and the association’s Web site. “Without a bill that can pass the House, there is no health reform this year.”

But six state medical societies and two former A.M.A. presidents sent a letter to Mr. Waxman opposing a government-run health plan and any requirement for individuals or employers to buy insurance. The societies include doctors in Alabama, Delaware, Georgia, Kansas, New Jersey and South Carolina.

“Very soon after the government places mandates on individuals or employers,” said Dr. M. Todd Williamson, a neurologist who is president of the Medical Association of Georgia, “we will see government dictating care, what’s going to be covered or provided.”

Lawmakers are frantically looking for ways to cut Medicare or raise new tax revenue to cover the cost of subsidizing insurance for tens of millions of Americans.

Mr. Baucus originally wanted to tax some employer-provided health benefits. Labor unions resisted that idea, and the Senate Democratic leader, Harry Reid of Nevada, raised objections.

As an alternative, Senator John Kerry, Democrat of Massachusetts, proposed an excise tax on insurance companies that offer coverage far exceeding the value of the average policy, now about $13,000 a year for a family.

Mr. Kerry contends that such a tax would put pressure on insurers to reduce the cost of their health plans, lower premiums and reduce the overall cost of health care.

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On healthcare, Obama courts Blue Dog Democrats worried about costs

Blue Dog Democrats, those fiscally conservative party members who represent historically centrist districts, could hold the balance of power in the increasingly wrenching debate over healthcare.

So President Obama has invited members of the House Energy and Commerce Committee -- the only one of three House panels that has yet to pass its piece of the healthcare pie -- to the White House this afternoon to talk to them about his initiative.

In an interview this morning on NBC's "Today" show, where the topics ranged from captured U.S. soldier Bowe Bergdahl to the jeans the president wore at  baseball's All-Star game last week, Obama said he shares the concerns of many moderates about the estimated $1 trillion price tag for reform, admitting that the healthcare bills are "not where they need to be yet."

Democrat Baron P. Hill agrees. One of the lawmakers invited to the session with the president, Hill is an example of the political perils facing the Blue Dogs, particularly on the Energy Committee.
Hill was first elected to Congress from his rural, southwest Indiana district in 1998 -- with 51% of the vote. Six years later, the Republican he defeated -- Mike Sodrel -- returned the favor, winning the seat by 1,500 votes. Then in 2006, Hill captured it again.

Worried about tax increases on the wealthy, the impact on the federal deficit and an artificial August deadline -- Hill told Fox News that the problem is Obama "hasn't taken anything off the table."

-- Johanna Neuman

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President Obama: "What We're Doing Is Hard"

President Obama continues to make his health care reform push, urging Congress to pass legislation before the deadline he has tried to impose: the August recess.

Shown the Washington Post newspaper headline indicating that his job approval ratings, particularly those dealing with health care reform, were sinking, the president told the NewsHour's Jim Lehrer that the results of the Post/ABC News poll "means that what we’re doing is hard and, you know, the truth is I feel pretty good about the fact that our polls have held up under extraordinarily difficult circumstances."

The president said "the congressional process, people are always a little suspicious of.  I’m confident, though, that in the end, any bill I sign is going to make more people secure in their health care and it’s going to drive down costs over the long term."

The president said that "members of Congress have worked their way through this process and examined what all the options are, what we’re going to be doing is bringing some of them into the White House and – "

"To crack heads?" asked Lehrer.

"Oh, I don’t know about 'cracking heads,'" the president said. "'Facilitating.'...Facilitating a discussion that solves these problems."

-jpt

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Listening to India

President Obama bills himself on the world stage as an empathetic guy, and Secretary of State Hillary Clinton is a veteran of a famous “listening tour” of her own. Let’s hope the Administration was paying attention to India’s environment minister when he told Mrs. Clinton a thing or two about climate policy Sunday
“There is simply no case for the pressure that we, who have among the lowest emissions per capita, face to actually reduce emissions,” Jairam Ramesh told Mrs. Clinton in a closed-door meeting, according to a copy of his remarks distributed after the session. “And as if this pressure was not enough, we also face the threat of carbon tariffs on our exports to countries such as yours.”
Mr. Ramesh was simply repeating the widespread consensus in India that it’s irresponsible to sacrifice economic growth benefiting hundreds of millions of mostly poor people for the sake of environmental absolutism. India’s per capita GDP is around $1,000. While its mostly state-owned energy industry is grossly inefficient and the country could benefit from less wasteful energy usage, emissions caps are the wrong way to go. Caps would send prices on energy and other goods higher, not to mention the longer-term damage to economic growth. China conveyed similar concerns at the Group of Eight meeting in Italy earlier this month.
Mr. Ramesh’s remarks point to another cost India could bear even if New Delhi resists imposing its own emissions caps: the cost of protectionist measures imposed by developed countries to shield their businesses from the costs of their own national emissions targets. The cap and tax bill recently passed by the U.S. House is explicit in proposing tariffs on goods from countries that don’t follow the developed world’s anticarbon line.

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Associated Press

Instead Mr. Ramesh repeated New Delhi’s longstanding call for developed countries to finance the import of expensive green technologies, which would in theory help India reduce emissions without incurring as many out-of-pocket costs. At the same time, India has rejected any calls for legally binding emissions targets.
If this concept sounds familiar, it should. President George W. Bush proposed such a framework almost exactly four years ago. The Asia-Pacific Partnership on Clean Development and Climate brought together the U.S., India, China and four other countries to find ways to spread green technologies. Environmentalists derided it at the time, partly because it didn’t set mandatory emissions reductions and partly because Mr. Bush had proposed it. It has since dropped off the radar screen, although it’s still in operation.
Call it a more honest form of environmentalism. The Indian government recognizes the public would never be willing to shoulder the costs of emissions controls, and that it’s unfair to ask millions of poor people to try. Mr. Bush understood that the developed world can best help developing countries green themselves up by supporting freer trade in environmentally friendly technologies. It’s a stark contrast to climate politics in today’s Washington, where Democrats try to push cap-and-trade through Congress before anyone notices the costs while special interests slip in protectionist carbon tariffs.
There is still serious scientific debate about the causes, effects and possible solutions for climate change. But if President Obama is determined to tackle the issue anyway, he could do worse than listen to what Mr. Ramesh said.

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Inspector General Fired by President Obama Files Lawsuit to Be Reinstated*

Gerald Walpin, the former Inspector General for the Corporation for National and Community Service whom President Obama took the unusual step of firing last month, filed a lawsuit against the CNCS on Friday in U.S. District Court for the District of Columbia

The suit seeks to force "to reinstate Mr. Walpin as the Inspector General and to declare unlawful and ineffective the efforts to date to terminate him from his office." In addition, the suit seeks that Walpin be awarded "costs and legal fees associated with this action" as well as any "further relief as may be appropriate in this matter."

White House deputy press secretary Josh Earnest told ABC News that the Obama administration "complied fully with the Inspector General Reform Act. The bipartisan leadership of the Senate committee that oversees IG's agrees. We strongly believe these claims are without merit and will be rejected by the courts."

Earnest was referring to a June 19 letter from the Senate Homeland Security and Governmental Affairs Committee Chairman Joe Lieberman, I-Conn., ranking GOPer Susan Collins, R-Me., and Sen. Claire McCaskill, D-Mo., saying that based on information the White House provided "we believe you have met the letter and spirit of the Inspector General Reform Act of 2008 with respect to congressional notifications of removal or transfer."

Walpin is expected to issue an official statement about the lawsuit on Monday.

The suit alleges that on or about June 10, Walpin "was unlawfully removed and transferred from his position as Inspector General precisely because he had performed his duties in an effective manner, supporting his career staff in their objective findings of wrongdoing, based on their audits and investigations, the truth of which those who sought to remove him did not want published."

The suit takes particular issue with the White House assertion that at one board meeting Walpin "was confused, disoriented, unable to answer questions and exhibited other behavior that led the Board to question his capacity to serve."

The suit, filed by attorneys from Greenburg Traurig LLP, asserts that Walpin suffered and continues to suffer "very real reputational, vocation and economic injuries … from the obvious loss of his post and the associated income and health insurance, to having his mental faculties questioned with not-so-subtle, and completely unfounded, suggestions of senility."

The lawsuit says that "(w)hile not the object of the instant pleading, it is plain that without the relief sought by this complaint the conduct at issue raises serious questions of age discrimination, retaliation against whistleblowers and defamation."

Walpin's lawsuit says the action taken by President Obama not only harmed Walpin personally but also the integrity of the Inspector General system.

**

As we've covered, on June 11 President Obama fired Walpin, who had been criticized for his handling of an investigation into the use of AmeriCorps funds by a community group called St. HOPE Academy, founded by Kevin Johnson, former point guard of the Phoenix Suns, who was elected Mayor of Sacramento last November and is an ally of the president’s.

In April of this year, St. HOPE Academy agreed to pay a $423,836.50 settlement -- $72,836.50 of which would be paid personally by Mayor Johnson.

But Walpin didn't approve of the settlement, or the way it was handled, and said he was "proud"  that he and the Inspector General's office "refused to go along with the U.S. Attorney’s office and the Corporation in bowing to the media and political pressure that resulted in this hasty settlement, contrary to the interests of the United States Government."

In a June 11 letter from President Obama to congressional leaders, the president said he no longer had the fullest confidence in Walpin as Inspector General.

A subsequent letter from White House counsel Greg Craig noted that Walpin’s termination “is fully supported by the Chair of the Corporation (a Democrat) and the Vice-Chair (a Republican)" and said that Lawrence Brown, the “Acting United States Attorney for the Eastern District of California, a career prosecutor who was appointed to his post during the Bush Administration, has referred Mr. Walpin’s conduct for review by the Integrity Committee of the Council of Inspectors General on Integrity and Efficiency.”

In that April 29 letter from Brown to Kenneth Kaiser, chair of the Integrity Committee for the Counsel of the Inspectors General on Integrity and Efficiency, the Acting US Attorney wrote "to express my Office's concerns about the conduct" of Walpin in the handling of the Johnson case, complaining that "Walpin viewed his role … as the investigator, advocate, judge, jury and town crier."

Walpin pleaded for his job when White House attorney Norm Eisen called him to notify him of the decision.

Some in Congress took issue with the way Walpin was fired, which appeared to them to not comply with the rules laid out in the Inspector General Reform Act of 2008, which was co-sponsored by then-Sen. Obama.

The author of that bill, key Obama ally Sen. McCaskill initially said that the "White House has failed to follow the proper procedure in notifying Congress as to the removal of the Inspector General for the  [CNCS]. The legislation which was passed last year requires that the president give reason for the removal. 'Loss of confidence' is not a sufficient reason." The law requires that 30 days' notice be given to Congress before an Inspector General is fired.

McCaskill later backed off her opposition, though Sen. Chuck Grassley, R-Iowa, demanded more answers.

Walpin's lawsuit asserts that "no investigation was made into the facts alleged as the basis for Mr. Walpin's termination" and the White House made no attempt to interview him or any of his colleagues in his office. Moreover, the suit asserts, the Integrity Committee of the Counsel of Inspectors General on Integrity and Efficiency was" not provided an opportunity to review the matter before the precipitous termination," contrary to the Inspector General Reform Act of 2008.

The suit also identifies as defendants CNCS acting chief executive officer Nicola Goren, chief human capital officer Raymond Limon, and general counsel Frank Trinity.

- jpt

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Deficits, Taxes and Time Appear to Doom Health Care Reforms

President Obama's budget chief says health care reform legislation won't be $240 billion in the hold in the next decade if the House includes reductions in Medicare payments to physicians.

President Obama's budget director on Sunday described a House bill on health care reform as "deficit neutral" even though it includes Medicare payments to doctors that would put the bill $240 billion in the hole over a decade.

Office of Management and Budget Director Peter Orszag insisted that Obama won't sign any health care reform that isn't paid for, but also said the legislation doesn't take into account savings that will be achieved in other bills to come.

Democrats say physician Medicare payment reductions that cause the $240 billion deficit in the bill, will be dealt with in upcoming "Paygo" legislation. Paygo, which requires government to pay for what it purchases, and not rely on deficit spending, hasn't passed the House but is likely to do so.

"The payments to physicians is in the legislation, and that is the only reason that the bill shows a deficit. Once you take that part out, the bill is deficit neutral," Orzsag told "FOX News Sunday," noting that reductions are "sort of already baked in to our fiscal trajectory" for future spending.

The Congressional Budget Office, Congress' number crunchers, angered Democrats last week when it showed that the House bill now on the table to institute nationalized health insurance, is unsustainable.

The CBO calmed nerves when it issued a second report late Friday that says adjusting the totals to reflect a 20 percent reduction in Medicare payments to physicians would save the country $6 billion over a decade.

Orszag, who formerly headed the CBO, said the budget agency also didn't account for other estimated future savings.

"There are additional steps that are necessary to make it even better than that over the long term, and I think the single most important thing is this proposal that we have for an independent commission to help bring down costs over the long haul," he added, noting the commission would be "setting reimbursement rates and moving towards a higher quality system."

But expanded government-provided health insurance to cover the estimated 50 million people in the United States without insurance will require some to pay additional taxes. One proposal has incomes over $280,000 for single payers and $350,000 for families coughing up 5 percent of their income for the additional costs.

Combined with state and local taxes, that Americans in 39 of the 50 states would have tax rates over 50 percent. Orszag said that additional tax should hit about 1 to 2 percent of income earners. He added that the president would like to include a revenue proposal that would limit the rate at which deductions could be itemized but Obama does not favor taxing employer-provided health insurance benefits.

But the chance of Congress getting health care reform legislation passed this year is growing increasingly slim. Congress takes a summer powder on Aug. 7. Obama had hoped to have legislation passed by then. But even his Health and Human Services Secretary, Kathleen Sebelius, said Sunday the bill in the House is not likely to be the final product.

The Senate also is struggling over various versions. Sen. Judd Gregg, R-N.H., the ranking member of the Senate Budget Committee, said Republicans have voted lockstep against any legislation "because it's not reform."

"The two bills that have been voted on so far are the Kennedy bill coming out of the Health Committee, which ... was a party-line bill because that bill is basically your old-fashioned expand the government, let's take over the system approach, and the House bill, which was even worse," Gregg said.

"And basically, both of those bills lead to putting the bureaucracy between you and your doctor, and I believe they lead to delay and rationing in the end."

Gregg said one bipartisan measure sponsored by Sens. Ron Wyden and Robert Bennett, "would get where we need to go."

That legislation would "cover everybody and bend the out-year costs of health care without going down the road of this massive expansion of the government role in health care and the massive increase in costs which are proposed in the two bills that have been voted on," Gregg said on "FOX News Sunday."

He added that reducing reimbursement rates to doctors and eliminating deductions on expensive health care plans would be two ways to raise money to pay for universal health care.

"Regrettably, neither of the proposals that are now pending in the Congress do either of those things," Gregg said.

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Did Obama say the same old thing less diplomatically, or was he different?

Looking beyond President Barack Obama’s call to African leaders for improved governance, some analysts are arguing that his brief visit to Ghana offered little reason to expect significant shifts in US policy towards the continent.

The Los Angeles Times offered an assessment in an editorial last week.

“President Obama sounded a familiar refrain: Africa must be made and remade by Africans, and the United States will continue to support nations on the path to progress,” the Times observed. “To critics, that meant he had nothing new to say — it was the same message about good governance they’d heard from presidents Clinton and George W Bush. No new programmes or initiatives for Africa.”

But Obama did announce at the G8 summit in Italy just prior to flying to Ghana that the United States will provide $3 billion to enhance “food security” in poor countries worldwide, the Times pointed out.

Politico, a daily publication focused on the US Congress and the White House, pointed out that Obama said little — in Ghana or in Washington — about “the two biggest crises in Africa.”

Politico’s widely read website noted that Bush “faced withering criticism for doing too little to end conflicts” in Darfur and Congo but that Obama has so far not experienced such attacks.

Still, John Prendergast, a Clinton administration specialist on Africa, said just prior to the Ghana trip that “Obama’s record in Africa will, in large part, be judged by how effectively he addresses these two deadly conflicts.

Good intentions and an envoy are not enough. A clear policy is needed that prioritises the end of these wars and the development of potent pressures and incentives” to stop the fighting.

It’s too early in Obama’s tenure to tell how his Africa policy will be defined, added Jennifer Cooke, director of the Africa programme at the non-governmental Centre for Strategic and International Studies.

She noted that his attention to international affairs has so far been monopolised by Iran and North Korea and other hot spots far from Africa.

President Obama’s approach to Africa may ultimately differ little from Bush’s, suggested Jennifer Widner, another analyst with a Washington-based think tank.

“Is it going to change US policy hugely? I’d say no, because they’re going to be constrained by the economic situation,” said Widner, a professor at the Woodrow Wilson School.

Two of Obama’s critics took specific issue with his comparison between Kenya and South Korea.

The president had said in an interview with Allafrica.com prior to his Ghana trip that Kenya actually had a larger economy than did South Korea at the time of independence.

Kenya and other countries in Africa have been “badly outpaced” by some Asian economies in the past few decades, President Obama added in Ghana.

“President Obama repackaged the same old views in less diplomatic language,” Andrew Mwenda, managing editor of The Independent in Kampala, wrote in a commentary on the website of the Washington-based journal Foreign Policy.

“He had the courage to be more explicit on Africa’s ills because, due to his African heritage, President Obama can say as he wishes without sounding racist — a fear that constrains other Western leaders when talking about Africa.

“Even so, President Obama said nothing new.”

South Korea was not democratic when it rose to economic prominence, Mwenda noted on the Foreign Policy website.

That fact contradicts President Obama’s claim that authoritarian rule accounts in large measure for Africa’s underdevelopment, Mwenda argued.

Similarly, Ron Walters, an African-American commentator and retired professor, observed that South Korea “did not have Africa’s history [of Western colonial domination] and so it was able to benefit from foreign investment with which it instituted a system of mass general education that built a skilled work force.”

Kenya, on the other hand, has not attracted substantial foreign investment — “and not just because of the existence of corruption,” Walters said in a commentary for an African-American newspaper in Seattle.

“Global racism is, no doubt, one of the major factors why Africa has been excluded from robust foreign investment, but there is also the residual control that European countries still exercise over many African countries, their currencies and raw materials.”

Walters also likened Obama’s call on Africans to take greater responsibility for their plight to appeals he often makes to African-American audiences.

“It seems to be a theme that paralyses black criticism and plays well with whites who believe that the irresponsibility of blacks — and their African kin — is the major reason for their failure to achieve equality with other nations.”

Rather than calling for responsibility, Walters said President Obama would do better to support African “self-determination.”

That would mean helping Africans gain control over their destiny not just by promoting democracy but also by recognising that internal conflicts in Africa result from a lack of resources such as food, jobs and education, Walters added.

A more empathetic appraisal of President Obama’s comments in Ghana was offered by Ruth Levine, an analyst with the Centre for Global Development.

Writing in a blog on that think tank’s website, Levine drew a contrast between President Obama’s reference in Ghana to America’s “conscience” and Bush’s emphasis prior to his early 2008 visit to Ghana on America’s “compassion”.

President Obama said in his speech to Ghana’s parliament that his administration will develop “a comprehensive global health strategy because, in the 21st century, we are called to act by our conscience but also by our common interest.”

Bush had said a year a half ago that his aim in Africa was to show that “the American people are a compassionate people, a decent people, who want to help moms with — deal with malaria, and families deal with HIV/Aids, and the need to feed the hungry.”

Does the difference in the two sets of word choices reflect “just a switch in speechwriters or a fundamentally different conception of why US tax dollars should be used to support improvements in Africans’ health?” Levine asked in her blog.

“I think the word choice represents a significant shift. Compassion connotes a relationship between individuals, where one is empathetic and voluntarily chooses to ease the suffering of another. Conscience implies a duty, based on knowledge of right and wrong.”

Moreover, President Obama’s mention of “common interest” conjures “an image of us all in the same boat,” Levine said.

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