Republican Ways and Means RSS Articles

Camp, Brady Urge Action on the U.S.-Colombia Trade Promotion Agreement

Fri, 20 Nov 2009 05:00:00 GMT

Washington, DC - Ranking Member Dave Camp (R-MI) and Trade Subcommittee Ranking Member Kevin Brady (R-TX) today issued the following statement on the upcoming third anniversary of the signing of the U.S.-Colombia Trade Promotion Agreement this Sunday, November 22:

Congressman Dave Camp said, “The President rightly said recently that increasing exports creates well-paying jobs without increasing government spending. It’s now been three years since the U.S.-Colombia trade promotion agreement was signed, and I am encouraged by Chairman Rangel’s probing of the Administration on timing for a path forward.”

Camp further noted that, "Our agreements with South Korea and Panama are also in limbo. Last week the President noted that increasing U.S. exports by just 1% can create 250,000 jobs. The independent U.S. International Trade Commission has found that the three pending agreements would increase U.S. exports by at least this amount. It is time for the President to move beyond the rhetoric and make these agreements happen.”

Congressman Kevin Brady said, “This weekend’s anniversary of the languishing Colombia agreement is but one example of many demonstrating that America no longer leads on trade. A succession of Democratic and Republican Administrations had always kept the United States at the head of the pack, but now America has fallen behind. Other nations are racing ahead of the U.S. to open markets for their products and services, creating jobs for their workers to our detriment, all because the Obama Administration has been sitting on the sidelines. The President must put America back at the head of the pack by moving forward to implement our pending agreements.”

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A Breast Cancer Preview

Thu, 19 Nov 2009 05:00:00 GMT

A government panel's decision to toss out long-time guidelines for breast cancer screening is causing an uproar, and well it should. This episode is an all-too-instructive preview of the coming political decisions about cost-control and medical treatment that are at the heart of ObamaCare.

As recently as 2002, the U.S. Preventative Services Task Force affirmed its recommendation that women 40 and older undergo annual mammograms to check for breast cancer. Since regular mammography became standard practice in the early 1990s, mortality from breast cancer—the second leading cause of cancer death among American women—has dropped by about 30%, after remaining constant for the prior half-century. But this week the 16-member task force ruled that patients under 50 or over 75 without special risk factors no longer need screening.

So what changed? Nothing substantial in the clinical evidence. But the panel—which includes no oncologists and radiologists, who best know the medical literature—did decide to re-analyze the data with health-care spending as a core concern.

The task force concedes that the benefits of early detection are the same for all women. But according to its review, because there are fewer cases of breast cancer in younger women, it takes 1,904 screenings of women in their 40s to save one life and only 1,339 screenings to do the same among women in their 50s. It therefore concludes that the tests for the first group aren't valuable, while also noting that screening younger women results in more false positives that lead to unnecessary (but only in retrospect) follow-up tests or biopsies.

Of course, this calculation doesn't consider that at least 40% of the patient years of life saved by screening are among women under 50. That's a lot of women, even by the terms of the panel's own statistical abstractions. To put it another way, 665 additional mammograms are more expensive in the aggregate. But at the individual level they are immeasurably valuable, especially if you happen to be the woman whose life is saved.

The recommendation to cut off all screening in women over 75 is equally as myopic. The committee notes that the benefits of screening "occur only several years after the actual screening test, whereas the percentage of women who survive long enough to benefit decreases with age." It adds that "women of this age are at much greater risk for dying of other conditions that would not be affected by breast cancer screening." In other words, grandma is probably going to die anyway, so why waste the money to reduce the chances that she dies of a leading cause of death among elderly women?

The effects of this new breast cancer cost-consciousness are likely to be large. Medicare generally adopts the panel's recommendations when it makes coverage decisions for seniors, and its judgments also play a large role in the private insurance markets. Yes, people could pay for mammography out of pocket. This is fine with us, but it is also emphatically not the world of first-dollar insurance coverage we live in, in which reimbursement decisions deeply influence the practice of medicine.

More important for the future, every Democratic version of ObamaCare makes this task force an arbiter of the benefits that private insurers will be required to cover as they are converted into government contractors. What are now merely recommendations will become de facto rules, and under national health care these kinds of cost analyses will inevitably become more common as government decides where finite tax dollars are allowed to go.

In a rational system, the responsibility for health care ought to reside with patients and their doctors. James Thrall, a Harvard medical professor and chairman of the American College of Radiology, tells us that the breast cancer decision shows the dangers of medicine being reduced to "accounting exercises subject to interpretations and underlying assumptions," and based on costs and large group averages, not individuals.

"I fear that we are entering an era of deliberate decisions where we choose to trade people's lives for money," Dr. Thrall continued. He's not overstating the case, as the 12% of women who will develop breast cancer during their lifetimes may now better appreciate.

More spending on "prevention" has long been the cry of health reformers, and President Obama has been especially forceful. In his health speech to Congress in September, the President made a point of emphasizing "routine checkups and preventative care, like mammograms and colonoscopies—because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse."

It turns out that there is, in fact, a reason: Screening for breast cancer will cost the government too much money, even if it saves lives.

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Boustany Statement: Joint Hearing on Food Banks and Charitable Giving

Thu, 19 Nov 2009 05:00:00 GMT

Chairman Lewis, thank you for yielding time.

I want to join with my colleagues in saying that as we approach the holiday season, we have grave concerns about how these difficult times are generating unprecedented need for life’s basic necessities: food, clothing, and shelter.

I also want to commend the work that the organizations testifying today – as well as countless others – do in trying to meet these needs with limited resources. You perform a critical role in our civil society, and we are grateful for your selfless efforts.

When considering what role the federal government should play in helping food banks and other charities provide assistance to the less fortunate, I think the first rule should be, “do no harm”.

Mr. Chairman, unfortunately this Congress and this Administration are pursuing an agenda that would violate that rule – by advancing tax increases that would reduce the incentive for charitable giving and by imposing new burdens and mandates directly on charities and foundations.

President Obama’s budget proposal to cap the value of itemized deductions at the 28% tax rate, while increasing the top rate to 39.6%, would have a detrimental effect on charitable giving. According to an analysis by Harvard economist Martin Feldstein, President Obama’s proposal would transfer more than $70 billion over ten years from charities to the federal government. He says, quote, “high-income taxpayers affected by the rule change are likely to cut their charitable giving by as much as the increase in their tax bills.” End quote. This means that the Obama budget would effectively impose an 11.6% tax on charitable donations made by people in the top tax bracket.

Mr. Chairman, I ask unanimous consent to enter Dr. Feldstein’s analysis into the record.

Add on top of this the 5.4% surtax that the House Democrats want to impose to pay for their government takeover of health care – against which taxpayers could not deduct charitable donations – and the combination of the President’s budget and the House-passed health care bill would impose a 17% tax on charitable donations made by singles earning over $500,000 and couples earning over $1 million.

And that’s no small charity tax. As opposed to what some believe, high-income Americans are extremely generous with their money. According to 2007 IRS data:

46% – almost half – of charitable contribution deductions are taken by households earning over $200,000;
more than one-third of charitable deductions are taken by households earning over $500,000; and
29% of charitable deductions are taken by people earning over $1 million.

These donations are in danger of being taxed if the Majority gets its way.

In addition, very little attention has been paid to the fact that under the employer mandate in the House-passed health care bill, charities – including food banks – fall under the definition of “employers”. This means charities that do not provide government-approved health insurance to their employees could face a tax of up to 8% of payroll. Given that 36% of nonprofits do not currently provide health insurance – including almost 50% of those with fewer than 50 employees – and given that most charities are stretched very tight these days, this new payroll tax could be the difference between being able to continue to serve the needy and having to shut their doors.

And because charities and foundations are tax-exempt, they cannot use the small employer tax credits included in the Democrats’ bill to help them meet this new burden. Without relief, struggling charities and those they serve face great uncertainty from Washington.

Ronald Reagan famously said that “the government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it.” Well, now we learn that the Majority’s view of philanthropy can be summed up in a few similar phrases: If it gives, tax it. If it keeps giving, impose a mandate on it. And if it stops giving, subsidize it.

I hope today’s hearing will serve as an important first step to promoting the good work our charities do.

Thank you, Mr. Chairman. I yield back.

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Linder Statement: Joint Hearing on Food Banks and Charitable Giving

Thu, 19 Nov 2009 05:00:00 GMT

Thank you, Mr. Chairman, for holding this hearing.

Republicans are all for promoting charitable giving to help those in need. Private charity is the most effective and compassionate form of aid. We all welcome the chance to promote more people helping one another, and look forward to hearing proposals to that effect.

As this hearing will review, this system of private charity is under unprecedented stress. This week brought fresh evidence why. We learned the number of families having trouble putting food on the table soared last year, after remaining stable or even falling over much of the past decade.

As the President of Feeding America, one of our witnesses today, recently said “It’s like we are living in a Third World country.” That was 2008.

When similar stories are written about 2009, we can be confident of one thing -- the situation will be worse. A recent Feeding America survey of food banks found that “unemployment is the leading factor for the increased demand.” And in the past year, unemployment has risen from 6.6% to 10.2%.

So we see yet another consequence of the failure of Democrats’ so-called stimulus legislation. Simply put, if stimulus were working and creating “jobs, jobs, jobs,” as Speaker Pelosi put it, more people would be donating to food banks instead of seeking help from them. But instead of creating 3.5 million new jobs as promised, stimulus has resulted in 3 million more jobs lost. Instead of keeping unemployment under 8%, it’s now 10.2%. Since stimulus, 49 out of 50 states have seen job losses.

Americans in need want real jobs and paychecks, not handouts. But almost 16 million currently unemployed workers are asking where are the jobs?

This grim data is despite record taxpayer assistance. Right now a record 9 million people are collecting unemployment checks. And a record 36 million – almost one in eight Americans – are on food stamps. Stimulus offered more and bigger benefits, but it’s still not enough because no amount of aid can replace a steady paycheck.

But jobs with paychecks are something Democrats have been totally incapable of delivering. In fact, beyond their failed stimulus bill, other Democrat policies are making things even worse when it comes to jobs. Democrats’ energy, health, and tax hike policies would destroy millions more jobs – further raising the number who would turn to food banks and other charities for help.

The simple truth is Americans need jobs. We all want to help those in need and the charities that assist them. We welcome today’s witnesses, including several of our colleagues, to discuss how we might better do so. That is a task that never will go away.

But that need has exploded due to failed Democrat policies that promised jobs but delivered more unemployment, poverty, and misery. The simple truth is we will never be able to adequately treat the symptom of greater need at food banks until we cure the disease of rising unemployment. And with the House considering a bill to add another quarter trillion dollars to the debt today, and Democrats planning another round of stimulus “treatment” much like the last one, the cure for the disease of high unemployment seems far away indeed.

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Ways and Means Republicans Write to AMA; Say Democrats' Physician Payment Fix Bill is Not True Reform

Thu, 19 Nov 2009 05:00:00 GMT

Washington, DC – In a letter authored by Ways and Means Ranking Member Dave Camp (R-MI) and Health Subcommittee Ranking Member Wally Herger (R-CA) to the President of the American Medical Association (AMA), Ways and Means Republicans expressed support for dealing with looming cuts to physician payments in Medicare but voiced their concerns over the Democrats' plan to address this by increasing the federal deficit by more than $200 billion. Currently, Medicare physician reimbursement rates are expected to be cut by 21% next year and by roughly 5% for each of the next several years thereafter, according to the 2009 Medicare Trustees Report.

Upon release of the letter, Ranking Member Camp stated: “I support the intent of the legislation to stop the physician payment cut, but not only does the Democrats’ bill not permanently solve the problem as some have claimed, it massively increases the deficit. Republicans have a fully paid for policy that will ensure doctors receive fair compensation without adding to our already oversized national debt.”

Health Subcommittee Ranking Member Herger added, “The Medicare physician payment system is deeply flawed and urgently needs to be reformed. But we can find a fiscally responsible and reasonable way to do so without adding hundreds of billions to an already out-of-control debt. The Democrats’ proposed ‘fix’ is really a shell game designed to mask the true cost of their proposed government takeover of health care, and it would add, by one estimate, nearly $2 trillion to Medicare’s long-term unfunded liabilities – which are already nearly $40 trillion. I am troubled by this approach. The Republican plan to address the impending SGR cuts will do more to improve physicians’ Medicare reimbursements and will also rein in frivolous medical lawsuits – all without adding to the deficit. I hope that the AMA and House Democrats will look reasonably at the options before them and support a bill that offers a responsible solution for physicians, senior citizens, and future generations.”

Click here for a copy of the letter, the text and signatories are below:

November 18, 2009

J. James Rohack, MD
President
American Medical Association
515 N. State Street
Chicago, IL 60654

Dear Dr. Rohack,

Every Member of Congress and every doctor in America agree that Medicare maintains an unreasonable payment system for physicians. Since 2002, physicians have faced annual cuts due to the flawed Sustainable Growth Rate (SGR). This is unacceptable and why Republicans have, in a fiscally responsibly manner, stepped in to defend doctors serving Medicare patients.

Tomorrow, Congress is expected to pass H.R. 3961. We support the intent of this act to stop the 21 percent payment cut you face next year and the roughly 5 percent cut projected for each of the next several years thereafter. What we cannot support is the deficit spending in this legislation. According to the Congressional Budget Office (CBO), this bill would increase the federal deficit by more than $210 billion. The Washington Post on Sunday, November 15, 2009, rightly noted that certain budget gimmicks hide the true deficit impact, which is closer to $300 billion.

In discussing a similar bill Senator Kent Conrad (D-ND), the Senate Budget Committee Chairman, said “I don’t agree with just adding that amount to the debt.” Senator Evan Bayh (D-IN), said he could not support such a measure “at a time when we’re hemorrhaging red ink.” We agree.

In its current form, H.R. 3961 asks lawmakers to borrow from our children’s future to pay doctors today without solving the underlying problem with the SGR. While H.R. 3961 would hit the reset button on the projected cuts and wipe the slate clean, physicians could see their Medicare rates slashed again in 2011. Just like the SGR, the Democrat's new "Target Growth Rate" would:

Allow physician payment rates to be slashed if government-set spending targets are exceeded (as they have been every year since 2001);
Tie spending targets to the Gross Domestic Product (GDP). So physicians would continue to be unfairly punished when the economy slows; and
Tie physician reimbursement rates to utilization, continuing to punish providers who focus on delivering high-quality care while rewarding those who focus on volume.

Republicans will offer you and the American taxpayers a better policy: a 2% increase in your Medicare payment rates in each of the next four years that is fully paid for, primarily by implementing real medical liability reform, a long-time priority of the AMA. In adopting lawsuit reforms modeled after successful programs in Texas and California – our two largest states – CBO says that taxpayers stand to save $54 billion, health insurance premiums will be reduced, physicians can stop looking over their shoulder out of fear of getting sued by overzealous trial lawyers looking to get rich quick, and we can save enough money to ensure you can continue treating and caring for our seniors. The Republican bill will ensure you receive fair compensation for your work until we can pay for and afford the long-term solution you deserve.

Americans across the country are making sacrifices to help our nation weather a weakened economy. Choosing between doctors and the long term financial health of our nation is no choice at all; it is simply an act of irresponsibility. It is our sincere hope that your organization, the American Medical Association, will join Republicans and the American people in recognizing the dire economic and financial position we face and support this financially sound fix to the flawed SGR.

Sincerely,

Ranking Member Dave Camp (R-MI)
Health Subcommittee Ranking Member Wally Herger (R-CA)
Republican Whip Eric Cantor (R-VA)
Rep. Sam Johnson (R-TX)
Rep. Kevin Brady (R-TX)
Rep. Paul Ryan (R-WI)
Rep. John Linder (R-GA)
Rep. Devin Nunes (R-CA)
Rep. Pat Tiberi (R-OH)
Rep. Ginny Brown-Waite (R-FL)
Rep. Geoff Davis (R-KY)
Rep. Dave Reichert (R-WA)
Rep. Charles Boustany Jr. (R-LA)
Rep. Dean Heller (R-NV)
Rep. Peter Roskam (R-IL)

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Johnson Statement - Hearing on Clearing the Disability Claims Backlog

Thu, 19 Nov 2009 05:00:00 GMT

Republicans and Democrats on this Committee have long worked together to make sure Social Security has the resources it needs to effectively administer their benefit programs. During the last two fiscal years Social Security received funding at levels higher than the President’s request, along with an additional $1 billion to build a new computer center and to process rising numbers of claims for disability benefits resulting from the recession.

Today Social Security will again report to taxpayers what return they are receiving on their substantial investment.

I understand we’ll hear some long overdue good news on the appeals front. Hearing offices have increased productivity and this has resulted in lower wait times for those who have been waiting well over a year for a decision on their appeal.

Beyond addressing today’s service delivery challenges, lasting returns on investment depend on Social Security modernizing its technology infrastructure and consistently addressing program waste, fraud and abuse, including conducting continuing disability reviews, in order to save billions in program dollars and build taxpayer confidence. So I will be listening for real progress in these areas as well.

Although clearing disability backlogs is important, today marks the fourth hearing of this subcommittee this Congress and the third hearing on backlogs while we continue to ignore the fiscal challenges Social Security faces.

In August, the Congressional Budget Office reported that Social Security cash surpluses will turn into cash deficits in the next two years and that the Disability Insurance Trust Fund will be unable to pay full promised benefits in just nine years. President Obama has expressed his commitment to advance Social Security reform and we all know the sooner we act to protect and strengthen Social Security, the better.

Further, we’ve had no hearings on other key Agency challenges including the ongoing problem of identity theft and Social Security number misuse by those attempting to work illegally in this country.

So I hope this Subcommittee will turn to these issues on a bipartisan basis as soon as possible to examine options for change and find solutions.

I thank the witnesses for joining us today and presenting their testimony.

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Ratify Korea trade pact

Wed, 18 Nov 2009 05:00:00 GMT

The South Korea-U.S. Free Trade Agreement should be ratified, and soon, because of the initialing last month of a similar agreement between South Korea and the European Union.

The EU-Korean free-trade agreement hasn't yet been formally signed or ratified, but it will be. Americans have their own agreement already in our pockets. It was signed on June 30, 2007. It awaits ratification, but has been stalled in Congress for more than two years. Americans could have their agreement before the Europeans have theirs, and have a trade advantage — if Congress acts.

If not, the trade advantage will go to the Europeans.

This is not like an agreement with Peru or Panama. This is a big one. South Korea is the 11th largest economy in the world. It's a country that makes some of the best flat-screen TVs on the market, and can afford products made by American workers.

Both agreements, America's and Europe's, reduce more than 90 percent of industrial-goods tariffs to zero over a few years. Agriculture is more difficult. Korea will continue to protect its rice, and it will only slowly reduce its high tariff on U.S. beef. Still, Korea's barriers against U.S. food products will fall substantially.

There are winners and losers on both sides when trade is made freer, but overall the gains are much bigger than the losses — on both sides. History is clear on this.

In Puget Sound country, we have a regional interest, and one that should transcend partisan loyalties. We were reminded of this recently when we received a joint news release of Rep. Adam Smith, Democrat, and Rep. Dave Reichert, Republican. They disagree on a number of things, but not on this.

For some Americans, whether to compete in the world is a big question. Here, there is no question. We made our decision long ago — at Boeing and Weyerhaeuser, Microsoft and Costco, the Aerospace Machinists and the Longshore workers, in our universities and our ports. Trade is good, and we are for it.

Get it done.

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Brady Opening Statement: Hearing on the Operation, Impact, and Future of the U.S. Preference Programs

Tue, 17 Nov 2009 05:00:00 GMT

Thank you, Mr. Chairman. International trade is a powerful engine for economic growth and job creation, as our experience here at home demonstrates. One out of every five American jobs depends on trade, and as Ambassador Kirk notes, jobs supported by exports pay higher wages than other jobs. For that reason, I commend you for holding this hearing. The global economic downturn has hurt workers all over the world. International trade will be a vital tool for promoting economic recovery and creating jobs everywhere.

The indisputable benefits of trade liberalization are why I strongly support open markets, both here in the United States and abroad. Trade preference programs can be a key tool to help developing countries break into the international market.

Congress has worked on a bipartisan basis to develop preference programs that have provided a vital economic boost to many developing countries. Congress has also demonstrated its willingness to regularly revisit our programs to make them more effective. Congress has amended the African Growth and Opportunity Act several times to spur the creation of thousands of jobs in Africa without creating adverse effects on U.S. workers here at home. The benefits have provided U.S. consumers with better prices and more choices.

Effective trade preferences are one stop on a country’s journey to becoming a full player in the international market. But trade preferences cannot be an end unto themselves. In fact, a truly successful trade preference program is one that makes itself obsolete.

For example, Malaysia and South Korea successfully used GSP as a tool for economic development, exceeding the need for continued benefits and thriving once those benefits were removed.

Chile, Singapore, the CAFTA countries, and Peru all graduated from trade preferences into permanent, bilateral trade agreement relationships, showing that trade preferences are a stepping stone to full engagement in the international market. These trade agreements offer advantages for both parties over a trade preference relationship.

Partner countries achieve full, permanent duty-free access to the U.S. market, a significant benefit over the partial, temporary access provided by preferences. This relationship also sends a strong signal to attract investment and capital. The capacity building and enforceable labor commitments help improve standards significantly.

For the United States the benefits are obvious. American workers and businesses finally enjoy a level playing field because these markets are open to U.S. exports, supporting more American jobs. When Chile, the CAFTA countries, and Peru went from a one-way, preference relationship to a two-way, free trade relationship, the United States went from a trade deficit to surplus with those countries. In the case of CAFTA, we saw our deficit of over $1.2 billion shift to a trade surplus of over $6 billion, and American workers benefited.

These examples demonstrate the importance of having developing countries become full members of the international market. We can quickly realize similar benefits by implementing the FTAs with Colombia and Panama, two countries anxious to move from a one-way relationship to a permanent, mature relationship, leveling the playing field for U.S. workers.

There are many countries that aren’t yet ready to move from preferences to a free trade relationship. For these countries effective trade preference programs are the right policy. To that end we must design our preference programs to ensure that developing countries can take full advantage of them, assuming they meet certain key conditions.

That means having eligibility criteria that challenge countries to improve their laws but at the same time encourage investment. After all, a developing country can have the best labor laws in the world, but that won’t make any difference if there aren’t any jobs. The eligibility criteria currently enshrined in our preference programs provide the right balance and incentives. As GAO has noted, we have successfully used these criteria to prompt improvements.

Even for the least developed countries, our preference programs must not become a disincentive to take that next, critical step to becoming full members in the international market through enthusiastic participation in the Doha Round. The ultimate goal of duty-free/quota-free access to the U.S. market for the least-developed through the Round will provide incentives for these countries to push the emerging developing countries to make the concessions we need to bring the Round to a close.

Engagement in the international market is a key development tool. Many countries have benefited from this engagement, and U.S. trade preference programs can help countries take advantage of opportunities to export their goods, create jobs, and eventually join the global market. With that Mr. Chairman I yield back, and I look forward to hearing from our witnesses.

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Obamacare: Buy now, pay later

Mon, 16 Nov 2009 05:00:00 GMT

There is an air of absurdity to what is mistakenly called "health-care reform." Everyone knows that the United States faces massive governmental budget deficits as far as calculators can project, driven heavily by an aging population and uncontrolled health costs. As we recover slowly from a devastating recession, it's widely agreed that, though deficits should not be cut abruptly (lest the economy resume its slump), a prudent society would embark on long-term policies to control health costs, reduce government spending and curb massive future deficits. The administration estimates these at $9 trillion from 2010 to 2019. The president and all his top economic advisers proclaim the same cautionary message.

So what do they do? Just the opposite. Their far-reaching overhaul of the health-care system -- which Congress is halfway toward enacting -- would almost certainly make matters worse. It would create new, open-ended medical entitlements that threaten higher deficits and would do little to suppress surging health costs. The disconnect between what President Obama says and what he's doing is so glaring that most people could not abide it. The president, his advisers and allies have no trouble. But reconciling blatantly contradictory objectives requires them to engage in willful self-deception, public dishonesty, or both.

The campaign to pass Obama's health-care plan has assumed a false, though understandable, cloak of moral superiority. It's understandable because almost everyone thinks that people in need of essential medical care should get it; ideally, everyone would have health insurance. The pursuit of these worthy goals can easily be projected as a high-minded exercise for the public good.

It's false for two reasons. First, the country has other goals -- including preventing financial crises and minimizing the crushing effects of high deficits or taxes on the economy and younger Americans -- that "health-care reform" would jeopardize. And second, the benefits of "reform" are exaggerated. Sure, many Americans would feel less fearful about losing insurance; but there are cheaper ways to limit insecurity. Meanwhile, improvements in health for today's uninsured would be modest. They already receive substantial medical care. Insurance would help some individuals enormously, but studies find that, on average, gains are moderate. Despite using more health services, people don't automatically become healthier.

The pretense of moral superiority further erodes before all the expedient deceptions used to sell Obama's health-care agenda. The president says that he won't sign legislation that adds to the deficit. One way to accomplish this is to put costs outside the legislation. So: Doctors have long complained that their Medicare reimbursements are too low; the fix for replacing the present formula would cost $210 billion over a decade, estimates the Congressional Budget Office. That cost was originally in the "health reform" legislation. Now, it's been moved to another bill but, because there's no means to pay for it (higher taxes or spending cuts), deficits would increase.

Another way to disguise the costs is to count savings that, though they exist on paper, will probably never be realized in practice. So: The House bill is credited with reductions in Medicare reimbursements for hospitals and other providers of $228 billion over a decade. But Congress has often prescribed reimbursement cuts that, under pressure from squeezed providers, it has later rescinded. Claims of "fiscal responsibility" for the health-care proposals reflect "assumptions that are totally unrealistic based on past history," says David Walker, former U.S. comptroller general and now head of the Peter G. Peterson Foundation.

Equally misleading, Obama's top economic advisers assert that the present proposals would slow the growth of overall national health spending. Outside studies disagree. Three studies (two by the consulting firm the Lewin Group for the Peterson Foundation and one by the Centers for Medicare & Medicaid Services, a federal agency) conclude that various congressional plans would increase national health spending compared with the effect of no legislation. The studies variously estimate that the extra spending, over the next decade, would be $750 billion, $525 billion and $114 billion. The reasoning: Greater use of the health-care system by the newly insured would overwhelm cost-saving measures (bundled payments, comparative effectiveness research, tort reform), which are either weak or experimental.

Though these estimates could prove wrong, they are more plausible than the administration's self-serving claims. Its health-care plan is not "comprehensive," as Obama and the New York Times (in its news columns) assert, because it slights cost control. Obama chose to emphasize the politically appealing path of expanding benefits rather than first attending to the harder and more urgent task of controlling spending. If new spending commitments worsen some future budget or financial crisis, Obama's proposal certainly won't qualify as "reform," as the president and The Post (also in its news columns) call it. It's more like malpractice: a self-inflicted wound.

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Report: Bill would reduce senior care

Sun, 15 Nov 2009 05:00:00 GMT

A plan to slash more than $500 billion from future Medicare spending -- one of the biggest sources of funding for President Obama's proposed overhaul of the nation's health-care system -- would sharply reduce benefits for some senior citizens and could jeopardize access to care for millions of others, according to a government evaluation released Saturday.

The report, requested by House Republicans, found that Medicare cuts contained in the health package approved by the House on Nov. 7 are likely to prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether.

Congress could intervene to avoid such an outcome, but "so doing would likely result in significantly smaller actual savings" than is currently projected, according to the analysis by the chief actuary for the agency that administers Medicare and Medicaid. That would wipe out a big chunk of the financing for the health-care reform package, which is projected to cost $1.05 trillion over the next decade.

More generally, the report questions whether the country's network of doctors and hospitals would be able to cope with the effects of a reform package expected to add more than 30 million people to the ranks of the insured, many of them through Medicaid, the public health program for the poor.

In the face of greatly increased demand for services, providers are likely to charge higher fees or take patients with better-paying private insurance over Medicaid recipients, "exacerbating existing access problems" in that program, according to the report from Richard S. Foster of the Centers for Medicare and Medicaid Services.

Though the report does not attempt to quantify that impact, Foster writes: "It is reasonable to expect that a significant portion of the increased demand for Medicaid would not be realized."

The report offers the clearest and most authoritative assessment to date of the effect that Democratic health reform proposals would have on Medicare and Medicaid, the nation's largest public health programs. It analyzes the House bill, but the Senate is also expected to rely on hundreds of billions of dollars in Medicare cuts to finance the package that Majority Leader Harry M. Reid (D-Nev.) hopes to take to the floor this week. Like the House, the Senate is expected to propose adding millions of people to Medicaid.

The Centers for Medicare and Medicaid Services administers the two health-care programs. Foster's office acts as an independent technical adviser, serving both the administration and Congress. In that sense, it is similar to the nonpartisan Congressional Budget Office, which also has questioned the sustainability of proposed Medicare cuts.

In its most recent analysis of the House bill, the CBO noted that Medicare spending per beneficiary would have to grow at roughly half the rate it has over the past two decades to meet the measure's savings targets, a dramatic reduction that many budget and health policy experts consider unrealistic.

"This report confirms what virtually every independent expert has been saying: [House] Speaker [Nancy] Pelosi's health-care bill will increase costs, not decrease them," said Rep. Dave Camp (Mich.), the senior Republican on the House Ways and Means Committee. "This is a stark warning to every Republican, Democrat and independent worried about the financial future of this nation."

Democrats focused Saturday on the positive aspects of the report, noting that Foster concludes that overall national spending on health care would increase by a little more than 1 percent over the next decade, even though millions of additional people would gain insurance. Out-of-pocket spending would decline more than $200 billion by 2019, with the government picking up much of that. The Medicare savings, if they materialized, would extend the life of that program by five years, meaning it would not begin to require cash infusions until 2022.

"The president has made it clear that health insurance reform will protect and strengthen Medicare," said White House spokeswoman Linda Douglass. "And he has also made clear that no guaranteed Medicare benefits will be cut."

Republicans argued that the report forecasts an increase in total health-care spending of more than $289 billion.

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Markup of: H.R. 598

Thu, 18 Jun 2009 21:10:15 GMT

Hearing on Scientific Objectives for Climate Change Legislation

Thu, 18 Jun 2009 21:05:33 GMT

Hearing on IRS Assistance for Taxpayers Experiencing Economic Difficulties

Thu, 18 Jun 2009 21:03:11 GMT

Hearing on the President’s Fiscal Year 2010 Budget Overview with U.S. Department of the Treasury Secretary Timothy F. Geithner

Thu, 18 Jun 2009 21:01:49 GMT

Hearing on the President’s Fiscal Year 2010 Budget Overview with OMB Director Peter R. Orszag

Thu, 18 Jun 2009 20:59:53 GMT

Markup of: Views and Estimates Letter to Budget Committee

Thu, 18 Jun 2009 20:53:40 GMT

Hearing on Health Reform in the 21st Century: Expanding Coverage, Improving Quality and Controlling Costs

Thu, 18 Jun 2009 20:51:45 GMT

Hearing on Protecting Lower-Income Families While Fighting Global Warming

Thu, 18 Jun 2009 20:46:28 GMT

Hearing on MedPAC’s Annual March Report to the Congress on Medicare Payment Policy

Thu, 18 Jun 2009 20:45:07 GMT

Hearing on the Troubled Asset Relief Program: Oversight of Federal Borrowing and the Use of Federal Monies

Thu, 18 Jun 2009 20:43:43 GMT