Pelosi says budget upholds American principles

by Christina Lovato, University of New Mexico-Talk Radio News Service

In the midst of Congressional infighting over the $3.5 trillion budget proposed by Democrats, House Speaker Nancy Pelosi is calling it responsible.

Republicans say the budget proposed by Democrats will put the U.S. in ruinous debt with unnecessary spending, and will create no assurance of a return for such a substantial investment.  

“The difference of opinion on these budgets is indeed a difference of principle,” said Pelosi this morning at a press conference.

Pelosi said the proposal provide a tax cut for 95% of Americans, which, she said, will bring more fairness to the tax code.

“It’s about the principle of opportunity,” said Pelosi. When asked what investments for education the budget will bring, Pelosi answered: “It’s about opportunity in education, about fairness in our healthcare, about fairness in the tax code, it’s about security.”

Pelosi said that under her watch, Congress has done more for education than any in one time in U.S. history. 

Pelosi called the Republican budget proposal a “hollow shell of a budget” and that the increase in tax cuts to the wealthy makes an assault on social security benefits, medicare, and medicaid. 

When asked about the how the legislative agenda will continue after the break, Pelosi said Congress have to first “reconcile” the budget. 

Chairman Obey: A rising tide has raised only all yachts

by Christina Lovato, University of New Mexico-Talk Radio News Service

“Loosely speaking, rich dumb kids are more likely to make it through college than poor smart kids, and that’s telling you that we are a society in which whatever we may like to imagine we are not a society that has anything like equality of opportunity,” said Paul Krugman, a Professor of economics and international affairs at Princeton University and Nobel Prize-winner.

Today at a House Appropriations Subcommittee on Labor, Health, and Human Services hearing, witnesses expressed their thoughts on the economy, healthcare and inequality. Krugman said that one major reason why a growing economy has failed to deliver to ordinary Americans is because of inequality. “Many of the gains in income went to a small minority of very well-off people, with most workers seeing little rise in real wage,” he said. Krugman said that the secondary reason for the failure of economic growth is the dysfunctional health care system. “We are unique among advanced countries in not having some form of universal coverage, yet we spend far more to cover 85 percent of our population than our counterparts spend to cover everyone, with no evidence that we receive correspondingly better care,” Krugman said.

Keith Hall, the Commissioner of the Bureau of Labor Statistics, had something different to say about healthcare. Hall said that since the start of the recession in December 2007, 4.4. million payroll jobs have been lost, and the unemployment rate has increased from 4.9 to 8.1 percent. But Hall said “employment has grown only in healthcare, private education, and government.”

“We first need to measure the stimulus package against the current needs of the economy.... The package as it now stands is mitigating. It’s not even enough to prevent us from having a very severe recession.... If we respond to concern about the size of the package by scaling back other government spending we’re undoing the effects of the stimulus package, making it even more inadequate,” concluded Krugman.

Chairman David R. Obey (D-Wis.) concluded the hearing by stating that he believes that we can strengthen the safety net for those who aren’t doing well in the economy through actions like universal healthcare and pension protection. “The problem is that it has been said by others in the past, at some times in our recent history it appears that a rising tide has raised only all yachts.”

It's Expensive, Yes, But What is the Cost of Doing Nothing?

Coffee Brown, University of New Mexico, Talk Radio News Service

Dr. Peter Orszag, previously the Director of the Congressional Budget Office, currently the Director of the President's Office of Management and Budget, told the Senate Committee on Finance that the cost of doing nothing about healthcare reform would be fiscal crisis, decreased take-home pay, 46 million uninsured Americans, and an increasing burden on state governments which is already cutting into other services, such as increased tuition costs for college.
"Do you know of anyone in either party who wants to do nothing?" Sen. Chuck Grassley (R-Iowa) asked.
Orszag replied, "No, Sir. That's why I am confident that we can get healthcare reform passed this year."
Grassley said there was not yet any conflict between Republicans and Democrats about healthcare reform, but that that was partly because the president's budget, while "bold", was "not very detailed."

Still, $634 Billion is a lot of money.

Sen. Max Baucus (D - Mont.) said, "Would healthcare reform now lead to substantial savings?"
"Yes," answered Orzack.
"Should we accept short term deficit spending to achieve that?" asked Baucus.
Orzack replied, "The president's budget for healthcare reform is designed to be deficit neutral for the first 5-10 years, then we should begin to see savings. If we could cut one percent per year from medical cost growth, we could realize savings of 20 percent of GDP in 50 years. For forty years, medical costs have risen 2 to 2.5 percent faster than inflation."

The hearing, at which Orszag was the sole witness, turned from general costs to specific strategies.

Baucus asked, "Can we incentivize consumers to be more cost effective?"
"25 percent of beneficiaries use 85 percent of the cost. That's the group to target," Orszag replied.
"Would costs come down if everyone were covered? And how could we do that?" Baucus asked.
According to Orszag, we need to reduce consumer costs, reduce complexity, and encourage enrollment. We can encourage enrollment by subsidies, mandates, and automatic enrollment with an opt-out choice. Social norms need to change, so that people would be as shocked if you had no health insurance, as they now are if you don't buckle your seatbelt. the key to that is massive public awareness campaigns, he finished.

Grassley said he was concerned that Medicare Advantage might be cut too sharply under the new budget. Physicians might opt out of Medicare if reimbursement is too low.
Orszag said that Medicare Advantage was targeted because it paid substantially more than basic Medicare.

Expansion of the public sector would place new pressures on the private sector.

"Would a public plan undermine Obama's promise that people who prefer to can stay with their current plan? Would Obama support a plan that would 'crowd' 18 million people off private plans onto public?" Grassley wondered.

Sen. Maria Cantwell (D - Wash.) was also concerned about proposed cuts: "We've found medical homes, home care, and Medicare Advantage to be cost effective, but they face cuts under the new budget."
"Evidence strongly favors integrated care...Long term health care is in the budget...Competitive bidding should reflect local costs," Orszag replied.
He pointed out later, however, that the budget office had found that home care typically had much higher profit margins than other sectors of healthcare, and had been targeted for that reason.

Public funding means public accountability.

Orrin Hatch (R - Utah) said, "A Federal Reserve-style medical board would be a disaster, leave standards of care to the specialty boards. Keep these decisions in the private sector. We should not be be setting prices."
"Those problems are common to all the models. Both public and private systems must change," Orszag said.

Sen. Baucus closed the meeting by pointing out that time is of the essence, and the Senate must move quickly.
"We have our sleeves rolled up; we're ready to go," said Orszag.

Nursing in Critical Condition

Coffee Brown, University of New Mexico, for Talk Radio News Service

Susan Reinhard, of AARP’s Public Policy Institute helped found the new Champion Nursing Coalition in response a critical and worsening shortage. Thousands of qualified prospective students are being turned away from nursing programs for lack of enrollment capacity, she said. At the same time, she continued, there will be a deficit of 500,000 to a million nurses by 2025.

John Lumpkin, MD, MPH, of the Robert Wood Johnson Foundation described a few of the many roles nurses fill, clinical, social, chronic care, and administrative. He called the shortage unprecedented.

There is some good news, however, according to Nancy LeaMond Ex. VP at AARP. Agency for Healthcare Research and Quality (AHRQ) polls show overwhelming positive ratings and public support for the profession. AHRQ is a federal agency tasked with studies of healthcare improvement.

Citing Institute of Medicine Studies, Nancy Reller, representing Consumers Advancing Patient Safety, said that understaffing of nurses is associated with worse outcomes.

Jerald Newberry, for the National Education Association, said that asthma, obesity, and diabetes are so common in elementary schools that every one of them should have a nurse, but that many do not.

The panel recommends that funds be used to expand nursing programs, which would require about twice as many instructors as now. As it stands, about half of current instructors are expected to retire over the next decade.

The High Cost of Doing Nothing

Coffee Brown, MD, University of New Mexico, for Talk Radio News Service

For each increase of one percent in the unemployment rate, the number of medically uninsured goes up by approximately 1 million, according to Professor Jeanne Lambrew, Deputy Director of the new White House Office of Health Care Reform. Unemployment and medical debt in turn, increases foreclosures, she stated while addressing the National Health Policy Conference in Washington D.C., speaking at the National Health Policy Conference.
The coming spike in the uninsured will trigger a provision in the recovery act to subsidize 65 percent of cobra payments. When workers lose their jobs, they usually lose their insurance as well. By law, they can continue their former plan for six months by paying the entire premium plus two percent. This is about 80 percent of typical unemployment benefits, rendering it unaffordable for most. It may be wise to offer medicare as a less expensive, longer-lasting alternative, Lambrew said.
She also expressed concern over medical error rates that are higher in America than in peer nations. Health reform is needed to address these problems and the healthcare workforce shortage as well. This in turn will create lasting jobs, and cash flow within communities, she concluded.


Robert Berensen said that there is no longer any significant debate about the need for healthcare reform, now it’s about the form of the healthcare delivery system itself. The effort to reform the system has been gridlocked for 30 years, he said.
Paul Wallace, M.D., spoke for Kaiser Permanente and Glenn Steele, M.D., spoke for the Geisinger Health System. They described private sector innovations aimed at increasing efficiency, such as varying pay structures to improve healthcare benchmarks. The most important of these was getting caregivers to adopt electronic records. This measure speeds flow, reduces redundancy and reduces errors by making sure that the patient’s history is up-to-date at each visit, even when they cannot see their usual provider.
Both physicians emphasized the importance of a patient “care home”, a clinic and staff who know the patient well. This practice, the modern equivalent of the family doctor, is increasingly common as states experiment with ways to reduce costs and increase patient satisfaction. Results reported at several recent conferences have been very positive.

Sen. Max Baucus, D-Mont., at the National Health Policy Conference, said there are several good reasons for healthcare reform right now.
First, he said, the cost of doing nothing has become greater than the cost of doing something. Prices were rising faster than inflation even before the crash, he said. By 2014, half of U.S. households will be spending 45 percent of their total incomes on health insurance premiums.
Second, the current system is failing. Costs are higher and quality markers are lower than for other industrialized nations. Medical errors are killing tens of thousands of us a year, largely due to poor Health IT systems, which are now a major item in the recovery package.
Third, there is an unprecedented degree of bipartisan and even industry support.
Baucus concluded with the statement that the first priority has to be changes that create economic stimulus, and the second needs to be speed, while the momentum is favorable. The problem, he said, is that we also have an economic crisis, two wars, and an oil-dependence crisis competing for the attention of congress and the president.