Yesterday, the House of Representatives passed a landmark bill that would “empower the Food and Drug Administration to regulate the tobacco industry” and allow regulators to demand the “elimination of other hazardous ingredients in cigarettes.”

The bill, which provoked a veto-threat from the White House, mirrors a failed 1998 proposal spearheaded by Sen. John McCain (R-AZ). McCain’s bill sought to give the federal government unprecedented oversight over the tobacco industry and led many Republicans to caricature the legislation as a “very liberal, big government, big bureaucracy, not a Republican bill.”

McCain responded by pledging to “never” give up on the effort — promising to “hold tobacco companies liable for their efforts to endanger children” — and publicly praising the regulatory nature of the legislation:

Nicotine and tobacco products will now be subject to broad regulatory and oversight by the Food and Drug Administration and the industry will be required to pay over $500 billion to settle claims and fund vital anti-smoking and related health care initiatives…Second, our goal is to insure that nicotine and tobacco products are regulated by the FDA to protect public health. [News Conference, 3/20/1998]

But McCain may now be backing away from his pledge to regulate the industry. While still officially a sponsor of the Senate version of the latest tobacco bill, McCain has suggested that he “won’t commit to voting for it until he sees the final legislation” and regularly belittles government regulation on the campaign trail:

- Again, we get back to Senator Obama believes that big government is the answer — government is the answer. He’ll raise your taxes. He will increase regulation. [Town Hall, 7/10/2008]

- So I think it really has to do — the fundamental difference is our view of the role of government in America. Everything he has supported is bigger government, more regulation, higher taxes, et cetera. And I am a very proud conservative that believes in less government, in our nation’s security, and lower taxes, and a government that basically only intervenes in people’s lives when every other avenue has been exhausted. [Town Hall, 7/7/2008]

- I was one of many newly elected members who claimed with pride to be disciples of Ronald Reagan. I am as proud of that distinction today as I was then… I think all Reagan Republicans would describe the core values of a conservative as…opposition to unnecessary government regulation; and lastly, and very importantly, belief that the government that governs best governs least. [Reagan Library, 6/23/2006]

Our guest bloggers are James Kvaal and Robert Gordon, Senior Fellows at the Center for American Progress Action Fund.

Sen. John McCain had a read-my-lips moment on taxes yesterday, telling a town hall meeting that “I want to look you in the eye: I will not raise your taxes nor support a tax increase. I will not do it.”

Of course, only three days earlier, McCain said that higher taxes were “on the table” to solve Social Security. And he seemed to say the same to a group of donors last night. ThinkProgress has more of McCain’s muddled history on Social Security taxes.

Here’s another place where John McCain may be willing to raise your taxes: to pay for his enormous health care plan.

McCain has proposed new health insurance tax credits, which his campaign estimates to cost $3.6 trillion over the decade. He says he pays for it by taxing workers’ health benefits, which are largely tax-free today. McCain aides say the plan has no net cost and left it out of their budget plan.

McCain’s numbers add up only by raising taxes on middle-class families. To raise $3.6 trillion by taxing health benefits, you need both income and payroll taxes. But that means an $1,100 tax increase on a typical married couple earning $60,000 in 2013.

Alternatively, McCain could avoid tax increases by applying only income taxes – but not payroll taxes – to health benefits. And this is what his spokesman told the Daily Tax Report he does. But income taxes alone fall $1.3 trillion short of paying for his tax credits.

McCain aides say they pay for their health care plan without raising middle-class taxes, but that’s not possible. So which is it? Do they raise taxes on ordinary families by more than a thousand dollars or add $1.3 trillion to the deficit? It may be the biggest unanswered question in the candidates’ fiscal policies.

While personally blocking more than 70 pieces of legislation, Sen. Tom Coburn (R-OK) has portrayed himself as a champion against “wasteful” government spending. In reality, Coburn’s obstructionism has delayed, deferred, or killed legislation that would have expanded medical research and improved the lives of millions of Americans.

Responding to Coburn’s obstructionism, Sen. Harry Reid (D-NV) crafted the Advancing America’s Priorities Act, a package of nearly 40 bills that Coburn and other conservatives prevented from coming to a vote.

The package included The Christopher Reeve and Dana Reeve Act, which would have “allocated $25 million for research on spinal cord injuries, rehabilitation and measures to improve the quality of life for paralyzed Americans.”

Because Coburn and his conservative allies successfully killed the deal, he has attracted a number of right-wing admirers:

- Two months ago, I made a rather vivid attack on a group of U.S. senators I called “the Coburn Seven,” who were blocking consideration of this measure. I was convinced that Tom Coburn — known in the Senate as “Dr. No” for objecting to nearly all spending increases — intended to kill the bill. Then I made the worst mistake of the commentator: actually meeting the object of your scorn….Coburn politely assured me that his motivation was not stinginess. His main goal was to increase the number of people receiving treatment. [WP, 7/30/2008]

- “Now that he is a member of the Senate and I am back in the private sector, paying taxes and worrying about the debt, my view of Coburn has changed. I love the guy.” [The Hill, 7/28/2008]

- “But this other Advancing America’s Priorities Act, that has to be shut down. And Senator Tom Coburn, we we love him. Dr. No , he is up there crusading, it’s a one man crusade if you ask me, against what’s going on on Capitol Hill.” [The Laura Ingraham Show, 7/28/2008]

- “Much like the late conservative hero “Senator No” (Jesse Helms), Coburn seems to be the only conservative willing to block legislation that would exacerbate the $9.3 trillion dollar debt this Congress is passing on to future generations.” [Human Events, 7/14/2008]

Coburn’s so-called ‘idealism’ has real and negative impacts on Americans. According to the Paralyzed Veterans for America, the bill, which would have cost just $0.82 cents per family, would have benefited the 240,000 Americans, including 44,000 veterans, “who suffer from spinal cord injuries or paralysis.”

Unfortunately, these Americans now have to bear the burden of Coburn’s “idealism.”

An editorial in today’s Wall Street Journal praises the equalizing quality of Sen. John McCain’s (R-AZ) plan to give every family in America a $5,000 tax credit to buy health insurance in the individual insurance market:

The McCain plan does not raise taxes, nor does it lower them. Instead, it takes the existing system of tax subsidies and treats everyone alike, regardless of income or job status….For the first time, low- and moderate-income families would get just as much tax relief as the very rich when they purchase health insurance.

But treating “everyone alike” is exactly the problem. Indeed, under McCain’s plan the sick and the not-yet sick, the poor and the wealthy would all receive a one-size-fits-all tax credit, regardless of their health history or income status.

Warren Buffet would collect the same $5,000 as his secretary. A chronically ill older patient, who requires more care or more expensive care, would obtain the same amount for health care as a younger and healthier American.

For poorer Americans, McCain’s credit would be like a five foot rope for a ten foot hole. A $5,000 tax credit for a low income family is not enough to cover the average price of an insurance policy (approximately $14,000) and would leave many poor families — who are unable to make up the difference in premium costs — without insurance.

In 2006 and again in 2007, President Bush vetoed bipartisan legislation that would have expanded federal funding of embryonic stem cell research and overturned Bush’s 2001 executive order which restricted federal funding to embryos derived before August 9, 2001.

Bush originally justified his position by claiming there were “more than 60” stem cell lines for researchers to work with. In April 2007, the White House revised the number to 21 after it became known that “many if not all of the…lines are now contaminated and unusable” because they were developed using mouse cells.

But a recent decision by scientists at Stanford University suggests that the administration may have to re-edit its brief. According to Rick Weiss, a Senior Fellow at the Center For American Progress Action Fund, “an expert panel at Stanford University has determined that nearly one quarter of the colonies of human embryonic stem cells that the Bush administration has approved as ethically derived and eligible for study with federal funds ‘do not meet ethical thresholds that would allow them to be approved for use at Stanford and will no longer be available to researchers there“:

The decision is the first of what is expected to become a string of such moves following the publication in May of a little-noticed report by a University of Wisconsin professor who found serious ethics lapses in the way some of the Bush-approved cells were obtained from embryo donors.

Researchers have long argued that Bush’s executive order — which limits federal funding “not on the basis of whether those cells were obtained by ethical means but simply on the basis of when they were derived” — artificially constrains research and development. As Rick Weiss points out:

…it makes no ethical or scientific sense to base a policy on the timing of when cells were derived, as opposed to how they were derived. There have been many technical improvements, he noted, that make more recently derived cells more scientifically useful. In addition, newer lines have largely been derived with the benefit of new ethics guidelines that in recent years have been promulgated by the National Academies and other groups.

Unfortunately, “Bush’s policy is getting in the way of us doing it better, scientifically and ethically.”

Yesterday, in a speech at the LIVESTRONG Presidential Town Hall, Sen. John McCain (R-AZ) conceded that his proposal to push Americans into the individual health insurance market could leave cancer patients without health insurance. But McCain promised that his Guaranteed Access Plan — which would subsidize state-run high-risk pools with federal and possibly industry money — will “help in the purchase of coverage for those hardest to insure”:

Some worry that even after this reform many Americans with pre-existing conditions — including many thousands of cancer patients — could still be denied insurance. And to make sure they get the high-quality coverage they need, I have proposed a — or GAP — that will combine industry, state, and federal resources to help in the purchase of coverage for those hardest to insure, including patients with pre-existing conditions. There would be limits on premiums, and lower-income Americans would get additional financial assistance.

Watch it:

Americans with cancer will need more “financial assistance” than McCain imagines. Financing insurance for the millions of Americans with pre-existing conditions who would lose employer-based coverage under McCain’s plan, would cost $100 billion a year, far more than the $10 billion McCain has proposed spending on shoring-up high risk programs.

In fact, the high cost of insuring a large pool of sick people has forced states to limit eligibility. As a result, the 33 states that run high risk pools “exclude from coverage the pre-existing condition that made you eligible for it in the first place.” According to Karen Pollitz, director of the Health Policy Institute at Georgetown University:

These programs [high risk pool programs] are very expensive…because [sick people] account for all of the spending. So these are very expensive programs for states to run…and so states look for ways to restrict these programs and in particular they have limited eligibility rules in some states, the premiums that they charge are exceedingly high…all of these pools will exclude from coverage the pre-existing condition that made you eligible for it in the first place.”

Given the high costs of running high-risk pools and McCain’s penchant for cutting government programs, it is likely that the senator’s Guaranteed Access Plan would leave cancer patients to finance their own treatments.

Our guest blogger is James Kvaal, a senior fellow at the Center for American Progress Action Fund.

Nine months after it was released, we still aren’t sure whether John McCain’s health care plan would raise taxes on the middle class or blow up the deficit.

McCain’s health care plan would tax workers’ health benefits, which are largely tax-free today, and create new health insurance tax credits. But will health benefits be subject to both income and payroll taxes or just to income taxes? Since many families pay more in payroll taxes (which fund Social Security and Medicare) than income taxes, the distinction is critical. But the campaign’s statements have been inconsistent.

If it’s both payroll and income taxes, he will raise taxes on tens of millions of middle-class families. A recent Center for American Progress Action Fund report concluded that a typical married couple earning $60,000 would pay $1,100 more in taxes by 2013.

But if it’s only income taxes, he will blow a hole in the budget. The Tax Policy Center report puts the cost at $1.3 trillion over 10 years.

Either way, McCain’s tax credit would rapidly fall behind rising health care premiums. Nearly every household would eventually pay higher taxes on their health insurance.

The new Tax Policy Center report includes a wealth of information on McCain and Sen. Obama’s health care plans (although it is labeled “very preliminary”). Other highlights:

–The McCain plan would decrease the number of uninsured by 5 million in 2013. However, there would still be 55 million without insurance, 8 million more than today. And McCain’s plan covers fewer people each subsequent year.

–Millions of people – 16 million in 2013 — would lose the health benefits they get from employers.

–McCain’s high-risk pools would need about $100 billion a year to “prevent large losses in insurance coverage among the sick and needy.” McCain aides have proposed spending no more than $10 billion a year.

Tomorrow, Sen. John McCain (R-AZ) will “share his cancer plan and answer questions” at the 2008 LIVESTRONG Summit, a cancer awareness event headed by LIVESTRONG founder Lance Armstrong.

But as CAPAF senior fellow Elizabeth Edwards points out, McCain, a cancer survivor himself, would be unlikely to get coverage under his own plan if he did not have government-provided insurance. Indeed, McCain’s health care proposal undermines cancer prevention and treatment in three major ways:

1. Excludes cancer patients from coverage: By pushing more Americans into the unregulated individual insurance market, McCain’s plan allows insurance companies to exclude individuals with pre-existing conditions, like cancer, from coverage. In fact, a recent Commonwealth analysis concluded that in the individual insurance market, “individuals with preexisting conditions are denied coverage, have conditions excluded, or face much higher and often unaffordable premiums.”

2. Allows insurance companies to exclude mammograms from coverage: McCain’s plan “could exempt insurers from stricter state regulations, such as requiring coverage of mammograms” by allowing insurance companies to sell policies across state lines without requiring insurance companies to comply with the consumer protection laws of the state. As a recent report by Families USA points out, “the last thing the health care system needs is a new wild west mentality…with little or no protection or oversight.”

3. Discourages preventive cancer screenings: McCain’s overall health reform philosophy, which encourages Americans to use less care to bring down health care costs, and his reliance on the individual market and the high deductible policies that proliferate in this market, would actually undermine preventative services and good chronic care management.

Back in April, Edwards asked McCain:

Doesn’t your plan really encourage insurers plans to compete to avoid people with cancer or other high-cost diseases? Don’t you think that the kind of competition that starts with a decent level of required coverage, that doesn’t exclude the care we actually need, would be better?

McCain’ didn’t attend LIVESTRONG’s Presidential Cancer Forum in 2007. Tomorrow he will have a lot to answer for.

UPDATE: Read more about how conservative proposals undermine provisions which help people with cancer access health insurance here.

Yesterday, Sen. Tom Coburn (R-OK) took to the floor to protest Sen. Harry Reid’s (D-NV) attempts to overcome conservative holds on popular bipartisan legislation by wrapping “many of the bills into one large measure to be voted on by the Senate.” Coburn, who currently has holds on about 80 bills, argued that ‘holding bills’ — a technique which allows senators to “object to bringing a bill or nomination to the floor for consideration” — actually improves the democratic process and is in the “tradition of the senate”:

A hold on a bill is not blocking a bill from coming to the Senate floor…So if you’re holding a bill because you’re saying ‘I don’t agree with unanimous consent,’ which means ‘I don’t agree that we should not debate, I don’t agree that we should not amend, and I don’t agree that the public shouldn’t have a recorded vote on this bill,’ that does nothing to stop the bill from coming to the floor….Debate—full, open, honest debate—is great for this country.

Watch it:

In his three short years in the senate, Coburn has earned the reputation of “a fly in the soup,” blocking many bills which are “non-controversial, bipartisan bills that he just doesn’t like.” In fact, despite his assertions, many of the bills he’s obstructing have bipartisan support and have been subject to debate and the amendment process:

Bill Name	House Vote	Republicans Voting Yes	Amendments Offered In Committee
Postpartum Depression (S. 1375/HR 20)	382-3	176	1 offered in House, 1 adopted
Amyotrophic Lateral Sclerosis Registry Act (S. 1382/HR 2295)	411-3	187	2 offered in Senate, 0 adopted
Drug Endangered Kids (HR 1199/S. 1210)	389-4	180	1 offered in Senate, 0 adopted
Enhancing Child Pornography Prosecution (S. 2869/HR 4136)	416-0	192	1 offered in House, 1 adopted
PROTECT Our Children Act (S 1738/HR 3845)	415-2	188	1 offered in House and Senate, Both adopted
Funding for victims of torture (HR 1678/S 840)	418-7	189	None offered
Preservation of Records of Servitude, Emancipation, and Post-Civil War Reconstruction (HR 390)	414-1	190	1 offered in House and Senate, Both adopted
Ocean Exploration, Mapping & Research (HR 1834/HR 2400/S. 39)	359-49	139	3 offered and adopted in House and 2 offered and adopted in Senate

On Thursday, at an event hosted by the Center for American Progress Action Fund, Al Hubbard, an architect of Sen. John McCain’s (R-AZ) health care plan, compared “Americans’ use of the health care system to shoppers who indiscriminately buy caviar while someone else foots the bill”:

When a third-party pays for a service or product—we consume it as if it was free…It’s interesting, if you would think about, the employers rather than providing health care insurance they provided food insurance. So every time you go to the grocery store you just take out your food insurance card, you give it to the cashier, she scans it, and you’re outta there. Pretty soon, you would start buying caviar, expensive steak, and you start buying more than you need, and also pretty soon the supermarket would discover that you really didn’t care about price, so the supermarket would remove price, because it doesn’t affect your decisions about what to buy and what not to buy.

Watch It:

It’s possible that families get less value from the health care system because its costs are opaque, but this is not the whole story with rising health care costs.

The rising costs of health care are a troubling trend. Americans spent $2.3 trillion on health care in 2007, “almost three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980.” According to a recent report by PriceWaterhouseCoopers, “health care costs for employers will increase almost 10 percent next year, double the rate of inflation.”But Hubbard’s insistence that health insurance costs too much because Americans over-use it or because they buy “caviar” health care, represents a fundamental misunderstanding of the current health care crisis. Eighty percent of the health care costs “are incurred by the sickest twenty percent of Americans, those whose doctors order expensive treatments for difficult diseases such as cancer.”

Moreover, the Kaiser Family foundation concludes that four major factors are responsible for driving up cost. Over-use is not one of them:

- Intensity of services: The increasing costs of treating “ongoing illness and long-term care services such as nursing homes.”

- Prescription drugs and technology: “Spending on prescription drugs and the major advancements in health care technology have been cited as major contributors to the increase in overall health spending.”

- Aging of the population: “Health expenses rise with age and as the baby boomers are now in their middle years, some say that caring for this growing population has raised costs.”

- Administrative costs: 7% of health care expenditures are for administrative costs (e.g. marketing, billing) .

The insured are also “paying a greater cost to cover the uninsured because the federal government is under-funding public programs while the number of uninsured is rising.” The United States spends “nearly $100 billion per year to provide uninsured residents with health services.” Similarly, “another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage.”

As Lester Feder points out, Hubbard’s attempts to blame Americans for the rising costs of health care “comes at a poor time for Senator McCain, who was forced to jettison co-chairman Phil Gramm” after he called Americans “a nation of whiners.” But Hubbard’s remarks also raise another important question: Does McCain consider health care a luxury like caviar?

UPDATE: Read more about the cost containment approaches articulated by Senators Obama and McCain here.

Health care costs have become a major issue this election—and with good reason. The facts are staggering.

- In 2006, America spent approximately $2.1 trillion on health care—even as more than 47 million individuals went without insurance and thus without access to affordable routine care.

- Health care spending, which doubled between 1996 and 2006 and is expected to double again in the next decade, outpaces wage growth and inflation.

- Between 2000 and 2006, private health insurance premiums increased more than 90 percent.

Today, the Center for American Progress Action Fund released a new analysis on the cost containment approaches articulated by Senators Obama and McCain. The political rhetoric emanating from the leaders of the conservative and progressive movements sounds remarkably similar. Agreement on the problem of rising health care costs, however, does not translate to agreement on how to achieve those solutions. And as the new analysis shows, there is little evidence for McCain’s claim that conservatives’ health care reforms will address health care costs, which he has called, “the biggest problem with the health care system.”

McCain’s Extreme Plan Will Likely Not Contain Health Care Costs:
Sen. McCain’s plan asks the impossible of consumers – it asks them to drive down prices and improve quality through one-on-one interactions with insurance companies. Extensive research, however, consistently shows that the pooling of individuals into large groups is the most effective way to manage risk and promote efficiency. The individual market approach is both more costly and less efficient than the group market approach.

McCain’s Lofty Rhetoric Unmatched by Details:
An analysis of Sen. McCain’s plan shows that his cost-containment steps lack specificity—regardless of his efforts to camouflage his proposals with rhetoric about “freedom” and “responsibility” lowering costs. There are few concrete steps for implementation in his plan, and almost no detail about the resources he would dedicate to the effort.

Coverage for All Americans Is the Fundamental Way to Contain Costs:
Current research suggests that the closer a health care system is to providing affordable coverage for all, the more successful it will be in achieving significant cost containment. By extending coverage to all, we can achieve efficiencies, end cost-shifting and rationalize financing mechanisms. Given Sen. McCain’s refusal to provide health care coverage for all, any success he may have in cost-savings will be limited.

The Progressive Alternative:
In contrast, progressive leaders have consistently offered concrete steps to making sure all Americans have access to affordable health care, and to help bring down health care costs. And progressive governors have led by taking proactive action when possible, as this report shows. Indeed, for his part, Sen. Obama has articulated clear steps to implement his cost containment measures.

On Monday, the Wonk Room reported on Sen. Tom Coburn’s (R-OK) stubborn insistence that the bipartisan President’s Emergency Plan for Aids Relief bill (PEPFAR) include a wasteful earmark mandating that “55 percent of the money go to treatment programs.” Speaking on the Senate floor, Coburn suggested that his insistence on restoring the mandate saved the PEPFAR program:

Maybe treatment wouldn’t have been eliminated but it would have taken a back seat… the commitment to treatment would have eroded over time and PEPFAR would have been like any other aid program.

But Coburn is no hero. Far from it. In his three years in the senate, Coburn has earned the reputation of “a fly in the soup,” abusing the senate’s hold privilege — a technique which allows senators to “object to bringing a bill or nomination to the floor for consideration” — to prevent “the Senate leadership” from bringing matters to a vote.

Remarkably, Coburn’s obstructionism has even led “senate aides to now take legislation directly to Coburn’s office” to ensure “he has no objections“:

Senate aides on both sides of the aisle now take legislation directly to Coburn’s office before moving forward to make sure he has no objections — whether he’s on the relevant committee or not. If he does, they often swallow their pride and make the changes he’s asking for.

Currently, “Coburn has holds on about 80 bills” which are “non-controversial, bipartisan bills that he just doesn’t like.” Here is a small sampling:

- Caroline Pryce Walker Conquer Childhood Cancer Act (S.911): The bill, named “in memory of Caroline Pryce Walker, daughter of Congresswoman Deborah Pryce (R-OH), who succumbed to neuroblastoma in 1999 at age nine,” authorizes $30 million over five years, “to significantly increase federal investment into childhood cancer research.”

- The ALS Registry Act of 2007 (S.1382): Creates a single nationwide patient registry for incidences of Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, to improve ALS research, disease management and the development of standards of care.

- The Christopher and Dana Reeve Paralysis Act (S.1183): The bill coordinates and collaborates paralysis research, prevents research redundancies and hastens the discovery of better treatments and cures.

- Stroke Treatment and Ongoing Prevention Act of 2008 (S.999): Amends the Public Health Service Act “to improve stroke prevention, diagnosis, treatment, and rehabilitation.”

Coburn argues that his holds make legislation “better” and claims that he is “not hard to deal with if you talk with us, but if you won’t talk with us, we are hard to deal with.”

This week, Sen. Harry Reid (D-NV) plans to “deal with” Coburn’s attention-seeking theatrics. According to the Crypt, Reid will “wrap most if not all of the bills held by Sen. Tom Coburn (R-Okla.) into one large measure to be voted on by the Senate.”

The “broad popularity of the bills means that there would likely be more than enough support for veto-proof passage.”

Sen. John McCain (R-AZ) has often cited Congress’ low approval rating and has suggested that it is failing Americans. Will he vote against Coburn’s obstructionism?

Today, President Bush “vetoed the Medicare bill that would stave off a 10.6 percent cut in reimbursements to doctors and replace it with a slight increase.” In his veto statement, Bush claimed that the legislation, which made cuts to the Medicare Advantage program, “would reduce benefits to millions of seniors, including lower-income seniors, who have chosen to join these plans“:

While the MMA increased the availability of private plan options across the country, it is important to remember that a significant number of beneficiaries who have chosen these options earn lower incomes. The latest data show that 49 percent of beneficiaries enrolled in MA plans report income of $20,000 or less. These beneficiaries have made a decision to maximize their Medicare and supplemental benefits through the MA program, in part because of their economic situation. Cuts to MA plan payments required by this legislation would reduce benefits to millions of seniors, including lower-income seniors, who have chosen to join these plans.

In fact, the bill Bush vetoed actually “helps low-income beneficiaries pay the costs of Medicare benefits” by increasing “the amount of assets that applicants are able possess and still qualify for the Medicare Savings Program.”

Bush’s argument that low income Americans benefit disproportionately from Medicare Advantage plans echoes the now discredited analysis of AHIP, the health insurance lobby. As the Center for Budget and Policy Priorities points out, this claim is “based on misleading use of data“:

– “The Administration notes that about 49 percent of Medicare Advantage enrollees have incomes below $20,000, but generally fails to point out that 51 percent of fee-for-service beneficiaries do.”

- Nearly half (48 percent) of all Medicare beneficiaries with incomes below $10,000 are enrolled in, and thus receive supplemental coverage through, Medicaid. This is nearly five times the proportion (10 percent) who are enrolled in Medicare Advantage plans.

- Among beneficiaries with incomes below $20,000… a larger share receive supplemental coverage through Medicaid than through a Medicare Advantage plan”

Thus, Bush’s veto undermines the health care coverage for “low-income seniors” in the name of saving it.

UPDATE: The House of Representatives voted 383 to 41 to override Bush’s veto.

This post is reprinted from Newsweek. See the original column here.

Tony Snow has died. A young man (with my next birthday being number sixty, I am entitled to the folly of calling a fifty-three year old “young”), with a facile mind, an easy smile, and a quick wit; a man who had a perpetual twinkle in his eye when he was doing what he he born to do; a man who loved his wife and his children; a man who loved politics and maybe a little more loved the verbal sparring that comes with politics well-played; a man who desperately did not want to die. And when he died, I cried. I know I cried not just for him, but—filled with fear—for myself as well. The diagnoses of our cancer recurrences (“recurrences” being one of those misnomers we simply endure) tumbled out upon one another by days, and I felt—and feel— connected to a man who loved what I loved, although we came to nearly every argument from opposite corners of the ring.

Last week—when Tony was still alive and I was not so afraid—I rode my bicycle in a small Fourth of July parade at the beach to which we have gone for close to two decades. When I got to the celebration and stepped off the bicycle, an older man approached me. I hope you are doing well, he said, and then he added—oddly, it is more often the case that people do feel obliged to confess the gap between us—”although we don’t agree on much of anything.” I thanked him for his good wishes and then I added—as I often do—”and I suspect we agree on more than you think.” He smiled, I smiled, and that was that. And then Tony died. And I thought more about the things on which we agree and the things on which we disagree. And as with my parade companion, I suspect Tony and I agreed on more things that we might have guessed. Read more

Our guest bloggers are Winnie Stachelberg and Robert Gordon. Stachelberg is is the Senior Vice President for External Affairs at the Center for American Progress Action Fund, and Gordon is a senior fellow.

This weekend, John McCain staked out an extreme position on “gay adoption.” Here’s what he said:

Q: President Bush believes that gay couples should not be permitted to adopt children. Do you agree with that?

Mr. McCain: I think that we’ve proven that both parents are important in the success of a family so, no I don’t believe in gay adoption.

Q: Even if the alternative is the kid staying in an orphanage, or not having parents.

Mr. McCain: I encourage adoption and I encourage the opportunities for people to adopt children I encourage the process being less complicated so they can adopt as quickly as possible. And Cindy and I are proud of being adoptive parents.

Q: But your concern would be that the couple should a traditional couple

Mr. McCain: Yes.

McCain not only expressed his opposition to adoption by “gay couples”–as if that weren’t bad enough. He said he wants “both parents” involved and therefore doesn’t believe in “gay adoption.” This approach rules out adoption by gay individuals–even though these adoptions are permitted in every state except Florida. In fact, it seems to rule out adoption by single heterosexuals too.

There’s a reason that nearly every child welfare organization in the country, from the American Academy of Pediatrics to the Child Welfare League of America opposes bans on adoption by gays and lesbians, and no state has followed Florida’s lead in banning these adoptions. About 130,000 children wait in the foster care system each year for a permanent, loving home. And every year, half of these children are never placed, and 20,000 children “age out” of the foster care system without ever finding a permanent home.

Children are placed in foster care on a case-by-case basis. Every potential parent undergoes extensive screening before a child is placed with them. A ban on certain adoptions eliminates potential parents and wastes child welfare agencies’ time and resources implementing it—in Texas alone, a ban would cost more than $75 million over 5 years.

Does John McCain really think hundreds of thousands of children should sit in foster care and orphanages while we wait for “Ozzie and Harriet” families to appear? As someone who himself made the admirable decision to adopt a child, Senator McCain surely knows better.

UPDATE: McCain walks it back. Via Andrew Sullivan:

“McCain could have been clearer in the interview in stating that his position on gay adoption is that it is a state issue, just as he made it clear in the interview that marriage is a state issue. He was not endorsing any federal legislation.

McCain’s expressed his personal preference for children to be raised by a mother and a father wherever possible. However, as an adoptive father himself, McCain believes children deserve loving and caring home environments, and he recognizes that there are many abandoned children who have yet to find homes. McCain believes that in those situations that caring parental figures are better for the child than the alternative,”
- Jill Hazelbaker, Director of Communications

We think the last sentence means McCain personally doesn’t agree with Florida, but it’s hard to say. How about a little straight talk? Barring gay people from adopting is morally wrong.

UPDATE II: McCain’s “clarification” doesn’t square with his position 8 years ago. Asked in 2000 about adoption by same-sex couples, McCain responded that he didn’t “believe it’s appropriate.” (San Francisco Examiner, March 1, 2000)

Today, the Senate plans to vote on the President’s Emergency Plan for Aids Relief or PEPFAR, an international health initiative dedicated to combating HIV/AIDS around the world.The Wonk Room has previously argued that the bill is imperfect and that its ideological restrictions place unnecessary obstacles in the path of effective prevention policies. Now, a small group of conservative senators, concerned about the cost of the bill, seek to further hamper access to life-saving information and services:

A main sticking point is a current program mandate that requires 55 percent of the money go to treatment programs. Writers of the new bill dropped the provision, arguing that health care workers on the ground – not Washington politicians – can better determine what programs are most effective.

But Sen. Tom Coburn, Oklahoma Republican and a longtime supporter of PEPFAR, has spearheaded an effort to get the requirement restored, saying the mandate is necessary to prevent money from getting diverted into unrelated development and poverty-relief programs.

Access “to treatment, while vital, cannot reverse the spread of HIV.” In fact, “given that there are about 2.5 new HIV infections for every person starting on AIDS drugs, there is no way to control the pandemic through treatment alone.”

The “real issue is how wisely the money is spent.” And, according to both the Institute of Medicine of the National Academy of Sciences and the Government Accountability Office, “earmarking a specific percentage of funds to be spent on particular activities hampers the flexibility and effectiveness of the program.”

The requirements also wastes aid resources. As Michael Gerson, President Bush’s former speech writer, points out:

And because treatment is less expensive than it used to be, PEPFAR is meeting its treatment goal for less money. The 55 percent treatment floor would force the program to waste money in pursuit of an arbitrary, nonsensical spending target — the worst kind of congressional earmark.

Since 2003, “PEPFAR has been getting life-saving treatment to nearly two million people,” but ideological and spending restrictions have wasted millions and “failed to slow the infection rate.” Self-professed fiscal conservatives should take note and drop their opposition to this imperfect, but certainly necessary, piece of legislation.

UPDATE: RH Reality Check has more on the pending PEPFAR vote.

Today, Sen. John McCain (R-AZ) will hold a women-only forum in Hudson, Wisconsin “to bolster his support among women.” But McCain’s repudiation of the Senate’s recent compromise to halt the cut in Medicare physician reimbursement rates undermines women’s access to affordable health care.

While the senator said he supported providing “proper reimbursements to Medicare physicians,” he opposed the compromise because it tried to eliminate the government’s overpayments to Medicare Advantage plans. Thus, when given the choice between protecting womens’ access to physicians and continuing to subsidize private insurance companies, McCain agreed with President Bush and chose the latter.

But low Medicare reimbursement rates have already led many OBGYNs to stop accepting Medicare patients. In 2002, for instance, The Los Angeles Times reported that some Medicare patients “had a hard time finding a gynecologist and an ophthalmologist”:

Three or four OB/GYN offices told her they were not accepting new Medicare patients. Finally, she persuaded a friend’s doctor to take her. But now the 75-year-old is afraid her new doctors will drop her. “You’ve got to be careful not to step on your doctor’s toes,” Bowers said. “They don’t want to mess” with Medicare because of the low payments.

Similarly, in 2003, OB-GYN News reported that “Ob.gyn. practices are being affected as physicians nationwide are rethinking treating Medicare patients” and have “begun limiting the number of Medicare patients they take on…or–in some cases–have stopped caring for Medicare patients entirely.”

McCain’s choice to side with the insurance companies would have further restricted women’s access to doctors who simply couldn’t afford the lower payments:

- “Steven Polansky, who’s been an obstetrician and gynecologist in Sacramento, Calif., since 1977, said he couldn’t afford a 10.6 percent pay cut from Congress…”We haven’t gotten a raise from anybody in centuries,” Polansky said in an interview. “And it is becoming more and more difficult to run a private practice.”

- “There’s a threshold out there beyond which people can’t keep their doors open,” added Jerry McLaughlin, a Hobbs obstetrician and gynecologist who is the former president of the New Mexico Medical Society.”

- “‘We can’t compete with other cities,’ said local OB/GYN Dr. Paul Kocay. Some doctors already are moving towards cash-only practices. These ’boutique medicine’ clinics are going to increase if these cuts are enacted. Local doctors are between the 10th and 20th percentile in national salary averages. This could become a crisis situation in Kerrville.”

As the Wonk Room has pointed out again and again, McCain is not what women want.

UPDATE: Steve Benen points out that “the key thing to remember here is that McCain’s record on reproductive rights and sexual health is utterly miserable. His rhetoric is awful, but his record is worse.”

Earlier, ThinkProgress noted Sen. John McCain’s (R-AZ) nervous reply to a question about why his top adviser erroneously suggested that he supported requiring insurance companies to cover prescription birth control. Looking confused, McCain replied:

I’ll look at my voting record on it … I’ll be glad to look at it and get back to you as to why … I don’t know enough about it to give you an informed answer because I don’t recall the vote, I’ve cast thousands of votes in the Senate.

Watch It:

Don’t expect McCain to “get back to you” anytime soon. In 2007, McCain similarly admitted to reporters that he was “not informed” about “whether I support government funding for them [contraceptives] or not,” and promised to “find out.” In the same interview McCain also expressed doubts about the effectiveness of condoms:

More questions: Do condoms stop sexually transmitted disease?

A long pause.

A stern look.

“I’ve never gotten into these issues or thought much about them,” he said, almost crying uncle.

McCain’s unfamiliarity with contraceptives has caused him to support regressive reproductive policies. McCain voted against requiring insurance companies to cover prescription contraception in both 2003 and 2005 and has consistently opposed expanding access to contraception. In fact, according to NARAL, McCain “has never cosponsored or supported legislation that would prevent unintended pregnancy or reduce the need for abortion“:

- Voted to “terminate the Title X family-planning program, which provides millions of women with health care services ranging from birth control to breast cancer screenings.”

- Voted in favor of “the domestic gag rule, which would have prohibited federally funded family-planning clinics from providing women with access to full information about their reproductive-health options.”

- Voted for an “amendment to prohibit distribution of condoms, contraceptives or drugs financed by federal aid without parental consent.”

- Voted to establish an “abstinence-only” program “that censors information about birth control.”

An article in today’s New York Times analyzes Sen. John McCain’s (R-AZ) approach to insuring Americans with preexisting conditions and concludes that the senator’s plan to federally subsidize state-run high risk pools is an inadequate solution to providing coverage to patients who can’t find insurance in the unregulated individual insurance market:

Though high-risk pools have existed for three decades, they cover only 207,000 people in a country with 47 million uninsured…Premiums typically are high, as much as twice the standard rate in some states, but are still not nearly enough to pay claims. That has left states to cover about 40 percent of the cost, usually through assessments on insurance premiums that are often passed on to consumers. Health economists say it could take untold billions to transform the patchwork of programs into a viable federal safety net.

The Wonk Room has long argued that McCain’s reliance on high risk pools is both expensive and unrealistic. Simply put, since high risk pools are populated by individuals whose pre-existing medical conditions require expensive treatments, states look for ways to limit participation. As a result, states “restrict availably, affordability, and adequacy of coverage.”

As Karen Pollitz, the health care expert quoted in the New York Times, argued last week at the Wonk Room’s McCain University event:

These programs [high risk pool programs] are very expensive…because [sick people] account for all of the spending. So these are very expensive programs for states to run…and so states look for ways to restrict these programs and in particular they have limited eligibility rules in some states, the premiums that they charge are exceedingly high.

McCain doesn’t fully comprehend the costs of covering patients through high risk pools. While he has proposed spending $7 to $10 billion to subsidize high risk pools, Pollitz notes in the article, “I do not for a minute think it will cost 7 to 10 billion dollars a year. It may cost 7 to 10 billion dollars a week.”

Ironically, for a candidate who proclaims to be concerned about the rising costs of health care coverage, McCain is proposing the most inefficient and expensive program possible.

Yesterday, Sen. John McCain (R-AZ) suggested that requiring employers to share the costs of expanding access to health insurance would add “$12,000 to the cost of employing anyone with a family” and lead to greater unemployment and lower wages:

Small businesses are the job engine of America, and I will make it easier for them to grow and create more jobs. My opponent wants to make it harder by imposing a ‘pay or play’ health mandate on small business.

But the rising costs of health insurance are already making it harder for small businesses to “grow and create more jobs.” According to a recent study from the Institute of Medicine, “the lost human capital related to lack of health insurance – including lost earning potential and the value of extra years of life – is as much as $170 billion.”

As the Small Business Majority points out, the current system is broken. Small businesses either “pay the overblown and disproportionate costs in purchasing and administering a health care plan or, worse, offer no health care plan at all and suffer the competitive disadvantage in attracting and retaining talented labor.”

To ensure that small businesses aren’t overwhelmed by the growing costs of health care, “all interest groups — business owners, employees, the health care community and government” must step-up and contribute through the concept of shared responsibility. Such an approach would save small businesses from the inadequacies of the current system.

Small businesses are willing “to pay their fair share“:

When part of a larger solution that includes pooling, cost controls and government subsidies, [employer] mandates offer useful tools in building comprehensive reform…Small businesses are prepared to pay their fair share: nothing less, nothing more.”

But unfortunately, McCain’s rhetoric suggests that he doesn’t understand the cost of doing nothing. McCain’s proposals don’t address the out-of-control costs of providing health care coverage and do nothing to ameliorate the current crisis. Progressives would control costs and provide new opportunities for small businesses to purchase affordable coverage.