Last week, after months of arguing that health care reform would ration care and pull the plug on grandma, Republicans initiated a focused and organized campaign against seniors. Since “older people vote in bigger numbers than younger people” and are “more likely to call their representatives or attend a town hall meeting,” their support is key. The elderly are weary of health care reform and afraid of losing their existing government-sponsored health care plans; convincing them of the Republican narrative on health care reform, could doom Democratic reform efforts and virtually guarantee large Republican gains in the midterm elections and beyond.

For Republicans, the strategy requires some juggling and plain old intellectual dishonesty: the GOP has to support Medicare, but argue against a Medicare-like public option. Last Monday, GOP Chairman Michael Steele penned a rather awkward op-ed defending and defaming the Medicare program. He rebranded the proposed $500 billion cuts to Medicare and Medicaid waste — which he himself has supported in the past — as a “raid” on Medicare and accused the President of cutting Medicare benefits.

The AMA and AARP endorsed House health care bill rationed care to seniors, Republicans claimed. The President must scrap the House plan, and propose his own legislation. This afternoon, during an appearance on Fox News, Rep. Mike Pence (R-IN) made that very argument, criticizing Democrats in Congress for writing health care legislation and calling on Congress to “scrap the bill that has been moving through the House of Representatives” and “demand the President of the United States to bring forward his own bill.” The House legislation, Pence claimed, increased “the cost of prescription drugs for seniors under Medicare Part D”:

It really is, particularly, when you start to realize that where they are going to find these supposed savings are in cuts to Medicare. They are actually talking, as House Republicans published today, they are talking about increasing the cost of prescription drugs for seniors under Medicare Part D of upwards to 20% in the coming years, to close that so-called ‘donut hole.‘

Watch it:

False hits only work if they build on kernels of truth. In this case, Pence is perverting a recently released Congressional Budget Office letter — which found that premiums would increase but net spending on drugs would decrease — to substantiate the Republican narrative. The reality is quite different. The House bill would improve Medicare payments to physicians, create incentives for doctors to work in underserved rural areas, eliminate co-payments and deductibles for preventive services in Medicare, and fill in the coverage gap – the “donut hole” – in the Medicare prescription drug benefit.

According to the Congressional Budget Office, closing the donut hole alone would cause “spending on prescription drugs apart from those premiums” to “fall, on average, as would their overall prescription drug spending (including both premiums and cost sharing).” The federal government would save “about $30 billion over the 2010–2019 period.”

Beneficiaries’ premiums would increase as a consequence of the donut hole contraction and the behavior of prescription drug companies. Under the legislation, “prescription drug plans would be responsible for covering some costs in the doughnut hole and above the catastrophic level that they are not required to cover under current law.” “Because enrollees pay for about 25 percent of the cost of coverage through their premiums, premiums would also be higher.” Pharmaceutical manufacturers would also add to premiums by “charging higher prices for new drugs,” and lowering “the rebates they pay to prescription drug plans.” Yet on the whole, “in return for those higher premiums, enrollees would receive greater protection against incurring high drug costs” and incur lower out-of-pocket expenses. As a result, “beneficiaries’ total prescription drug spending would fall on average,” the CBO found.

The counter-narrative is more complicated but no less essential; without it, the President will likely lose the debate. Until now, Obama has treated the health care debate as an economic symposium; he has played the professor in the GOP’s far more moving drama about long waiting lines and rationed health care services. To win the health care debate and blunt the GOP’s far more compelling story, the President will have to reassure seniors that health reform will strengthen the Medicare. His story could sound something like this: health care reform “ensures that Medicare beneficiaries will continue to choose their doctors, hospitals and other providers, receive an improved range of benefits, and enjoy the financial and health security Medicare has provided for more than 40 years.” After all, this narrative has the benefit of being true.

This morning, during an interview with WNYC’s Brian Lehrer, health care provocateur Betsy McCaughey suggested that policy makers could slow Medicare spending without cutting $500 billion from Medicare and Medicaid over 10 years and “denying care to the elderly.”

Instead, the author of the “death panels” charge, suggested that policy makers should cut Americans aged 65 to 69 from the program:

The fact is that if Medicare inched up the eligibility age one month a year, until 2043 when it reached age 70, Medicare would be solvent. And that is what the Congress should do and that is what the Congressional Budget Office has urged Congress to do every year. That would solve the problem without telling elderly people that they have to suffer with crippling arthritis rather than get a knee replacement.

Listen:

Despite McCaughey’s claim, the Congressional Budget Office does not “urge” Congress to raise Medicare’s eligibility age “every year.” The CBO merely includes the policy as one of “115 options for reducing (or, in some cases, increasing) federal spending on health care, altering federal health care programs, and making substantive changes to the nation’s health insurance system.”

To put the debate in terms McCaughey can understand, page 51 (37 in print version) of “CBO’s Budget Options Volume 1” says that death paneling Americans 65 to 69 years old from the Medicare system would have little effect on the trajectory of Medicare’s long-term spending. First, the option would require Medicare to “inch up” the eligibility age by two month every year, not one. And, since “younger beneficiaries are healthier and thus less costly than the program’s average beneficiary,” “outlays for Medicare would [still] rise to 7.7 percent of GDP by 2050.”

What’s more, “increasing the age of eligibility for Medicare would shift costs that are now paid by that program to individuals and to employers that offered health insurance to their retirees. Those higher costs might lead more employers to reduce or eliminate such coverage.” Uninsured 65 to 69 year olds would enter the Medicare program in worse health, only increasing Medicare’s costs.

Today, in an attempt to criticize Democrats for using Ted Kennedy legacy to pass health care reform, Gov. Mike Huckabee (R-AK) argued during a radio segment for ABC Radio Networks that Kennedy would have died sooner under health care reform:

It was President Obama himself who suggested that seniors who don’t have as long to live might want to just consider taking a pain pill instead of getting an expensive operation to cure them. Yet when Sen. Kennedy was diagnosed with terminal brain cancer at 77, did he give up on life and go home to take pain pills and die? Of course not. He freely did what most of us would do. He choose an expensive operation and painful follow up treatments. He saw his work as vitally important and so he fought for every minute he could stay on this earth doing it. He would be a very fortunate man if his heroic last few months were what future generations remember him most for.”

Listen:

Piggy backing off of Sarah Palin’s claim that health care reform would establish “death panels,” Republicans have launched a coordinated campaign to scare seniors. This week, the effort found Republicans in the rather awkward stance of defending Medicare while simultaneously arguing that the program is “a very good example of what we should not have happen with all of our health care.” Huckabee’s contention is even more baffling. Following Huckabee’s argument to its logical conclusion would suggest that Kennedy fought cancer in order to strip other older Americans of the ability to vigorously fight the disease.

A soon-to-be-released report from the Heritage Foundation finds that the play-or-pay employer mandates that Congress is currently debating (which would require employers who don’t provide comprehensive health insurance to pay a new payroll tax to help fund health care for their workers) “will cost businesses at least $49.4 billion to $52.7 billion per year” and put 5.2 million “low-wage employees at risk of unemployment”:

All told, 5.2 million low-wage employees will be at risk of losing their jobs or having their hours of work reduced, and they will likely have fewer job opportunities in the future. Another 10.2 million employees are at risk of slower wage growth and cuts in other benefits, and some of the cost of any play-or-pay mandate will be passed onto Americans in the form of higher prices for the goods and services they buy – an indirect tax on savers and those on fixed incomes.

The four health care bills before Congress require large employers to either provide coverage to their workers or pay a tax to finance the expansion of health care coverage. But the Heritage analysis erroneously assumes that higher costs to business inevitably translate into job loss or lower take-home pay. It disregards all of the expected job and productivity gains from health care reform — the additional jobs in the health care sector, increased productivity and efficiency in the work force, and the lower rate of growth of health care costs — and simply subtracts the costs of complying with the new pay-or-play requirements from wages. The established economic literature surrounding employers’ response to increase costs and modest pay-or-play proposals completely contradicts the Heritage conclusion.

For instance, virtually all economic research shows that minimum wage increases — which are similar to the new modest pay or play requirements — “have little or no impact on employment.” In fact, even the most pessimistic pay-or-play studies have concluded that the mandate would have a very modest impact on unemployment — only abut 166,000 jobs would be lost, according to one study, far less than the Heritage estimate and even lower than the estimated 500,000 new jobs that could be created as a result of reform. A study of the impact of the Hawaii health care mandate, moreover, “found no evidence of reduced employment.” In Massachusetts, where employers with more than 10 employees are required to provide coverage or pay a fine, “few firms reported making changes as a result of health reform.”

The Heritage analysis also relies on an outdated bill and disingenuously implies that the overwhelming majority of American businesses would face higher costs. In reality, the new bill passed by the House Energy and Commerce Committee exempts 87 percent of all American businesses from any pay or play requirements (by increasing the small business exemption for payroll from $250,000 to $500,000); the older House version that Heritage analyzes would have exempt 77 percent of businesses.

The overwhelming majority of Americans work for very large businesses. In fact, 13% of firms have a payroll larger than $500,000 and employ 81 percent of the country’s workers. Thus, as Pat Gorafalo explains, “this is essentially a mandate on large employers, to ensure that they can’t simply drop their coverage” and send their employees into the health insurance Exchange or the non-group market.

In a ‘pay-or-play context,’ large employers would have to pay more under reform, but they would also see concrete savings. With increased access to care, all firms would benefit from the reduction in unpaid medical bills incurred by the uninsured and the savings due to a reduced rate of health-care cost growth and greater labor productivity. On the whole, the consequences of failing to reform health care reform far outweigh even the Foundation’s inflated concerns about costs to businesses and low income workers. In fact failing to act would hurt the very same businesses and low income individuals that Heritage is supposedly so concerned about.

Yesterday, Sen. Chuck Grassley (R-IA) — the ranking member on the Senate Finance Committee and a member of the so-called bipartisan ‘Gang of Six’ negotiations — joined the growing chorus of Republican lawmakers who are using the adjusted deficit numbers to argue for a smaller health reform package:

Senator Charles Grassley of Iowa, one of three Senate Republicans negotiating on health care, said the soaring federal budget deficit “puts a stake in the heart” of $1 trillion measures being debated in Congress….“It’s going to have a big impact on whether I’ll even support something,” he said at a town-hall meeting yesterday in Le Mars, Iowa….Still, he said, a forecast by the Congressional Budget Office that deficits between 2010 and 2019 will total $7.1 trillion calls for a more-limited measure than the $900 billion bill the bipartisan group was discussing last month. “We’re going to be looking at smaller numbers,” he said. The deficit projection also dooms $1 trillion measures already moving through the House and approved by the Senate health committee, Grassley said.

Grassley’s suggestion that health care reform would grow the deficit demonstrates that the Senator is either misinformed or deliberately manufacturing reasons to oppose health care reform. The budget framework requires a deficit-neutral health care reform bill, and the Democrats have pledged to fully finance coverage expansion from savings within the system and new sources of revenue.

Secondly, health care is the economy; health care is the deficit. Health care costs are the long-term driving force in federal and state budgets and represent the single most important factor “influencing the Federal Government’s long-term fiscal balance.” The Democrats’ health care reform will help re-orient the system from spending 80% of its dollars treating chronic illnesses into a system prevents the chronic conditions from developing in the first place. It will begin to change the way providers are paid so that we are rewarding quality care and not just quantity care.

In other words, in order to transform America’s expensive patchwork health care system into a system that covers everyone and reduces health care spending by successfully preventing and managing chronic conditions, Congress will have to invest a significant amount into reform. If done right, that investment can place the system and the nation on a firm fiscal footing and save millions of middle class families from catastrophic increases in health care costs. As Tim Fernholz points out, “health-care reform will lead to increases in GDP, reaching over 2 percent in 2020 that would lead to proportional increases in tax revenue and lower deficits. But most important, eliminating the “crazy system of cross-subsidies,” as Center for Budget and Policy Priorities economist Jim Horney calls the complex interweaving of publicly and privately subsidized care for the under- and uninsured, would create a much simpler framework for future cost-reduction efforts.”

The Wonk Room has compiled a list of Grassley’s most egregious misrepresentations and will continue monitoring and fact checking Grassley’s statements throughout the reform process. Read the full document HERE.

This morning, Sen. John McCain (R-AZ) honored Ted Kennedy’s legacy by disingenuously arguing that Kennedy’s absence from the Senate’s Health, Education, Labor and Pensions Committee (HELP) mark-up hearings allowed Democrats to reject Republican amendments “of any significance”:

You’d have to change the way things have been done and that is the fact that there have been no real negotiations. There has been a bill before committee, on which I sit, the HELP committee and it was done by Democrats and no amendments were agreed to of any significance and so that’s not the kind of negotiations I did with Senator Kennedy.

Watch it:

While McCain and the other Republicans on the HELP committee tried to delay the mark-up process by offering numerous nuance amendments and complaining that the Congressional Budget Office (CBO) had not yet scored the entire proposal, the committee accepted 160 Republican amendments and spent 13 days and more than 60 hours debating the legislation. McCain objected to mark-up from the very beginning, arguing that the committee should “scrap the current bill and start over and start over in a true bipartisan fashion.”

As Slate’s Christopher Beam pointed out, “many of the GOP amendments on this incomplete list do seem pretty substantive.” (The committee even accepted several of McCain’s more substantive amendments):

- McCain 205: To establish certain policies for small group health plans

- McCain 2: Determines whether existing Federal Government sponsored health and wellness initiatives are effective in achieving their stated goals.

- Enzi 25: To impose an earning requirement with respect to enrollees.

- Hatch: Adds programs based on pain care, environment, antimicrobial resistance, oral health, wellness programs for at risk populations.

Since Kennedy’s death, a long line of Republicans have argued that “Kennedy’s absence from the health care debate prevented lawmakers from reaching a bipartisan compromise and that had Kennedy been present, agreement on health care reform would have been more likely.” But as Ezra Klein argues, “this stuff just isn’t plausible. Kennedy was around in 1994 and there was no deal. More to the point, Kennedy’s committee, the HELP Committee, has passed health-care reform. Kennedy’s staff, as you might expect, led their effort. But neither Kennedy nor his staff can make the deals for another committee. If Kennedy were in the Senate now, health care would be exactly where it is: Through Ted Kennedy’s Committee and stuck in the morass of Max Baucus’s Gang of Six. ”

Indeed, the GOP has refused to negotiate in good faith, consistantly misrepresenting the consequences of reform and fearmongering about the public health insurance option. Some Republicans are also manipulating the events of the August recess to argue that that Americans are more concerned about jobs than health care reform and are urging Congress to abandon the present effort and adopt “incremental” changes.

Sen. Ted Kennedy considered health care reform “the cause” of his life. Throughout his 47 years in the U.S. senate, Kennedy fought for universal comprehensive coverage some 15 different times, working closely with the Senate Health, Education, Labor and Pensions (HELP) committee to pass health care reform bill this year, even while undergoing cancer treatments in Massachusetts.

Looking over today’s health care battle field, one wonders if reform would be in a different place under Kennedy’s leadership. As Ezra Klein correctly points out, “what was important about Kennedy’s career, though, was that he managed to marry compromise and principle. He was not a believer in lonely stands that underscored his purity. Nor was he a believer in compromising simply for the sake of compromise.”

Indeed, in 1971, Kennedy proposed an alternative to President Richard Nixon’s plan to expand private health insurance coverage. Kennedy offered a single-payer like plan that would have expanded coverage to every American, covered 70% of medical expenses, eliminated cost sharing and capped medical expenses. By 1974, the Kennedy proposal morphed into a plan that built on the existing employer system. Employer health benefit plans were unaffected, but Americans without coverage would have been eligible for the national plan administered by the Social Security administration.

Kennedy never allowed the perfect to become the enemy of the good; his passion for health care reform grew out of personal experiences and a deep commitment to justice and equality. He weaved his personal experiences and years of public service into a powerful and compelling narrative for health care reform. As a public servant, Kennedy received government sponsored health insurance coverage through the Federal Employees Health Benefits (FEHB) Program. But for Kennedy, that privilege only highlighted the inequality of America’s health care system. In this speech before the Montgomery County Democratic Committee, Kennedy recalls the time he spent in a children’s hospital in Boston where his son lost his leg to cancer. While his government-sponsored health insurance covered the treatments, the other families — either uninsured or underinsured — paid some $3000 every single week:

And I listened to these families whose children had the same kind of infliction as my child had. And they said, “Look, we’ve sold our house. We have the $30,000. We have $20,000. We are able to afford it for 3 months, for 4 months, for 5 months. What kind of chance does my child have to be able to survive?” I knew that my child was going to have the best because I had the health insurance of the United States Senate. And I knew that no one, no parent, no parent in that hospital had the kind of coverage that I had. That kind of choice, for any parent in this country is absolutely unacceptable and wrong, my friends.

Watch it:

Kennedy explained that “for the 15 times that I have fought on the floor of the United States Senate that we ought to have universal, comprehensive coverage, listen to the voices on the other side who have universal and comprehensive coverage say ‘No, it’s not time. We can’t afford it. It is the wrong bill at the wrong time.’”

Today, opponents of reform are making the same argument. But as Kennedy reminded us in his 1980 concession speech, “for all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.” Kennedy spent his life fighting for health care reform, now it’s up for progressives to deliver on that promise.

Earlier this summer, guided by pollsters who argued that conservatives can’t oppose the idea of health care reform, Republicans proposed at least five comprehensive alternatives to the Democratic legislation. But now, in the context of the August town halls, conservatives are openly arguing that the nation does not need or cannot afford comprehensive health care reform.

Conservatives want to abandon the effort to reform the system this year. Instead, they’re proposing “incremental” reforms:

- Sen. John Thune (R-SD): And I think the — there are Republicans who would vote for reforms, insurance reforms and, you know, I think elements that would demonstrate more incremental change that actually do bend the cost curve down, as opposed to driving it up. [Conference call, 8/25/2009]

- Sen. Mike Enzi (R-WI): We do need to have health care reform,” Enzi said. “We do need to get it right. We need take the time to do it. I think the only way it will happen is we need to break it down into smaller parts than we have now and put it through one at a time. [Billings Gazette, 8/17/2009]

- Sen. Chuck Grassley (R-IA): If we start over again, you know, it’ll probably be more incremental, probably less controversial and maybe get done, but it still will take time to do that. [Conference call, 8/13/2009]

- Sen. Joe Lieberman (I-CT): There’s no reason we have to do it all now, but we do have to get started. [CNN, 8/23/2009]

- Sen. Richard Lugar (R-IN): I would advise the president that the — bringing up of the health care situation in the midst of recession…And therefore he ought to postpone the decision…For the moment, let’s clear the deck and try it again next year or in subsequent times. [CNN, 8/23/2009]

Yesterday’s revised deficit projections have given conservatives an additional argument for paring down existing legislation. Sen. Lamar Alexander (R-TN) issued a statement arguing that the higher projections were “a flashing red light for any health care proposal that doesn’t reduce the cost of health care for Americans and their government,” and Rep. Dave Camp (R-MI), the ranking Republican on the Ways and Means Committee, declared that “if the House Democrats’ unaffordable $1 trillion health care bill wasn’t dead before, it should be now.”

A smaller health reform package would do little to reduce health care costs and increase access to affordable health care coverage. In fact, health care costs are the long-term driving force in federal and state budgets and represent the single most important factor “influencing the Federal Government’s long-term fiscal balance.” Health care reform that begins to lower the curve of health care spending is “the single most important step we can take to put the Nation on firm fiscal footing.” Scaling down legislation, would not only fail to address the long term cost challenge, it “basically means gutting the benefits that would go to the working and middle class,” the New Republic’s Jonathan Cohn points out. “In other words,” Cohn says, “it would help fulfill the fear many of these voters already have and that opponents of reform have tried hard to stoke: That reform doesn’t have much to offer the typical middle-income American.” As the late Ted Kennedy observed in a recent article for Newsweek, “Incremental measures won’t suffice anymore. We need to succeed where Teddy Roosevelt and all others since have failed. The conditions now are better than ever.”

The New York Times’ Prescriptions blog points to the Tennessee Hospital Association’s (THA) two page analysis of the American Hospital Association’s decision to contribute “some $155 billion in Medicare and Medicaid savings over the 10 years to cover health care cost reform.” In the document, THA explains that under the deal, hospitals would still net about $16 billion from reform:

The breakdown estimates that the industry will receive additional money of about $171 billion over those same 10 years as a result of reimbursements for newly insured patients who would be covered under the overhaul plan. In other words, the hospitals would give up $155 billion in cost cuts, but take in $171 billion in new money — a net gain of $16 billion. What’s more, the Tennessee association notes that the deal delays most of the industry’s cost givebacks until the second half the agreement’s 10-year year period — well after the hospitals have enjoyed some of the benefits of the new money they’re expecting from expanded insurance coverage. In other ways, the agreement appears to protect the hospitals from cuts they might have sustained anyway.

This isn’t to say that the agreement between the hospitals and the administration is a bad one. If the prospect of newly insured patients solidifies industry support for reform (and prevents hospitals from undermining the effort), then both patients and hospitals will gain from the effort. The deals with hospitals is significant in that it forces the industry to admit that there is waste in the system and adopt more efficient practices. The goal of the compromise, after all, isn’t to prevent hospitals from netting some amount from the initial influx of the newly insured; the goal is to reinvest the waste in the health care system towards financing health care reform.

Still, given the profitability of reform, reformers must hold hospitals to their pledge to contain costs and also use Medicare to further prod the industry — which accounts for over 40 percent of all spending — to slow cost growth. As Judy Feder and Marilyn Moon point out, “in response to payment changes in the early 1980s, hospitals reduced their lengths of stay enormously…For the last six years, Medicare has applied no such constraints, leaving open the opportunity for achieving short run savings now.” If the industry is scheduled to earn some $16 billion from health care reform, then “policy makers have no excuse not to use that leverage.”

The Wall Street Journal reports that, in a recent interview, Sen. Chuck Grassley (R-IA) — the ranking member on the Senate Finance Committee and member of the “Gang of Six” tasked with producing bipartisan health care legislation — “vowed not to vote for an ‘imperfect’” health care bill:

“Now is the time to do this right or not do it.” … “We need to slow down and do a little less,” Mr. Grassley told another town-hall gathering in Pocahontas, Iowa, Monday afternoon. “We need to fix what’s broken and leave alone what’s working well.” In an interview, he vowed not to vote for an “imperfect bill” that includes a public option or gives the government too much control over end-of-life issues.

In March, Grassley characterized himself as an honest negotiator, telling the Kaiser Family Foundation that “everything is on the table. … You don’t negotiate when everything is not on the table…everything’s got to be on the table if you’re negotiating in good faith.” Watch it:

Since then, Grassley has adopted the rhetoric of the far right, routinely referring to health care reform as a government takeover, disingenuously misrepresenting reform legislation, and even going so far as to endorse the “dealth panels” myth.

The Wonk Room has compiled a list of Grassley’s most egregious misrepresentations and will continue monitoring and fact checking Grassley’s statements throughout the reform process. Read the full document HERE.

On August 18th, Jim Towey — director of the White House Office of Faith-Based and Community Initiatives from 2002 to May 2006 — wrote an op-ed in the Wall Street Journal in which he criticized the Department of Veterans Affairs for distributing an end-of-life counseling booklet that “presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political ‘push poll.’”

Towey argued that the Bush administration abandoned the 52-page work book, “Your Life, Your Choices,” because it reflected a bias towards ‘ending your life’, but Obama reinstated the publication. On Sunday, Towey appeared on FOX News Sunday to press his case:

The message they want to communicate, I think, is if you have a stroke, or if you have a coma situation that somehow your life has lost a little value and it may not be worth living anymore….the VA has been using this, a new directive just came out in July, urging providers to refer patients to it.

Watch it:

The book’s message, as its title suggests, is open to interpretation and Towey — who has a competing end-of-of life booklet — is certainly entitled to disagree with the publication’s particular approach to end-of-of life counseling. In fact, the VA is currently reviewing the publication. But in making his case, Towey and by extension Chris Wallace, fudged the facts. As Jed Lewison points out at Daily Kos, “despite Fox’s claim that the guide encourages assisted suicide and euthanasia, it is solely focused on helping veterans determine what type of care they wish to receive if they should ever become incapable of making their wishes known. The guidebook specifically makes clear that it has nothing to do with assisted suicide, which is illegal.”

The Bush administration referenced the book on the VA website from February 2001 through December 2008. In July 2009 the Obama administration made “a minor update to a small portion of the Bush directive and had nothing to do with the guidebook.” Thus, “there’s no truth to Fox’s claim that Pres. Obama gave new life to a guidebook killed off by Bush,” Lewison concludes.

Towey spread his myth (or personal pet peeve) by wrapping the story in an already-established (false) narrative — “when the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?,” he asked — and by Sunday he was explaining himself to an all-to-eager Chris Wallace. It’s a familiar template. Betsy McCaughey, Sally Pipes, Sarah Palin, Newt Gingrich, Rick Scott, and now Jim Towey have all mastered the art of perverting a single kernel of truth into a sensational story about an administration’s lust for euthanasia. While the administration is unable to rally around a single health care bill — since no one bill exists — opponents can freely cherry pick provisions and place the entire pro-reform movement on the defensive.

Perhaps inspired by Rep. Michelle Bachmann’s misinformed claims that the public option is unconstitutional, an op-ed in Saturday’s Washington Post makes the false claim that another key health reform provision is unconstitutional:

The Constitution assigns only limited, enumerated powers to Congress and none, including the power to regulate interstate commerce or to impose taxes, would support a federal mandate requiring anyone who is otherwise without health insurance to buy it. [...]

Significantly, in two key cases, United States v. Lopez (1995) and United States v. Morrison (2000), the Supreme Court specifically rejected the proposition that the commerce clause allowed Congress to regulate noneconomic activities merely because, through a chain of causal effects, they might have an economic impact. These decisions reflect judicial recognition that the commerce clause is not infinitely elastic and that, by enumerating its powers, the framers denied Congress the type of general police power that is freely exercised by the states.

For starters, the Post showed exceptionally poor judgment by choosing to publish the authors of this op-ed, right-wing attorneys David Rivkin and Lee Casey. The same duo labeled Amnesty International “un-American” after it criticized widespread human rights abuses at Guantanamo Bay, and they recently claimed that Bush-era DOJ memos authorizing the use of torture “prove we didn’t torture.”  Rivkin once claimed that President Bush had unilateral authority to use weapons of mass destruction on Russia. 

Saturday’s op-ed, however, is weak even even by Rivkin and Casey’s low standards.

In essence, the duo argue that Congress does not have the power to enact an individual mandate because such a mandate is “noneconomic” in nature.  Yet while they are correct that the Supreme Court has held Congress’ power to be more limited when it regulates outside of the economic sphere, their claim that insurance regulation is not “economic” is frankly absurd.

The provision Rivkin and Casey take aim at would require most uninsured Americans to buy a product — health insurance coverage — which pools thousands of people’s premiums together and pays those people’s medical costs as they become ill.  As Rivkin and Casey admit, the individual mandate would lower premiums nationwide by requiring more healthy individuals to buy into the system; while reducing the risk of catestrophic financial loss should a person who was previously uninsured experience catestrophic illness.  It is difficult to imagine a law which has a more obvious economic impact than a requirement that all Americans be insured.

Neither the Lopez nor the Morrison case, which Rivkin and Casey point to in their op-ed, support their claim that insurance reform is not economic in nature.  Lopez struck down a federal ban on guns in school zones; Morrison struck down a law providing federal remedies to the victims of violence against women.  Thus,  both cases involved activity that is far less economic in nature than the purchase of health insurance.  Neither carrying a gun nor committing an act of violence involve a sale, a market, or an exchange of something of value.  No employer hires workers simply to carry a gun into a schoolhouse; and there is little marketplace for cowardly acts of violence.

Simply put, Rivkin and Casey’s attack on health care reform has no basis in reality–and no grounding in the Constitution.  Even right-wing legal academics have dismissed it as entirely without merit.  Hopefully, next time these discredited attorneys submit a piece to the Washington Post, its editors will have the good sense to point them to a more appropriate publication.

This morning’s op-ed in the Washington Post suggests that the Republican party has abandoned any intention of negotiating a health care reform bill in good faith. The GOP chairman, as it turns out, has outsourced the party’s health care thinking to professional provocateur Betsy McCaughey and Republicans are now arguing that “that government shouldn’t get between seniors and their Medicare:”

But he and congressional Democrats are planning to raid, not aid, Medicare by cutting $500 billion from the program to fund his health-care experiment….. Second, we need to prohibit government from getting between seniors and their doctors. The government-run health-care experiment that Obama and the Democrats propose will give seniors less power to control their own medical decisions and create government boards that would decide what treatments would or would not be funded… Simply put, we believe that health-care reform must be centered on patients, not government.

The anti-government rhetoric is a throwback to the fear mongering of the 1960s, when party icons Ronald Reagan and Barry Goldwater warned that the Medicare program would lead to socialism and undermine the doctor patient relationship. Despite Medicare’s success and the unrealized fears of its detractors, the party is doubling down on its critique, seemingly condemning both the government-run Medicare program and the new public option. Or is it defending it? Along with the op-ed — Protecting Seniors — the Republican party has also released The Seniors’ Health Care Bill of Rights to “protect Medicare” and “ensure seniors can keep their current coverage” while prohibiting “doctors from getting in between seniors and their doctors.”

Does the party support the government-run program or is it against government-sponsored care? Steele is on a tight rope. He wants to “prohibit government from getting between seniors and doctors” — i.e. limit the government’s role in the Medicare program — but “protect [government sponsored] Medicare” — including the $500 billion in waste that’s already in the system.

Steele characterizes the proposed cuts as a “raid” on the system, but they’re really designed to eliminate inefficiencies, reduce insurance company subsidies, unnecessary hospital readmissions, and lower payments that encourage overtreatment. None of the $500 billion is coming out of benefits. In fact, some of the cuts have been endorsed by the health industry, and supported by Republicans. All of the latest Republican health care plans call for eliminating Medicare “waste, fraud and abuse”, for instance, and a good number of Republicans voted for Medicare payment cuts as part of the Balanced Budget Act of 1997. In other words, they supported decreasing Medicare spending by 12.7% in 1997, but they’re now opposing cutting some 10% out of the program over 10 years.

To be clear, there is a difference between cutting around the edges of the Medicare system and cutting into the system. And, despite Steel’s commitment to “protect Medicare,” Republicans have proposed numerous schemes to slash benefits or privatize the program. Most notably, in 1995, under the leadership of then House Speaker Newt Gingrich (R-GA), Republicans proposed cutting 14% from projected Medicare spending over seven years and forcing millions of elderly recipients into managed health care programs or HMOs. The cuts were to ensure that Medicare is “going to wither on the vine,” Gingrich explained. Similarly, during the 2008 Presidential campaign, Sen. John McCain (R-AZ) proposed cutting $1.3 trillion from Medicare and Medicaid.

The party that opposed the creation of Medicare (and has worked to undermine it) is now disingenuously coming to its rescue by opposing the kinds of changes that would help sustain the program over the long term. It’s recycling the inflammatory charges of Betsy McCaughey and Sally Pipes — Steele writes that government will “ration health care based on age” and dictate “the terms of end-of-life care” — and then feigning surprise at the Democrats’ inability to pass a so-called “bipartisan health care bill.”

Despite the GOP’s political posturing, however, Democratic health care reform still attracts popular support. “More than three out of every four Americans feel it is important to have a “choice” between a government-run health care insurance option and private coverage,” and the majority support the other tenets of Obama’s reforms. As Tom Daschle has pointed out, “the degree to which Republicans make themselves less and less relevant is the degree to which a public option is more and more likely, because we are negotiating with the Democrats rather than the Republicans who oppose it. So I would say that a reconciliation vehicle would probably have a pure public option just because most likely it will only involve Democrats deciding what that reconciliation package will be.”

Speaking on Fox News last night, right-wing Congresswoman Michele Bachmann (R-MN) claimed that health care reform is unconstitutional:

It is not within our power as members of Congress, it’s not within the enumerated powers of the Constitution, for us to design and create a national takeover of health care. Nor is it within our ability to be able to delegate that responsibility to the executive.

Watch it:

Bachmann, however, is wrong about both the contents of the health care plan and the requirements of the Constitution. There is nothing in any of the health care bills under consideration which resembles a “national takeover of health care.” Conservatives like to use this language when referring to the public health option. Like other insurers, the public option would collect premiums from people who choose to buy into it, and then spend those premiums to insure these participants.

Had Bachmann bothered to read Article I of the Constitution before going on Fox, she would have learned that Congress has the power to “lay and collect taxes, duties, imposts and excises” and to “provide for….the general welfare of the United States.” Rather than itemizing specific subject matters, such as health care, which Congress is allowed to spend money on, the framers chose instead to give Congress a broad mandate to spend money in ways that promote the “general welfare.”

It’s unclear what the basis is for Bachmann’s claim that the public option is an unconstitutional delegation of power to the Executive. There is a 74 year-old decision — decided by the same right-wing Supreme Court which believed most of the New Deal to be unconstitutional — which holds that Congress could not simply grant President Roosevelt nearly limitless authority to do whatever he wanted in order to prevent “unfair competition.” But no one has proposed giving President Obama similarly unchecked authority over health care. Rather, pages 116-128 of the House bill that Bachmann will vote on provide extremely detailed instructions explaining how the Executive Branch must manage a public health plan.

It’s important to note just how radical Bachmann’s theory of the Constitution is. If Congress does not have the power to create a modest public option which competes with private health plans in the marketplace, then it certainly does not have the authority to create Medicare. Similarly, Congress’ power to spend money to benefit the general welfare is the basis for Social Security, federal education funding, Medicaid, and veterans benefits such as the VA health system and the GI Bill. All of these programs would cease to exist in Michele Bachmann’s America.

Cross-posted on ThinkProgress.

Our guest blogger is Gov. Howard Dean, former chairman of the DNC and the author of Howard Dean’s Prescription For Real Health Care Reform.

In today’s Washington Post, Steven Pearlstein argues that Democrats should just give up on the public option. “Enough already with the public option!,” he writes. Steven thinks we should drop one of the most popular and effective aspects of health care reform simply because the fight is too politically difficult in Congress. I think such an approach would ruin health care reform and devastate the Democratic party.

Steven is confusing health insurance reform with health care reform. If we only get reform that requires insurance companies to provide coverage to everyone who applies, charge everyone the same premiums, and end their discriminatory practices, that would be great insurance reform, but it’s not, as Steven writes, health care reform.

Real health care reform that includes a new public health insurance option would give Americans a real choice and not reward for-profit health insurers with 47 milllion new customers. Real health care reform that includes a new public health insurance option would cut out the administrative waste of private insurers and begin changing the way health care is delivered. Real health care reform that includes a new public health insurance option could adopt the kind of payment reforms that would start to “hold down long-term growth in health spending” and encourage providers to deliver care more efficiently. We know that premiums in the public option would be about 10 percent lower and that a real robust plan that piggy backs off of Medicare’s infrastructure could save us somewhere between $75 billion and $150 billion over 10 years.

Just because the public health insurance option is “new,” moreover, does not mean it’s not worth fighting for. Steven points out that I did not propose a robust public option in 2004 election. The measure of good politics and policy is the ability to accept and identify new ideas. My 2004 plan may not have included a new stand-alone program, but it did allow Americans 55 to 65 to enroll in Medicare and everyone under 25 would have been eligible for Medicaid.

I believed that government could help expand coverage and control costs then and the overwhelming majority of Americans believe it today. If the August recess has taught us one thing, it’s that Republicans have ended all serious conversations about reform and will oppose reform whether it includes a public option or not. They want to make the choice for the American people instead of letting Americans have their own choice of coverage. And if Democrats follow their lead, they will have to face the voters’ choice come November.

Two of the three Republicans working to pass a bipartisan health care reform bill in the Senate Finance Committee aren’t interested in producing comprehensive legislation. While Sen. Chuck Grassley (R-IA), the committee’s ranking member, is crisscrossing Iowa grossly misrepresenting the intent of reform, Sen. Mike Enzi (R-WI) has indicated that he disagrees with “the entire approach the Finance Committee is taking:”

Congress should approach health care reform in steps, instead of trying to put together a comprehensive package said U.S. Sen. Mike Enzi, R-Wyo.

Health care is so massive that reforms can’t be made with one major bill, which is what the Obama administration and congressional Democrats are pushing, Enzi told members of the Casper Rotary Club on Monday at the Parkway Plaza Hotel. [...]

“We do need to have health care reform,” Enzi said.

“We do need to get it right. We need take the time to do it. I think the only way it will happen is we need to break it down into smaller parts than we have now and put it through one at a time.”

It’s unclear if Enzi has previously supported incremental reform. In October 2008, Enzi wrote, “I have introduced a comprehensive plan, 10 Steps to Transform Health Care in America, to make sure that every American can have the health care coverage they need….We could enact any one of these steps today and produce real results tomorrow.” “Steps” suggests incrementalism, but comprehensive implies a certain level of immediacy. Earlier this month, Enzi argued against a Sept. 15 deadline for the bill by saying that he was “committed to getting health care reform right, not finishing a bill by some arbitrary date.” In fact, he even tired to win assurances from Senator Reid and Speaker Pelosi, as well as the Administration “that the bipartisan agreements reached in the Finance Committee will survive in a final bill that goes to the President.”

Enzi’s ambiguity says as much about Enzi and the Republican party as it does about Sen. Max Baucus (D-MT) and the viability of the six-party talks. As ranking member of the Senate HELP Committee, Enzi sat through a 12 days of mark-up, offered a series of amendments to the Kennedy bill, and pretended to support reforming the health care system through a single piece of legislation. Likewise, Enzi must have known that Baucus’ ‘six party talks’ were intended to produce a very similar measure. If he didn’t support the goal of the talks, why did he join the effort? And more importantly, why did Baucus invite Enzi to the table? Negotiating a comprehensive health care reform bill with an incrementalist is like debating the merits of the fur trade with a PETA representative. You have to overcome a certain hurdle and accept certain premises before agreeing to talks.

Democrats are understandably frustrated at Baucus’ lack of progress and Sen. Sherrod Brown (D-OH) has even suggested that if the committee fails to produce a bill by the September 15th deadline, Democrats should push the Kennedy bill through the Senate and add the financing parts in conference. Enzi’s admission that he does not support immediate reform further suggests that Baucus’ bipartisan measure won’t make very good health care policy.

In March, Sen. Chuck Grassley (R-IA) raised eyebrows when he urged opponents of health care reform to continue lying about the consequences of comparative effectiveness research and electronic medical records. Since then, the ranking member of the Senate Finance Committee has adopted the rhetoric of the far right, routinely referring to health care reform as a government takeover of health care, disingenuously misrepresenting reform legislation, and even going so far as to endorse and sign a copy of Glenn Beck’s book.

The Wonk Room has compiled a list of Grassley’s most egregious misrepresentations and will continue monitoring and fact checking Grassley’s statements throughout the reform process. Read the full document HERE.

This afternoon, during an appearance on Fox News’ America’s Newsroom, Grassley remained unapologetic for suggesting that the federal government would “pull the plug on grandma.” Instead, Grassley blamed Democrats for his statements, suggesting that they were “diverting attention” from the health bill:

I’m not going to do anything with a health care bill that puts a government bureaucrat, or any government policy making a determination about whether or not we are going to value life and the end of life any more than at age 30 or 20…all of their proposal with end of life are connected in the bill with ways of saving money and takeover of national health care…the Lewin think tank in Washington says that 120 million people are going to crowd out into that plan.

Watch it:

But Grassley’s rant is entirely false. In trying to defend himself from accusations that he was misrepresenting the end-of-life provisions, Grassley doubled down on his false claim that “government policy” would determine the value of life. He echoed Betsy McCaughey’s assertion that “end of life are connected in the bill with ways of saving money” and completely misrepresented the findings of the Lewin report. (Lewin did not study the House bill, as Grassley implied.)

Given Grassley’s long history of obstructing health care reform, “President Obama and Sen. Max Baucus (D-MT) should stop courting Grassley’s vote.” As Steve Benen has pointed out, “negotiating with Grassley in good faith is a mistake. Grassley isn’t serious about reform…It’s time to stop trying. Grassley will only let down reform advocates in the end.”

Including sound Republican ideas is far different from succumbing to disingenuous attacks designed to defeat honest negotiations. If Democrats resort to the latter and work to satisfy stone-throwing Republican lawmakers from small states, they will abandon their principles and wholly disappoint the overwhelming majority of Americans. After all, the country would have “never gotten Medicare 40 years ago if everyone had waited for the conservative Republicans to join on board.”

Read some of Grassley’s greatest hits HERE.

Since the administration suggested that it’s not committed to a “robust” public health insurance option, supporters of Sen. Kent Conrad’s (D-ND) co-op compromise have argued that a member-driven cooperative could achieve the goals of the public option and appease conservatives weary of increasing the government’s involvement in the health care system. But this morning, Conrad conceded that the co-ops would not lower health care costs:

ROBERTS: What would they do to reduce costs? Because that is one of the central issues of health care reform.

CONRAD: Well, the important thing is they’d provide more competition. … Beyond that, I think it’s very important not to over-promise here. [...]

ROBERTS: So nothing really in driving down the costs of service then?

CONRAD: Uhhh, no. If you believe competition helps drive down costs, then they would certainly contribute to holding down costs.

Watch it:

Indeed, small member-driven cooperatives would lack all of the advantages of a Medicare-like public health insurance option. Without relying on Medicare’s reach and infrastructure, a network of co-ops could not: 1) achieve the market clout necessary to to negotiate better rates with providers, 2) change the way care is delivered and 3) lower the costs of medical services. “It’s very difficult to start up a new insurance company and break into markets where insurers are very established,” said Paul B. Ginsburg, president of the Center for Studying Health System Change. “I don’t see how they’re going to obtain a large enough market share … to make a difference.” In a post titled “Co-Ops Are the Single Dumbest Idea I Have Heard in the Health Care Debate in Twenty Years,” long-time health care analyst Bob Laszewski identifies the heart of the problem:

OK, let’s start with the notion that a co-op can do a better job of negotiating prices and protocols. But wait, on day one how many members does the co-op have? Well it has no members on day one. So, the co-op’s provider relations guy goes to the doctor and hospital administrator and demands better prices and protocols. My guess is the provider’s response would go something like this, “So you are here because your stated objective is to screw my reimbursement down more than it is, you have no members now, and if I give you the rates to take members away from the existing health plans you are going to make life even more difficult for me than those existing health plans have?”

The co-op is not a compromise between supporters and opponents of a public option; it will effectively undermine the option, alienate progressives and fail to appease conservative opponents of reform. Read more

Health care provocateur Betsy McCaughey is pushing back against critics who claim that the end-of-life counseling provision in the House bill is “voluntary.” “Partisans for the legislation claim that it simply aims to provide Medicare coverage for once-every-five-year conversations with doctors over end of life care. Wrong,” she writes.

In fact, after initially claiming that “the Congress would make it mandatory, absolutely require, that every five years, people in Medicare have a required counseling session that will tell them how to end their life,” McCaughey is now arguing that the bill does not directly mandate the sessions. Instead, the language would encourage doctors to perform consultations by basing a “doctor’s quality” and reimbursement levels on “the percentage of your doctor’s patients who create living wills and adhere to them.” “Doctors will incur penalties when families don’t adhere to end of life plans,” she argues:

Partisans for the legislation claim that it simply aims to provide Medicare coverage for once-every-five-year conversations with doctors over end of life care. Wrong. The new “benefit” is inserted in legislation with the express purpose of controlling health care costs (page 1). The bill lists what must be covered in the consultation (pages 425-30). Worse still, the legislation states that the Medicare system will rate your doctor’s “quality” and (and adjust reimbursement) based on the percentage of your doctor’s patients who create living wills and adhere to them.

McCaughey’s claim that the benefit’s express purpose is to “control costs” is an outright invention. Page 1 of the bill doesn’t even mention the provision. Moreover, if the bill pegged a physician’s reimbursement to the actions of the patient, then it could potentially be construed as coercive. But pg 432 of the House health bill allows the provider to offer a patient a comprehensive perspective of end-of-life counseling and adhere to certain quality standards. Nowhere does the language connect a physician’s “quality” or “reimbursement” with “the percentage of your doctor’s patients who create living wills and adhere to them.”

Ironically, the “quality standards” language that “patient advocate” McCaughey is perverting are intended to encourage doctors to provide patients with comprehensive information about end-of-life decisions and protect patients from incomplete or improper sessions.

This morning, as the President Obama prepares to address the Veterans of Foreign Wars in Phoenix, Arizona, “conservative groups including Americans for Prosperity are planning to protest” greater government involvement in the health care system. But like Medicare recipients who oppose government interference in the health care system, opponents of a public option should be weary of denouncing ‘government care’ in front of veterans who rely on the Veterans Health Administration.

The VA “outpaces other systems in delivering patient care,” consistently delivering higher quality health care more efficiently.

A recent study by the RAND corporation found that “VA patients were more likely to receive recommended care” and “received consistently better care across the board, including screening, diagnosis, treatment and follow up”:

The study also concludes that “if other health care providers followed the VA’s lead, it would be a major step toward improving the quality of care across the U.S. health care system.” The public option — a frequent target of critics who argue that government health care would ration care or provide subprime coverage — would push health providers to adopt some of the VA’s delivery system reforms.

A public health insurance option is not a threat to Americans with private health insurance coverage; it’s an important component of the nation’s public-private health infrastructure. In 2008, federal, state and local governments contributed 47 percent of health care spending and if the VA system is any indication, then rather than intruding between the patient and the doctor or rationing care, federal dollars have only improved access and enhanced the delivery of care.