Progressive Breakfast: Obama Faces The AMA

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Obama Faces The AMA

Health Care Blog's Michael Millenson previews [2] today's presidential address to the AMA: "Look for Obama to remind the doctors how many more uninsured patients they’re seeing today [2] and how much more involved Medicare has become in setting doctor pay scales."

NYT speculates on possible concession restraining malpractice liability: [3] "In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul ... one Democrat close to the president said Mr. Obama, who wants health legislation to have broad support, views addressing medical liability issues as a 'credibility builder' — in effect, a bargaining chip that might keep doctors and, more important, Republicans, at the negotiating table."

OurFuture.org FLASHBACK: "Capping jury awards would have almost no impact on health costs [4], according to the Congressional Budget Office. But it would help conservatives protect insurance company profits, instead of patients victimized by fraud or negligence." More background from Committee for Justice for All [5].

W. Post reports intra-party dispute over paying for health care reform: [6]

In recent days, Obama has revived a tax plan he first offered in February: limiting itemized deductions for the nation's 3 million highest earners. Polls show that the idea is popular ... and it would enable him to abide by a campaign pledge to pay for coverage for the uninsured with new taxes on the rich ...

...But many Democrats, particularly in the Senate, have balked at the idea, saying they prefer a tax that has some hope of winning Republican support. In legislation that could be unveiled as early as this week, Senate Finance Committee Chairman Max Baucus (D-Mont.) is expected to propose a new tax on the health benefits that millions of Americans currently receive tax-free through employers...

...Baucus is considering a tax on employer-sponsored premiums in excess of $15,000 a year, Senate aides said, a plan that would strike many of the very families Obama has vowed to protect from a tax increase. Yesterday, top administration officials pushed back forcefully against the tax, which Obama criticized during the campaign...

...Senate Democrats have been considering two options. The first would be to tax premiums above a certain level, such as the value of the standard family plan offered to federal employees, which will be about $15,000 in 2013, Senate aides said. That would raise about $420 billion over 10 years. The other option would be to apply the cap only to families earning more than $200,000 a year ($100,000 for individuals), which would raise about $160 billion over 10 years. A senior Baucus aide said the committee is leaning toward the former option...

Sen. Dick Durbin offered mild resistance to taxing employer benefits on CBS' Face The Nation: [7] "Senate Majority Whip Dick Durbin (D-Ill.) said he agrees with Vice President Joe Biden that taxing employer-based health insurance is not a good remedy for the health care crisis. 'Max Baucus has a tough assignment,' Durbin said of the chairman of the Senate Finance Committee, who is proposing such a option. As for voting for a plan which includes a tax on existing benefits, Durbin said, 'It would not be easy for me to do.'"

USA Today reports Baucus will unveil draft bill this week: [8] "More details about public insurance and how lawmakers intend to pay for overhauling the health care system, which could cost more than $1 trillion [over 10 years], are likely to emerge this week when the Senate Finance Committee releases a draft bill. To ease concerns about cost, Obama said Saturday the administration could squeeze $313 billion in savings out of Medicare and Medicaid over the next decade. Sen. Chuck Grassley, R-Iowa, the top Republican on the Senate Finance Committee, said he did not know whether those trims were realistic."

The Hill recaps Sen. Kent Conrad's criticism during CNN interview of public plan option: [9] "'In a 60-vote environment, you’ve got to attract some Republicans as well as holding virtually all the Democrats together, and that, I don’t believe, is possible with a pure public option. I don’t think the votes are there,' Conrad said on the morning talk show ... Moderates on both sides of the aisle have started to embrace a slightly different proposal put forward by Conrad that would entail forming privately operated nonprofit health-insurance cooperatives."

The Treatment's Jacob Hacker dissects the weakness in Conrad's compromise: [10] "[Non-profit cooperatives] have been hard to establish or extend, and when they have been established, they’ve been under constant siege from doctors and insurers and eventually largely operated as private insurance plans or weak purchasing arrangements. It is hard to see how any sort of decentralized cooperative model could do what a public plan can do ... The saddest part of this is that Conrad’s announcement has overshadowed a truly constructive contribution to the debate by his colleague on the Senate Finance Committee: Jay Rockefeller ... a self-sustaining national public plan that would have to be abide by the same rules as private insurance plans and be run by the federal government separately from the new insurance pool that would oversee the competition among public and private plans."

CNN has more on Senate "moderate" criticism on public plan option: [11] "Comments by a bipartisan trio of moderate senators Sunday suggest that the Obama administration and more liberal Senate Democrats could be in for a fight if plans to overhaul the nation’s health care delivery system focus primarily on a public health insurance option. Moderate Republican Sen. Susan Collins of Maine said Sunday that she found an approach involving private health insurance co-operatives 'far preferable to the government-run plan that has been discussed by the administration.' Sen. Ben Nelson of Omaha, a moderate Democrat, struck a similar note, suggesting that his party should look first at trying to make current private health insurance options operate more effectively and for more people."

Change.org's Tim Foley on the track record of the so-called moderates: [12] "...this same trio worked to trim wasteful spending like, oh, I don’t know, pandemic flu preparation funds out of the stimulus package should already have worry lines in your brow. Sure enough, Collins calls the [non-profit cooperative from Sen. Conrad] idea 'intriguing' and Nelson says 'he’s on to something here.' However, Nelson then went on to talk about how big corporations that self-insure might provide competition to private insurance. Um, OK, but most corporations that self-insure use private insurance as administrators for their plan. Plus, much like non-profit insurance, we’ve already got those ... if your proposed solution for our health care crisis is something we already have, then by definition, it’s already proven that it does not dramatically change the game on controlling costs or expanding access."

Americans United for Change air new ad challenging obstructionists to get behind the 62% [13] supporting the president's plan:

Financial Market Overhaul Wednesday

WSJ previews the presidential proposal: [14]

President Barack Obama is expected Wednesday to propose the most sweeping reorganization of financial-market supervision since the 1930s... At the center of the plan ... is a move to remake powers of the Federal Reserve to oversee the biggest financial players, give the government the power to unwind and break up systemically important companies -- much like the Federal Deposit Insurance Corp. does with failed banks -- and create a new regulator for consumer-oriented financial products, according to people involved in the process.

The plan stops short of the complete consolidation of power that some lawmakers have advocated. For example, it will allow several agencies to continue supervising banks. It also won't place specific limits on the size or scope of financial institutions, but it will make it much harder for large companies to be so overleveraged that they threaten the broader economy.

After Mr. Obama details his proposal, the process will quickly move to Capitol Hill, where Congress would have to pass legislation to enact the changes. Treasury Secretary Timothy Geithner is scheduled to appear before both Senate and House panels on Thursday, where he is likely to face questions and criticisms.

Lawmakers are expected to take issue with several of the plan's more thorny issues, including how to create a system that won't simply bail out large financial companies when they topple. Giving the Fed more clout ... will also be a controversial idea...

...House Financial Services Committee Chairman Barney Frank (D., Mass.) is expected to take up the measure on Capitol Hill soon and could have a comprehensive package passed by August. Senate Banking Committee Chairman Christopher Dodd (D., Conn.) said his panel could hold votes in the fall with a final measure completed by the end of the year. That is consistent with the administration's timetable.

McClatchy offers more detail on expanding Fed reg power: [15] "One of the more controversial proposals expected from Obama would give the Federal Reserve greater power to act as a systemic risk regulator. This would expand the Fed's mission, most often associated with fighting inflation and setting interest rates ... Obama wants to have the Fed gauge whether companies that are deemed so big that they pose a risk to the global financial system have adequate reserves in case the economy sours. The Fed and other regulators will expand reporting requirements and look at a wider scope of a bank's investments. The Federal Deposit Insurance Corp. and the Treasury Department are likely to get special 'resolution powers' to allow them to dissolve large financial institutions outside the bankruptcy process. The absence of these powers forced the Bush administration to rescue insurer American International Group, and that commitment has cost taxpayers more than $180 billion."

NYT adds: [16] "Some of Mr. Obama’s advisers and some senior Democratic lawmakers have suggested creating a single bank regulator. But the administration’s current version, which could be announced as early as this week, would not combine the regulatory agencies. Instead, it would give [Comptroller of the Currency John] Dugan and [chairwoman of the Federal Deposit Insurance Corporation Sheila] Bair significant new powers — and could intensify their turf battles"

Baseline Scenario's James Kwak expresses concern: [17] "when you are reforming the regulatory structure of an industry where the existing regulators got it horribly, embarrassingly, catastrophically, world-historically wrong, the last thing you want to do is strike a compromise between the positions of the existing regulators."

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Geithner and Summers preview in W. Post oped: [18] "...raising capital and liquidity requirements for all institutions ... robust reporting requirements on the issuers of asset-backed securities ... stronger framework for consumer and investor protection ... a resolution mechanism that allows for the orderly resolution of any financial holding company whose failure might threaten the stability of the financial system..."

Economist View's Mark Thoma reacts: [19] "Sounds good, and hits the right notes, but let's wait to see what legislation actually emerges."

Myopic Pressure To Pull Back Stimulus

Bloomberg reports: "Group of Eight finance ministers began drawing up contingency plans for rolling back budget deficits and bank bailouts [20] as the economy shows signs of recovery and investors start worrying about inflation. Officials meeting in Lecce, Italy, over the weekend said it’s prudent to consider what exit strategies to deploy once global growth is secured and asked the International Monetary Fund to examine how to do so without reigniting the two-year crisis. At the same time, they said it’s premature to rein back more than $2 trillion in stimulus packages. 'Growth should remain the principal focus of policy,' U.S. Treasury Secretary Timothy Geithner said after the meeting ended on June 13. 'It is too early to shift toward policy restraint.'"

NYT's Krugman warns against pulling back early: [21] " A few months ago the U.S. economy was in danger of falling into depression. Aggressive monetary policy and deficit spending have, for the time being, averted that danger. And suddenly critics are demanding that we call the whole thing off, and revert to business as usual. Those demands should be ignored. It’s much too soon to give up on policies that have, at most, pulled us a few inches back from the edge of the abyss."

Stateline flags the dire condition of the states: [22] "While 2009 is bad, states worry 2010 and beyond will be even worse. Even if the national recession ends this year as many predict, the outlook for states is bleak. State fiscal conditions historically lag behind national economic recovery. The year after a recession ends is typically when state budgets are hit hardest, because by then, Medicaid rolls have swelled with the higher numbers of the unemployed who have lost their health insurance."

Climate Update

W. Post reports Dems still struggling to appease critics before sending climate protection bill to the House floor: [23]

The latest rough patch came late Thursday afternoon when House Agriculture Committee Chairman Collin C. Peterson (D-Minn.) met with the two chief sponsors of a climate bill to hash out differences in the office of House Speaker Nancy Pelosi (D-Calif.). After more than an hour, they emerged without an agreement, gave reporters curt expressions of optimism and left without taking questions.

"There's no deal, but I'm optimistic," said Henry A. Waxman (D-Calif.), chairman of the House Energy and Commerce Committee and co-sponsor of the bill. Peterson, who earlier that day said he would oppose the bill, said only that "we made good progress."

Peterson wants to make the bill more favorable to farmers and agricultural businesses. For example, he wants the Agriculture Department to have the authority to decide whether environmentally friendly actions by farmers would qualify for lucrative benefits under a system in which allowances to emit greenhouse gases would be bought and sold. Under the bill drafted by Waxman and Rep. Edward J. Markey (D-Mass.), the Environmental Protection Agency would have that authority.

Terrance Heath contributed to the making of this Breakfast