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Recent Second Opinion:

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Obesity and Public Health
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President Obama's Plan for Reform
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The Healthcare Reform Debate
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PhRMA's New Marketing Code
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Personal Genetics Testing
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Second Opinion:
Where health care policy experts have their say

March 5, 2010:
The Route to Reconciliation

The president's bipartisan summit at the Blair House last Thursday had been billed by the administration as a last ditch attempt to bridge policy differences between the two parties on health care reform. A week later, on Wednesday, the president said that the time for debate and discussion was over, and called for Democrats to pass health reform legislation through the senate "reconciliation" process, without any Republican support.

What is your reflection on the summit, and the ensuing events?

This edition of our expert panel includes:


By Diana Furchtgott-Roth

On Wednesday, standing in the East Room of the White House, President Obama declared, "If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor. I can tell you as the father of two young girls, I would not want any plan that interferes with the relationship between a family and their doctor." But, under the plan the president has proposed, no existing plan could remain the same, because the government would require all plans to change.

In the future, all health insurance plans would have to cover adult dependents up to age 26; put in place a stronger appeals process for those denied a particular treatment; give up any lifetime or annual limits on care; take everyone, irrespective of pre-existing conditions; give up any co-payments on preventive services, and be subject to an annual review of premiums by the state. With these required changes, all plans—and premiums—would be very different.


Diana Furchtgott-Roth is an adjunct fellow at the Manhattan Institute and a columnist for RealClearMarkets.com. She is also a senior fellow at the Hudson Institute, where she directs the Center for Employment Policy. From 2003 to 2005, Ms. Furchtgott-Roth was Chief Economist of the U.S. Department of Labor. From 2001 to 2002 she served as chief of staff at the President's Council of Economic Advisers.

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By David Gratzer

President Obama went into last week's Blair House summit with a new plan that differed from the Senate version in only three respects: it's bigger, it's more expensive, and it's more complicated.

President Obama, in other words, didn't sue for peace; he declared war. And thus, it comes down to one question. Does he have the votes? The passage of ObamaCare rests with a handful of House Democrats.

But whether or not ObamaCare makes it to a Rose Garden Ceremony, this much is clear: it changes little. The President's reforms promised to "bend the curve" of health inflation; even Medicare's chief actuarial—a federal employee—suggests costs will rise. The President's reforms sought to lower premiums; CBO scoring predicts an uptick in costs.

Thus, with or without ObamaCare, we'll face the challenge faced by every Western nation: how to deal with the full implications of the "high-tech, high-cost" medical revolution?


David Gratzer, a physician, is a senior fellow at the Manhattan Institute. His research interests include consumer-driven health care, Medicare and Medicaid, drug reimportation, and FDA reform. The late Milton Friedman, Nobel Laureate in Economics, wrote that Dr. Gratzer is "a natural-born economist." David Gratzer's most recent book, with Foreword by Milton Friedman, is The Cure: How Capitalism Can Save American Health Care (Encounter Books, October 2006).

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By Douglas Holtz-Eakin

I was surprised by my reaction to the President's health care summit. I expected political rhetoric, and the participants fought to a draw on that front. I expected little change in the legislative landscape, and it remains the case that the only path forward is the Democrats ramming a partisan bill through using reconciliation protections. And I expected it to run late; the Democrats have missed every previous deadline on the reform journey.

But I did not expect such a thoroughgoing and high-quality debate on the policy issues associated with health care reform. On all sides important issues were raised regarding the appropriate role of government, the best strategy for implementing reform, the underpinnings of cost control and improved quality and access.

And I certainly did not expect to feel a twinge of regret. If only the President had done this one year ago when Americans believed he stood for more than the narrow pursuit of Democrats' political gain. Unlike now, there was not an unbridgeable gulf between the parties in Congress. Presidential leadership could have identified areas where principled compromise was possible, cut off wasted debate on non-starters like the "public option", and raised the probability of a genuinely bipartisan reform.

Partisan legislation is almost always bad policy. So, too, are bills passed nearly unanimously—everyone can agree to pass out the pork. Bipartisan bills that emerge from tough negotiations will better reflect good policy consensus and stand the test of time. Yesterday we saw a glimpse of what might have been.


Douglas Holtz-Eakin has a distinguished record as an academic, policy adviser, and strategist. Currently he is the President of the American Action Network Forum for Issues, Ideas and Innovation and a Commissioner on the Congressionally-chartered Financial Crisis Inquiry Commission. Since 2001, he has served in a variety of important policy positions. During 2001-2002, he was the Chief Economist of the President's Council of Economic Advisers (where he had also served during 1989-1990 as a Senior Staff Economist). At CEA he helped to formulate policies addressing the 2000-2001 recession and the aftermath of the terrorist attacks of September 11, 2001. From 2003-2005 he was the 6th Director of the non-partisan Congressional Budget Office, which provides budgetary and policy analysis to the U.S. Congress.

* * *

By Tom Miller

Health Reform's Weekdays at Bernie's (Is it dead, yet?)

"Will you walk into my parlour?" said the Spider to the Fly.

Did the tactical gambit of a Blair House health summit late last month work for President Obama? Once the initial (and periodically recurring) bloviating ended, the respective objectives of the Democratic and Republican sides took shape, as expected. The president's two-tiered strategy was first to repeatedly paint a number of differences between Democrats and Republicans as not all that great, as soon as the latter agreed even more with the former's final offer.

The president's second approach was to depict (sometimes subtly, sometimes not) remaining opposition to his ideas and those of his congressional allies as simply wrongheaded, untrue, unreasonable, and/or partisan-to prime more public support for the forthcoming procedural end-around of a budget reconciliation bill attempt later this month in the Senate and House.

Although President Obama clearly signaled earlier this week his resolve to press ahead with a reupholstered version of the Senate's legislative furniture (left parked on the curb in January), he hoped to put a fresh façade of open-mindedness to any new idea that mimicked his old ones. At times, he jabbed back at Republican critiques quite effectively, although he struggled with containing an "I'm the smartest guy in the room" urge to rebut too much and at too great length, while outrunning his knowledge base. He also left no straw man argument unvoiced, again and again. Key message: We're not proposing a full government takeover of your healthcare (yet).

On the minority side, the initial hope was to establish that Republican healthcare reform was not a null set. Mission accomplished. The highlight for this observer and many others was Rep. Paul Ryan's cool and clear explanation of both the fiscal and personal long-term consequences of the respective versions of health overhaul, plus the limits of the Congressional Budget Office's GIGO (garbage in, garbage out) scoring.

President Obama went back before the cameras again last Wednesday afternoon, providing yet another recycling of fading rationales for his health reform product that more voters would rather leave on the Capitol Hill store shelves than purchase. His relentless search for Republican health care ideas he could deem "legitimate" was only slightly more aggressive than O.J. Simpson's never-ending search for the killers of his ex-wife Nicole and her friend Ron. He came up with four low-dose remedies that offer little more relief than placebos would.

Although there were a few knockdowns in the two events, the final decision will have to be scored on points. On that front, the congressional minority has a majority among current voters. The White House and the current congressional majority can pull out some heartrending stories and narrow policy themes, but they continue to be tone deaf to what most of the country keeps saying: We want real health reform, but this legislative dog won't hunt. It just barks a lot.


Thomas Miller is a former senior health economist for the Joint Economic Committee (JEC). He studies health care policy and regulation. A former trial attorney, journalist, and sports broadcaster, Mr. Miller has testified before Congress on issues including the uninsured, Medicare prescription drug benefits, health insurance tax credits, genetic information, Social Security, and federal reinsurance of catastrophic events. While at the JEC, he worked on Social Security reform legislation and organized a number of hearings that focused on reforms in private health care markets.

* * *

By Michael Tanner

Democrats, Republicans, and President Obama sat down last Thursday for an utterly meaningless display of "bipartisanship" over health care reform, far more kabuki theater than kumbaya moment. No one expected an agreement, and given those low expectations, no one was disappointed.

The health care divide is not one that can be easily bridged by appeals to bipartisanship. This is not an appropriations bill where Democrats seek $200 billion, Republicans want $100 billion, and everyone agrees on $150 billion. Rather, the debate over health care reform is a rare case of fundamental philosophical differences.

The Democrats genuinely believe in a top down, centralized, command and control approach to reform. The government would require everyone to have health insurance, would determine what benefits that insurance must include, would regulate insurance prices and physician reimbursement, and would micromanage how medicine is practiced. Their priority is extending coverage to the uninsured (and, in their opinion, the underinsured). And, they are willing to pay whatever it costs to do so.

Republicans, on the other hand, see health care more as a commodity than fundamental right. Their priority is bringing down costs, which they think will eventually lead to expanded coverage. Republicans believe that markets and informed consumers are most likely to reduce costs, and that reforms should be from the bottom up—starting with consumers themselves.

This is an important debate and it was on full display last Thursday. If nothing else, we can thank the summit for clarifying things.


Michael Tanner heads research into a variety of domestic policies with a particular emphasis on health care reform, social welfare policy, and Social Security. His most recent book, Leviathan on the Right: How Big-Government Conservatism Brought Down the Republican Revolution (2007), chronicles the demise of the Republican party as it has shifted away from its limited government roots and warns that reform is necessary to avoid continual electoral defeat.

* * *

By Grace-Marie Turner

The End Game

The health reform debate can be bewildering, with thousands of pages of legislation and mind-numbing complexity of parliamentary procedures. But none of that matters now.

The Congress is just one vote away from passing legislation that would put one sixth of our economy under permanent government control.

How can that be when this legislation is so overwhelmingly disapproved by the American people?

President Obama and his congressional allies are meeting with House Democrats to convince them to vote for the Senate bill "to just keep the process moving."

But if the House passes the Senate bill with a simple majority of 217 votes, ObamaCare becomes the law of the land. Nothing else matters. The Senate may, or may not, pass a second bill to "fix" problems the House has with their provisions. It matters not.

It would be the dupe of all time if House members were to be convinced that they must go first to keep the process moving forward, only to find that ObamaCare has passed the finish line. If the House passes legislation identical to the Senate bill, the president signs it, and it becomes law.

That means House Democrats will be on the hook for a vote for:

  • The Cornhusker Kickback, the Louisiana Purchase, and every other vote-buying deal buried in the Senate bill.
  • Abortion language that clearly allows federal funding for abortion and which the U.S. Conference of Bishops solidly opposes.
  • The Cadillac tax on high-cost health insurance policies that labor unions hate.
  • Weak enforcement provisions for the individual mandate that health insurers say will cause pools to disintegrate, causing premiums to skyrocket for those still buying policies.

If the House complies, and Speaker Pelosi is close to having the needed votes, then President Obama would sign his comprehensive health reform plan in the form of the Senate bill the next day, and the job would be done. Any promises that it would be fixed later on aren't worth the paper they might, or might not, be written on.

This is the end game. The White House is going for broke on ObamaCare.


Grace-Marie Turner is president of the Galen Institute, a public policy research organization that she founded in 1995 to promote an informed debate over free-market ideas for health reform. She speaks and writes extensively about incentives to promote a more competitive, consumer-driven marketplace in the health sector. She also is founder and facilitator of the Health Policy Consensus Group, which serves as a forum for analysts from market-oriented think tanks around the country to analyze and develop health policy recommendations.

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