Monday, May 10, 2010
A fight for the soul of American democracy
From The Hindu
Obama is pitted against Washington's powerful lobbies and going against the judiciary's will in his latest fight.
You thought the healthcare battle in the United States was fiercely fought? You think the White House and Congress are slugging it out over Wall Street reform? Well, you have not seen anything yet because the most wrenching battle, a fight for the very soul of American democracy, may be yet come. Ladies and gentlemen, please fasten your seatbelts.
Recently, President Barack Obama virtually chalked out the battle lines when he said: “What we are facing is no less than a potential corporate takeover of our elections … This should not be a Democratic issue or a Republican issue. This is an issue that goes to whether or not we will have a government that works for ordinary Americans — a government of, by, and for the people. That is why these reforms are so important and that is why I am going to fight to see them passed into law.”
Growing rift
At the heart of the conflict coming to a boil, is a deep and growing rift between the U.S. political executive and judiciary over transparency around how powerful lobbies wield tremendous influence in Washington. As Mr. Obama put it, “Every time a major issue arises, we have come to expect that an army of lobbyists will descend on Capitol Hill in the hopes of tilting the laws in their favour … the voices of ordinary Americans were being drowned out by the clamour of a privileged few in Washington.”
Matters came to a head in January this year when the Supreme Court passed judgement on the case Citizens United versus the Federal Election Commission. The court voted five-to-four that political spending by corporations in candidate elections would be permitted, free of government restrictions.
While the justification for the ruling was the protection of the First Amendment's right to free speech, critics noted that “allowing corporate money to flood the political marketplace would corrupt democracy” and that this decision of the court “represented a sharp doctrinal shift, and it will have major political and practical consequences”, including reshaping the way elections are conducted.
But that was only the beginning. At the State of the Union address shortly after the decision, Mr. Obama — a former professor of law — chided the Supreme Court for allowing special interests a backdoor entry into the policymaking arena.
During the address, Mr. Obama said: “Last week, the Supreme Court reversed a century of law to open the floodgates for special interests — including foreign corporations — to spend without limit in our elections. Well I don't think American elections should be bankrolled by America's most powerful interests, or worse, by foreign entities.”
He went on to say that elections ought to be decided only by the American people, and that is why he was urging Democrats and Republicans to pass a bill that helps to “right this wrong”.
Following Mr. Obama's comments, Democrats in the chamber, who were seated around the six Supreme Court Justices present, stood and applauded.
The Justices, in the front and second rows of the House chamber, sat motionless and expressionless. However, Justice Samuel Alito appeared to be mouthing “not true, not true”, and shaking his head in disagreement.
Chief Justice John Roberts later recalled that moment, saying: “The image of having the members of one branch of government standing up, literally surrounding the Supreme Court, cheering and hollering, while the court according to the requirements of protocol, has to sit there expressionless, I think is very troubling.”
Yet, in his address to the American public, Mr. Obama repeated his warning about the negative consequences that the Supreme Court ruling would have on democratic practice: “In the starkest terms, members [of Congress] will know — when pressured by lobbyists — that if they dare to oppose that lobbyist's client, they could face an onslaught of negative advertisements in the run up to their next election. And corporations will be allowed to run these ads without ever having to tell voters exactly who is paying for them.”
Reforms
He further set out some of the main reforms that he hopes Congress will pass to mitigate the effect of the Supreme Court decision. These include getting “shadowy” campaign committees to reveal their financial backers.
Additionally, corporations and special interests that take to the airwaves would have to reveal their source of funding and claim responsibility for it. “This will mean citizens can evaluate the claims in these ads with information about an organisation's real motives,” Mr. Obama said.
Finally, foreign corporations and foreign nationals would, under the Obama proposals, be restricted from spending money to influence American elections — even via U.S. subsidiaries; and large contractors receiving taxpayer funds would no longer be able to interfere in elections.
In a sign of his determination to bring the fight to the lobbies' doorstep, Mr. Obama quoted President Theodore Roosevelt, saying that every special interest was entitled to justice but not one was entitled to a vote in Congress, a voice on the bench, or representation in any public office. Urging for more transparency in Washington's dealings, he added, “sunlight is the best disinfectant”.
Labels: American politics, democracy, healthcare
Friday, March 19, 2010
Democrats feel healthcare heat
From The Hindu
With the 72-hour deadline for passing the contentious healthcare reform bill approaching rapidly Democrats, under steady fire from across the aisle, are scrambling to get to the “magic number” of 216 votes required for its passage in the House of Representatives on Sunday.
This week a barrage of criticism was levelled at House Speaker Nancy Pelosi for attempting to get the bill through the House using the “deemed passed” rule. By this procedure, House members would simply vote on additional changes to the Senate version of the bill rather than the Senate bill itself. However, after this vote the Senate bill, along with the changes, would be “deemed passed.”
The idea behind this would be to give fence-sitters in the House the option of not having to affix their signature to a Senate bill that they have fundamental doubts about. One major difference between the two versions of the bill is the Senate version's language on funding for health insurance policies that include abortion is weaker than the House's so-called “Stupak amendment.”
Republicans, already mounting stronger attacks against what they have called a “government takeover of healthcare” came out strongly against the proposed House procedure. John Boehner, House Minority Leader described it as a “slaughter solution,” saying it was nothing more than an incumbent protection programme for “Democrats afraid to stick their necks out because they know how much the American people oppose this bill.”
Yet a key development in favour of the Democrats' ambition to win over some 36-odd wavering members of their party was the updated cost-benefit “scoring” provided by the non-partisan Congressional Budget Office this week. The CBO ruled that the proposed reform programme would cost $940 billion and lead to a reduction in the deficit by close to $138 billion over the next 10 years — an estimate that cheered Democrats for showing a lower cost level than what was assumed earlier.
However, the Republicans countered this strongly too: Senator John Cornyn, a member of the Senate Finance Committee, said, “My Democratic colleagues never let the facts get in the way of a good story. Despite claims to the contrary, there is no CBO score… and what it reveals is nothing more than a guess.”
Meanwhile President Obama has busied himself delivering a slew of fiery speeches in Washington and elsewhere, seeking to win support for a bill whose passage would help him end the U.S.'s painful struggle with healthcare reform.
With the 72-hour deadline for passing the contentious healthcare reform bill approaching rapidly Democrats, under steady fire from across the aisle, are scrambling to get to the “magic number” of 216 votes required for its passage in the House of Representatives on Sunday.
This week a barrage of criticism was levelled at House Speaker Nancy Pelosi for attempting to get the bill through the House using the “deemed passed” rule. By this procedure, House members would simply vote on additional changes to the Senate version of the bill rather than the Senate bill itself. However, after this vote the Senate bill, along with the changes, would be “deemed passed.”
The idea behind this would be to give fence-sitters in the House the option of not having to affix their signature to a Senate bill that they have fundamental doubts about. One major difference between the two versions of the bill is the Senate version's language on funding for health insurance policies that include abortion is weaker than the House's so-called “Stupak amendment.”
Republicans, already mounting stronger attacks against what they have called a “government takeover of healthcare” came out strongly against the proposed House procedure. John Boehner, House Minority Leader described it as a “slaughter solution,” saying it was nothing more than an incumbent protection programme for “Democrats afraid to stick their necks out because they know how much the American people oppose this bill.”
Yet a key development in favour of the Democrats' ambition to win over some 36-odd wavering members of their party was the updated cost-benefit “scoring” provided by the non-partisan Congressional Budget Office this week. The CBO ruled that the proposed reform programme would cost $940 billion and lead to a reduction in the deficit by close to $138 billion over the next 10 years — an estimate that cheered Democrats for showing a lower cost level than what was assumed earlier.
However, the Republicans countered this strongly too: Senator John Cornyn, a member of the Senate Finance Committee, said, “My Democratic colleagues never let the facts get in the way of a good story. Despite claims to the contrary, there is no CBO score… and what it reveals is nothing more than a guess.”
Meanwhile President Obama has busied himself delivering a slew of fiery speeches in Washington and elsewhere, seeking to win support for a bill whose passage would help him end the U.S.'s painful struggle with healthcare reform.
Labels: Barack Obama, Democrats, healthcare, Stupak amendment, U.S. President
Thursday, June 18, 2009
Barack Obama’s bitter medicine
(This article is reproduced from The Hindu)
Success will depend on the government’s ability to get service providers such as doctors and insurance companies as well as patients to break with conventional thinking in at least four areas.
With the oratory that has now become the Obama signature, the U.S. President recently addressed the American Medical Association (click here to read Obama's speech) (AMA) on one of the thorniest issues his country faces: reform of the U.S. healthcare system. Barack Obama’s persuasive powers were further challenged by the composition of his audience. A powerful lobby representing the medical profession, it has often in the past sided with the Republican view in debates on healthcare reform.
As with the other challenges Mr. Obama faces domestically and internationally, actions will matter more than words. Both the AMA and his detractors elsewhere in America will be waiting to see what concrete policies emerge to back his promise to expand medical insurance to the 50 million Americans who are uninsured and face uncertain prospects should a health problem or crisis emerge. What is more, virtually all Americans now have a vested interest in how reform pans out: the country faces a public finance crisis given the Wall Street bailouts and the deep recession. Costly healthcare reform, if mishandled, could be the sledgehammer that breaks the camel’s back. Critics of Mr. Obama will point to two aspects of the proposed reform that are ambiguous: first, the numbers and, secondly, the attitudinal or paradigm shifts needed to get this reform working on the ground.
The numbers thus far do not ring in Mr. Obama’s favour. Democratic Senators Edward Kennedy and Christopher Dodd, responsible for the proposal for healthcare reform, have produced a draft version that suggests, according to Congressional Budget Office calculations (click here to read the document), that reforms would cost $1 trillion over 10 years, increase the number of insured Americans by 16 million, and yet leave 36 million Americans uninsured, even by 2017. Hardly an easy case for pushing through one of the most complex and embattled cases for reform?
Wrong, answered Mr. Obama, who contended that “one essential step” on the American journey towards prosperity was to “control the spiralling costs of healthcare in America... and in order to do that we are going to need the help of the AMA.” Recent estimates suggest that the U.S. spends close to $700 billion a year on healthcare and almost 50 per cent more per person than the next most costly nation. According to Peter Orszag of the Office of Management and Budget: “For families, after adjusting for inflation, health insurance premiums have increased 58 per cent while wages have risen only 3 per cent since 2000.” Similarly the states face burgeoning healthcare costs and resultant budget squeezes, which lead to cuts in essential services and tax rises.
So where, in the parched wastelands of the U.S. economy is the President going to find $1 trillion? A major portion will come from what Mr. Obama calls the Health Reserve Fund — $635bn set aside over 10 years. Half of this massive saving will be financed by limiting the itemised deduction rate for the wealthiest Americans to what it was when Ronald Reagan was President (an implicit allusion to Republican provenance); the other half from ending overpayments to Medicaid and Medicare Advantage plans (a system of private companies offering care under Medicare and essentially a subsidy to insurance companies). A further $313bn will be wrested by reducing payments to hospitals that cater to uninsured Americans — the logic being that the number of such Americans should decline if the overall insurance coverage is expanded, as the Kennedy-Dodd proposal hopes it will be.
While these proposed savings, assuming they are possible, puts the Obama administration “in a good position to fully fund health reform in a deficit neutral way,” the real bite of the reform will depend on the government’s ability to get service providers such as doctors and insurance companies as well as patients to break with conventional thinking in at least four areas.
First, doctors must be incentivised to provide the best care rather than simply more care. For this to happen there would not only have to be changes in the system of doctor remuneration, for example, rewarding doctors for good patient health outcomes rather than for treatments prescribed. Doctors would also need to be provided better information on patient histories and the relative effectiveness of different treatments. President Obama spoke of both issues to the AMA, asserting that a switchover to an electronic records system would help restore doctors to their traditional role of healers instead of being “bean-counters” and “paper-pushers”. Further the system’s ability to inform doctors about the most effective treatments available will be honed. Currently less than 1 per cent of healthcare spending goes into determining which treatments are most effective. However, Mr. Obama said, initial investments towards improving electronically available information to doctors have already been undertaken as part of the economic recovery programme.
Secondly, patients will have to invest much more in preventive care so as to “avoid illness and disease in the first place,” Mr. Obama demanded. The American struggle with obesity and sedentary and harmful lifestyles is well known, the stuff of movies like “Supersize Me” and numerous newspaper columns. But if there is to be any real hope of long-term cost reductions in healthcare, this message must be spread with unprecedented emphasis and effect. Mr. Obama seems to agree. He now faces the task of convincing America.
Thirdly, insurance companies will have to yield to the growing clamour of voices seeking greater competition in the industry. For decades, health insurance giants such as Cigna and Humana have enjoyed a relatively unrestricted ability to set insurance premiums and in many cases deny payouts to sick patients on the basis of controversial ‘prior conditions.’ This status quo may be significantly altered under Mr. Obama’s plan to introduce an “insurance exchange” or a system of publicly provided, lower-cost insurance policies for the uninsured. The AMA has already signalled its opposition to this single payer public-funded insurance plan. The path of persuasion Mr. Obama has chosen may be longer than he hopes.
Fourthly, and this is being hailed as a benefit of Mr. Obama’s revolutionary campaign tactics, is his gentle hint to the AMA that medical malpractice reform, anathema thus far to Democrats and very much a Republican agenda item, may be necessary. If the 44th President really hopes for a cost-effective healthcare system where doctors can prescribe treatments based on evidence and evidence-based guidelines, it does imply a shift away from excessive treatments, leading to a potential increase in medical malpractice suits. Under other Democratic administrations, including Bill Clinton’s, the President’s ability (setting aside the question of willingness) to tackle the increasingly obese white elephant of malpractice suits has been circumscribed by the fact that the Democrats have had an entrenched relationship with the trial lawyers interest group. The latter, the prime beneficiaries of the litigious circumstances that have trapped the U.S. healthcare system, have fiercely resisted challenges to this source of their ascendancy. Yet Mr. Obama has, given his grassroots approach to campaigning and campaign financing, been able to sidestep the influence of this lobby, perhaps by sheer luck — or perhaps not.
Beset by massive financing and paradigm-shift challenges, President Obama is likely to sleep lightly over the coming months. However, his conciliatory approach combined with a no-nonsense speaking of truth to power might turn out to be the best chance of transforming the ailing healthcare system that any President could ask for.
Success will depend on the government’s ability to get service providers such as doctors and insurance companies as well as patients to break with conventional thinking in at least four areas.
With the oratory that has now become the Obama signature, the U.S. President recently addressed the American Medical Association (click here to read Obama's speech) (AMA) on one of the thorniest issues his country faces: reform of the U.S. healthcare system. Barack Obama’s persuasive powers were further challenged by the composition of his audience. A powerful lobby representing the medical profession, it has often in the past sided with the Republican view in debates on healthcare reform.
As with the other challenges Mr. Obama faces domestically and internationally, actions will matter more than words. Both the AMA and his detractors elsewhere in America will be waiting to see what concrete policies emerge to back his promise to expand medical insurance to the 50 million Americans who are uninsured and face uncertain prospects should a health problem or crisis emerge. What is more, virtually all Americans now have a vested interest in how reform pans out: the country faces a public finance crisis given the Wall Street bailouts and the deep recession. Costly healthcare reform, if mishandled, could be the sledgehammer that breaks the camel’s back. Critics of Mr. Obama will point to two aspects of the proposed reform that are ambiguous: first, the numbers and, secondly, the attitudinal or paradigm shifts needed to get this reform working on the ground.
The numbers thus far do not ring in Mr. Obama’s favour. Democratic Senators Edward Kennedy and Christopher Dodd, responsible for the proposal for healthcare reform, have produced a draft version that suggests, according to Congressional Budget Office calculations (click here to read the document), that reforms would cost $1 trillion over 10 years, increase the number of insured Americans by 16 million, and yet leave 36 million Americans uninsured, even by 2017. Hardly an easy case for pushing through one of the most complex and embattled cases for reform?
Wrong, answered Mr. Obama, who contended that “one essential step” on the American journey towards prosperity was to “control the spiralling costs of healthcare in America... and in order to do that we are going to need the help of the AMA.” Recent estimates suggest that the U.S. spends close to $700 billion a year on healthcare and almost 50 per cent more per person than the next most costly nation. According to Peter Orszag of the Office of Management and Budget: “For families, after adjusting for inflation, health insurance premiums have increased 58 per cent while wages have risen only 3 per cent since 2000.” Similarly the states face burgeoning healthcare costs and resultant budget squeezes, which lead to cuts in essential services and tax rises.
So where, in the parched wastelands of the U.S. economy is the President going to find $1 trillion? A major portion will come from what Mr. Obama calls the Health Reserve Fund — $635bn set aside over 10 years. Half of this massive saving will be financed by limiting the itemised deduction rate for the wealthiest Americans to what it was when Ronald Reagan was President (an implicit allusion to Republican provenance); the other half from ending overpayments to Medicaid and Medicare Advantage plans (a system of private companies offering care under Medicare and essentially a subsidy to insurance companies). A further $313bn will be wrested by reducing payments to hospitals that cater to uninsured Americans — the logic being that the number of such Americans should decline if the overall insurance coverage is expanded, as the Kennedy-Dodd proposal hopes it will be.
While these proposed savings, assuming they are possible, puts the Obama administration “in a good position to fully fund health reform in a deficit neutral way,” the real bite of the reform will depend on the government’s ability to get service providers such as doctors and insurance companies as well as patients to break with conventional thinking in at least four areas.
First, doctors must be incentivised to provide the best care rather than simply more care. For this to happen there would not only have to be changes in the system of doctor remuneration, for example, rewarding doctors for good patient health outcomes rather than for treatments prescribed. Doctors would also need to be provided better information on patient histories and the relative effectiveness of different treatments. President Obama spoke of both issues to the AMA, asserting that a switchover to an electronic records system would help restore doctors to their traditional role of healers instead of being “bean-counters” and “paper-pushers”. Further the system’s ability to inform doctors about the most effective treatments available will be honed. Currently less than 1 per cent of healthcare spending goes into determining which treatments are most effective. However, Mr. Obama said, initial investments towards improving electronically available information to doctors have already been undertaken as part of the economic recovery programme.
Secondly, patients will have to invest much more in preventive care so as to “avoid illness and disease in the first place,” Mr. Obama demanded. The American struggle with obesity and sedentary and harmful lifestyles is well known, the stuff of movies like “Supersize Me” and numerous newspaper columns. But if there is to be any real hope of long-term cost reductions in healthcare, this message must be spread with unprecedented emphasis and effect. Mr. Obama seems to agree. He now faces the task of convincing America.
Thirdly, insurance companies will have to yield to the growing clamour of voices seeking greater competition in the industry. For decades, health insurance giants such as Cigna and Humana have enjoyed a relatively unrestricted ability to set insurance premiums and in many cases deny payouts to sick patients on the basis of controversial ‘prior conditions.’ This status quo may be significantly altered under Mr. Obama’s plan to introduce an “insurance exchange” or a system of publicly provided, lower-cost insurance policies for the uninsured. The AMA has already signalled its opposition to this single payer public-funded insurance plan. The path of persuasion Mr. Obama has chosen may be longer than he hopes.
Fourthly, and this is being hailed as a benefit of Mr. Obama’s revolutionary campaign tactics, is his gentle hint to the AMA that medical malpractice reform, anathema thus far to Democrats and very much a Republican agenda item, may be necessary. If the 44th President really hopes for a cost-effective healthcare system where doctors can prescribe treatments based on evidence and evidence-based guidelines, it does imply a shift away from excessive treatments, leading to a potential increase in medical malpractice suits. Under other Democratic administrations, including Bill Clinton’s, the President’s ability (setting aside the question of willingness) to tackle the increasingly obese white elephant of malpractice suits has been circumscribed by the fact that the Democrats have had an entrenched relationship with the trial lawyers interest group. The latter, the prime beneficiaries of the litigious circumstances that have trapped the U.S. healthcare system, have fiercely resisted challenges to this source of their ascendancy. Yet Mr. Obama has, given his grassroots approach to campaigning and campaign financing, been able to sidestep the influence of this lobby, perhaps by sheer luck — or perhaps not.
Beset by massive financing and paradigm-shift challenges, President Obama is likely to sleep lightly over the coming months. However, his conciliatory approach combined with a no-nonsense speaking of truth to power might turn out to be the best chance of transforming the ailing healthcare system that any President could ask for.
Labels: healthcare, insurance, Obama, reform, U.S.
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