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A few more (minor) concessions on healthcare reform by Obama

The main Democratic theme at last Thursday's healthcare reform summit was that their proposals weren't all that far from the GOP's position on many core issues. President Obama stayed on message Tuesday, issuing a letter to House and Senate leaders identifying four GOP proposals he hoped to incorporate into the bill. (Download a PDF of the letter here.) These weren't dramatic concessions, though, just small modifications. Specifically, Obama said he was "exploring" these four Republican ideas:

  • Using undercover patients to root out fraud in Medicare and Medicaid (an idea suggested by Republican Sen. Tom Coburn of Oklahoma);
  • Tripling the funding for state experiments in medical malpractice reform;
  • Increasing physician reimbursement rates for Medicaid (as requested by Republican Sen. Charles E. Grassley of Iowa);
  • Clarifying that high-deductible insurance policies will be available through the new insurance exchanges (a response to a plea by Republican Sen. John Barrasso of Wyoming to stop trying to kill health savings accounts).

Obama's letter also said that his proposal discarded the special treatment for Medicare Advantage subscribers in Florida, as Republican Sen. John McCain of Arizona had called for at the summit.

The letter offered no timetable, but the White House on Wednesday is expected to unveil a revised version of its 11-page blueprint for bridging the differences between the bills passed by the House and Senate. Republicans, who argued at the summit that those bills ought to be discarded in favor of a much more modest effort, aren't likely to be satisfied with the tweaks. But Obama signaled that he's ready to move forward anyway by rejecting the GOP's call for incremental change:

I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs.

Lines like that one suggest that today's letter was intended mainly to rebut the GOP's accusations that their healthcare ideas were being ignored, not to attract Republican votes. Regardless, the main challenge for healthcare reform advocates is retaining the support of wavering Democrats in the House, who've made a growing number of concessions to the GOP and moderate Democratic senators.

-- Jon Healey


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Dr. Phillips

The entire nation whether Democrat or Republican was filled with enthusiasm that night when a young President elect appeared in Grant Park to address thousands. America was proud of our nation which would at last elect an African American to serve as President of the United States. Obama spoke that night of ending government gridlock in Washington D.C. and bringing a new day of cooperation between Republicans, Democrats and Independents in the Congress, we were all proud and attracted to a new vision. Yes We Can was on the lips of millions in America. It was a night of joy.

Months later we have experienced division, closed minds and an aimless vision of where this nation should proceed from the administration's poor leadership. Along the way we have lost perhaps as many as 17-22 million jobs. Trillion dollar deficits loom in the distance and economic predictions forecast years ahead before jobs return. Cities like Detroit are no longer a nexus of manufacturing and good jobs. Most Americans feel we are in worse condition now than we were a year ago.

Today March 3 was a sad day as the President told us that there will be no further discussion on healthcare reform. He is headed for a reconciliation cram down your throat healthcare reform package which is not desired by a majority of Americans in spite of his words to the contrary. Freedoms earlier foreseen in a new vision are now hard to imagine. A majority of the nation's citizens are concerned about losing freedoms and constitutional traditions.

Ronald Reagan said in 1980 that the Novelist Thomas Wolfe once wrote of our country, there is a mighty music to the proud glittering names of places in America. He called out our cities; Youngstown, Detroit, Buffalo, Pittsburgh, Seattle, Houston, Hartford, Jersey City, New York city, etc. But Reagan also observed that many of these cities no longer proclaim the confident roar of American progress, growth and optimism - there is now only silence, unemployment and discouraged Americans. Savings have disappeared, pensions decimated and homes lost as hope for a recovery has literally evaporated.

Many of our leaders today tell us we must meekly accept our nation's economic decline. We must learn to live with little and tell our children that their lives will be less prosperous and full than ours have been. We are reminded by Washington D.C. that the America of the future will be a country where, because of our past mistakes, it will be impossible to hope and make dreams come true.

I absolutely refuse to accept this conclusion. We have had a high standard of living in past years because people have worked hard. Americans have not created the situation we are in at the moment. This aimlessness and depression is a result of leaders overspending, abusing businesses, under representing and forgetting the needs of most of the American people. The failure of today's leaders focuses primarily on placing themselves ahead of the needs of the American people.

In 2010 and 2012 there will be millions of us who will not accept this nation's decline and the failure of this administration to restore and create jobs. We will not stand idly by and watch the destruction of our small businesses and entrepreneurial vision by bureaucrats,

With God's grace we Americans, including Republicans, Democrats and Independents will work 24/7 to restore the timeless vision of a great and prosperous people in a land we call America.

Dr. Alan G. Phillips
Bloomington, IL


Not that anyone in congress read this, but.....

Starting in 2011—next year—the W-2 tax form sent by your employer will be increased to show the value of whatever health insurance you are provided. It doesn't matter if you're retired. Your gross income WILL go up by the amount of insurance your employer paid for. So you’ll be required to pay taxes on a larger sum of money that you actually received. Take the tax form you just finished for 2009 and see what $15,000.00 or $20,000.00 additional gross income does to your tax debt. That's what you'll pay next year. For many it puts you into a
much higher bracket. This is how the government is going to buy insurance for fifteen (15) percent that don't have insurance and it's only part of the tax increases, but it's not really a "tax increase" as such, it a redefinition of your taxable income.

Don't worry, there's more to come.

Jon Healey

@avatar666 -- No one in Congress read that because it's not in the bill. Let me make this incredibly clear: Congress did not end the tax exemption for employer-provided healthcare benefits. Period.

What Congress decided to do was to reduce the tax subsidy for some health plans indirectly, by levying a tax on the income insurers generate from high-cost policies. The tax applies to coverage plans whose costs are well above the national average. Such plans include the sort of no-deductible, no-copay plan that top executives and some unions negotiate, as well as some plans for high-risk workers (although these were exempted by the legislation). It's likely that the cost imposed on insurers will be passed on to the people who buy these policies, through higher premiums or trimmed benefits. Still, that's nothing close to your characterization of the bill. The tax exemption for employer-provided health benefits remains intact.

Setting aside the myriad of hypocrisies surrounding the issue of the tax subsidy for healthcare, the reality is that it's politically impregnable. No matter that people would be better off decoupling their health insurance from their employment -- coverage would be more portable, risk pools would be larger leading to lower rates, competition would increase, people would have more choice. Workers believe employers *give* them health insurance, so they're not willing to part with it. In truth, employees pay for every dime of their health insurance -- the benefits they receive come in lieu of salary.

Sens. Wyden and Bennett had a great proposal that would have liberated health insurance from the employment trap. It was legitimately bipartisan, which is a rarity these days. But it was too radical, so it never got out of the starting gate.



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The Opinion L.A. blog is the work of Los Angeles Times Editorial Board membersNicholas Goldberg, Robert Greene, Carla Hall, Jon Healey, Sandra Hernandez, Karin Klein, Michael McGough, Jim Newton and Dan Turner. Columnists Patt Morrison and Doyle McManus also write for the blog, as do Letters editor Paul Thornton, copy chief Paul Whitefield and senior web producer Alexandra Le Tellier.

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