Despite last-minute efforts to improve the language on abortion and conscience rights in the Senate’s proposed health care reform bill, the U.S. bishops oppose its passage.

This was affirmed in a statement released Saturday by Cardinal Daniel DiNardo of Galveston-Houston, chairman of the conference’s Committee on Pro-Life Activities; Bishop John Wester of Salt Lake City, chair of the bishops’ Committee on Migration; and Bishop William Murphy of Rockville Centre, New York, chair of the Domestic Policy Committee.

The prelates acknowledge the “good faith” efforts of several Senators in proposing changes to the bill, as well as several positive points of the Manager’s Amendment that was proposed Saturday.

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The health-care debate in the Senate has, thankfully, returned to the paramount issue of cost. Unfortunately, the most obvious, time-tested and feasible approach to providing high-quality care at reasonable cost remains excluded from consideration.

The irony is that President Obama and a number of legislators have lauded the work of approximately 30 health-care organizations, caring for about 6 percent of the population, that for decades have provided care reliably better than average at lower cost. These are the “group employed models,” or GEMs, such as Geisinger Health System, the Marshfield Clinic, Kaiser Permanente, the Mayo Clinic and the Cleveland Clinic. Two of these GEMs — the Cleveland Clinic and the Mayo Clinic — have been ranked among U.S. News and World Report’s top five hospitals in the country. And shouldn’t all Americans have access to such better and cheaper care?

Most health-care organizations are run on a “fee-for-service” model. GEM organizations are different in that their physicians are employed, they are physician-led, and they work closely together and share information.

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Obama’s overhaul would also change how private firms insure workers. Perhaps 18 million workers could lose coverage and 16 million gain it, as companies adapt to new regulations and subsidies, estimates The Lewin Group, a consulting firm. Private insurers argue that premiums in the individual and small group markets, where many workers would end up, might rise an extra 25% to 50% over a decade.

The administration and the CBO disagree. The dispute underlines the bills’ immense uncertainties. As for cost control, even generous estimates have health spending growing faster than the economy. Changing that is the first imperative of sensible policy.

So Obama’s plan amounts to this: partial coverage of the uninsured; modest improvements (possibly) in their health; sizable budgetary costs worsening a bleak outlook; significant, unpredictable changes in insurance markets; weak spending control. This is a bad bargain. Benefits are overstated, costs understated.

This legislation is a monstrosity; the country would be worse for its passage. What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of “universal coverage.” What it’s not is leadership.

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While welcoming a “good-faith effort” by Sen. Robert Casey to improve the treatment of abortion in the Senate’s health reform legislation, the chairman of the U.S. bishops’ Committee on Pro-Life Activities said a “fundamental problem” remains that makes the bill morally unacceptable.

Cardinal Daniel N. DiNardo of Galveston-Houston said the U.S. Conference of Catholic Bishops would continue to oppose the Senate legislation “unless and until” it is amended to “comply with long-standing Hyde restrictions on federal funding of elective abortions and health plans that include them.”

Casey, a Catholic Democrat from Pennsylvania, has proposed language that he says would permit individuals to opt out of abortion coverage in any policy offered in a health-care exchange and would require segregation of funds in the exchange so that federal subsidies are not used to pay for abortions.

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David Axelrod, an adviser to President Barack Obama, predicted health-care legislation would pass “soon,” after Senate Democrats on Saturday secured the 60 votes needed to clear a path for quick Senate passage of the measure.

“We’re right on the one-yard line” with Senate Democrats reaching a deal, Mr. Axelrod said on CNN’s “State of the Union” which aired Sunday. “I believe this is going to happen soon”¦. People understand we’re on the doorstep of doing something really historic that will help the American people and strengthen our country for the long run.”

Senate Majority leader Harry Reid secured the pivotal 60th vote after a late-night deal on abortion coverage locked in the support of Nebraska Sen. Ben Nelson. The agreement capped weeks of negotiations aimed at building consensus on the White House-backed initiative.

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Thirty million people without health insurance stand to gain coverage under a deal announced on Saturday by Senate Democrats.

To get the 60 votes needed to pass their bill, Democrats scrapped the idea of a government-run public insurance plan, cherished by liberals, and replaced it with a proposal for nationwide health plans, which would be offered by private insurers under contract with the government.

The legislation also includes a proposal that would limit insurance coverage of abortion. The provision, which was the last piece of the puzzle to fall into place, was negotiated by the Senate majority leader, Harry Reid, Democrat of Nevada, to win the support of Senator Ben Nelson, Democrat of Nebraska, who is an opponent of abortion.

Under the agreement, states could choose to prohibit abortion coverage in the insurance markets, or exchanges, where most health plans would be sold.

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A Senate compromise toughening abortion restrictions drew criticism from activists on both sides of the issue Saturday, prolonging rather than settling the controversy as Democrats try and complete work on President Barack Obama’s health care overhaul.

Critics included Douglas Johnson, legislative director for the National Right to Life Committee, who said the compromise is “light years removed” from the restrictions in the House bill and creates a series of new problems. Johnson warned that the new Senate language would not pass in the House, where anti-abortion Democrats control a crucial bloc of votes.

On the other side of the divide, Nancy Keenan, president of NARAL Pro-Choice America, called the deal “unacceptable” and said it was “outrageous” that senators would accept it. It would create too many hurdles for women seeking coverage of a legal medical procedure, she complained.

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The U.S. Senate’s health-care overhaul plan would almost double a proposed increase in Medicare payroll taxes for high-earners and impose a new tax on indoor tanning, replacing an earlier levy on plastic surgery.

The new version of the bill announced today by Senate Majority Leader Harry Reid contains a 0.9 percentage-point increase in the Medicare tax for individuals who earn more than $200,000 and couples earning more than $250,000, according to an estimate by the nonpartisan Joint Committee on Taxation. The increase would start in 2013.

That would generate $86.8 billion over six years, up from about $50 billion that would have been generated by an earlier proposed increase of 0.5 percentage point. Those affected would pay a Medicare tax rate of 2.35 percent, while their employers would continue to pay 1.45 percent.

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Sen. Ben Nelson (Neb.), the final Democratic holdout on health care, announced to his caucus Saturday morning that he would support the Senate reform bill, clearing the way for final passage by Christmas.

“We’re there,” said Sen. Kent Conrad (D-N.D.), as he headed into a special meeting to outline the deal.

Democratic leaders spent days trying to hammer out a deal with Nelson, and worked late Friday night with him on abortion coverage language that had proved the major stumbling block. Nelson also secured other favors for his home state.

Under the new abortion provisions, states can opt out of allowing plans to cover abortion in insurance exchanges the bill would set up to serve individuals who don’t have employer coverage. Plus, enrollees in plans that do cover abortion procedures would pay for the coverage with separate checks – one for abortion, one for rest of health-care services.

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When Senate Democratic leaders agreed this week to remove a public insurance plan from their massive healthcare bill, they did more than quash a liberal dream of expanding the government safety net. They effectively pinned their hopes of guaranteeing coverage to all Americans on a far more conventional prescription: government regulation.

The change sprang from a compromise made to placate conservative Democrats wary of a new government program. But shorn of a “public option,” the Senate healthcare bill has reverted to a long-established practice of leveraging government power to police the private sector, rather than compete with it.

Despite the resistance among Republicans and conservatives to more government regulation, even the insurance industry has agreed to broad new oversight of their business in exchange for the prospect of gaining millions of new customers.

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A moderate Democrat whose vote could be crucial said Thursday an attempted Senate compromise on abortion is unsatisfactory, raising doubts about whether the chamber can pass President Barack Obama’s health care overhaul by Christmas.

“As it is, without modifications, the language concerning abortion is not sufficient,” Nebraska Sen. Ben Nelson, a key holdout on the health care bill, said in a statement after first making his concerns known to Majority Leader Harry Reid, D-Nev.

Nelson said there were positive improvements dealing with teen pregnancy and adoption, and that he was open to further negotiations. But in a radio interview earlier in the day with KLIN in Lincoln, Nebraska, Nelson also said that abortion wasn’t his only concern and he didn’t see how the Christmas deadline was achievable.

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Senate Democratic leaders appeared poised Monday night to abandon efforts to create a government-run insurance safety net in their push for health-care reform, as they attempted to close ranks around a bill they hoped would win the backing of all 60 members of their caucus.

Democratic negotiators had already disappointed liberal lawmakers by jettisoning a full-fledged public insurance plan a week earlier. Last night, party leaders conceded that a key portion of the compromise they crafted to replace the public option — a proposal allowing people as young as 55 to buy into Medicare — also did not have sufficient support from Democratic moderates to overcome a likely Republican filibuster.

Senate Majority Leader Harry M. Reid (D-Nev.), after consulting with senior White House officials, rallied his caucus in a closed-door meeting Monday evening, reminding senators that there was broad consensus behind most of the provisions in the $848 billion package and warning them of the consequences of not passing a bill before the end of the year.

“Democrats are not going to let the American people down,” he told reporters after the meeting. “I am confident that by next week, we will be on our way to final passage.”

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Democratic leaders in the U.S. Senate struggled on Monday to move forward on a sweeping healthcare overhaul sought by President Barack Obama in the face of opposition from a frequent irritant — Joe Lieberman.

As the Senate opened a make-or-break week for healthcare, Senator Lieberman’s threat to join Republicans in blocking the bill complicated Democratic efforts to gather the 60 votes needed to overcome Republican opposition.

Obama invited all 60 members of the Senate Democratic caucus to the White House on Tuesday to discuss a way to reach agreement, party sources said.

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The president of the U.S. bishops’ conference is calling the Senate’s move to table an amendment that would prevent federal money from funding abortion “a serious blow” to health care reform.

Cardinal Francis George, the archbishop of Chicago, said this today after the Senate voted 54-45 on Monday to kill the Nelson-Hatch-Casey Amendment proposed by senators Ben Nelson, Orrin Hatch and Robert Casey.

A similar measure was passed in the House of Representatives, paving the way for the passage there of the “Affordable Health Care for America Act.”

“The Senate is ignoring the promise made by President Obama and the will of the American people in failing to incorporate longstanding prohibitions on federal funding for abortion and plans that include abortion,” Cardinal George said.

“While we deplore the Senate’s refusal to adopt the Nelson-Hatch-Casey amendment, we remain hopeful that the protections overwhelmingly passed by the House will be incorporated into needed reform legislation,” he added. “Failure to exclude abortion funding will turn allies into adversaries and require us and others to oppose this bill because it abandons both principle and precedent.”

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“There is a huge middle class marriage penalty hidden in the House and Senate health care bills. The penalty becomes evident by evaluating questions like the following: How much would two single people, each making $30,000 per year, pay for private health insurance if the Pelosi bill was in effect now? The answer is $1,320 per year for both individuals combined (based on the premium limits and subsidies outlined on the charts below). But how much would they pay for the same level of insurance under the Pelosi bill if they were to marry? Their combined cost would then be about $12,000 a year (the estimated cost for private insurance).

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Most New Yorkers hadn’t heard of Bart Stupak before he attached his devastating anti-abortion amendment to the House’s health-care-reform bill three weeks ago. We know a lot more about him now, of course: that he lives in a Christian rooming house on C Street; that he’s a former state trooper. He has become a symbol of legislative zealotry, living proof that the fight over the right to choose will always attract a more impassioned opposition than defense. (As Harrison Hickman, a former pollster for NARAL, put it to me: “If you believe that choosing the wrong side of the issue means spending eternal life in Hades, of course you’re going to be more focused on it.”) Just a week after the vote, when I reached the Michigan Democrat as he was driving across his district, he seemed dumbfounded that anyone found his brinkmanship surprising. “I said to anyone who’d listen: ”˜Do you want health care, or do you want to fight out abortion?’”‰” says Stupak. He points out that he’d nearly managed to bring down a rule about abortion funding earlier in the summer, this time in a bill about spending in the District of Columbia. “I said, ”˜Look, that was a shot across your bow,’”‰” he recalls. “”‰”˜I was being polite to you. That was a warning.’ And the leadership just blew us off.”

Until it realized it couldn’t, of course. And the results sent chills through the pro-choice world, dampening what was otherwise an impressive victory for Democrats on the issue of universal health care. If Stupak’s amendment holds, then any health-insurance plan that’s either listed on the government-run exchange or accepts federal subsidies””which would likely be almost all of them””would not be allowed to cover abortions. (The Senate bill is better thus far, but what the legislation will ultimately be, assuming it passes at all, is anyone’s guess.) Four days after the vote, Kate Michelman, the former head of NARAL, and Frances Kissling, the former head of Catholics for Choice, warned of an ominous new landscape in a Times op-ed: “The House Democrats reinforced the principle that a minority view on the morality of abortion can determine reproductive-health policy for American women.”

But is that actually right? Was Stupak’s truly the minority view?

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Democratic Senate negotiators struck a tentative agreement Tuesday night to drop the controversial government-run insurance plan from their overhaul of the health-care system, hoping to remove a last major roadblock preventing the bill from moving to a final vote in the chamber.

Under the deal, the government plan preferred by liberals would be replaced with a program that would create several national insurance policies administered by private companies but negotiated by the Office of Personnel Management, which oversees health policies for federal workers. If private firms were unable to deliver acceptable national policies, a government plan would be created.

In addition, people as young as 55 would be permitted to buy into Medicare, the popular federal health program for retirees. And private insurance companies would face stringent new regulations, including a requirement that they spend at least 90 cents of every dollar they collect in premiums on medical services for their customers.

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The Senate on Tuesday rejected an effort to tighten restrictions against using federal funds for abortion under Democrats’ landmark healthcare legislation, handing a victory to abortion-rights advocates but setting up a potential conflict with the House.

The Senate voted 54-45 to kill an amendment offered by Sen. Ben Nelson (D-Neb.) to make sure the bill does not undermine the long-standing ban on federal abortion funding.

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We have now reached the stage of the health-care debate when all that matters is getting a bill passed, so all news is good news, more subsidies mean lower deficits, and more expensive insurance is really cheaper insurance. The nonpolitical mind reels.

Consider how Washington received the Congressional Budget Office’s study Monday of how Harry Reid’s Senate bill will affect insurance costs, which by any rational measure ought to have been a disaster for the bill. CBO found that premiums in the individual market will rise by 10% to 13% more than if Congress did nothing. Family policies under the status quo are projected to cost $13,100 on average, but under ObamaCare will jump to $15,200.

Fabulous news!

“No Big Cost Rise in U.S. Premiums Is Seen in Study,” said the New York Times, while the Washington Post declared, “Senate Health Bill Gets a Boost.” The White House crowed that the CBO report was “more good news about what reform will mean for families struggling to keep up with skyrocketing premiums under the broken status quo.”

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Psychology Professor Anita Blanchard has a pretty sweet deal with her employer. Even if the 40-something mother of three leaves her job at the University of North Carolina at Charlotte, the state of North Carolina guarantees her premium-free health insurance that will cover 80% of her health care costs for life. But’s there’s a hitch: she can’t gain too much weight or start smoking. If she does, she could be on the hook for an additional 10% of her health care tab.

Companies have long promoted healthier behavior by subsidizing gym memberships and smoking-cessation classes. But several private and public employers have started tying financial incentives to their health-insurance plans. North Carolina this year became the second state to approve an increase in out-of-pocket expenses for state workers who smoke and don’t try to quit or who are morbidly obese and don’t try to lose weight. Alabama was the first to pass what critics call a fat fee, in 2008, and several state insurance plans have started imposing a $25 monthly surcharge on smokers.

There’s even a push in Congress to let employers further link lifestyles to insurance premiums. Right now companies that run their own insurance programs can reward employees with bonuses or premium reductions of up to 20% if they meet certain health guidelines. John Ensign, Republican Senator from Nevada, and Tom Carper, Democratic Senator from Delaware, co-sponsored an amendment to the current health care bill that would raise the limit to as high as 50%. The Senate Finance Committee gave it a thumbs-up in September.

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…the general view among independent health care economists is that these changes will not fundamentally bend the cost curve. The system after reform will look as it does today, only bigger and more expensive.

As Jeffrey S. Flier, dean of the Harvard Medical School, wrote in The Wall Street Journal last week, “In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it.”

…the current estimates almost certainly understate the share of the nation’s wealth that will have to be shifted. In these bills, the present Congress pledges that future Congresses will impose painful measures to cut Medicare payments and impose efficiencies. Future Congresses rarely live up to these pledges.

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Leading up to the vote, Gregg reportedly said Republicans will attempt to filibuster the bill if it resembles what passed the House. After the vote he criticized it for creating a “new multitrillion dollar entitlement program that massively grows the size and role of the federal government, significantly increases taxes, especially on small businesses, and cuts Medicare by over a trillion dollars.”

Nine faiths were represented by the 15 religious leaders, which included rabbis, priests and pastors, including, from Dover, Rabbi Larry Karol of Dover Temple Israel; the Rev. Susan Garrity of St. Thomas Episcopal Church; the Rev. Mark Monson Alley of St. John’s Methodist Church; Dr. Julian Olivier, chaplain at Wentworth Douglass Hospital; and the Rev. Kendra Ford of First Unitarian Universalist Society of Exeter.

“As religious leaders, we affirm that all human life is sacred. We affirm our moral obligation to provide for the basic needs of all people, including food, clothing, shelter, legal protection and medical care,” they wrote in the letter. “We affirm the equal, just and impartial treatment of all people. … As religious leaders, we recognize that we are all morally bound to work for equal access to health care.”

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A sudden crisis is unlikely. Other rich countries with far bigger debts relative to the size of their economies, from Italy to Japan, have soldiered on without hitting a wall. Stable politics, transparent laws and economic dominance give America unequalled credibility with lenders. For all the anxiety the declining dollar drew from China this week (see article), it has no serious rival as the world’s reserve currency. America has sensibly used this fiscal freedom to enact an aggressive stimulus programme. This should be maintained for as long as it is needed.

Yet ignoring the future is also costly. The problem is not the deficits in the next couple of years, but in the years that follow. Uncertainty over how taxes may be raised to shrink deficits may already be weighing on business confidence. Worries about inflation or default could start to push up interest rates. Eventually, private investment will be crowded out.

Barack Obama and Congress can pre-empt such corrosive uncertainty with a plan to reduce the deficit now. Far from requiring immediate spending cuts or tax increases, a credible plan would reassure markets and allow an orderly exit from fiscal stimulus. The Federal Reserve provides a model: it does not plan to tighten monetary policy in the near future, but has signalled its willingness to do so when inflation threatens.

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Sen. Joseph Lieberman, speaking in that trademark sonorous baritone, utters a simple statement that translates into real trouble for Democratic leaders: “I’m going to be stubborn on this.”

Stubborn, he means, in opposing any health-care overhaul that includes a “public option,” or government-run health-insurance plan, as the current bill does. His opposition is strong enough that Mr. Lieberman says he won’t vote to let a bill come to a final vote if a public option is included.

Probe for a catch or caveat in that opposition, and none is visible. Can he support a public option if states could opt out of the plan, as the current bill provides? “The answer is no,” he says in an interview from his Senate office. “I feel very strongly about this.” How about a trigger, a mechanism for including a public option along with a provision saying it won’t be used unless private insurance plans aren’t spreading coverage far and fast enough? No again.

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Companies and groups hiring lobbying firms on health issues nearly doubled this year as special interests rushed to shape the massive revamp of the nation’s health care system now in its final stretch before Congress.

About 1,000 organizations have hired lobbyists since January, compared with 505 during the same period in 2008, according to a USA TODAY analysis of congressional records compiled by the nonpartisan CQ MoneyLine.

Overall, health care lobbying has increased, exceeding $422 million during the first ninth months of the year, according to the Center for Responsive Politics, which tracks money in politics. That’s more than any other industry and a nearly 10% jump over the same period in 2008. The center’s Dave Levinthal said the frenzy of new lobbying activity makes financial sense.

“If lobbying didn’t work, people wouldn’t do it,” he said.

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As one of the few senators undecided on healthcare reform, Arkansas Democrat Blanche Lincoln faces a huge headache. Liberals attack her as an obstructionist, even though she cast a key vote keeping the effort alive. Republicans are lining up to run against her — seven, so far, and counting.

The voters here at home seem conflicted, if not downright confused.

Take Jim Havens. He greeted Lincoln with a warm embrace when she showed up at the University of Central Arkansas for a service honoring veterans; his late brother was a family friend. Moments later, as Lincoln sat on stage, the 73-year-old state employee related his frustrations with the healthcare system: the struggle to cover his wife before Medicare kicked in, the exclusions that made her expensive policy barely worth the cost.

“What we got is broken,” Havens said. But, he quickly added, “what I don’t think we need to do is rush to fix it and make things even worse.”

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The Catholic Bishops of the United States have long supported adequate and affordable health care for all. As pastors and teachers, we believe genuine health care reform must protect human life and dignity, not threaten them, especially for the most voiceless and vulnerable. We believe health care legislation must respect the consciences of providers, taxpayers, and others, not violate them. We believe universal coverage should be truly universal, not deny health care to those in need because of their condition, age, where they come from or when they arrive here. Providing affordable and accessible health care that clearly reflects these fundamental principles is a public good, moral imperative and urgent national priority.

Sadly, the legislative proposal recently unveiled in the Senate does not meet these moral criteria. Specifically, it violates the longstanding federal policy against the use of federal funds for elective abortions and health plans that include such abortions – a policy upheld in all health programs covered by the Hyde Amendment, the Children’s Health Insurance Program, the Federal Employee Health Benefits Program – and now in the House-passed “Affordable Health Care for America Act.” We believe legislation that violates this moral principle is not true health care reform and must be amended to reflect it. If that fails, the current legislation should be opposed.

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Only a day after Senate Democrats voted to move into a historic debate on overhauling the nation’s healthcare system, key centrists made it clear today that the party is still a long way from delivering on its promise to provide near-universal insurance coverage and contain medical costs.

Faced with the prospect of Republican filibusters, Democratic leaders must deliver the same kind of total unity they managed to achieve in Saturday’s vote to begin debate: Every Democratic senator, plus two independents who caucus with them, supported the key procedural motion.

But several of those senators spoke out today to say that they will not support the healthcare bill itself unless major changes were made.

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Senate Majority Leader Harry M. Reid (Nev.) appeared Saturday to secure the 60 votes needed to move an $848 billion health-care reform bill to the Senate floor for debate, as the last two holdouts in his Democratic caucus said they will not join in a Republican filibuster.

After days of indecision, Sens. Blanche Lincoln (Ark.) and Mary Landrieu (La.) declared that they will vote to advance the bill despite reservations. Reid now expects all 60 members of his caucus to vote yes at 8 p.m. Saturday, clearing the way for amendment deliberations to begin after the Thanksgiving recess.

Reid is aiming for final passage before Christmas. The House has already passed its version of the bill.

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It’s simply not true that America is ambivalent about everything when it comes to the Obama health plan.

The day after the Congressional Budget Office (CBO) gave its qualified blessing to the version of health reform produced by Senate Majority Leader Harry Reid, a Quinnipiac University poll of a national cross section of voters reported its latest results.
This poll may not be as famous as some others, but I know the care and professionalism of the people who run it, and one question was particularly interesting to me.

It read: “President Obama has pledged that health insurance reform will not add to our federal budget deficit over the next decade. Do you think that President Obama will be able to keep his promise or do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?”

The answer: Less than one-fifth of the voters — 19 percent of the sample — think he will keep his word. Nine of 10 Republicans and eight of 10 independents said that whatever passes will add to the torrent of red ink. By a margin of four to three, even Democrats agreed this is likely.

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