It could all come down to abortion. Health-care reform hangs in the balance. Nancy Pelosi, the speaker of the House of Representatives, is desperately trying to round up the last few votes. If the House passes a bill the Senate passed in December, it can then be tweaked through the “reconciliation” process and sent to President Barack Obama for signature. But every single House Republican is likely to vote no, so Ms Pelosi needs 216 Democratic votes (out of 253) for a majority. This is proving surprisingly hard. Among the holdouts are a dozen or so pro-life Democrats, several of them Midwestern Catholics, who object to the abortion provisions in the Senate bill.

Thanks to the Supreme Court, abortion has been legally protected since 1973 and neither Congress nor any state has the power to ban it. But a law called the Hyde amendment bars federal funding for abortion, except in cases of rape or incest, or to save the life of the mother. The question now is whether Obamacare will use taxpayers’ money to subsidise abortion more widely. Mr Obama insists that it will not. Under his plan, many individuals and small businesses will buy subsidised health insurance through state-sponsored exchanges. Under the Senate bill, they would only be able to obtain abortion coverage through these exchanges if they paid for it with a separate, unsubsidised, cheque. Thus, federal dollars would be kept out of abortion clinics, say the bill’s supporters. But many pro-lifers are not convinced. So the version of the health bill that was passed by the House would have required those who wanted abortion coverage to buy a completely separate insurance policy. The Democrat who wrote the House abortion provision, Bart Stupak, says he won’t back the Senate bill. Several other pro-life Democrats may also balk.

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It could all come down to abortion. Health-care reform hangs in the balance. Nancy Pelosi, the speaker of the House of Representatives, is desperately trying to round up the last few votes. If the House passes a bill the Senate passed in December, it can then be tweaked through the “reconciliation” process and sent to President Barack Obama for signature. But every single House Republican is likely to vote no, so Ms Pelosi needs 216 Democratic votes (out of 253) for a majority. This is proving surprisingly hard. Among the holdouts are a dozen or so pro-life Democrats, several of them Midwestern Catholics, who object to the abortion provisions in the Senate bill.

Thanks to the Supreme Court, abortion has been legally protected since 1973 and neither Congress nor any state has the power to ban it. But a law called the Hyde amendment bars federal funding for abortion, except in cases of rape or incest, or to save the life of the mother. The question now is whether Obamacare will use taxpayers’ money to subsidise abortion more widely. Mr Obama insists that it will not. Under his plan, many individuals and small businesses will buy subsidised health insurance through state-sponsored exchanges. Under the Senate bill, they would only be able to obtain abortion coverage through these exchanges if they paid for it with a separate, unsubsidised, cheque. Thus, federal dollars would be kept out of abortion clinics, say the bill’s supporters. But many pro-lifers are not convinced. So the version of the health bill that was passed by the House would have required those who wanted abortion coverage to buy a completely separate insurance policy. The Democrat who wrote the House abortion provision, Bart Stupak, says he won’t back the Senate bill. Several other pro-life Democrats may also balk.

Read it all.

The survey shows astonishing intensity and sharp opposition to reform, far more than national polls reflect. For 82% of those surveyed, the heath-care bill is either the top or one of the top three issues for deciding whom to support for Congress next November. (That number goes to 88% among independent women.) Sixty percent want Congress to start from scratch on a bipartisan health-care reform proposal or stop working on it this year. Majorities say the legislation will make them and their loved ones (53%), the economy (54%) and the U.S. health-care system (55%) worse off””quite the trifecta.

Seven in 10 would vote against a House member who votes for the Senate health-care bill with its special interest provisions. That includes 45% of self-identified Democrats, 72% of independents and 88% of Republicans. Three in four disagree that the federal government should mandate that everyone buy a government-approved insurance plan (64% strongly so), and 81% say any reform should focus first on reducing costs. Three quarters agree that Americans have the right to choose not to participate in any health-care system or plan without a penalty or fine.

That translates into specific concerns with the Senate legislation””and none of these objections would be addressed by the proposed fixes. Over 70%””indeed in several districts over 80%””of respondents, across party lines, said that the following information made them less supportive: the bill mandates that individuals purchase insurance or face penalties; it cuts Medicare Advantage; it will force potentially millions to lose existing coverage; it will cost an estimated $2.3 trillion over its first 10 years; and it will grant unprecedented new powers to the Health and Human Services secretary.

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The survey shows astonishing intensity and sharp opposition to reform, far more than national polls reflect. For 82% of those surveyed, the heath-care bill is either the top or one of the top three issues for deciding whom to support for Congress next November. (That number goes to 88% among independent women.) Sixty percent want Congress to start from scratch on a bipartisan health-care reform proposal or stop working on it this year. Majorities say the legislation will make them and their loved ones (53%), the economy (54%) and the U.S. health-care system (55%) worse off””quite the trifecta.

Seven in 10 would vote against a House member who votes for the Senate health-care bill with its special interest provisions. That includes 45% of self-identified Democrats, 72% of independents and 88% of Republicans. Three in four disagree that the federal government should mandate that everyone buy a government-approved insurance plan (64% strongly so), and 81% say any reform should focus first on reducing costs. Three quarters agree that Americans have the right to choose not to participate in any health-care system or plan without a penalty or fine.

That translates into specific concerns with the Senate legislation””and none of these objections would be addressed by the proposed fixes. Over 70%””indeed in several districts over 80%””of respondents, across party lines, said that the following information made them less supportive: the bill mandates that individuals purchase insurance or face penalties; it cuts Medicare Advantage; it will force potentially millions to lose existing coverage; it will cost an estimated $2.3 trillion over its first 10 years; and it will grant unprecedented new powers to the Health and Human Services secretary.

Read it all.

Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggests that many Americans are being overtreated. Maybe even President Barack Obama, champion of an overhaul and cost-cutting of the health care system.

Is it doctors practicing defensive medicine? Or are patients so accustomed to a culture of medical technology that they insist on extensive tests and treatments?

A combination of both is at work, but new evidence and updated guidelines are recommending a step back and more thorough doctor-patient talks about risks and benefits of screening tests.

Americans, including the commander in chief, need to realize that “more care is not necessarily better care,” wrote cardiologist Rita Redberg, editor of Archives of Internal Medicine. She was commenting on Obama’s recent physical.

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Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggests that many Americans are being overtreated. Maybe even President Barack Obama, champion of an overhaul and cost-cutting of the health care system.

Is it doctors practicing defensive medicine? Or are patients so accustomed to a culture of medical technology that they insist on extensive tests and treatments?

A combination of both is at work, but new evidence and updated guidelines are recommending a step back and more thorough doctor-patient talks about risks and benefits of screening tests.

Americans, including the commander in chief, need to realize that “more care is not necessarily better care,” wrote cardiologist Rita Redberg, editor of Archives of Internal Medicine. She was commenting on Obama’s recent physical.

Read it all.

The Democrats have not been completely irresponsible. It’s just that as the health fight has gone on, their passion for coverage has swamped their less visceral commitment to reducing debt. The result is a bill that is fundamentally imbalanced.

This past year, we’ve seen how hard it is to even pass legislation that expands benefits. To actually reduce benefits and raise taxes, we’re going to need legislators who wake up in the morning passionate about fiscal sanity. The ones we have now are just making things worse.

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They see themselves as crusaders for human rights–protectors of the innocent, the voiceless, and the powerless. After years of enduring the slings and arrows of opposition, these activists are finally in the power seat. They are among the most important voices on a crucial political question: will abortion finally scuttle health-care reform?

They are America’s Roman Catholic bishops.

It goes without saying that the Catholic hierarchy has always been pro-life. Nevertheless, the new prominence of this ancient fraternity is somewhat surprising. For one thing, the American public hardly regards the institutional Catholic Church as sacrosanct. Thanks to continuing sex scandals, many Americans–even American Catholics–roll their eyes on the subject of the Catholic hierarchy’s ability to stand as a moral example.

Also, American Catholics reflect the voting public at large, which is to say that they are–and have long been–pro-choice. According to a 1999 poll, more than half of American Catholics believe you can be a good Catholic and disregard the bishops’ teachings on abortion.

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A US Catholic group on Friday accused Roman Catholic bishops of meddling in health care reforms by making backroom deals to ensure the bill does not allow funding for abortion.

“Religious and ethical concerns can legitimately inform public policy, but the bishops have overstepped the mark,” said Jon O’Brien, president of Catholics for Choice.

“Interference by the US Catholic bishops in health care reform does not help women. The bishops should not be allowed to use health care reform to restrict women’s access to safe and legal reproductive healthcare services,” he said.

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A dozen House of Representatives Democrats opposed to abortion are willing to kill President Barack Obama’s healthcare reform plan unless it satisfies their demand for language barring the procedure, Representative Bart Stupak said on Thursday.

“Yes. We’re prepared to take responsibility,” Stupak said on ABC’s “Good Morning America” when asked if he and his 11 Democratic allies were willing to accept the consequences for bringing down healthcare reform over abortion.

“Let’s face it. I want to see healthcare. But we’re not going to bypass the principles of belief that we feel strongly about,” he said.

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Of the remaining issues with the potential to bring down the entire health overhaul effort, the one that lawmakers fear most is abortion.

Abortion is such a politically hazardous issue that sponsors of both the House and Senate health bills have said their object was to maintain the status quo. “It is not the intention of this bill to, as the speaker has said, to change the policy that has been in place for three decades,” said House Majority Leader Steny Hoyer, (D-MD), on Tuesday. Hoyer was referring to what is known as the Hyde Amendment. It has barred federal funds from being used to pay for abortions since 1977.

But keeping the health bills abortion-neutral has proved impossible. And now the abortion language in the Senate-passed bill in particular could threaten the strategy Democratic leaders hope to use to get a final measure to President Obama’s desk for a signature.

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Read it all (and follow the link to the original NPR story).

As always with the Obama compromise offers, this offer seemed to be both sincere and insincere. Embodying the core contradiction of the Obama presidency, the president seemed both to want to craft a new package and also to defend the strictly Democratic approach. I think he’s a bipartisan man stuck in a partisan town, but maybe he’s an iron partisan fist in a velvet postpartisan glove.

Fourth, you got to see how confident Republicans are. Obama’s compromise offer is one the Republicans can happily refuse. In their eyes, he is saying: If you don’t make some concessions now, I’m going to punch myself in the face. If you don’t embrace parts of my bill, I will waste the next three months trying to push an unpopular measure through an ugly reconciliation process that will probably lead to failure anyway.

Fifth, you got to see at least one area of bipartisan agreement. Neither side was willing to be specific about how to cut costs and raise revenue. The Republicans continued to demagogue efforts to restrain Medicare spending. The Democrats (and the Republicans) conveniently neglected to mention the fact that they had just gutted the long-term revenue source for their entire package, the excise tax on high-cost insurance plans. That tax was diluted and postponed until 2018. There is no way that members of a Congress eight years from now are going to accede to a $1 trillion tax increase to pay for a measure that the 2010 Congress wasn’t brave enough to pay for itself.

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The future of President Obama’s health care overhaul now rests largely with two blocs of swing Democrats in the House of Representatives ”” abortion opponents and fiscal conservatives ”” whose indecision signals the difficulties Speaker Nancy Pelosi faces in securing the votes necessary to pass the bill.

With Republicans unified in their opposition, Democrats are drafting plans to try on their own to pass a bill based on one Mr. Obama unveiled before his bipartisan health forum last week. His measure hews closely to the one passed by the Senate in December, but differs markedly from the one passed by the House.

That leaves Ms. Pelosi in the tough spot of trying to keep wavering members of her caucus on board, while persuading some who voted no to switch their votes to yes ”” all at a time when Democrats are worried about their prospects for re-election.

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Medicare payments to doctors will fall by 21 percent starting on Monday, but Congress may soon act to block the cut. It’s the latest reminder of a chronic problem for the federal government: figuring out how to pay doctors who treat Medicare patients.

The story goes all the way back to 1965, when the federal government was about to launch Medicare ”” the health-insurance plan for the elderly.

The idea of a government-run health-insurance plan made doctors nervous, and Lyndon Johnson’s administration was worried that doctors wouldn’t take Medicare patients. So Joseph Califano, Johnson’s adviser for domestic affairs, made what seemed like a small concession: Medicare would pay doctors whatever they thought was reasonable.

That worked out well for doctors. They had been providing lots of free care for old people, and they started getting paid whatever they asked for, as long as it wasn’t wildly out of line with what others were charging….

Read or listen to it all.

“It is time to set aside partisan divisions and special interest pressures to find ways to enact genuine reform. We encourage the administration and Congress to work in a bipartisan manner marked by political courage, vision and leadership,” the bishops said [in a letter sent to Senate Majority Leader Harry Reid this week].

“As pastors and teachers,” the letter continued, “we believe genuine health care reform must protect human life and dignity from conception to natural death, not threaten them, especially for the voiceless and vulnerable. We believe health care legislation must respect the consciences of providers, taxpayers, purchasers of insurance and others, not violate them.

“We believe universal coverage should be truly universal and should not be denied 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.”

“We hope and pray,” the letter added, “that the Congress and the country will come together around genuine health care reform that protects the life, dignity, consciences and health of all.”

Read it all.

The nationally televised session stretched over more than seven hours and, to no one’s surprise, yielded no new agreement, although lawmakers strove to maintain an atmosphere of decorum and cooperation””even as they aired their warring views.

The president tried to project the sense he was searching for a middle ground. “We might surprise ourselves and find out that we agree more than we disagree,” Mr. Obama said at the start, before adding what seemed like a judgment rooted more in experience than hope: “It may turn out, on the other hand, there’s just too big of a gulf.”

Republicans, only emphasizing the gulf, said they’d like to wipe out the last 13 months from the record and start over. “This is a car that can’t be recalled and fixed,” Sen. Lamar Alexander (R., Tenn.) said.

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You may not have noticed, but today is a very important day for US politics, world economic prospects and even for the global balance of power between Western democracy and benign dictatorship along Chinese lines. Why? Because today marks either the beginning of the end of Barack Obama’ presidency, or the end of the beginning.

At 10am US Eastern Time, he will host an all-day “summit”, broadcast live on nationwide TV, with his Republican congressional opponents and his wayward Democratic supporters, to try to establish some kind of political consensus on the top priority of his presidency ”” reform of the ruinously expensive US healthcare system. Medicine now absorbs 17 per cent of US national income, double the average in other advanced economies and half as much again as Switzerland, which has the next most expensive healthcare.

If nothing is done to change the US healthcare system, it can be stated with mathematical certainty that the US Government and many leading US companies will be driven into bankruptcy, a fate that befell General Motors and Chrysler largely because of their inability to meet retired workers’ contractually guaranteed medical costs.

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Sen. Chris Dodd, D.-Conn., who will be among the lawmakers participating, worked a rally of supporters on the eve of Thursday’s meeting, scheduled to start at 10 a.m. EST.

“After that meeting, you can either join us or get out of the way,” Dodd said.

Not if Republicans have anything to do with it. Riding a populist backlash against the widening reach of government, they insist that Obama start from scratch, a notion the White House rejects. They’re unified in opposing the Democratic bills passed last year and have pulled back from more ambitious GOP-backed plans that might have provided a foundation for compromise.

With premiums going up by double digits for some consumers, polls show the public wants Congress and the president to deal with spiraling medical costs, shrinking coverage and questionable quality. But Americans are split over the Democratic bills. If Obama and the Democrats can’t get their legislation passed, there may still be a chance for a modest measure this year that smooths the rough edges of the current system but stops well short of coverage for all.

Read it all.

On Monday, the White House made another compromise. On the surface, it seems mundane. The imposition of the excise tax will be delayed until 2018, and the threshold at which the tax kicks in will be raised. In reality, the delay turns the tax into another Washington gimmick. Lord, give me virtue, but not yet.

The odds are high that the excise tax will never actually happen. There is no reason to think that the Congress of 2018 will be any braver than the Congress of today. It will probably get around the pay-go rules or whatever else might apply and it’ll postpone the tax again. The excise tax will turn into another “doc fix.” This is a mythical provision in which doctors are always about to get their reimbursements cut. But somehow they never do because the cuts are always pushed back, year after year.

So we’ve sunk another level in our tawdry tale. The White House, to its enormous credit, has tried to think about the long term. But it has been dragged ever lower into the mire by Congressional special interests that are parochial in the extreme.

This bill may be deficit-neutral on paper. But it has just become a fiscal time bomb. The revenue will never come. Compromises have to be made to keep it (barely) alive. But responsibility ebbs. Politics wins.

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If President Obama’s proposal for federal regulation of health insurance rates becomes law, rates for individual policyholders likely would still climb, experts said Monday, but not by as much as insurers might want.

Roughly half the states have the power to limit or block rate hikes for individual health insurance customers. Initial increases generally get knocked down by state officials, often substantially, based on recent cases.

And holding down rates below the level where insurers could make a fair profit would only drive many out of the market, consultants and analysts said, reducing competition and reducing access ”” the opposite of what the Obama administration has been seeking.

Read it all.

…Mrs. [Angela] Braly says. “We really do have to get at the underlying question of health-care costs.”

That was the core promise of ObamaCare. Overall health costs for people insured by WellPoint increased by 8.9% in 2009 alone, and arresting this climb was the reason so many industry groups, not only the insurers, joined with the White House and Democrats. Nobody thinks the status quo is a success. But as Mrs. Braly notes ruefully, “The nature of health care is very complex, and sometimes the nature of politics is very simple.”

The tragedy, as she sees it, is what “a wasted opportunity” it all turned out to be. “Health-care reform” soon became “health-insurance reform” exclusively. “It was a pivot that was””unfortunate,” she says, “because it is not going to solve the longer-term problem.”

It’s hard to see how WellPoint could be to blame for surging health spending, Mrs. Braly says, when 85 cents out of every premium dollar or more “is paid out in the actual cost of care, doctors, hospitals, suppliers, drugs, devices.” Confiscating the 2009 profits of the entire insurance industry would pay for two days of U.S. health care.

Read it all from this Weekend’s Wall Street Journal.

As President Obama prepares to deliver his first State of the Union address and the future of health care reform hangs in the balance, nationally prominent religious leaders, including eight members of the White House Council for Faith-based and Neighborhood Partnerships, are encouraging him to exercise the full influence of his office to urge Congress to pass comprehensive health reform legislation.

Despite the last week’s political twists and turns on Capitol Hill, the reality for families suffering needlessly due to lack of access to affordable health care has not changed — and the faith community’s commitment to making quality health care affordable for all remains steadfast.

Read it all and check the list of signatories.

Democratic Sen. Chris Dodd said today that Democrats may need to take more than a month off from the health care debate to regroup, saying it is up to President Obama to lead the way.

Dodd is the first congressional Democratic leader to suggest such an extended break, signaling that Democrats’ may be much further from a workable endgame strategy than they have suggested in the days since Republican Scott Brown won the Massachusetts Senate seat and ended the Democrats’ 60-vote majority.

The comments are sure to raise questions about whether Democrats are giving up on reform. A month-long break would almost certainly kill any momentum health reform has left, making it that much harder to pass.

Read it all.

Brown’s victory ”” some called it “the Scott heard round the world” ”” on the eve of the first anniversary of Barack Obama’s Inauguration was an ominous sign for Democrats for the midterm elections ahead and a potentially crippling blow to Obama’s entire agenda. Brown ran explicitly on a promise to be the “41st Senator,” who would give the Republicans the power to block what he called “the trillion-dollar health care bill that is being forced on the American people,” one that will “raise taxes, hurt Medicare, destroy jobs and run our nation deeper into debt.”

That such a message would resonate here was poignant, given that no one had fought harder and longer than Kennedy for universal health care, something that the terminally ill liberal lion had referred to before his death in August as “the cause of my life.” And it was all the more ironic considering that Massachusetts has come closer than any other state to assuring coverage to all of its citizens, thanks to a 2006 law that was championed by a Republican governor, Mitt Romney, who was celebrating onstage with Brown on election night.

Although the rest of the country sees Massachusetts as the bluest of blue states ”” it had not elected a Republican Senator since Richard Nixon was President ”” its political complexion is actually more subtle. Registered Democrats outnumber Republicans 3 to 1, but fully half the state’s voters are registered “unenrolled” ”” not affiliated with any party. And four of its last five governors have been Republicans, albeit ones of a more moderate stripe than that of the national party.

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The majority party normally loses seats in midterm elections, but the Republican resurgence of recent months is more than a conventional midterm rebound. How can a little known Republican run a competitive Senate campaign in Massachusetts? The culprit is the unpopularity of health reform, and it means that Democrats will face even worse problems later this year in less liberal places than Massachusetts.

We have polled voters in 11 states likely to have competitive Senate races in November on how they feel about health reform and how they might vote in November. The interviews were conducted from Jan. 6-11 with 500 registered voters in Arkansas, Colorado, Connecticut, Delaware, Florida, Louisiana, Missouri, Nevada, North Dakota, Ohio and Pennsylvania. The polls were conducted by YouGov using a panel of Internet users selected to be representative of the registered voters in each state.

Health reform is more popular in some of these states than in others. Where it’s popular, Democratic candidates don’t have too much of a problem, but where it’s unpopular””and that includes most states””the Democratic Senate candidates are fighting an uphill battle. Support for health reform varies in these 11 states from a low of 33% in North Dakota to a high of 48% in Nevada. Democrats trail Republicans in six of the states; three are toss-ups; and in two, Democrats have a solid lead.

Read it all from yesterday’s Wall Street Journal.

Watch it all.

As Senate Democrats reconvened Wednesday at the Capitol in the wake of their devastating loss in Massachusetts, they vowed to press ahead toward enacting a health-care bill, possibly with a scaled-back package of provisions that could gain Republican support.

But Democrats cautioned that discussion of such plans is just getting underway. “We’re not going to rush into anything,” said Senate Majority Leader Harry M. Reid (Nev.). “Remember, the bill we passed in the Senate is good for a year. There are many different things that we can do to move forward on health care, but we’re not making any of those decisions now.”

Scott Brown’s victory in a special election Tuesday “changes the math in the Senate,” Reid conceded. But just as Democrats face new pressures to reach across the aisle, he added, GOP senators must be willing to meet halfway.

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With Democrats reeling from the Republican victory in the Massachusetts special Senate election, President Obama on Wednesday signaled that he might be willing to set aside his goal of achieving near-universal health coverage for all Americans in favor of a stripped-down measure with bipartisan support.

“It is very important to look at the substance of this package and for the American people to understand that a lot of the fear-mongering around this bill isn’t true,” Mr. Obama said in an interview on ABC News. “I would advise that we try to move quickly to coalesce around those elements of the package that people agree on.”

He continued: “We know that we need insurance reform, that the health insurance companies are taking advantage of people. We know that we have to have some form of cost containment because if we don’t, then our budgets are going to blow up and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements of, to this bill.”

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Sen. Russ Feingold (D-Wis.) told a local reporter, “It’s probably back to the drawing board on health care, which is unfortunate.” Rep. Bill Delahunt (D-Mass.) told MSNBC this morning he will advise Democratic leaders to scrap the big bill and move small, more popular pieces that can attract Republicans. And Anthony Weiner (D-N.Y.) said his leadership is “whistling past the graveyard” if they think Brown’s win won’t force a rethinking of the health care plan.

Sen. Evan Bayh (D-Ind.), who now might draw a challenge from Rep. Mike Pence (R-Ind.), said the party needs to rethink its entire approach to governing.

Read it all.