Thank you to everyone who is joining us to discuss the recently passed health care legislation today and thank you to everyone who submitted questions online via the website and Facebook. As I’ve said many times before, even though the House passed the bill and the President has signed the bill into law, this debate rages on – we’ll talk about your concerns as well as what happens next with this legislation over the next hour.

Let me quickly introduce the experts we joining us today. First, Dr. Bob Moffit, the Health Policy Center Director at the Heritage Foundation joins us from Washington, D.C. Robert Moffit has been a veteran of Washington policymaking for more than 25 years, he has dedicated his entire career to health care policy. A former senior official at the U.S. Department of Health and Human Services and the Office of Personnel Management during the Reagan administration, Moffit specializes in Medicare reform, health insurance, and other health policy issues. He has strong opinions on “Obamacare” and I look forward to his insights.



We also have Dr. Charles Willey joining the discussion. Dr. Willey has been successfully practicing general internal medicine in Missouri and Illinois for 25 years, and lives with the American health care dilemma on a daily basis. He not only diagnoses and treats individual patients, but also diagnoses and treats the health care system as well. He was the founding CEO of a thriving 70- physician medical group. During his thirteen years as CEO, he directed implementation of their electronic records system in 1998 and invention of their own evidence-based, electronic prescription writer in 2001. In 2003, he guided the group to form what is one of the most efficient patient-centered and physician-friendly health plans in the country. Dr. Willey knows that free market solutions in health care reform exist and he is extremely concerned about greater government intervention in health care.



Between Dr. Moffit and Dr. Willey, we have an outstanding panel to answer your questions.



We’ll kick things off with the first question that was submitted online by Emily. She asks a good question: “How can this bill possibly reduce the debt?”

Jim Talent and Dr. Moffit are responding to Emily’s question and then we’ll start taking questions from those of you who are logged in now.

Emily,



It won’t reduce the debt. The claim that the law pays for itself is patently false — deceptive even by Washington standards — because it assumes Congress will make certain Medicare cuts that will never happen. No one in Washington would bet ten cents of their own money on the proposition that this bill will pay for itself.



More fundamentally, the federal government is broke and bleeding red ink. It borrowed 200 billion dollars last MONTH. Long before the “benefit” in this bill cuts in, the government will be scrambling just to make its interest payments. I doubt the benefit will ever be paid. I have a column on this subject today in National Review Online.

It can’t, and it won’t. The Senate bill creates a brand new entitlement, and expands Medicaid dramatically. The true cost of the bill is $2.5 trillion when the benefits and the revenues are properly combined togather, not $1 trillion as advertized by the Administration.

To be more specific: Medicare spending will be cut under the bill on one hand; but explode through continued maintenance of current law on Medicare physician spending – a $371 bbillion ten year cost. The medicare savings, close to 500 billion over ten years depends on Congress maintaining the spending reductions in the medicare program. They could do that; but it would be a reversal of all experience. The Senate bill also creates a new longterm care entitlement. CBO says that the first ten years will result in $70 billion in premiums collected (that’s part of the $138 billion deficit reduction that the Administration claims), but the benefits will be paid out later and that will dramatically outpace the premiums. So, you can believe that this will reduce the deficit. But in the face of the evidence, it would require a powerful act of faith.

Thanks Dr. Moffit. We’ll take a question from Ann.

Thanks for joining us today Ann. Sen. Talent is responding now.

Anne, thanks for logging in. This law is very bad. It’s unworkable from a number of perspectives. For example, the bill sets up a new subsidy system — an entirely new program for the uninsured, but doesn’t consider how that program will interact with Medicaid. Medicaid is partially paid for by the States; the new subsidy is entirely federal. The incentive will be for the States to try to dump their Medicaid populations on the federal government. Brilliant.

Our next question comes from Dr. Steve Buckles.

Dr. Buckles, you get the gold star for asking a question that Bob Moffitt can’t answer. He’s not sure. But we can find out.

We’ll get a comment from Dr. Moffit and then we’ll take another question from Mike Clynch.

I would have to go back and check the provisions of this monster. But to be honest, whatever the provisions are, one thing is indisputable: large numbers of physicians, regardless of the formal endoresement of the AMA, have registered their opposition to the bill. More recently, the New England Journal of Medicine indicated that many physicians would cut back their practice if they have to operate under the terms of this bill.

John, I’ve gotten a lot of Constitutional questions since the bill passed. I wish I was a good enough Constitutional lawyer to answer them with any certainty. I’m sure we”ll read a lot more in days to come. We should in any event continue working through the political and legislative processes for relief. There is a long way to go on this issue. There are no permanent victories or defeats in Washington.

Dr. Moffit is responding to your question Mike. We’ve got a lot questions in the que and we’re working through all of them.

The costs are very real and significant. The savings are illusory. You would, as I said earlier, have to believe certain things to be true to believe that the claimed savings are real. And adults don’t believe these things, like for example, the ten year savings from Medicare cuts that are said to both enhance the Medicare solvency and at the same time finance the expansion of a new government health care entitlement. As for the states, the bill is going to set up a series of Constitutional challenges, including the flashpoint of state versus federal authority over the erection of federally designed state health insurance exchanges. States will not be subject to penalties, as far as I can see. But their will be subject to federal intervention in areas where federal rule has never before reached.

Our next question is from John, Sen. Talent already responded to your question above.

To Dr. Buckles Question: Whether there are incentives for new primary care or not the payment program for primary care now is very much broken. Medicare has beeen so underfunding the PCP’s and the five health plans left follow Medicare’s lead that they (Medicare) have all but destroyed the profession. The only survival mode in the curent era is better pay from other than Medicare. This bill will put so much cost pressure on the Health Plans they will all drop to or even below Medicare and put the profession out of its misery. Incent PCP’s if they will, they will only be entering a dead end if this bill survives.

Dr. Moffit is adding his two cents on the Constitution question. Then we’ll take another question.

In 1994, the Congressional Budget Office examined the issue of a Congressional imposition of an individual mandate to purchase of health insurance. The CBO said, after an exhaustive search of the question, that there is no precedent for Congress doing any such thing. So, there is no case law that the United states Supreme Court can point to in making any decision on this. They will have to look at the cold, black and white text of Article I, Section 8 of the Constitution, and there , they will find no such congressional power. John you are correct in citing the champions of this idea in attempting to rely upon the Commerce Clause. But the right of Congress to regulate interstate commerce is logically distinct from the power to force individuals to engage in commerce. I think, on the face of it, the federal mandate is unconstitutional. But I would not predict what the Supreme Copurt will do. We are certain of one thing: this is going to the highest court in the land. Bet on it.

Our next question is from Jason on student loan provisions. Sen. Talent is working on a response. We’ve got lots of great questions coming in – our experts are typing as fast as they can.

Jason, thanks for the student loan question. The Democratic leadership is taking the student loan program inside the government — they’re going to have the government do the lending — because they think that will generate money for the government, and since it raises revenue, it can be included in reconciliation even though it doesn’t deal with health care. That’s the theory, anyway.



Substantive point is this. They are scrambling for revenue to try to cover the costs of this bill; everyone knows that very soon the falseness of their projections will be exposed. Keep in mind that EVEN WITHOUT THIS BILL the government is hopelessly in debt. They are borrowing as much in a month as the government used to borrow in a year. Now, the credit ratings services have already indicated that they will lower the government’s credit rating unless Congress starts cutting spending. Under the circumstances, how will it be possible to pay this additional huge new cost when the bill is fully implemented? Within a few years at most, the federal government will be where California is now. What if California announced it was going to begin some enormous new expenditure? It would be a bad joke.

We’ll take a question from John Malone next.

John Malone — we’re holding a lot of feet to the fire with town halls like this. Hope they’re feeling the heat.

Our next question is on innovation and technology. Dr. Charles Willey will respond.

Jason, Innovation doesn’t lower cost in health care because the consumers of the technology don’t have to pay enough of the bill to have concern; the bills are paid by the “third party” and doctors and hospitals are able to pass the cost on and sometimes get a margin. There is no market pressure on the decision. If the technology catches on then the lawyers get involved to bring suit if the technology is not used so the doctors and hospitals get paid a little to use the technology and get sued if they don’t. Meanwhile the patient thinks they need it so the pressures are massive to bring the technology out at very high charge. Congresss gets in and “approves the technology and sets high fees for it creating entitlement.” Understand this is whether the technology is really evidence proven tobe useful or not – and often is not useful. There are ways to create “a market’ in health care but this bill goes backward in this regard. For example they have curtailed Health Savings Accounts and would have preferred to kill them.

John, one other point about holding the President’s feet to the fire. The President said he would not sign the bill if it increased the deficit. Now, it will soon become clear that the law WILL be in deficit, because Congress will not make some of the Medicare cuts they are projecting. At that point, we should all ask the President whether he will support suspending implementation of the law, since his own numbers will show that it will produce a deficit, and since he himself said that he did not want the bill if it was not paid for.

We’ll take another question – this one comes from Tracy. Dr. Moffit is responding.

The impacts on small businesses are tremendous. Tracy has asked a very important question. Dr. Moffit is working on a response.

Tracy, small businesses will be greatly impacted by this bill. Even though the bill provides for a small business tax credit to help employers buy insurance, the insurance itself is going to be federally designed coverage and small businesses are not going to be able to determine for themselves if they want to purchase a cheaper plan. This is going to be a hassle for small business owners. The tax credit will only be available to very small firms, those with ten employees or less. Larger firms with 11 to 25 employees will get a reduced credit. Any firm that is larger than 25 employees will get no credit at all. Moreover, the size of the tax credit is reduced as the average wage of the employees increases. And, to top it off, the small busines tax credit is only available for 5 years.

At the same time, beginning in 2011, small busineses will be faced with an annual health insurance tax. The tax will not fall on self-insured health plans, such as large business plans and union plans. The tax will bring in an estimated $2 billion in revenues oin 2011, and will increase to an annual tax take of $9 billion in 2014.

I should note, in closing , that one of the biggest features of this bill is the employer mandate. The firm must offer the government approved health insurance or pay a tax penalty. It kicks in for all firms that have more than 50 full time employees. The penalty is to be assessed at $750 per employee.

Our next question from Rusty Kahrs – the Presiding Commissioner of Pettis County. Thanks for joining us today Rusty. You’ve raised a good question. You’ll get response from a few of our experts.

Rusty, the bill’s small business mandate only covers full time employees but you better be careful to find out what they mean by that. Offhand, I don’t know. And this points out concretely why the bill is a job killer. It creates tremendous uncertainty in workplaces around the country. Now, you and I know that small business people don’t have the time or money to research every aspect of the bill that might affect them. So the tendency will be for them to freeze their decisions, including hiring, until they can be sure of the impact. That is already happening because of the government’s actions in so many other areas — the incredible spending, the proposed taxes, the financial services legislation, cap and trade — the list goes on and on. I wrote about this for the Springfield News Leader some time ago. You can see the article on the website.

Jason asks a good question – that’s on the minds of many. We’ll respond to him next.

Jason We have all been way too passive in our government and this is what we get for it. Get involved, read both sides and find candidates that will support your view and aggressively help them get elected. Money is very important as elections are very expensive but the candidates need throngs of people to talk them up, spread their word and get people to the voting booth. We have a very important Congressional race in the St. Louis are that could make a profound difference.

Our next question comes from Tracy.

Tracy Some time ago I would wonder that and dismiss it. Now I am not so certain. They are, at a minimum, so self absorbed in their lust for power and fame that they are blinded to the real crux of their actions.

Rusty, it depends on what kind of contracting firm you have. If you are a small construction company, the employer mandate is applied differently. A construction firm with 5 or fewer employees is exempt from the employer mandate. Otherwise, the small construction firms are subject to it. Worse, the language of the bill does not define clearly what is or is not a construction firm; that will be left to the bureaucrats. If you think this is insane, you are correct.

Sen. Talent is responding to Tracy and then we’ll move on to other questions.

Tracy, read my article today on National Review Online. I begin by saying that the most dangerous mistakes occur when leaders allow their ideology to trump reality. They want something so much that they refuse to accept any facts that keep them from getting it. That is happening here. Now, I never speculate as to peoples’ motives. But I have said that if the leaders of the federal government had wanted to attack the American economy, they would have done what they are doing now — doubling the national debt, raising taxes, threatening to raise energy prices, passing new regualtions that no one can understand, casting huge sections of the economy into uncertainty.

Our next question comes from Dr. Buckles. Dr. Willey is drafting a response now.

Dr. Buckles, As a 25 year physician and a leader in medical business having started a physician lead Medicare Advantage plan I can tell you for certain the big health plans look for any excuse and or leverage they can to pay you less. This bill with its benefit mandates, its prohibitrions to tailoring benefit plans to encourage healthy behavior and its mandate to accept anyone who shows up with any illness their cost pressures wil be tremendous. They have no real ability to control cost as they are disinterested and distant bureaucrats at best. They do know how to decrease what they pay for various units of service and since they have preserved their Antitrust Exemption by bribing Ben Nelson with the Cornhusker Kickback they have the leverage to pay what they want. As noted above this is why it will drive doctors out of business or to seek cover by selling their practices to hospitals. Unfortunately hospitals are the most inefficient sector in the industry and that only will allow the cost problem to worsen over time.

Thank you. Our next question comes from Lisa.

Lisa: the Senate bill does provide an interstate market for one set of health insurance companies; the companies that are sponsored directly by the federal government and administered by the United States Office of Personnel Management (OPM), the federal agency that runs the federal civil service. These are the only plans that would be allowed to compete nationwide, across state lines, and they would compete against all other private health insurance companies in the federally-designed state health insurance exchanges. While the bill does not provide for the “robust” public option that liberals wanted in the House bill, it does give OPM extraordinary power to set premiums, profit margins and benefits of these government-sponsored health plans. What this means is that the federal officials could very easily tilt the playing field to the advantage of their favored, sponsored health plans. Many analysts, myself included, believe that this is nothing more than a stalking horse for a “public option” and eventually a government monopoly, or single payer system.

We’ll take another question – this one is from Tripp. Sen. Talent is responding.

Tripp,



Yours is a fair question. It would be easier for me to give this bill a chance if the downside risk wasn’t so high. The cost — the effect on Medicare (a program tens of millions of vulnerable people depend on) — the very real danger of restricting choices and undermining quality in the private market — there are so many aspects of the bill that are plainly problematical and hugely dangerous if they go wrong. And there are a number of alternatives that would at least reduce the number of uninsured without any risk at all. Association Health Plans are an example. As for the individual mandate, again there are ways far to overcome the free rider problem without being so coercive. And really the reason they needed the individual mandate is because they eliminated preexisting conditions clauses even for people who are buying insurance for the first time. If someone has never bought insurance, and you say they can buy it whenever they want and can’t be excluded for a preexisting condition, there is an obvious danger that they will wait to buy until they get sick. I think that’s why they included the mandate. Far better to eliminate preexisting conditions exclusions for people who have insurance and want to switch, and then seek other, less costly and less intrusive and less dangerous means of reaching the uninsured..



I should say that I pushed hard for Association Health Plans while I was in the Senate. I got it onto the Senate floor after it had passed the House. It was filibustered by the same people who now say it is so important to act and claim that people like me have no plausible alternatives.

We’ve had great participation today, I’m sorry that we couldn’t get to everyone. Our very last question comes from Shehzad Kahn. Dr. Moffit is responding and then we’ll go to closing comments.

Shehzad, there is one simple reason why there is such intense negative publicity about the legislation. Despite House Speaker Nancy Pelosi’s famous remark that it was necessary to pass the legislation because then we would find out what was in it, the truth is that we do know what is in it. In fact, the Senate bill, and it predecessors have been available for public inspection on the internet for months. People have read it and they don’t like what they are reading. That is why there was such intense popular blowback against the legislation during the 2009 August Town Hall Meetings. Moreover, for months, in poll after poll, in popular protests, in town hall meetings and special elections, voters have made it clear that, though they supported health care reform, they did not support the congressional legislation on the table. Washington’s official response, time and again, was that cavalier and often contemptuous dismissal of the legitimate concerns of the vast majority of the American people. It was not just the substance of the bill, but its process that has disgusted millions of Americans, particularly the special interest deals for certain companies and states and favored constituents at the expense of the taxpayers. Yes, it has happened before. But no, it has never been so blatant, and it has never happened on a matter that is this consequential; for this affects all 300 million Americans. And some of the damage could be permanent.

Meanwhile, just like the glitch in the pre-existing condition provisions, expect more bad news to come out routinely, once the implementation of this monster begins.

No, the negative publicity is not going to go away.

Everyone — great participation, great forum. Thanks so much for your questions.

I am hopeful that this economically and constitutionally awful bill will motivate every tax paying citizen into participation to find the truth and agressively promote candidates who will govern in selfless support of the truth.



In heath care we need a few things such as more competition, creation of markets, more participation in costs for the consumer, more accountability to quality cost and serviice by the clinicians and hospitals. All these could be accomplished with a very small set of changes that have been proffered by oponents of this bill for a long time. More on this in future sessions.

Thank you for joining us. You can read the transcript on our website: www.FreedomSolutions.org.

The health care debate is not over; it is just entering a new phase. It will be a long and contentious. The implementation of this bill will take years, and so will the continuing education of the American electorate. They will learn, day in and day out, what Congress says it is trying to do for them, and they will also learn what Congress is trying to do to them. Americans value their personal freedom; we are not going to be pushed around by a tone deaf government that is supposed to be our servant, and acts like a master.