A Closer Look at the House Democrats' Health Care Bill

[spursncowboys]

A Closer Look at the House Democrats' Health Care Bill
by the Staff of the Center for Health Policy and the Staff of the Center for Data Analysis

The House of Representatives will soon vote on a massive overhaul of America's $2.4 trillion health care system. This amounts to one-sixth of American gross domestic product (GDP), a sector roughly equal to the size of the entire British economy.

To accomplish this task, House Speaker Nancy Pelosi (D-CA) recently unveiled a 1,990-page House health care bill (H.R. 3962). The latest product, which dwarfs the 1,342-page Clinton health plan of 1993, is the result of the merging of three committee versions of the original House health care proposal (H.R. 3200). Like its massive predecessor, H.R. 3962 contains page after page of highly prescriptive legislation that would centralize power over the health care system in Washington. New bureaucracies and government programs, along with the expansion of existing entitlements and higher taxes, would give federal lawmakers ultimate control over what kind of health insurance Americans carry, where they get it, and how much they pay for it.

Federal Control of Health Care

The new House bill would dramatically increase the role of the federal government in health care. H.R. 3962 creates a new minimum federal standard benefit package that would eventually apply to nearly all health plans. It establishes a new "Health Benefits Advisory Committee," housed within the Department of Health and Human Services (HHS), that would make detailed recommendations, which the HHS Secretary would then impose on all private insurers and employers through regulation.

All existing employment-based health insurance coverage would have to be modified or replaced to meet the new federal benefit package by 2018. Starting in 2013, all new individual or employment-based coverage would have to conform to the federal minimum benefit rules.


The bill also limits age rating of premiums to no more than a two-to-one difference between the highest and lowest premium costs. Thus, a 64-year-old could not be charged more than twice the premium of an 18-year-old. However, there is about a five-to-one natural difference in the consumption of medical care between a 64-year-old and an 18-year-old. Thus, the effect will be to significantly increase the cost of health insurance for young adults in their 20s and 30s.


Finally, under H.R. 3962, HHS is given extremely vague orders to "establish a process for the annual review of increases in premiums for health insurance coverage" and further specifies that "the process shall require health insurers to submit a justification for any premium increases prior to implementation of the increase." This is an open invitation to politicized federal insurance rate regulation that could result in insurers being prevented from raising rates to cover increased claims costs, potentially forcing insurers into insolvency and leaving policyholders liable for provider claims.

Creating an Uneven Playing Field


The new bill contains a slightly revised version of the "public option," a new government-run health plan designed to compete against private health plans in a "national health exchange." In year one, employers with 25 employees or fewer would become eligible for the exchange. In year two, employers with 50 employees or fewer would become eligible, and in year three, employers with at least 100 employees would become eligible. Starting that year, the "Health Choices Commissioner" would be able to expand employer participation as appropriate, "with the goal of allowing all employers access to the exchange."


To attract moderate Democrats in the House who are concerned about the impact of adopting low Medicare reimbursement to physicians and hospitals, Speaker Pelosi modified the bill to have the government "negotiate" rates with medical providers. The Congressional Budget Office (CBO) predicts that if the public plan were to truly negotiate reimbursement rates, the public plan would actually cost more than private plans. Since the intent of the public plan is to drive down costs, the reality is that "negotiated" rates today will lead to price controls tomorrow. Look no further than the history of Medicare. Medicare was initially designed to pay private rates, but the program now has a complex formula for administered pricing combined with a rigid system of price controls.


In the end, by opening the exchange to more Americans and creating an uneven playing field between the public plan and private plans, more Americans will enroll in the public plan. As enrollment in the public plan soars, private insurers will be unable to keep up with the artificially low cost of the government plan. Worse yet, the public plan's reimbursement rates would not cover the cost of care, forcing many hospitals and physicians to close their doors.

Expanding Medicaid Dependence


The Speaker's mammoth health legislation includes the largest Medicaid expansion in history, adding as many as 18 million people to the program. Not only will childless adults become eligible for Medicaid for the first time in the history of the program, but approximately 5 million children who have been served under the successful and popular State Children's Health Insurance Program (SCHIP) will also be transferred into Medicaid.


For more than 10 years, states have decided whether to run their SCHIP programs as a separate non-Medicaid program or as a Medicaid expansion. A separate SCHIP program provides states with greater flexibility in managing benefits, service delivery, and eligibility.


Under the current SCHIP program, there is no individual entitlement, and eligibility is reserved only for those who were previously uninsured. States had the flexibility to impose a waiting period to protect against families dropping their private coverage. All of this will be overridden under the new legislation. State SCHIP programs will be dismantled.


Lastly, the Centers for Medicare and Medicaid Services, in an analysis of H.R. 3200--where the Medicaid expansion was to 133 percent of the federal poverty level (FPL), not the proposed 150 percent FPL in the current bill--shows that Medicaid spending would surpass Medicare spending and grow nearly twice as fast as spending in employer sponsored insurance. By 2019, one in five health care dollars will be spent through Medicaid. More than half of all health spending would flow through Medicare, Medicaid, or other public spending by 2019.[1] (http://www.heritage.org/Research/HealthCare/wm2648.cfm#_ftn1)


New Taxpayer-Funded Subsidies


The House bill also extends generous taxpayer-funded subsidies to individuals and families with incomes up to 400 percent FPL (roughly $90,000 for a family of four) for coverage purchased through the new health exchange. In addition to premium subsidies, individuals and families with incomes below 350 percent FPL (roughly $80,000) could also receive cost-sharing subsidies to cover a portion of their out-of-pocket costs. Premium subsidies would be tied to lowest-cost "basic" plans in the exchange, and for the first two years, those receiving a subsidy could only purchase the basic plan, regardless of their desire to pay for additional services.

CBO estimates an average premium of $15,000 for a "basic" family plan with cost-sharing of about $5,500. Based on the CBO analysis, a family just under 300 percent FPL (roughly $70,000) could receive up to $10,500 in federal subsidies ($8,700 for the premium and $1,800 for cost-sharing) to cover more than half of its health care costs.


Although some Americans would receive lavish subsidies, the bill creates huge inequities. For instance, with the exception of a hardship exemption of 12 percent of income, the bill would exclude those individuals with access to employer coverage from receiving a subsidy. Therefore, a similarly situated family at 300 percent FPL (roughly $70,000) struggling to pay for their current employer-sponsored plan would generally not receive assistance at all. Neither would a family at 200 percent FPL (roughly $45,000) with employer-based coverage.


The bill also excludes individuals from receiving the subsidies if they are eligible for Medicaid. Incidentally, the bill would freeze existing Medicaid eligibility levels at the state level to prevent states from lowering their Medicaid programs in favor of the federal subsidy. Without financial assistance, the only rational option for these low-income Americans is to join Medicaid, a substandard health care program. This situation would perpetuate the two-tiered health care system that permanently segregates lower-income Americans, as well as those often classified as poor, from the rest of America.

New Mandates on Individuals and Employers


The new House bill, like its predecessor, increases the financial burden on low- and moderate-income Americans through individual and employer mandates.


The bill requires the uninsured to pay an extra income tax--2.5 percent of adjusted gross income above the filing threshold, capped at the national average premium. The tax would also apply to persons who have health insurance that does not qualify as "acceptable" coverage under the new federal standards. Those paying this tax would remain uninsured. However, low- and moderate-income individuals and families would have to pay higher premiums than they would otherwise pay for health coverage to avoid the tax. Those premiums would increase rapidly with income, amounting to an additional tax on those with incomes below four times the FPL (about $88,000 per year for a family of four) ranging from 1.5 percent to 12 percent. This tax on low- and moderate-income Americans would be in addition to a "surtax" of up to 5.4 percent on higher incomes.


The bill also imposes a new 8 percent payroll tax on employers who do not cover specified percentages of their employees' health insurance. Employers would have to get the money to pay the tax somewhere, and much of it would come from cutting wages or other benefits. This tax would also not go to pay for any coverage; the bill specifically says that the tax paid by the employer "shall not be applied against the premium of the employee." Furthermore, since the amount of this tax would be lower than the cost of providing health insurance (especially for low-income workers), many employers would opt to pay the tax and not offer health plans, disrupting their employees' existing coverage.


Furthermore, health plans would have to meet new requirements defined by the new Health Choices Commissioner. Insurers and employer-based plans would have five years to bring their plans into compliance. The commissioner could require coverage of services people do not want (increasing premiums) and then in the name of "cost containment" prohibit plans from covering services people want but that the commissioner does not want.

Billions in New Taxes


The new House health care plan includes several tax increases that would cost taxpayers $700 billion over the next 10 years. In addition to the surtax, employer mandate, and individual mandate provisions found in the original bill, H.R. 3962 adds on several new taxes.
The new plan establishes a 5.4 percent surtax on joint filers with over $1 million in adjusted gross income or $500,000 for single filers. This surtax is not based on final adjusted gross income but instead on modified gross income, thereby increasing the overall effect of the tax.


This surtax is also not indexed to inflation. This would cause more and more taxpayers to be hammered by the surtax even as their real income does not increase. This is one reason the Joint Tax Committee expects the cost of the surtax to more than double in 10 years, from $30.9 billion in 2011 to $68.4 billion in 2021, and that taxpayers will be forced to pay $460.5 billion in higher taxes due to this provision.[2] (http://www.heritage.org/Research/HealthCare/wm2648.cfm#_ftn2) This is a larger tax increase than the 1993 Clinton income tax increase provisions.
The House bill also limits contributions to flexible spending accounts (FSAs) to $2,500 per year and limits the ability of FSAs or health savings accounts to purchase goods by excluding over-the-counter drugs. It also taxes medical devices and self-insured health plans.

The Real Cost


The CBO's preliminary estimate of H.R. 3962 puts the total cost of the health care coverage provisions at $1.05 trillion (with offsets bringing the net cost down to close to $900 billion).[3] (http://www.heritage.org/Research/HealthCare/wm2648.cfm#_ftn3) But there are other spending provisions in the bill that the CBO has not accounted for, such as special funding for prevention and wellness, increases in the federal Medicaid matching rate, and Medicaid reimbursement for primary care physicians.

Former CBO Director Donald Marron calculates that these additional provisions would add $217 billion to the total cost of the House health care bill, raising the total cost to almost $1.3 trillion.[4] (http://www.heritage.org/Research/HealthCare/wm2648.cfm#_ftn4) Moreover, although the score is technically a 10-year score, it is not a 10-year cost under full implementation. A full 10-year cost puts the total close to $2.4 trillion.[5] (http://www.heritage.org/Research/HealthCare/wm2648.cfm#_ftn5)

The real price tag for taxpayers gets higher when the cost of fixing the scheduled Medicare cuts to physicians is included. While House leaders propose to separate it from the larger bill in order to make their health care spending agenda appear less expensive, the CBO estimates the 10-year cost for this "doc fix" at over $200 billion. As of this writing, it is not clear whether House leaders will find a way to offset the "doc fix" or simply add the extra spending to the already massive increase in deficit spending.


One thing is certain: In the end, the House bill would cost more than the President's promised $900 billion price tag. As with previous health care programs, it will likely cost even more than its current estimated price tag: $1.5 trillion.

Ineffective Treatment


The new House bill is clearly just more of the same. Higher taxes and increased government intervention will not improve health care, and increasing enrollment in costly and troubled government programs will only add to the rising costs of care.


Congress should take a step-by-step approach to fix what is clearly broken in this massive sector of the economy. For doctors and patients alike, it should adopt changes to financing and delivery that would put the country on a path to expanded coverage, higher quality care, and greater innovation. It should tackle the perverse incentives that drive health care costs up, and it should empower individuals and families to control their health care. That is a far superior policy than trying to micromanage and maintain a broken system.


http://www.heritage.org/Research/HealthCare/wm2648.cfm

[coyotes_geek]

This whole thing just sucks to no end. All this bill is going to do is make healthcare more expensive than it is already. The democrats know it. That's why you don't see them using words like "affordable" any more. They just talk about needing "reform", knowing that they're being sufficiently vague and hoping that people just assume that "reform" means "cheaper".

[ElNono]

This morning I was awoken by my alarm clock powered by electricity
generated by the public power monopoly regulated by the U.S. Department of
Energy. I then took a shower in the clean water provided by a municipal
water utility. After that, I turned on the TV to one of the FCC-regulated
channels to see what the National Weather Service of the National
Oceanographic and Atmospheric Administration determined the weather was
going to be like, using satellites designed, built, and launched by the
National Aeronautics and Space Administration.

I watched this while eating my breakfast of U.S. Department of
Agriculture-inspected food and taking the drugs which have been determined
as safe by the U.S. Food and Drug Administration.

At the appropriate time, as regulated by the U.S. Congress and kept
accurate by the National Institute of Standards and Technology and the
U.S. Naval Observatory, I get into my National Highway Traffic Safety
Administration-approved automobile and set out to work on the roads build
by the local, state, and federal Departments of Transportation, possibly
stopping to purchase additional fuel of a quality level determined by the
Environmental Protection Agency, using legal tender issued by the Federal
Reserve Bank. On the way out the door I deposit any mail I have to be
sent out via the U.S. Postal Service and drop the kids off at the public
school.

After spending another day not being maimed or killed at work thanks to
the workplace regulations imposed by the Department of Labor and the
Occupational Safety and Health administration, enjoying another two meals
which again do not kill me because of the USDA, I drive my NHTSA car back
home on the DOT roads, to my house which has not burned down in my absence
because of the state and local building codes and Fire Marshal's
inspection, and which has not been plundered of all its valuables thanks
to the local police department. And then I log on to the internet --
which was developed by the Defense Advanced Research Projects
Administration and post on Freerepublic.com and Fox News forums about how
SOCIALISM in medicine is BAD because the government can't do anything
right.

[coyotes_geek]

This morning I was awoken by my alarm clock powered by electricity
generated by the public power monopoly regulated by the U.S. Department of
Energy.

Operative words being "regulated by", as opposed to "provided by".


I then took a shower in the clean water provided by a municipal
water utility.

A municipal water utility that survives solely off of fees collected from the individual users who get their water from that specific utility. Note the abscence of one giant nation-wide utility run by the federal government.


After that, I turned on the TV to one of the FCC-regulated
channels to see what the National Weather Service of the National
Oceanographic and Atmospheric Administration determined the weather was
going to be like, using satellites designed, built, and launched by the
National Aeronautics and Space Administration.

Of course if you don't want to watch the national weather service you could also tune in to one of the several local networks who fund their own weather broadcasts.


I watched this while eating my breakfast of U.S. Department of
Agriculture-inspected food and taking the drugs which have been determined
as safe by the U.S. Food and Drug Administration.

You mean the government didn't grow that food for you?


At the appropriate time, as regulated by the U.S. Congress and kept
accurate by the National Institute of Standards and Technology and the
U.S. Naval Observatory, I get into my National Highway Traffic Safety
Administration-approved automobile and set out to work on the roads build
by the local, state, and federal Departments of Transportation

Funded by only those people who use the roads via gasoline taxes, tolls and vehicle registrations. Also noting the absence of one giant nationally controlled transportation agency.


, possibly
stopping to purchase additional fuel of a quality level determined by the
Environmental Protection Agency,

Yet produced and delivered by self-sustaining private businesses.


using legal tender issued by the Federal
Reserve Bank.

A yet to be audited agency virtually free from any form of responsibility to the taxpayers.


On the way out the door I deposit any mail I have to be
sent out via the U.S. Postal Service

An entity that still can't make money despite having a government mandated monopoly.



and drop the kids off at the public
school.

Schools which always seem to be in need improvement no matter how much money we spend on them.


After spending another day not being maimed or killed at work thanks to
the workplace regulations imposed by the Department of Labor and the
Occupational Safety and Health administration,

While working for either a self sustaining private sector business or for a public sector business that sustains itself solely from taking money from private sector businesses and employees.


enjoying another two meals
which again do not kill me because of the USDA,

Neither of which were provided by the federal government.


I drive my NHTSA car back
home on the DOT roads, to my house which has not burned down in my absence
because of the state and local building codes and Fire Marshal's
inspection,

Neither of which were controlled by the federal government.


and which has not been plundered of all its valuables thanks
to the local police department.

And not some giant singular governmental bureaucracy charged with providing nation wide law enforcement services .


And then I log on to the internet --
which was developed by the Defense Advanced Research Projects
Administration

Using a computer developed and produced by private industry.


and post on Freerepublic.com and Fox News forums about how
SOCIALISM in medicine is BAD because the government can't do anything
right.

Making reference to inefficient, ineffective government sponsored entitlement programs like social security and medicare which not only are threatening to bankrupt this country but also have infinitely more in common with the currently proposed healthcare "reform" efforts than any of the other previous examples of how government affects my day to day life.

[ElNono]

What I actually find sad is that this is the year 2009 and we're still debating wether the lives of americans are worth saving.
What I dislike the most about this specific bill is that it actually leaves about 4% of people still without coverage.
We can do better than that.

[ElNono]

:blah

You missed the point entirely, which is not surprising.
We do rely more than what people like you are willing to admit on public programs/institutions on a daily basis, and for the MOST part, they do a very good job at it.
Which brings down the whole "government cannot do one thing right" argument.

[coyotes_geek]

You missed the point entirely, which is not surprising.
We do rely more than what people like you are willing to admit on public programs/institutions on a daily basis, and for the MOST part, they do a very good job at it.
Which brings down he whole "government cannot do one thing right" argument.

If the point was that I should trust my federal government to be capable of fixing health care because my local government does a good job with building codes then the point is incredibly flawed.

[ElNono]

If the point was that I should trust my federal government to be capable of fixing health care because my local government does a good job with building codes then the point is incredibly flawed.

Let's not pretend here for a second that you hate 'just' the federal government as opposed to any type of government intervention.
I think we pretty much know how you really feel.

[coyotes_geek]

Let's not pretend here for a second that you hate 'just' the federal government as opposed to any type of government intervention.
I think we pretty much know how you really feel.

:lol

How do I really feel?

Also, what do local building codes have to do with federal health care reform? That was the point, wasn't it?

[spursncowboys]

Who do the Post Office turn to for an overnight delivery- FedEx (the free market)
What works better than our public school system in every study and trial- a voucher system or school choice, which would bring competition (free market principle)

[spursncowboys]

What I actually find sad is that this is the year 2009 and we're still debating wether the lives of americans are worth saving.
What I dislike the most about this specific bill is that it actually leaves about 4% of people still without coverage.
We can do better than that.
You mean we can steal more.

[George Gervin's Afro]

Who do the Post Office turn to for an overnight delivery- FedEx (the free market)
What works better than our public school system in every study and trial- a voucher system or school choice, which would bring competition (free market principle)

do you have one original thought to bring to this forum?

dummy.

[spursncowboys]

do you have one original thought to bring to this forum?

dummy.
Uh oh. The trolls have smelt logic and are coming to destroy it with their personal attacks in an attempt to make it about them. Caution.

[ElNono]

Who do the Post Office turn to for an overnight delivery- FedEx (the free market)
What works better than our public school system in every study and trial- a voucher system or school choice, which would bring competition (free market principle)

Why don't we just hand over our military and national security to the free market also?
Why does the free market only works if you're younger than 65?

We've been unsuccessfully waiting for the free market to provide health coverage for every american for the past 20 years... what makes you think it ever will?

[Wild Cobra]

What I actually find sad is that this is the year 2009 and we're still debating wether the lives of americans are worth saving.
That's not the debate.

What I dislike the most about this specific bill is that it actually leaves about 4% of people still without coverage.
We can do better than that.
If we are going to do it, we need to do it the right way. Government control is not the solution. It makes things worse.

[ElNono]

Also, what do local building codes have to do with federal health care reform? That was the point, wasn't it?

No, it wasn't. The point was that government runs a lot of things in our lives on a daily basis and they do it with more positive than negative outcomes.

Which renders the point of 'Government can't run anything right' completely moot.

Now you did get the point the first time. You merely brought up the federal vs local strawman to distract. The reality is that if a state government were to propose a public plan you'll be all up in arms about it too.

[ElNono]

That's not the debate.

Sure it is. Stalling is not different than inaction, considering that the uninsured remain uninsured while the debate moves on.


If we are going to do it, we need to do it the right way. Government control is not the solution. It makes things worse.

There's irrefutable proof to the contrary. Maybe not in this country, but pretty much elsewhere in the world.

What is the right way? Would it cover every single American?

[spursncowboys]

Why don't we just hand over our military and national security to the free market also?
Why does the free market only works if you're younger than 65?WHy are 65+ the biggest opponents of this? More people are living longer than 65 because of free market solutions.


We've been unsuccessfully waiting for the free market to provide health coverage for every american for the past 20 years... what makes you think it ever will?
Who has been waiting? If the idea is to cover all americans, why do this? It doesn't cover all americans. If it is to lower costs, why do this? This bill won't lower costs. All this does it socialize more of our economy. Our economy the size of Brittian's will be controlled by a few living in the city on the hill. WHere did this entitlement mentality come from. Even if the government could give a better product for less, why is that their place. Are we not a country with individual rights? Seeing as how Medicaid, Medicare is more expensive in total but jacks up the average cost, why increase it? Private costs have to go up to compete with Medicaid and Medicare.

[spursncowboys]

Sure it is. Stalling is not different than inaction, considering that the uninsured remain uninsured while the debate moves on.



There's irrefutable proof to the contrary. Maybe not in this country, but pretty much elsewhere in the world.

What is the right way? Would it cover every single American?
DId you read this article?

[ElNono]

WHy are 65+ the biggest opponents of this? More people are living longer than 65 because of free market solutions.

This is simply not true. The US ranks 31st in life expectancy (tied with Kuwait and Chile), according to the latest World Health Organization figures.

LINK (http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf)

I mean, I hate to wake you up to the news, but countries with socialized medicine actually have a larger life expectancy than the US.


...ramblings...

I did say I don't like this bill because it doesn't cover all americans.

[ElNono]

DId you read this article?

You mean the "Heritage Foundation - Conservative Policy Research and Analysis" hit piece?

[spursncowboys]

Any thoughts about the article in the post?



The new House bill would dramatically increase the role of the federal government in health care. H.R. 3962 creates a new minimum federal standard benefit package that would eventually apply to nearly all health plans. It establishes a new "Health Benefits Advisory Committee," housed within the Department of Health and Human Services (HHS), that would make detailed recommendations, which the HHS Secretary would then impose on all private insurers and employers through regulation.


HHS is given extremely vague orders to "establish a process for the annual review of increases in premiums for health insurance coverage" and further specifies that "the process shall require health insurers to submit a justification for any premium increases prior to implementation of the increase."


In the end, by opening the exchange to more Americans and creating an uneven playing field between the public plan and private plans, more Americans will enroll in the public plan. As enrollment in the public plan soars, private insurers will be unable to keep up with the artificially low cost of the government plan. Worse yet, the public plan's reimbursement rates would not cover the cost of care, forcing many hospitals and physicians to close their doors.


Not only will childless adults become eligible for Medicaid for the first time in the history of the program, but approximately 5 million children who have been served under the successful and popular State Children's Health Insurance Program (SCHIP) will also be transferred into Medicaid.



The House bill also extends generous taxpayer-funded subsidies to individuals and families with incomes up to 400 percent FPL (roughly $90,000 for a family of four) for coverage purchased through the new health exchange...individuals and families with incomes below 350 percent FPL (roughly $80,000) could also receive cost-sharing subsidies to cover a portion of their out-of-pocket costs... for the first two years, those receiving a subsidy could only purchase the basic plan, regardless of their desire to pay for additional services...CBO estimates an average premium of $15,000 for a "basic" family plan with cost-sharing of about $5,500. Based on the CBO analysis, a family just under 300 percent FPL (roughly $70,000) could receive up to $10,500 in federal subsidies... with the exception of a hardship exemption of 12 percent of income, the bill would exclude those individuals with access to employer coverage from receiving a subsidy. Therefore, a similarly situated family at 300 percent FPL (roughly $70,000) struggling to pay for their current employer-sponsored plan would generally not receive assistance at all. Neither would a family at 200 percent FPL (roughly $45,000) with employer-based coverage...The bill also excludes individuals from receiving the subsidies if they are eligible for Medicaid. Incidentally, the bill would freeze existing Medicaid eligibility levels at the state level to prevent states from lowering their Medicaid programs in favor of the federal subsidy. Without financial assistance, the only rational option for these low-income Americans is to join Medicaid, a substandard health care program.



The bill requires the uninsured to pay an extra income tax--2.5 percent of adjusted gross income above the filing threshold, capped at the national average premium. The tax would also apply to persons who have health insurance that does not qualify as "acceptable" coverage under the new federal standards. Those paying this tax would remain uninsured. However, low- and moderate-income individuals and families would have to pay higher premiums than they would otherwise pay for health coverage to avoid the tax...This tax on low- and moderate-income Americans would be in addition to a "surtax" of up to 5.4 percent on higher incomes...The bill also imposes a new 8 percent payroll tax on employers who do not cover specified percentages of their employees' health insurance...This tax would also not go to pay for any coverage; the bill specifically says that the tax paid by the employer "shall not be applied against the premium of the employee." Furthermore, since the amount of this tax would be lower than the cost of providing health insurance (especially for low-income workers), many employers would opt to pay the tax and not offer health plans,...Furthermore, health plans would have to meet new requirements defined by the new Health Choices Commissioner.


The new House health care plan includes several tax increases that would cost taxpayers $700 billion over the next 10 years...The new plan establishes a 5.4 percent surtax on joint filers with over $1 million in adjusted gross income or $500,000 for single filers. This surtax is not based on final adjusted gross income but instead on modified gross income, thereby increasing the overall effect of the tax.This surtax is also not indexed to inflation. This would cause more and more taxpayers to be hammered by the surtax even as their real income does not increase...Joint Tax Committee expects the cost of the surtax to more than double in 10 years, from $30.9 billion in 2011 to $68.4 billion in 2021, and that taxpayers will be forced to pay $460.5 billion in higher taxes due to this provision...The House bill also limits contributions to flexible spending accounts (FSAs) to $2,500 per year and limits the ability of FSAs or health savings accounts to purchase goods by excluding over-the-counter drugs. It also taxes medical devices and self-insured health plans.



The CBO's preliminary estimate of H.R. 3962 puts the total cost of the health care coverage provisions at $1.05 trillion (with offsets bringing the net cost down to close to $900 billion).[3] (http://www.heritage.org/Research/HealthCare/wm2648.cfm#_ftn3) But there are other spending provisions in the bill that the CBO has not accounted for, such as special funding for prevention and wellness, increases in the federal Medicaid matching rate, and Medicaid reimbursement for primary care physicians.

Former CBO Director Donald Marron calculates that these additional provisions would add $217 billion to the total cost of the House health care bill, raising the total cost to almost $1.3 trillion.[4] (http://www.heritage.org/Research/HealthCare/wm2648.cfm#_ftn4) Moreover, although the score is technically a 10-year score, it is not a 10-year cost under full implementation. A full 10-year cost puts the total close to $2.4 trillion.[5] (http://www.heritage.org/Research/HealthCare/wm2648.cfm#_ftn5)

The real price tag for taxpayers gets higher when the cost of fixing the scheduled Medicare cuts to physicians is included...the CBO estimates the 10-year cost for this "doc fix" at over $200 billion.

[spursncowboys]

This is simply not true. The US ranks 31st in life expectancy (tied with Kuwait and Chile), according to the latest World Health Organization figures.

LINK (http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf)

I mean, I hate to wake you up to the news, but countries with socialized medicine actually have a larger life expectancy than the US.



I did say I don't like this bill because it doesn't cover all americans.
Kuwait and Chile? Do they have 300 million people?

[coyotes_geek]

No, it wasn't. The point was that government runs a lot of things in our lives on a daily basis and they do it with more positive than negative outcomes.

There's a difference between "runs" and "regulates". The government is a lot more effective at one than the other.


Which renders the point of 'Government can't run anything right' completely moot.

Who is trying to make that point?


Now you did get the point the first time. You merely brought up the federal vs local strawman to distract. The reality is that if a state government were to propose a public plan you'll be all up in arms about it too.

The only straw man here is your attempt to use local government activities that have absolutely nothing to do with healthcare to justify healthcare reforms to be run by the federal government. Yet for some reason medicare, the government program most similar in size, scope and function to the healthcare reforms you're supporting, gets ignored. I wonder why that is.

[ElNono]

Kuwait and Chile? Do they have 300 million people?

What does total population has anything to do with life expectancy?

Your claim was that 65+ older people in the US live longer because of the free market. That claim is not true at all.

[spursncowboys]

What does total population has anything to do with life expectancy?

Your claim was that 65+ older people in the US live longer because of the free market. That claim is not true at all.
No I stated that more people are living longer because of free market solutions. That means all countries are getting a free lunch to our market demands for a better product in healthcare.

[ElNono]

There's a difference between "runs" and "regulates". The government is a lot more effective at one than the other.

I would argue the government is as effective on both. Notice that 'effective' does not equal to 'efficient'.


Who is trying to make that point?

You are... "to justify healthcare reforms to be run by the federal government"


The only straw man here is your attempt to use local government activities that have absolutely nothing to do with healthcare to justify healthcare reforms to be run by the federal government. Yet for some reason medicare, the government program most similar in size, scope and function to the healthcare reforms you're supporting, gets ignored. I wonder why that is.

I don't ignore it. I think Medicare is quite effective, just not necessarily efficient. Obviously, Republicans are just as much guilty as Democrats for it's lack of efficiency. But it's not something that couldn't be fixed if we really wanted to.

[ElNono]

No I stated that more people are living longer because of free market solutions. That means all countries are getting a free lunch to our market demands for a better product in healthcare.

How are they getting a free lunch when they don't have a free market system and they have a BETTER outcome than our free market healthcare system?

[spursncowboys]

How are they getting a free lunch when they don't have a free market system and they have a BETTER outcome than our free market healthcare system?
Every other country has a better outcome than our free market healthcare system?

[ElNono]

Every other country has a better outcome than our free market healthcare system?

Did I claim EVERY country? No.
However, as much as it hurts you, there's plenty of socialized healthcare countries that do.

[coyotes_geek]

I would argue the government is as effective on both. Notice that 'effective' does not equal to 'efficient'.

You would argue it, and you would be wrong. The post office is a disaster, medicare is a disaster, social security is a disaster, the budget is a disaster. Most of what the federal government runs turns out to be a disaster.


You are... "to justify healthcare reforms to be run by the federal government"

Huh? How does me thinking that the government can't run a healthcare system equate to me not thinking that they can do one thing right?


I don't ignore it. I think Medicare is quite effective, just not necessarily efficient. Obviously, Republicans are just as much guilty as Democrats for it's lack of efficiency. But it's not something that couldn't be fixed if we really wanted to.

:lol

How reassuring to know that we could fix a program that's got $80 trillion dollars worth of unfunded liabilities if we wanted to, but we're just not in the mood right now.

[ElNono]

You would argue it, and you would be wrong. The post office is a disaster, medicare is a disaster, social security is a disaster, the budget is a disaster. Most of what the federal government runs turns out to be a disaster.

You would LOVE to actually have evidence of that, wouldn't you? But I bet you do not. Other than isolated incidents, you really have nothing on them.


Huh? How does me thinking that the government can't run a healthcare system equate to me not thinking that they can do one thing right?

You're making my point with every post:
"Most of what the federal government runs turns out to be a disaster"


How reassuring to know that we could fix a program that's got $80 trillion dollars worth of unfunded liabilities if we wanted to, but we're just not in the mood right now.

Well, it doesn't help when you pass something like Medicare Part D and you don't say how it's going to be paid for.
As far as the mood to pass things, it has everything to do with lobbying and partisanship than anything else. Both parties were suddenly in the mood to bailout Wall Street. Both parties were suddenly in the mood of passing stimulus packages.
Medicare will have to be addressed at some point, just like Social Security, or the Defense budget.

[MiamiHeat]

You would argue it, and you would be wrong. The post office is a disaster, medicare is a disaster, social security is a disaster, the budget is a disaster. Most of what the federal government runs turns out to be a disaster.

I love the US Post Office. They provide affordable services in comparison to FedEx and UPS. For instance, when I was 20, I owned a small business which involved sending media like DVD's, books, etc to customers around the country.

Guess what service I used? The US Post Office. They never let me down, and it was FAR cheaper than FedEx/UPS counterparts.

When I couldn't afford to pay FedEx's 50 dollars to mail a box, I'd pay the US Post Office's 20 bucks to mail the same box.


I'd say the government can do some things very well.

[coyotes_geek]

You would LOVE to actually have evidence of that, wouldn't you? But I bet you do not. Other than isolated incidents, you really have nothing on them.

If the $100+ trillion dollar hole those things add up to isn't proof enough then you've got your head too deep in the sand for me to reach you.


You're making my point with every post:
"Most of what the federal government runs turns out to be a disaster"

I suggest you grab a dictionary and look up the difference between "most" and "all". You also might want to read back earlier in the thread where I explained the differences betweeen "runs" and "regulates". I said most of what the federal government runs turns out to be a disaster.


Well, it doesn't help when you pass something like Medicare Part D and you don't say how it's going to be paid for.

I agree.


As far as the mood to pass things, it has everything to do with lobbying and partisanship than anything else. Both parties were suddenly in the mood to bailout Wall Street. Both parties were suddenly in the mood of passing stimulus packages.

How are we paying for this BTW? Certainly somebody told us...........


Medicare will have to be addressed at some point, just like Social Security, or the Defense budget.

But not before we create a new multi-trillion dollar entitlement program huh?

[coyotes_geek]

I love the US Post Office. They provide affordable services in comparison to FedEx and UPS. For instance, when I was 20, I owned a small business which involved sending media like DVD's, books, etc to customers around the country.

Guess what service I used? The US Post Office. They never let me down, and it was FAR cheaper than FedEx/UPS counterparts.

When I couldn't afford to pay FedEx's 50 dollars to mail a box, I'd pay the US Post Office's 20 bucks to mail the same box.


I'd say the government can do some things very well.

Affordable service and they're only losing billions in the process.

[MiamiHeat]

That's because of DIFFERENT REASONS other than 'because the government is running it'

For instance, the rise in popularity of the internet has caused thousands of advertisers to tone down their mail advertisements and just go online.

Many customers no longer ask for information booklets, or write letters to friends and family, or write letters to companies, or pay their bills through the mail.

They just use websites, e-mails, and the internet.

Did you know this already or were you really ignorant of this? I'd like to know if you are trolling or not

These are the biggest reasons why the US Post Office is suffering now. The US Post Office ran for a LONG time before the rise of the internet, and did it quite well

[George Gervin's Afro]

Every other country has a better outcome than our free market healthcare system?

Is this a question or a statement dummy?

[coyotes_geek]

That's because of DIFFERENT REASONS other than 'because the government is running it'

For instance, the rise in popularity of the internet has caused thousands of advertisers to tone down their mail advertisements and just go online.

Many customers no longer ask for information booklets, or write letters to friends and family, or write letters to companies, or pay their bills through the mail.

They just use websites, e-mails, and the internet.

Did you know this already or were you really ignorant of this? I'd like to know if you are trolling or not

These are the biggest reasons why the US Post Office is suffering now. The US Post Office ran for a LONG time before the rise of the internet, and did it quite well

So instead of finding ways to cut costs, be more efficient or increase revenues they just let the taxpayers cut them a check to cover whatever money they lose. There is only one reason why this option is available to them. It's "because the government is running it".

[ElNono]

That's because of DIFFERENT REASONS other than 'because the government is running it'

For instance, the rise in popularity of the internet has caused thousands of advertisers to tone down their mail advertisements and just go online.

Many customers no longer ask for information booklets, or write letters to friends and family, or write letters to companies, or pay their bills through the mail.

They just use websites, e-mails, and the internet.

Did you know this already or were you really ignorant of this? I'd like to know if you are trolling or not

These are the biggest reasons why the US Post Office is suffering now. The US Post Office ran for a LONG time before the rise of the internet, and did it quite well

He is most certainly trolling.

The USPS is mandated to be profit-neutral by Congress. They've actually started to incur in loses only recently, and for a number of reasons, including an amazing decrease in mail volume as you mention, and the recession that hit everyone (don't look now, but Fedex lost money too).

[MiamiHeat]

So instead of finding ways to cut costs, be more efficient or increase revenues they just let the taxpayers cut them a check to cover whatever money they lose. There is only one reason why this option is available to them. It's "because the government is running it".

Who told you they aren't cutting costs?

Post Offices in my area are proposing to stop delivering mail on Saturdays for this very reason.

They are also looking into other methods....

[MiamiHeat]

He is most certainly trolling.

The USPS is mandated to be profit-neutral by Congress. They've actually started to incur in loses only recently, and for a number of reasons, including an amazing decrease in mail volume as you mention, and the recession that hit everyone (don't look now, but Fedex lost money too).

Imagine health care in this country combined with the words "profit neutral"

Ah, sweet.

I didn't vote for Obama, but I support him on this issue. Having citizens who cannot afford to be ALIVE in the USA is despicable.

Making a PROFIT on another man's life and death situation is also despicable.

Health care and free market is a CONFLICT OF INTEREST as far as I am concerned

We can thank one of the biggest scumbags in the presidency, ol nixon

[ElNono]

So instead of finding ways to cut costs, be more efficient or increase revenues they just let the taxpayers cut them a check to cover whatever money they lose. There is only one reason why this option is available to them. It's "because the government is running it".

http://www.usps.com/communications/newsroom/2009/pr09_028.htm

[ElNono]

Imagine health care in this country combined with the words "profit neutral"

Ah, sweet.

I didn't vote for Obama, but I support him on this issue. Having citizens who cannot afford to be ALIVE in the USA is despicable.

Making a PROFIT on another man's life and death situation is also despicable.

Health care and free market is a CONFLICT OF INTEREST as far as I am concerned

We can thank one of the biggest scumbags in the presidency, ol nixon

Not only that, I find it hysterical that these same guys that have no problem giving this same government a blank check to spend on the military in order to 'save American lives', bitch and moan to no end when it comes to healthcare... even though it's also to save American lives.

[spursncowboys]

The House bill also extends generous taxpayer-funded subsidies to individuals and families with incomes up to 400 percent FPL (roughly $90,000 for a family of four) for coverage purchased through the new health exchange...individuals and families with incomes below 350 percent FPL (roughly $80,000) could also receive cost-sharing subsidies to cover a portion of their out-of-pocket costs... for the first two years, those receiving a subsidy could only purchase the basic plan, regardless of their desire to pay for additional services...CBO estimates an average premium of $15,000 for a "basic" family plan with cost-sharing of about $5,500. Based on the CBO analysis, a family just under 300 percent FPL (roughly $70,000) could receive up to $10,500 in federal subsidies... with the exception of a hardship exemption of 12 percent of income, the bill would exclude those individuals with access to employer coverage from receiving a subsidy. Therefore, a similarly situated family at 300 percent FPL (roughly $70,000) struggling to pay for their current employer-sponsored plan would generally not receive assistance at all. Neither would a family at 200 percent FPL (roughly $45,000) with employer-based coverage...The bill also excludes individuals from receiving the subsidies if they are eligible for Medicaid. Incidentally, the bill would freeze existing Medicaid eligibility levels at the state level to prevent states from lowering their Medicaid programs in favor of the federal subsidy. Without financial assistance, the only rational option for these low-income Americans is to join Medicaid, a substandard health care program.
How is this not stealing?

[ElNono]

How is this not stealing?

How is it stealing?

[Duff McCartney]

I thin in order to pay for the healthcare bill I propose we cut down our 500+ billion dollar defense budget.

People IE democrats/republicans bitch about the government..but both want big government..just in different ways..democrats want the government for healthcare/welfare state and republicans want a huge defense budget/regulate society.

Anyone who pretends otherwise is a fool.

[George Gervin's Afro]

How is it stealing?


He doesn't get the fact that he has to be able to prove it is stealing..:lmao

he's not very bright.. he's your classic talk radio warrior..

[spursncowboys]

I thin in order to pay for the healthcare bill I propose we cut down our 500+ billion dollar defense budget.

People IE democrats/republicans bitch about the government..but both want big government..just in different ways..democrats want the government for healthcare/welfare state and republicans want a huge defense budget/regulate society.

Anyone who pretends otherwise is a fool.

Our defense is in our constitution. Free healthcare is not.

[Wild Cobra]

This is simply not true. The US ranks 31st in life expectancy (tied with Kuwait and Chile), according to the latest World Health Organization figures.

LINK (http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf)

I mean, I hate to wake you up to the news, but countries with socialized medicine actually have a larger life expectancy than the US.


That's right. Cherry pick your data. If you look under HALE, the data for the USA is much better.

We live in more urbanized areas than most places in the world. Don't you think auto accidents, killings, etc. have an effect to the numbers you picked?

[spursncowboys]

WHich country is best for cancer survival after treatment? - USA
http://www.emaxhealth.com/51/23285.html

[ElNono]

That's right. Cherry pick your data. If you look under HALE, the data for the USA is much better.

We live in more urbanized areas than most places in the world. Don't you think auto accidents, killings, etc. have an effect to the numbers you picked?

I'm sorry. I didn't cherry pick anything. I was under the impression that the WHO was non partisan and an authority in conducting these analysis.
I really have no idea what HALE is, never heard of them.

[spursncowboys]

Ten reasons why America’s health care system is in better condition than you might suppose. By Scott W. Atlas.
http://www.hoover.org/publications/digest/49525427.html

[spursncowboys]

I'm sorry. I didn't cherry pick anything. I was under the impression that the WHO was non partisan and an authority in conducting these analysis.
I really have no idea what HALE is, never heard of them.
Maybe you should know your information you are passing off is valid or not. You should definitely know who it is you're getting your information from. Hopefully not wikepedia.

[ElNono]

Maybe you should know your information you are passing off is valid or not. You should definitely know who it is your getting your information from. Hopefully not wikepedia.

Do you know how to read?
Or is it your comprehension that's completely out of whack?

Maybe you're not even trying anymore?

[Wild Cobra]

I'm sorry. I didn't cherry pick anything. I was under the impression that the WHO was non partisan and an authority in conducting these analysis.
I really have no idea what HALE is, never heard of them.
Then you just admited to not reading the report you linked.

[ElNono]

Then you just admited to not reading the report you linked.

I thought you meant HALE as in another organization conducting research, not as part of the report.
I would argue that picking HALE numbers from that report is also cherry picking, since that's the 'Healthy life expectancy at birth'.
We're actually looking at life expectancy period.

[baseline bum]

Our defense is in our constitution. Free healthcare is not.

You don't give a fuck about the constitution, as evidenced by your complete disregard for the 1st amendment in other threads, so stop wrapping yourself in it, hypocrite.

[spursncowboys]

You don't give a fuck about the constitution, as evidenced by your complete disregard for the 1st amendment in other threads, so stop wrapping yourself in it, hypocrite.
When did I disregard the 1st Amendment you back-woods hick?

[MiamiHeat]

Our defense is in our constitution. Free healthcare is not.

well, you could argue that it is in the constitution

"The right to Life, liberty, and the pursuit..."

[Wild Cobra]

I thought you meant HALE as in another organization conducting research, not as part of the report.
I would argue that picking HALE numbers from that report is also cherry picking, since that's the 'Healthy life expectancy at birth'.
We're actually looking at life expectancy period.
Even those numbers are higher than most the world.

Where are your numbers in the report. I didn't see them.

How about this:

http://upload.wikimedia.org/wikipedia/commons/d/de/Life_Expectancy_2008_Estimates_CIA_World_Factbook. png
Even with accidents calculated, we are in the second best catagory.

[spursncowboys]

well, you could argue that it is in the constitution

"The right to Life, liberty, and the pursuit..."

Thats the Dec. of Independance. Common mishap. I do it too. the 5th Amendment is "life, liberty or property without due process..."

[ElNono]

How about this:
...
Even with accidents calculated, we are in the second best catagory.

And I don't disagree with that graph/data at all. They actually reinforce my argument:
How somebody can claim that the rest of the world is having a "free lunch" with our free market health system?
Or simply deny that other countries that have a socialized health care do just as good or better than the US on people 65+ years old.

Now, YOU didn't make those unsubstantiated claims, so you don't have to back them up.
But some other posters here are running their mouths and they simply can't back up what they claim...

[Duff McCartney]

The Defense may be in the constitution, but the amount of money spent on it in this country is obscene. Hell I'd cut Defense spending to pay for Education too. Since we are sorely lacking behind in public education.

[antimvp]

I love that Stupak amendment......destruction of a healty fetus IS NOT HEALTHCARE......................PERIOD.

If there are complications after an abortion....the obamacare would then kick in, but the abortion itself..........NO!

.......and I am glad.

[ElNono]

Democrats Raise Alarms Over Costs of Health Bills

By SHERYL GAY STOLBERG

WASHINGTON — As health care legislation moves toward a crucial airing in the Senate, the White House is facing a growing revolt from some Democrats and analysts who say the bills Congress is considering do not fulfill President Obama’s promise to slow the runaway rise in health care spending.

Mr. Obama has made cost containment a centerpiece of his health reform agenda, and in May he stood up at the White House with industry groups who pledged voluntary efforts to trim the growth of health care spending by 1.5 percent, or $2 trillion, over the next decade.

But health economists say it is impossible to know whether the bills, including one passed by the House on Saturday night, would meet that goal, and many are skeptical that they even come close.

Experts — including some who have consulted closely with the White House, like Dr. Denis A. Cortese, chief executive of the Mayo Clinic — say the measures take only baby steps toward revamping the current fee-for-service system, which drives up costs by paying health providers for each visit or procedure performed. Some senators are also dissatisfied.

“My assessment at this point,” said Senator Ron Wyden, Democrat of Oregon and a member of the Finance Committee, “is that the legislation is heavy on health and light on reform.”

There are a variety of ideas for attacking cost increases more aggressively, including setting Medicare reimbursement rates for doctors and hospitals more rigorously and discouraging workers and employers from buying expensive health insurance policies that mask the true costs of treatment.

Among other innovations being considered is a cost-cutting method known as bundling, in which health providers receive a lump sum to care for a patient with a particular medical condition, say, diabetes or heart disease. The House bill calls for the administration to develop a plan for bundling, while the Senate Finance Committee version of the bill gives it until 2013 to create a pilot program.

Some experts would like to see such changes adopted more quickly, and senators of both parties say they will press for more aggressive cost-cutting measures when the bill comes up for debate. But drastic changes in the health care reimbursement system could cost the White House the support of doctors and hospital groups, who have signed onto the legislation and are lobbying hard to keep the current fee-for-service system from being phased out too quickly.

The debate underscores a fundamental tension inside the White House between cost-containment idealists and pragmatists.

The first group includes officials like Peter R. Orszag, the budget director, and Dr. Ezekiel J. Emanuel, the medical ethicist whose brother Rahm is the chief of staff. The second includes Rahm Emanuel and Nancy-Ann DeParle, the director of the Office of Health Reform, who must contend with the realities of getting legislation passed.

“Let’s be honest,” Rahm Emanuel said in a recent interview. “The goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.”

He went on: “I’m sure there are a lot of people sitting in the shade at the Aspen Institute — my brother being one of them — who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.”

Mr. Orszag would not be interviewed. But in an e-mail message sent through a spokesman, he said the current legislation “lays the foundation” for cost-cutting over the long-term, adding: “Will more need to be done in the future? Absolutely.”

Senator Susan Collins, the Maine Republican whose vote the administration is courting, convened a news conference on Monday with Senator Lamar Alexander of Tennessee, a member of the Republican leadership, to spotlight her concerns over cost containment. Ms. Collins said she had been meeting with a group of moderate Democrats who shared her views.

“I don’t believe we need more pilot projects to show us that health care delivery reforms are necessary,” she said in an interview. She added, “I think people are much more upset over the cost of care than the administration is acknowledging.”

Both the House and the Senate are proposing cost-saving measures. The House bill projects $440 billion in Medicare savings over 10 years; the Senate Finance Committee bill projects about $420 billion. White House officials say there will be additional, substantial savings in the private sector, as well. But how much is not clear.

Still, it is one thing to wring savings out of a bloated system, quite another to change the way that system does business.

Experts agree that the Senate Finance bill does more to put systemic changes in place. That is because the bill includes two measures that health economists favor: a tax on high-value “Cadillac” health plans, and an independent commission that would make binding recommendations on how to cut Medicare costs.

House Democrats strongly oppose the Cadillac tax, which would hurt, among other people, union workers with generous benefit plans. But Ms. DeParle said in an interview that she sensed fresh interest in the House in adopting the Medicare commission idea. “There is a lot of support for cost containment,” she said.

Dr. Cortese, of the Mayo Clinic, said the bills could do more to reward quality care over quantity. He said he had met with Mr. Orszag and others at the White House and had proposed legislative language that would give Medicare three years to begin rewarding hospitals that are delivering better care at lower cost.

“Our position has been focusing on paying for value,” he said, adding, “My take is there are people in the White House who understand exactly what I’m saying.”

Yet a deal the White House made with the hospital industry could make it difficult to cut costs too deeply.

The White House and the Senate Finance Committee chairman, Max Baucus of Montana, agreed to limit hospitals’ payment reductions to $155 billion over 10 years. Those savings will come almost exclusively from “an agreement to squeeze the prices a little bit across the board, rather than reforming the way payments work,” said Mark McClellan, who ran Medicare under President George W. Bush.

LINK (http://www.nytimes.com/2009/11/10/health/policy/10cost.html?_r=1&hp)