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Health Care Is a Right, Not a Privilege

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Michael Terranova
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« on: June 09, 2009, 11:19:14 am »

Health Care Is a Right, Not a Privilege

AP sources: House Dems favor insurance requirement

DAVID ESPO | June 8, 2009 09:41 PM EST | 




WASHINGTON — Senior House Democrats drafting health care legislation are considering slapping an unspecified financial penalty on anyone who refuses to purchase affordable health insurance, a key committee chairman said Monday.

In addition, officials said Democrats are considering a new tax on certain health insurance benefits as one of numerous options to help pay for expanding coverage to the uninsured. No details on the tax were immediately available, and no final decisions were expected until next week at the earliest.

These officials said drafters of the legislation will include a government-run insurance option as well as plans offered by private companies. The government option draws near-unanimous opposition from Republicans and provokes concerns among many Democrats, as well, although President Barack Obama has spoken out in favor of it.

Under the emerging House Democratic plan, individuals and small businesses would be able to purchase coverage from a "health exchange" and the government would require all plans to contain a minimum benefit, these officials added. No applicant could be rejected for pre-existing conditions, nor could they be charged a higher premium, they said.

House Democrats also are considering a wide-ranging change for Medicaid that would provide a uniform benefit across all 50 states and increase payments to health professionals, according to several officials. Medicaid is a state-federal program of health coverage for the poor.

The officials spoke on condition of anonymity, saying they did not want to pre-empt a presentation to rank-and-file Democrats on Tuesday.

At the same time, Rep. Charles Rangel, D-N.Y., chairman of the House Ways and Means Committee, confirmed the proposed penalty for those who refuse to purchase coverage they can afford, referring to it as "play or pay."

"There is no use having a mandate without a contribution," he said.



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Michael Terranova
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« Reply #1 on: June 09, 2009, 11:19:40 am »

Waivers would be available for those who could not cover the cost of insurance.

The disclosures came as the pace of activity quickened in both the House and Senate on health insurance legislation, a top priority for the administration. Obama is scheduled to meet Tuesday afternoon at the White House with several Democrats.

Democratic leaders hope to pass legislation in both houses by the first few days of August, and complete work on a compromise measure in the fall for Obama's signature.

Obama has stepped up his own involvement in the issue in recent days, and there has been a flurry of negotiations involving outside interest groups who have pledged to take steps to achieve savings within the private insurance market.

Alongside those efforts, financing Obama's plan to spread coverage more widely carries a price tag estimated at higher than $1 trillion over a decade. House Democrats are considering cutting projected Medicare payments to home health care, pharmaceutical companies, insurance companies, hospitals and others to cover costs.

The option for taxing insurance benefits is also under consideration as part of legislation taking shape across the Capitol in the Senate Finance Committee.

Numerous options are possible, many involving either a tax levied according to the value of an individual's employer-provided health plan, or on the benefits received by upper-income taxpayers.

The issue poses multiple potential problems for Obama, who has pledged not to raise taxes on individuals making less than $250,000 and also ran commercials during the presidential campaign criticizing GOP rival Sen. John McCain's call for a tax on health benefits.

In recent weeks, the president and his aides have sought to straddle the issue, neither accepting it nor ruling it out.

Equally troublesome politically is the issue of a government insurance option. Critics argue it would render private companies unable to compete, and it has emerged as a key sticking point in the Democratic search for a bipartisan plan in the Senate.

All the Republicans on the Senate Finance Committee except one wrote Obama recently telling him he was making a mistake if he insisted on a government option. The exception was Sen. Olympia Snowe, R-Maine, who has been trying to find a compromise that would make a government plan available as a last resort if health insurance remains unaffordable for many families even after Congress overhauls the system.

Even before last fall's general election, health care was a key issue in the battle for the Democratic presidential nomination. Obama proposed requiring parents to buy health insurance for children, with a possible fine if parents refused. But he would not insist that all adults buy insurance.

Secretary of State Hillary Rodham Clinton, who was a New York senator at the time as well as a presidential candidate, said a mandate was essential. At one point, she said she was open to garnisheeing the wages of anyone who refused to comply.

___

Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.
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Michael Terranova
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« Reply #2 on: June 09, 2009, 11:21:17 am »

RJ EskowConsultant, Writer, Health Analyst
Posted: June 9, 2009
A Health Care Bailout For the Middle Class


It's on. The president's assuming direct ownership of the health debate. Draft bills are beginning to circulate on the Hill. Dozens of policy details are being debated. Universal coverage is one way to describe the objective, but here's one that might be better: We need a health care bailout for the middle class.

High-income Americans will make out fine, and public programs will be strengthened for lower-income groups. But medical illness caused nearly two-thirds of all bankruptcies, and most of these bankrupt debtors had medical insurance. That raises two questions:

1. What's the value of "universal coverage" if "coverage" isn't providing the financial security people need?

2. If we can rescue troubled banks, what are we doing to rescue families whose "toxic assets" consist of unpaid medical bills for urgently needed care?

It's a mistake to assume that health reform will inevitably ease the financial burden for financially imperiled households. Medical problems caused 62.1% of all bankruptcies in 2007. Three quarters of these bankrupt debtors had health insurance. And 92% of them had medical bills of at least $5000, or 10% of pretax family income.

"10% of pretax family income" is also the figure many health policy analysts say families should be prepared to spend for health care under a mandate. But for many people that was a burdensome figure even before the financial crisis. We can't assume that a policy forcing them to spend that much will be either effective or politically popular. Nevertheless, AP reports House Dems are floating the idea of "slapping an unspecified financial penalty on anyone who refuses to purchase affordable health insurance." That's what is known as an "individual mandate."

Insurance was originally designed to eliminate financial ruin for individuals by distributing costs among many people. Does it make sense to insist that people buy coverage that won't necessarily protect them from disaster?

Feelings run high about this issue among us health policy wonks. Most Democratic/liberal analysts insist that reform can't succeed unless all individuals are first mandated to obtain coverage. The idea's based on sound economics: If some people can opt out, the healthiest are most likely to do so. Then the system will be burdened with sicker enrollees, driving up costs and making it harder to achieve universal coverage.

That's why smart and knowledgeable people like Jonathan Cohn can imply, as he does here, that individual mandates are indistinguishable from "good public policy."

I understand the economics, but here's the concern: The underlying concept of "shared responsibility" is sound, but in other countries -- and in Medicare -- that responsibility is mainly shared through the progressive mechanism of taxation. Unless carefully designed, individual mandates run the risk of being overly punitive and politically explosive among middle-income Americans.

Consider Sen. Kennedy's new draft proposal. It offers more generous subsidies than other proposals, with a sliding scale of assistance that goes up to $110,000 in income for a family of four. But a lot can happen beneath and near that $110,000 mark, especially in these perilous times. Yearly premiums for family coverage reached $12,680 in 2008 and continue to climb. That's one reason why families struggling to make ends meet sometimes 'bet' that they won't have catastrophic medical costs. That may be a bad bet, but using the levers of government to force them to pay $8,000 to $13,000 in premiums alone might not be the best solution.

And the assumption that mandates are more politically liberal is just that: an assumption. Mandates could, in fact, be economically regressive. They could also give the GOP a hot-button issue for 2010 and 2012. Proposals like Jacob Hacker's, which limit out-of-pocket premium costs to $2,500, go a long way toward addressing those concerns. But they're also costlier from the government side, so they don't seem to be on the table right now (even if those costs could ultimately be offset by improved compliance).

What's the solution? At least one proposal that has been anathema to Democrats might help. The Democrats campaigned against McCain's plan to tax health benefits. But a health tax, like any other, can be either progressive or regressive. (There's a good discussion of the topic here.)

It's true that a tax on all workers receiving health benefits could be disastrous. And nobody's receiving overly luxurious benefits, despite what some partisans claim. As Merrill Goozner observes, there are no "Cadillac health plans" for employees, though that phrase is has become a buzzword. (And Cadillacs are made by GM, where a little help was also needed.)

Here's one possibility: a health benefits tax that kicks in at high income levels. That could conceivably pay for some Hacker-like caps on premiums. It would also have the added benefit of sensitizing corporate decision-makers to the true cost of medical care in this country. It might even motivate more of them to take a proactive stand on health issues.

There are a number of other possible ways to "bail out" the American middle class in health care, too:

1. Phase mandates in slowly, as overall health costs are reduced through other measures. (This one's unpopular with a number of analysts, but is still do-able.)

2. Emphasize the public plan option. (If you're going to lay a heavy cost burden on the middle class, it's a good idea to give them every choice you can.)

3. Develop innovative ways of helping consumers pay their health debts through easy-to-use financing tools at favorable interest rates.

4. Ensure than health benefits include appropriate caps on out-of-pocket costs.

Universal coverage without universal financial security would be a Pyrrhic victory. The President and Congress can ensure successful health reform by making sure that American families can receive the care they need at a price they can afford.

RJ Eskow blogs when he can at:

A Night Light
The Sentinel Effect: Healthcare Blog

It's on. The president's assuming direct ownership of the health debate. Draft bills are beginning to circulate on the Hill. Dozens of policy details are being debated. Universal coverage is one wa...
It's on. The president's assuming direct ownership of the health debate. Draft bills are beginning to circulate on the Hill. Dozens of policy details are being debated. Universal coverage is one wa...


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Michael Terranova
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« Reply #3 on: June 09, 2009, 11:24:34 am »

Sen. Bernie Sanders
Independent U.S. Senator from Vermont
Posted: June 8, 2009
Health Care Is a Right, Not a Privilege


Let's be clear. Our health care system is disintegrating. Today, 46 million people have no health insurance and even more are underinsured with high deductibles and co-payments. At a time when 60 million people, including many with insurance, do not have access to a medical home, more than 18,000 Americans die every year from preventable illnesses because they do not get to the doctor when they should. This is six times the number who died at the tragedy of 9/11 - but this occurs every year.

In the midst of this horrendous lack of coverage, the U.S. spends far more per capita on health care than any other nation - and health care costs continue to soar. At $2.4 trillion dollars, and 18 percent of our GDP, the skyrocketing cost of health care in this country is unsustainable both from a personal and macro-economic perspective.

At the individual level, the average American spends about $7,900 per year on health care. Despite that huge outlay, a recent study found that medical problems contributed to 62 percent of all bankruptcies in 2007. From a business perspective, General Motors spends more on health care per automobile than on steel while small business owners are forced to divert hard-earned profits into health coverage for their employees - rather than new business investments. And, because of rising costs, many businesses are cutting back drastically on their level of health care coverage or are doing away with it entirely.



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Michael Terranova
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« Reply #4 on: June 09, 2009, 11:24:48 am »

Further, despite the fact that we spend almost twice as much per person on health care as any other country, our health care outcomes lag behind many other nations. We get poor value for what we spend. According to the World Health Organization the United States ranks 37th in terms of health system performance and we are far behind many other countries in terms of such important indices as infant mortality, life expectancy and preventable deaths.

As the health care debate heats up in Washington, we as a nation have to answer two very fundamental questions. First, should all Americans be entitled to health care as a right and not a privilege - which is the way every other major country treats health care and the way we respond to such other basic needs as education, police and fire protection? Second, if we are to provide quality health care to all, how do we accomplish that in the most cost-effective way possible?

I think the answer to the first question is pretty clear, and one of the reasons that Barack Obama was elected president. Most Americans do believe that all of us should have health care coverage, and that nobody should be left out of the system. The real debate is how we accomplish that goal in an affordable and sustainable way. In that regard, I think the evidence is overwhelming that we must end the private insurance company domination of health care in our country and move toward a publicly-funded, single-payer Medicare for All approach.

Our current private health insurance system is the most costly, wasteful, complicated and bureaucratic in the world. Its function is not to provide quality health care for all, but to make huge profits for those who own the companies. With thousands of different health benefit programs designed to maximize profits, private health insurance companies spend an incredible (30 percent) of each health care dollar on administration and billing, exorbitant CEO compensation packages, advertising, lobbying and campaign contributions. Public programs like Medicare, Medicaid and the VA are administered for far less.

In recent years, while we have experienced an acute shortage of primary health care doctors as well as nurses and dentists, we are paying for a huge increase in health care bureaucrats and bill collectors. Over the last three decades, the number of administrative personnel has grown by 25 times the numbers of physicians. Not surprisingly, while health care costs are soaring, so are the profits of private health insurance companies. From 2003 to 2007, the combined profits of the nation's major health insurance companies increased by 170 percent. And, while more and more Americans are losing their jobs and health insurance, the top executives in the industry are receiving lavish compensation packages. It's not just William McGuire, the former head of United Health, who several years ago accumulated stock options worth an estimated $1.6 billion or Cigna CEO Edward Hanway who made more than $120 million in the last five years. The reality is that CEO compensation for the top seven health insurance companies now averages $14.2 million.

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Michael Terranova
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« Reply #5 on: June 09, 2009, 11:25:04 am »

Moving toward a national health insurance program which provides cost-effective universal, comprehensive and quality health care for all will not be easy. The powerful special interests - the insurance companies, drug companies and medical equipment suppliers - will wage an all-out fight to make sure that we maintain the current system which enables them to make billions of dollars. In recent years they have spent hundreds of millions on lobbying, campaign contributions and advertising and, with unlimited resources, they will continue spending as much as they need.

But, at the end of the day, as difficult as it may be, the fight for a national health care program will prevail. Like the civil rights movement, the struggle for women's rights and other grass-roots efforts, justice in this country is often delayed - but it will not be denied. We shall overcome!



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Michael Terranova
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« Reply #6 on: June 09, 2009, 11:27:17 am »

Obama to Forge a Greater Role on Health Care

By SHERYL GAY STOLBERG
Published: June 6, 2009
WASHINGTON — After months of insisting he would leave the details to Congress, President Obama has concluded that he must exert greater control over the health care debate and is preparing an intense push for legislation that will include speeches, town-hall-style meetings and much deeper engagement with lawmakers, senior White House officials say.

Mindful of the failures of former President Bill Clinton, whose intricate proposal for universal care collapsed on Capitol Hill 15 years ago, Mr. Obama until now had charted a different course, setting forth broad principles and concentrating on bringing disparate factions — doctors, insurers, hospitals, pharmaceutical companies, labor unions — to the negotiating table.

But Mr. Obama has grown concerned that he is losing the debate over certain policy prescriptions he favors, like a government-run insurance plan to compete with the private sector, said one Democrat familiar with his thinking. With Congress beginning a burst of work on the measure, top advisers say, the president is determined to make certain the final bill bears his stamp.

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Michael Terranova
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« Reply #7 on: June 09, 2009, 11:27:38 am »

“Ultimately, as happened with the recovery act, it will become President Obama’s plan,” the White House budget director, Peter R. Orszag, said in an interview. “I think you will see that evolution occurring over the next few weeks. We will be weighing in more definitively, and you will see him out there.”

On Saturday, while Mr. Obama was traveling in Europe, he used his weekly radio and Internet address to make the case that “the status quo is broken” and to set forth his ambitious goals.

Broadly speaking, he wants to extend coverage to the 45 million uninsured while lowering costs, improving quality and preserving consumer choice. His budget includes what he called a “historic down payment” of $634 billion over 10 years, accomplished mostly by slowing Medicare growth and limiting tax breaks for those with high incomes.

“We must attack the root causes of skyrocketing health costs,” Mr. Obama said, pointing to the Mayo Clinic in Minnesota and other institutions as among those that offer high-quality care at low cost. “We should learn from their successes and promote the best practices, not the most expensive ones. That’s how we’ll achieve reform that fixes what doesn’t work and builds on what does.”

The radio address was the start of a public relations campaign coinciding with a 50-state grass-roots effort that Organizing for America, the president’s political group, began Saturday to promote a health care overhaul. His hope is to provide what his chief of staff, Rahm Emanuel, called “air cover” for lawmakers to adopt his priorities. It is a **** by the White House that Mr. Obama can translate his approval ratings into legislative action.

“Obviously,” Mr. Emanuel said, “the president’s adoption of something makes it easier to vote for, because he’s — let’s be honest — popular, and the public trusts him.”

But as Mr. Obama wades into the details of the legislative debate — a process that began last week when he released a letter staking out certain specific policy positions for the first time — he will face increasingly difficult choices and risks.

Aides say he will not dictate the fine print. “It was never his intent to come to Congress with stone tablets,“ said his senior adviser, David Axelrod. But he will increasingly make his preferences known.

If he embraces a tax on employee benefits, an idea he attacked when he was running for president, he may infuriate labor and the middle class. If he insists on a big-government plan in the image of Medicare, he could lose any hope of Republican support and ignite an insurance industry backlash. If he does not come up with credible ways to pay for his plan, which by some estimates could cost more than $1 trillion over 10 years, moderate Democrats could balk.

Many Republicans are already angry over the emphasis Mr. Obama placed on the public plan in last week’s letter. Senator Mitch McConnell, the Republican leader, said Friday that “the key to a bipartisan bill is not to have a government plan in the bill.”

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« Reply #8 on: June 09, 2009, 11:27:56 am »

Mr. Obama is well aware of these risks, advisers say. “This is what he is now very focused on,“ Mr. Orszag said. “What are the key things that are nonnegotiable? He is asking those sorts of questions: What are the drop-dead things that we need to have in order to have some hope of addressing long-term cost growth?”

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, recalled how Mr. Obama made a personal pledge of bipartisanship when he and Senator Max Baucus of Montana, the committee’s Democratic chairman, joined the president for a private lunch at the White House last month.

“I said, ‘Yeah, it’s a problem,’ ” Mr. Grassley said of the public plan, “and he said something along the lines of, ‘If I get 85 percent of what I want with a bipartisan vote, or 100 percent with 51 votes, all Democrat, I’d rather have it be bipartisan.’ ”

On Friday, Mr. Grassley said he viewed the letter as “a political document, not a policy document,” intended to shore up Democratic support while letting Mr. Obama remain flexible.

Senator Ron Wyden, an Oregon Democrat who is a longtime proponent of revamping health care, said Mr. Obama seemed to be wrestling with how far he could push Congress.

“The president is very much aware that to bring about enduring change — health care reform that lasts, gets implemented, wins the support of the American people and does not get repealed in a couple of years — you need bipartisan support,” said Mr. Wyden, who was among two dozen Senate Democrats who met with Mr. Obama about health care last week. “So he’s grappling with, how do you do that?”

Mr. Obama began taking steps to make his case early in his administration. He convened a “fiscal summit” where health care was a major topic, followed by a “health summit.” Not long ago, he invited industry leaders to the White House, where they pledged to cut $2 trillion in health care costs over the next decade. But he has been restrained in his dealings with Congress.

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Michael Terranova
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« Reply #9 on: June 09, 2009, 11:28:12 am »

He has, however, shown himself willing to exercise his presidential muscle when he thinks it is necessary. In April, Senator Kent Conrad of North Dakota, the Budget Committee chairman, balked at the idea of having the Senate consider health legislation under the fast-track process known as reconciliation, which could avoid a Republican filibuster. At a private meeting, Mr. Obama pressed him on it.

“ ‘I want to keep it on the table as an option,’ ” Mr. Conrad recalled the president saying. Not long after that, Mr. Emanuel, the White House chief of staff, visited Mr. Conrad on Capitol Hill. Mr. Conrad was not convinced, but decided not to stand in the way. “The Budget Committee chairman does not top the president of the United States,” he said.

Going forward, Mr. Emanuel said, lawmakers could expect “quiet one-on-one discussions” with the president.

But Republicans like Mr. Grassley say that after promising to leave the legislative process to Congress, Mr. Obama must be cautious about his words, and about the appearance of meddling.

He has, however, shown himself willing to exercise his presidential muscle when he thinks it is necessary. In April, Senator Kent Conrad of North Dakota, the Budget Committee chairman, balked at the idea of having the Senate consider health legislation under the fast-track process known as reconciliation, which could avoid a Republican filibuster. At a private meeting, Mr. Obama pressed him on it.

“ ‘I want to keep it on the table as an option,’ ” Mr. Conrad recalled the president saying. Not long after that, Mr. Emanuel, the White House chief of staff, visited Mr. Conrad on Capitol Hill. Mr. Conrad was not convinced, but decided not to stand in the way. “The Budget Committee chairman does not top the president of the United States,” he said.

Going forward, Mr. Emanuel said, lawmakers could expect “quiet one-on-one discussions” with the president.

But Republicans like Mr. Grassley say that after promising to leave the legislative process to Congress, Mr. Obama must be cautious about his words, and about the appearance of meddling.

“He’s doing good by staying out of it as much as he is,” Mr. Grassley said. “He’d better use kid gloves at the start.”

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Michael Terranova
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« Reply #10 on: June 09, 2009, 11:33:52 am »

WASHINGTON — Senior House Democrats drafting health care legislation are considering slapping an unspecified financial penalty on anyone who refuses to purchase affordable health insurance, a key committee chairman said Monday.

In addition, officials said Democrats are considering a new tax on certain health insurance benefits as one of numerous options to help pay for expanding coverage to the uninsured. No details on the tax were immediately available, and no final decisions were expected until next week at the earliest.

These officials said drafters of the legislation will include a government-run insurance option as well as plans offered by private companies. The government option draws near-unanimous opposition from Republicans and provokes concerns among many Democrats, as well, although President Barack Obama has spoken out in favor of it.

Under the emerging House Democratic plan, individuals and small businesses would be able to purchase coverage from a "health exchange" and the government would require all plans to contain a minimum benefit, these officials added. No applicant could be rejected for pre-existing conditions, nor could they be charged a higher premium, they said.

House Democrats also are considering a wide-ranging change for Medicaid that would provide a uniform benefit across all 50 states and increase payments to health professionals, according to several officials. Medicaid is a state-federal program of health coverage for the poor.

The officials spoke on condition of anonymity, saying they did not want to pre-empt a presentation to rank-and-file Democrats on Tuesday.

At the same time, Rep. Charles Rangel, D-N.Y., chairman of the House Ways and Means Committee, confirmed the proposed penalty for those who refuse to purchase coverage they can afford, referring to it as "play or pay."

"There is no use having a mandate without a contribution," he said.

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Michael Terranova
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« Reply #11 on: June 09, 2009, 11:34:08 am »

Waivers would be available for those who could not cover the cost of insurance.

The disclosures came as the pace of activity quickened in both the House and Senate on health insurance legislation, a top priority for the administration. Obama is scheduled to meet Tuesday afternoon at the White House with several Democrats.

Democratic leaders hope to pass legislation in both houses by the first few days of August, and complete work on a compromise measure in the fall for Obama's signature.

Obama has stepped up his own involvement in the issue in recent days, and there has been a flurry of negotiations involving outside interest groups who have pledged to take steps to achieve savings within the private insurance market.

Alongside those efforts, financing Obama's plan to spread coverage more widely carries a price tag estimated at higher than $1 trillion over a decade. House Democrats are considering cutting projected Medicare payments to home health care, pharmaceutical companies, insurance companies, hospitals and others to cover costs.

The option for taxing insurance benefits is also under consideration as part of legislation taking shape across the Capitol in the Senate Finance Committee.

Numerous options are possible, many involving either a tax levied according to the value of an individual's employer-provided health plan, or on the benefits received by upper-income taxpayers.

The issue poses multiple potential problems for Obama, who has pledged not to raise taxes on individuals making less than $250,000 and also ran commercials during the presidential campaign criticizing GOP rival Sen. John McCain's call for a tax on health benefits.

In recent weeks, the president and his aides have sought to straddle the issue, neither accepting it nor ruling it out.

Equally troublesome politically is the issue of a government insurance option. Critics argue it would render private companies unable to compete, and it has emerged as a key sticking point in the Democratic search for a bipartisan plan in the Senate.

All the Republicans on the Senate Finance Committee except one wrote Obama recently telling him he was making a mistake if he insisted on a government option. The exception was Sen. Olympia Snowe, R-Maine, who has been trying to find a compromise that would make a government plan available as a last resort if health insurance remains unaffordable for many families even after Congress overhauls the system.

Even before last fall's general election, health care was a key issue in the battle for the Democratic presidential nomination. Obama proposed requiring parents to buy health insurance for children, with a possible fine if parents refused. But he would not insist that all adults buy insurance.

Secretary of State Hillary Rodham Clinton, who was a New York senator at the time as well as a presidential candidate, said a mandate was essential. At one point, she said she was open to garnisheeing the wages of anyone who refused to comply.

___

Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.
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« Reply #12 on: June 09, 2009, 12:04:43 pm »

Gov't Health-care = Eugenics
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Harconen
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« Reply #13 on: June 09, 2009, 04:00:39 pm »

FREE HEAT CARE.

In Former Yugoslavia Health Care was paid by State.If you in need to go abroad to have operation, or anything else, you just go.
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Ignis Natura Renovandum Integra
Tom Hebert
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« Reply #14 on: June 09, 2009, 04:11:37 pm »

Universal health care in America is long overdue!  We are way behind the other developed countries thanks to powerful lobbying interests.
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