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Wednesday, December 2, 2009  |  posted by Hugh Hewitt

Senate Democrats are putting on a brave face and putting out the word that a deal on Obamacre will come together.

Perhaps, but that is what Harry Reid has to say and what his colleagues must put out if they are going to maintain momentum. Opponents have to double and triple their efforts to let the key Democrats –Blanche Lincoln of Arkansas, Evan Bayh of Indiana, Ben Nelson of Nebraska– know that the country realizes that their votes are the ones that will decide whether American medicine is sent over the cliff. Call them at 202-224-3121 and urge that this version of Obamacare be shelved and real reform begun, an effort that doesn’t attempt to pay for insuring the uninsured on the backs of seniors and doctors.

The best way of massaging the political consequences of Obamacare is with a contribution to If Obamacare does escape the Senate it will have to return to the House where the switch of three Democrats from “yes” to “no” will scuttle the bill. has identified the 24 Democrats who voted yes and who are most vulnerable in 2010, and is raising money to give to the Republican nominees in those districts. Contributing to that fund sends a message to every Democrat in the House and the Senate that the political cost to passing Obamacare will include their jobs.

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Far from The Worst Decision, But Some Distance From The Best

Tuesday, December 1, 2009  |  posted by Hugh Hewitt

President Obama’s speech reflected the deep unease he and his base feel with the projection of American power.

And it is very unfortunate that the president took 90 days to decide to short change the effort in Afghanistan.

It is even more dispiriting that he could not bring himself to use the word “victory,” and that he remains under the delusion that he has engineered a new start to America’s relations with the Muslim world, even as Iran holds Americans and Brits hostage and announces new surges in its drive for nuclear capability.

Still worse, he telegraphed our enemies in the region that he will cut-and-run in 18 months, thus assuring their celebration tonight as they tell their troops that their victory is assured if they stay their course.

But, it could have been worse. Much worse. The hard-left base that propelled him to the White House wanted him to declare defeat and flee. For whatever reason, the president didn’t give up. And for not being as bad as it could easily have been, we should be thankful.

Another Obamacare Expert-Enthusiast

Tuesday, December 1, 2009  |  posted by Hugh Hewitt

Princeton Professor Uwe Reinhardt was my guest Tuesday (Transcript here). Professor Reinhardt is widely regarded as an expert on health care economics and is a backer of the Obamacare effort.

Professor Reinhardt dismissed the concerns of doctors that they will see their reimbursements cut next year:

HH: What about doctors and reimbursement rates, Professor Reinhardt? Will they be having their reimbursement rates cut?

UR: No. The answer is no. They never were cut, and they won’t get cut. What happened is in 1997, the Congress passed what they called a sustainable growth rate formula. It’s literally a mathematical equation, which is pegged on the growth of GDP, and a variety of other factors. And with that, they set for the physicians a budget for the coming year for Medicare, and said basically, we can sustain and afford as a nation a total budget for doctors of so many billion. Now when doctors bill more volume than had been budgeted, then next year, suppose the doctors bill 3% more volume than had been budgeted, then next year what would have been the fee update will get cut by 3%. That was the original idea. Now what actually happened, every year, for the most part every year, doctors exceeded the volume that was budgeted, because the fees were controlled so doctors can make more money by expanding volume-tests, imagining and so on. And each time, they exceeded the budget, and each time, they were supposed to take a hit for last year’s budget excess. But the Congress never imposed the hit on them, and banked it. So by now, you know, according to this equation, the doctors owe the rest of society a 20% fee cut. Now you and I, and every dog in Oregon knows this will never happen.

But if doctor’s reimbursement rates aren’t cut –and many doctors called and e-mailed the show to challenge the professor’s assertion– then the representations about the bill’s budget neutrality are completely bogus. The professor agreed with this obvious conclusion:

HH: Well, I know that, but President Obama said he wouldn’t sign a bill that was other than deficit neutral. And so if they’re scoring it based upon this massive cut to physician reimbursement, it’s not an honest scoring, is it, Professor?

UR: No, none of the scoring is really very honest.

HH: Oh, that’s interesting.

UR: No, you know, the American people are really weird and funny people. They like these games. What the way the Congressional Budget Office calculates the so-called savings, there is a projection of what health spending would be in the next ten years if no law were ever passed again. In other words, everything is frozen the way it is today, and then what would spending be, which is a total guesstimate, and even that is a kind word.

HH: So is there, is it a deficit neutral bill that’s before the Senate right now, Professor?

UR: According to the rules that the Congressional Budget Office works by, yes it is.

HH: But under those rules, they count those physicians cuts which aren’t going to happen. So what do you really think is the cost of Obamacare?

UR: Well, I think they claim that it’s actually cutting the deficit over the next ten years, and much more thereafter. I personally doubt that the deficit will in fact be cut. For one, I mean, this physician fee cut, even if they put it in the bill, which is convenient, you and I know this is not going to happen, and some other cuts won’t happen. So it will in fact, when the ten years are over, this bill will have been not added to the deficit? I doubt it very much. It probably will. However, and this is what citizens should keep in mind, President Bush gave the elderly highly subsidized drugs. In the coming decade, that drug bill will add $1.2 trillion dollars to the deficit. President Bush didn’t even worry about financing. He just said financing? That’s not for me.

What Will Obamacare Do –To You? Part 6

Tuesday, December 1, 2009  |  posted by Hugh Hewitt

Another e-mail:

Hi Hugh,

My wife is a practicing dermatologist. Although it may be crazy, we’re actually in the process of opening a new micro practice. From our perspective, one of our biggest fears is that the government will mandate physicians accept any/all government sponsored insurance under threat of losing or revoking medical licenses. There may not be an option out. I believe New York State does this already. If that’s the case, our new business won’t last long. As it is margins for small practices are very tight and overhead is unbelievable high. Add even more complicated medical billing and reduced physician compensation and I don’t see how any private practices will survive. Maybe that’s the plan.

The government knows most physicians have to much time invested in their education and care too much about their patients to simply walk away. I believe that’s why Medicare has continued to cut or keep static their rates. Physician compensation will be a large target for cuts. I guess eight to twelve years of post graduate education and training don’t deserve high compensation. It’s shocking that most people don’t realize how long it takes, how much work it is, and how expensive it is to become a licensed practicing physician.

The worst part about all of this is the feeling of helplessness. The politicians know the people don’t want this, but they’re going to jam it down anyway. We’ve donated to Reverse the Vote, and my wife has attended and spoken at any local town hall meeting that comes around, but it seems like none of it matters. Maybe the fickle politicians will yet respond to falling approval ratings and negative healthcare polling, but I feel like the power grab temptation is just too much to resist.

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