Many Americans don’t know what to make of their new president. They’ve never seen one quite like him in their lifetimes.
He seems to have the unique idea that he represents all Americans - not just the liberals that he’s been so scathingly associated with. In the process, he’s been reaching out to conservatives, independents, business interests, war hawks, peaceniks, special interest groups, international adversaries and Republicans, among others. He has sought the advice of most and has incorporated their ideas into his efforts.
At first blush, it would appear that he’s found the ultimate key to political success. However, as time has passed in these early months of his presidency, that particular assumption has become not only uncertain, but it’s beginning to look like the key he found might only open the door to failure.
The style of the new president is arguably one hundred and eighty degrees removed from the policies and strategies of his predecessor. The Bush administration consulted no one outside its inner circle and it went whole hog for exactly what it wanted, the public be damned.
It conducted a preemptive invasion of a relatively innocent country, displacing millions and causing the deaths of more than one hundred thousand people, including over four thousand Americans. It passed out no-bid contracts and otherwise rewarded the wealthy with exorbitantly extravagant tax cuts while the buying power for the un-wealthy declined. And it oversaw the greatest orgy of greed on the part of the moneyed interests that the world has ever seen.
From the perspective of the point being made here, however, the significance of all of the foregoing is simply that the Bush administration was spectacularly effective in achieving its goals. And this is all the more remarkable when one considers that those goals were diametrically opposed to the best interests of the general public.
Bush and his inner circle did it without a moment’s consideration for the feelings of anyone else in the country or even in the world, which causes one to wonder if that wasn’t the the key to their “success.”
Now, fast-forwarding to the Obama administration, it almost seems that the new president is so busy reaching out, that the public is losing sight of just what his vision is. As a result, the situation appears to threaten his legacy as being tagged with weak leadership, quite the opposite picture from what seemed to be presented during the campaign.
Examples are plentiful. In the “war on terrorism,” that very title has been dropped, and he has reached out to the Muslims of the world with a major speech in Cairo. With respect to Israel, he has attempted to show a more even-handed approach by reaching out to the Palestinians. He is attempting to initiate a dialogue with Iran, and his envoys are meeting with anti-American groups in Pakistan.
These and other international efforts may be long overdue and, at this point, seem to hold out the prospect for an increase in global harmony.
However, the same strategy at home, in the somewhat broken-down system we call American politics, does not seem to be working so well and, unfortunately for the president, that is getting, by far, the most attention.
For example, Obama has reached out to business interests by suggesting that much of the fees for exceeding carbon emissions caps might be given to factory owners and power companies instead of going towards middle-class tax cuts; by allowing companies to blow the tops off of a dozen mountains in their mining endeavors; by opposing efforts to support and defend 60 million acres of federal woodlands from corporate development; and by letting stand a Bush administration policy baring the government from using the precarious state of the polar bear population as a reason to crack down on global warming. These positions, and others, are all either specifically or generally contrary to the president’s previously stated goals.
He has further mollified conservatives by defending Bush’s program of warantless wiretapping, by dragging his feet on doing away with the “don’t ask don’t tell” policy of the military, by reversing his intent to release photos of Iraqi prisoner abuse and by not ruling out the practice of turning suspected terrorists over to other countries that employ torture, a practice known as “extraordinary rendition.”
The president has also catered to politicians on the Hill as well as to special interest groups by signing a spending bill with over 8,000 earmarks in it, according to reports.
You might think that this would have gotten our leader a broad base of support, but such is not the case.
And nowhere have his efforts been more obvious or frustrating than with his current attempts to get a healthcare reform bill passed.
In the process, he has met with healthcare lobbyists and CEO’s on numerous occasions and he’s been accused of attempting to win the support of the pharmaceutical industry by protecting its patent rights overseas, even when such efforts resulted in the denial of much needed drugs for third world countries.
He has presented his healthcare reform plan but has welcomed input from those opposed to it which, from a political standpoint, has represented most, if not all, the Republicans in Congress. When a provision enabling the choice of a government-run program encountered opposition, he said, according to reports, that it wasn’t a necessary part of the reform. Still, the Republican Senators and Congressmen opposed the effort. And the situation has been further hampered by lies and orchestrated disruptions.
Further casting a big question mark on the effectiveness of the administration’s strategy is a new Washington Post-ABC News poll showing that the public’s confidence in the president and its support of healthcare reform are both dropping. Obama’s overall approval rating now stands at 57%, 12 points lower than its April peak. Disapproval of Obama’s handling of the healthcare issue has reached 50%.
The politicians are faring even worse. As far as making the right decision for the country’s future is concerned, only 21% of the respondents had confidence in the congressional Republicans and 35% in the Democrats.
Congress has been in low esteem for some time, however, and for good reason. One of the issues it is now embroiled in, for example, is whether to use low-energy bulbs in lighting up the Capitol. The democrats are in favor and, of course, the Republicans are opposed. A lighting consultant was hired for $671,900 (2/3 of what the whole project would cost) and it is more than a year behind schedule. Nevertheless, we may soon learn - as the L.A. Times put it - just how many lawmakers it will take “to screw in a light bulb.”
At the end of the day, however, the White House is the ultimate plum and the principle target for the opposition. So it all comes down to the initial question…
... Is the president is reaching out too much?
Dave McGill, News Correspondent
Dave’s column, “The Contrarian,” generally published every Friday to Gather Essential News and other groups will sometimes present a contrary view to various aspects of the news, or an alternate take on the conventional wisdom of the day. It will also often appear on other days of the week
Dave has been a senior officer of an eastern insurance company, involved in economic projections and investment strategy, president of a Midwestern mortgage banking company, and a financial consultant in Southern California, serving clients in the field of commercial real estate development.
You can find all of Dave’s “the contrarian” columns at: http://gather.com/thecontrarian. Keep up with Dave’s other postings and Gather activity by joining his Gather network at: http://atadaskew.gather.com. You’ll find Dave and other News correspondents, plus celebrity content and plenty of news experts at: news.gather.com.
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Comments: 87
The merely impossible has been accomplished already! Miracles take a little longer.
Pop a Ritalin and stay focused.
Having said that, I do believe that the insurance industry is too happy with the proposed health care reform. If we are truly to see a health care system that works and is cost effective the feathers of the insurance industry will have to be ruffled and long held practices will have to stop. If those things don't happen, there will be no meaningful reform, as far as I'm concerned. So, I am not a happy camper over the health care reform process at this point.
Additionally, the Republicans failed the country. President Obama will certainly hurt himself if he doesn't claim the Democratic mandate that was surely won in November of 2008. I think that the Republicans are worth listening to and worth meeting half way. But, their mentality has been a "my way or the highway" sort of politics that has damaged our politics and our culture beyond belief. I believe that President Obama won because the voters want something different than that.
I continue to have hope, but I have reservations. Thanks for sharing your ideas, Dave. I like your even handed tone and ability to call things as you see them without being insulting or belittling of other viewpoints.
I still think it is a good plan if the president will stick with it. He should try harder to leverage the reaching out that he has already done but I'd hate to see him stop trying to be bipartisan in his efforts.
This Bipartisan retoric is just lip service. I't Obama's way or no way in DC and he will find out how foolish that is in 2010.
If we want change we have to show overwhelming support for Democrats in the next election, of change with languish.
So we cannot lose faith and even if we do it is still a priority to make the Republicans lose more faith.
I think if Democrats show staying power we will see violence sooner or later from Republicans in some form. Coming to rallies with guns is just the prelude.
Untill we kick the NeoCons out and elect people who care more for out country than they do for a World Government we will continue to sink into oblivion.
I hope your statement that the coercion you first noticed was under Clinton is not what you believe! I'm sure you are old enough to have noticed it under administrations of both parties going back to Eisenhower. This seems to be a time honored tradition. Sure it is worse under some than others but that is a mere technicality on the whole thing.
Obama is not nearly as practiced in this as was GWB. Under Carter and Ford it was minimal. Under Regan it was rampant, and so on. I have no doubt that if we'd lived in the days of Jefferson we'd be familiar with it from that administration as well.
Linda,
I also believe he cannot stay inclusive if he is not very carful about what he says at all times.
Even then he boo booed with the Harvard professor's arrest.
Obama has,
Limbaugh, Hannity, O'Reilly, Levin, and 300+ am conservative talk jockersters parsing and manipulating and "Interpreting" every word he utters, twisting into some he didn't say at all.
Their listeners, see Mary Bradley" comment believe and repeat everything said by the Fox and AM talk liars.
I am sick of them. The nation voted in a Democratic president and Congress. It's time for them to stand up and use their power.
We have used the good cop approach with the GOP; until they start cooperating, it's time for the bad cop style.
Reading the comments above from Republicans, it's clear that they don't see the compromise being extended by this administration at all. So, why are we catering to them?
He is dancing
Bush didn't start or pursue the war in Iraq for so many years all by himself, he had some help from you and I. Now we've decided to end the war because it just isn't worth it anymore for us to ride around in our SUV's at the expense of the lives of peope in another part of the world, foreign people who died at our hands just so we could maintain our standard of living and all of a sudden we are expecting a president to solve our problems for us. It wasn't entirely bush's job to do that and it isn't entirely Obama's either. we all have something to do with it.
Another point, what are or were the demographics of the American military anyway, doesn't it matter? I have not heard a word said about it for close to 8 years. Did the demographics of the American military have anything to do with the fact that the race problem in America has all l but dissapeared since the war started.
I rest my case! I read Dave's article because he was kind enough to send a message to my in box.
peace on earth, good will toward human kind
Afghanistan will see change. Afghanistan will see more violence. Pakistan will see more violence, and India will see more violence.
I hope that our military will adapt and change to the changing mission.
It would be nice if there were greater cooperation on a global front. Sadly, most nations are concerned about themselves only.
We are trying to bring others along in this game of life.
Obama will go down the liberal only route at his own peril. 2010 could see large swings in majorities of control.
Our business Should be our Nation. Our military does not have a legitimate mission in any of those countries.
On the other hand and also as expected, the wealthy interests have powerful influence not just on Congress but on the Executive branch as well. They may not have a much influence but it is still considerable.
One final point, a President cannot make decisions based on what is popular and have success. The President must do a lot of unpopular things to be successful. The President has to be better at making decisions than Congress and the American people because, well, look at how foolish our laws are and what foolish decisions we Americans make to get ourselves in trouble. (Bad mortgage, anyone?) I know Obama could have done a better job and I know he doesn't understand how the economy works (but then the economists don't either). So I don't expect a lot of success from this Administration, they're only human. But he is doing some good things and is obviously attempting to do more good things despite great resistance all 'round. Of course mixed in with those good things are some goofs.
The Democrats just never say nothing about the Republican policies. They behave as if the dwindling minority of responsible Republicans are still in power and ignore the fascist branch of the GOP that has been in charge since W. Bush. Half Democrat support comes from Businesses or Republicans hedging their bets, so the Democrats do not have the guts to say anything. Republicans are at war with the people of the US and put them in about as much regard as they do the native population of any country they seek to exploit.
It has been prime Republican policy to drown the government in debt, and make social programs appear to fail, all while lecturing everyone from the high ground about responsibility. They have done it. The country is failing economically, and we do not see it and we will not admit it.
And much of the world is now convinced that the world is not going to be any different without an active US. Nothing is going to happen until it is clear that the US is either back or getting weaker. The market going up and all the talk or recovery is just a nice facade, and as long as they can hide the reality of American life at this point why should they care.
What this country needs is to take a cue from France, some general strikes and bycotts of major corporations until they realize that they people are the boss. And if they cannot exert their power the people are nothing.
As one of the folks the President is supposedly "reaching out to", I believe he is lecturing us "nonbelievers" with a "Father knows best" tone in his voice. The fact that he keeps referring to "my health care reform plan" which has never been published so his remarks can be verified, is another irritant (I notice he has recently shifted to talking about the "bill" instead of "my plan".)
Finally, his remarks on the record about favoring a single payer plan, which is a government takeover of health care, don't do much for his credibility when he denies that a takeover is his intent. That is why I, and a very large number of Americans, don't trust this President on health care reform, or anything else.
The exception is Union members, they still have a voice.
Everyone else lets the very rich and big big business send the money then whine that we have no voice.
When an organization like Commn Cause tries to end business money.
SCREAMS about First Amendment Rights and Freedom Ring out.
Where WERE you during the Obama campaign?
This Obama-care debate is without a doubt the most idiotic and embarrassing- screw-up in the history of political thinking.
Mr.Obama, if you want a chance to turn things around- and at this point your chances are near zero-try this.
1-, Stop Lying, no one believes you anymore.
2-. Get a Press- person with a Brain- Robert Fibbs, is LAME.
3- Tell the statist-press to stop asking you softball questions and treat you like they treated W. or like they treated Reagan- mean and tough.
4-. Fire Biden hire yourself a Dick Cheney v.p. you desperately need a strong inside Washington politician in your ear. Biden is a joke.
5-. most important Mr. President do not, play the "Race-Card" excuse for your failures. Obama it is time for you to man-up, admit your mistakes, make changes and get yourself some non-leftist help.
Obama, look at your numbers, sir, you need Hope and Change for you to survive.
Call me, I will get you back on track.
Neither the world or the US ever, ever,ever needs another VP like Dick Cheney. War profiteer, liar and overall criminal.
The recent Gallup poll points the way. If you take out the Wash. DC stats
30 - 49 % is the conservative range
32 - 41 % is the moderate range
14 - 29 % is the liberal range
Conservatives and moderates have the best party base for national elections.
This was clearly a well thought out article Dave. Thanks for sending it to me.
It was given away by racist, religious and reactionary voters trying to recreate 1950.
It's interesting to hear people complain about his search for consensus. Some people see it as insincere and others see it as caving in. I think he's a centrist by temperament.
Beginning with Bill Buckley's campaign in the late 1960s, (he recruited Regan into politics)
The Conservatives (The rich/powerful) not only have used tricks and lies, racism, religion, fear. to be elected,
there are
more than 100 Conservative "think tanks" pouring out "papers" and information promoting capitalism(unregulated) and a "return to America's roots".)
The Roots being the Rich firmly in control, Profits maximized no matter the cost to the environment, no control on exploitation of labor, even child labor is ok with these people.
Good wages, good lives, out the door for the workers. Profit is king.
These essays and opinion pieces appear everywhere, in every kind of magazine, on every kind of broadcast show. Yes, PBS & NPR included.
Some are more subtle than others.
They are so successful, very poor, very low wage earners, run out and vote against their own rights and economic self interest.
And it is this movement that must be countered before there will be any change.
I don't know how people like "mickey d" can be turned around, but they are dying, and the U.S.A. demographics are much changed from 1970 when this juggernaut began with Nixon's election.
Even good union member Democrats have been so exposed to this propaganda they would not vote for anyone as liberal as Lyndon Johson today.
The Republicans spent 40 patient years destroying the U.S.A. worker and the U.S.A, Middle Class.
When everything began to crumble & crash, they all had a gigantic champagne celebration, don't doubt it for a second.
They are now doing everything possible to prevent any liberal ideas from being legislated or adapted.
I rarely read news.
I do read history.
I do follow the story, in hard to describe ways. . .
I like original documents, direct quotes, what is actually going on around me, at work and in the community, all that "general bs"
Whatever....
Obama, is a very weak man- he has no ability to lead the glow is off the Messianic - ONE!
And please mr.president, stop lying-everyday .
Micky,
You never lost an opportunity to compliment your President Bush. Now that we have another president who you didn't happen to vote for, you are playing a different game.
And, we Americans are not submitting to Castro or anyone else. The US Constitution guides the American experiment - not your silly notion of our culture.
President Obama is the first professor of constitutional law that we have had since Herbert Hoover. He is better trained and more able to understand our legal process than most people want to admit. His former students at the University of Chicago have not only commented on his knowledge, but his incredible ability to bring this knowledge alive so that everyone gains a better understanding. He is known as a brilliant educator in the Chicago area. Many people don't know this about President Obama.
Now, President Bush was handed an excellent education at excellent schools throughout his formative years. He did not work hard enough to really benefit from those advantages. His father then gave him the seed money for many business ventures throughout his early adult life. He managed to fail at every one of those ventures. (How does one screw up an oil business in Texas?) His entry into Texas politics was the smartest thing that he ever did. He is a very intelligent man. He lacks a more important characteristic, however. He lacks persistence. He complained about the hours required of a governor many times over the years. When people questioned a few judgment errors he made as president, he informed everyone who would listen that it is hard to be president. He just didn't develop the necessary components of a successful man. So, when his ideology didn't carry him through, he failed the country. History will not be kind to him. It is not that he isn't smart enough or even talented enough. It is that he did not grow and evolve into the type of leader that we needed. With President Obama, we already have a leader who has proven his leadership qualities and abilities. We may not always agree on everything that our leaders do. But, we should always discern the truths about our leaders. We are better off with President Obama at the helm than we were with President Bush at the helm. It isn't about politics. It is about character and ability.
It would be easy to be discouraged, contrary to the lie that the "media" is liberal. . . . It is mostly conservative and at best moderate. It is called the Fourth Estate because it is part of the establishment, not separate from it. Contrary to Limbaugh/Hannity, Obama’s press is not that great. His policies are questioned and critiqued far more than Geo. W. Bush’s were.
I don't think we need to be in such a hurry. If we know that the Republicans who are really in control.
Still want to end Social Security and Medicare
Still want more deregulation, the broken economy has not harmed the rich, and has given them more power.
Republica goals are No minimum wages, no worker safety, no environental rules, no government programs except the military and so on.
I am looking forward to the health care "debate" to continue. Next week the Republicans will introduce their plan.
Here are the main two differences.
Remember now both plans. . . . will cost the taxpayer billions, Republican plan is deceptive since it intends to move more costs to individual states.
Main goal of Democrat plan:
Povide healthcare for more people and reduce costs, especially for Medicare and medicaid, the existing government run health programs.
Main goal of Republican plan:
Free business from the cost of providing health care for their employees.
So once again we do have to remember, it is not bad, but good for Obama to keep looking for inclusion and a wider discussion.
I am anxious for change, it is impossible for it to happen overnight.
Povide healthcare for more people and reduce costs, especially for Medicare and medicaid, the existing government run health programs."
Their plan can do one of those two things, but only one.
Wage and price controls could be a fantastic compromise.
funny really
T.I., did the passing of Novak stir up any old feelings?
The next contentious issue, they say, will be Medicare Advantage. It costs the government an extra 14% and the media is saying that the companies collecting the money don't provide anything that Medicare doesn't, at least that is exactly what the L.A. Times said.
Also, it is a target of Obama's.
As far as I know, the media report is wrong. I'm not aware that medicare insures the cost of drugs that members use. Perhaps it does, but I have never been advised of such.
I get my prescriptions from Target or the VA. My wife gets hers mostly from a mail order pharmacy through a Medicare Advantage company. Without that, I don't believe she would have any insurance coverage for drugs. If that is true, Medicare Advantage is significant for millions of seniors. Medicare Advantage also provides coverage for eyeglasses and dentistry, neither of which are covered by Medicare as far as I know.
If anyone knows otherwise, I'd like to hear from him or her on this thread.
The one thing I am very much afraid of on behalf of all seniors is that they are zeroing in on the costs of maintaining health care for the aged and their concern is all the more magnified by the knowledge that the baby boomers start turning 65 in a little over a year.
When I hear of the need to cut Medicare costs, it means to me that people are going to start dying earlier - period.
To put this in a little perspective, the additional aggregate annual cost to the government for Medicare Advantage is less than the money that was provided to AIG without a second thought, which, at the time, appeared to be a very risky undertaking.
But anything that's for the people these days will find political opposition because "the people" by and large don't grease the politicians hands... Stay tuned to see if Medicare Advantage doesn't turn out to be the next hot button...
.
Since some of what he wrote even long ago was Karl Rove style lies,
I always wondered why he was granted any credibility at all.
Medicare Advantage is Medicare, but with HMO style coverage, I don't think it will be called out separately from the program. The intent for Medicare Advantage was to contain costs.
I will have to look up and see if there is information about costs of Medicare Advantage vs. Medicare + the MediGap costs.
There certainly is no "news" coverage on Medicare Advantage being more costly.
I hope the plan to cut Medicare costs is based on stopping fraud and injury and death from mistakes.
There is a lot of duplication of tests, delays for treatment because of lost records, treatments, and office visits that seem excessive for patients with good Medi-Gap policies, less care for others. So inequalities exist in the current system.
I don't think there is an intention to limit treatment, but to very honestly provide treatment necessary. I don’t think the government is going to be denying care as often as our private insurers do.
Changing the way we provide medical care is not going to be an overnight process.
I wish we were all arguing about the best ways to provide good quality care instead of if we are going to cover everyone.
Some say adding more people to receive available treatment will crash the system.
I say people often need extra follow-up care from mistakes made in treatment, and of course the extra complications from receiving treatment so late for chronic conditions that treatment is ineffective.
Profit based medical systems are inherently flawed. And there is the problem that we have fraud in both Medicare and the State Workmen's Comp Insurance programs, because we have doctors and hospitals profiting from the fraud.
I think the Obama administration is not speaking out on fraud because they would then be accused of punishing the providers.
I don't know how a retiree can game the Medicare system, except the Social Security Disability recipients who continue to work for cash while receiving benefits.
I will have to look through HR 3200 and see if it includes any information about Medicare Advantage, which is run like private HMOs.
It looks like for now the plan to include workers in a health care program is focused on getting coverage for more people and upgrading the care Medicaid patients receive. (This varies state by state, and as you know in California, and probably other states, not many doctors are willing to see these patients because the reimbursement fees are so low.)
Banking/Wall Street/AIG Certainly have more influence than you or I.
I remain appalled at how many Medicare recipients say Medicare is not a Government Health Care Program..
They all seem blind to the fact that their employers paid 1/2 the cost as long as they were employed and that this is indeed a tax on the employer.
It currently looks like Medicare will continue as is for now. It is working, and the expected shortage of funds is because the number of employed are not numerous enough to cover the costs of the retirees.
What you will never hear a Republican say is that part of this problem is the reduction in pay of blue collar workers Social Security & Medicare tax is a percentage of gross pay) and the illegal immigrant workers, working for cash, neither they, nor they employers are paying the tax to support the program.
So we have blue collar workers happy that union pay is reduced, instead of pushing for higher pay for themselves.
Strange world.
Buried in the thousand plus pages of the House bill on healthcare reform is, in fact, a provision to cut payments to Medicare Advantage companies. All ten million of the seniors that are now directly affected should be vitally concerned, as should aging baby boomers.
If this provision survives, the "care" that I believe will be in jeopardy for seniors on Medicare Advantage will be with respect to drug coverage.
If the government cuts its fees to medicare Advantage companies, they, in turn, will reduce their drug coverage and thereby pass the added burden on to the seniors. "Some" seniors - and perhaps that should be "many" will then have to cut back on their drugs which may, in fact, be keeping them alive and relatively healthy. This may actually cause an increased burden to fall back on the government.
Here's an example. The most major cause of hospitalization has been reported to be congestive heart failure among mainly elderly patients. At the same time, great strides have been made over the past 15 years in the development of drugs to control congestive heart failure and keep seniors out of the hospitals. These drugs can be costly, however, so if economic necessity causes a reduction in the use of these drugs, hospital admissions may rise, and, as we all know, that's where the biggest costs lie.
Incidentally, my statement in a previous comment regarding the extra money the government pays Medicare Advantage companies should have read as follows. (The corrected words are in upper case and replace words that indicated the cost total was an annual figure)..
"...the additional cost to the government, OVER 10 YEARS, for Medicare Advantage is less than the money that was provided to AIG without a second thought, which, at the time, appeared to be a very risky undertaking."
None of these bills are passed.
I know our Senators and Congresspeople are buried in emails. I will write all three of mine to not kill off Medicare Advantage by cutting payments.
We can also look up the companies covering these plans and check their profit status, that may be what prompted the idea to cut the payment.
I went to the Medicare site, it is necessary to look state by state to find the HMOs providing these plans.
Subtitle D--Medicare Advantage Reforms
PART 1--PAYMENT AND ADMINISTRATION
SEC. 1161. PHASE-IN OF PAYMENT BASED ON FEE-FOR-SERVICE COSTS.
Section 1853 of the Social Security Act (42 U.S.C. 1395w-23) is amended--
(1) in subsection (j)(1)(A)--
(A) by striking `beginning with 2007' and inserting `for 2007, 2008, 2009, and 2010'; and
(B) by inserting after `(k)(1)' the following: `, or, beginning with 2011, 1/12 of the blended benchmark amount determined under subsection (n)(1)'; and
(2) by adding at the end the following new subsection:
`(n) Determination of Blended Benchmark Amount-
`(1) IN GENERAL- For purposes of subsection (j), subject to paragraphs (3) and (4), the term `blended benchmark amount' means for an area--
`(A) for 2011 the sum of--
`(i) 2/3 of the applicable amount (as defined in subsection (k)) for the area and year; and
`(ii) 1/3 of the amount specified in paragraph (2) for the area and year;
`(B) for 2012 the sum of--
`(i) 1/3 of the applicable amount for the area and year; and
`(ii) 2/3 of the amount specified in paragraph (2) for the area and year; and
`(C) for a subsequent year the amount specified in paragraph (2) for the area and year.
`(2) SPECIFIED AMOUNT- The amount specified in this paragraph for an area and year is the amount specified in subsection (c)(1)(D)(i) for the area and year adjusted (in a manner specified by the Secretary) to take into account the phase-out in the indirect costs of medical education from capitation rates described in subsection (k)(4).
`(3) FEE-FOR-SERVICE PAYMENT FLOOR- In no case shall the blended benchmark amount for an area and year be less than the amount specified in paragraph (2).
`(4) EXCEPTION FOR PACE PLANS- This subsection shall not apply to payments to a PACE program under section 1894.'.
SEC. 1162. QUALITY BONUS PAYMENTS.
(a) In General- Section 1853 of the Social Security Act (42 U.S.C. 1395w-23), as amended by section 1161, is amended--
(1) in subsection (j), by inserting `subject to subsection (o),' after `For purposes of this part'; and
(2) by adding at the end the following new subsection:
`(o) Quality Based Payment Adjustment-
`(1) HIGH QUALITY PLAN ADJUSTMENT- For years beginning with 2011, in the case of a Medicare Advantage plan that is identified (under paragraph (3)(E)(ii)) as a high quality MA plan with respect to the year, the blended benchmark amount under subsection (n)(1) shall be increased--
`(A) for 2011, by 1.0 percent;
`(B) for 2012, by 2.0 percent; and
`(C) for a subsequent year, by 3.0 percent.
`(2) IMPROVED QUALITY PLAN ADJUSTMENT- For years beginning with 2011, in the case of a Medicare Advantage plan that is identified (under paragraph (3)(E)(iii)) as an improved quality MA plan with respect to the year, blended benchmark amount under subsection (n)(1) shall be increased--
`(A) for 2011, by 0.33 percent;
`(B) for 2012, by 0.66 percent; and
`(C) for a subsequent year, by 1.0 percent.
`(3) DETERMINATIONS OF QUALITY-
`(A) QUALITY PERFORMANCE- The Secretary shall provide for the computation of a quality performance score for each Medicare Advantage plan to be applied for each year beginning with 2010.
`(B) COMPUTATION OF SCORE-
`(i) FOR YEARS BEFORE 2014- For years before 2014, the quality performance score for a Medicare Advantage plan shall be computed based on a blend (as designated by the Secretary) of the plan's performance on--
`(I) HEDIS effectiveness of care quality measures;
`(II) CAHPS quality measures; and
`(III) such other measures of clinical quality as the Secretary may specify.
Such measures shall be risk-adjusted as the Secretary deems appropriate.
`(ii) ESTABLISHMENT OF OUTCOME-BASED MEASURES- By not later than for 2013 the Secretary shall implement reporting requirements for quality under this section on measures selected under clause (iii) that reflect the outcomes of care experienced by individuals enrolled in Medicare Advantage plans (in addition to measures described in clause (i)). Such measures may include--
`(I) measures of rates of admission and readmission to a hospital;
`(II) measures of prevention quality, such as those established by the Agency for Healthcare Research and Quality (that include hospital admission rates for specified conditions);
`(III) measures of patient mortality and morbidity following surgery;
`(IV) measures of health functioning (such as limitations on activities of daily living) and survival for patients with chronic diseases;
`(V) measures of patient safety; and
`(VI) other measure of outcomes and patient quality of life as determined by the Secretary.
Such measures shall be risk-adjusted as the Secretary deems appropriate. In determining the quality measures to be used under this clause, the Secretary shall take into consideration the recommendations of the Medicare Payment Advisory Commission in its report to Congress under section 168 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275) and shall provide preference to measures collected on and comparable to measures used in measuring quality under parts A and B.
`(iii) RULES FOR SELECTION OF MEASURES- The Secretary shall select measures for purposes of clause (ii) consistent with the following:
`(I) The Secretary shall provide preference to clinical quality measures that have been endorsed by the entity with a contract with the Secretary under section 1890(a).
`(II) Prior to any measure being selected under this clause, the Secretary shall publish in the Federal Register such measure and provide for a period of public comment on such measure.
`(iv) TRANSITIONAL USE OF BLEND- For payments for 2014 and 2015, the Secretary may compute the quality performance score for a Medicare Advantage plan based on a blend of the measures specified in clause (i) and the measures described in clause (ii) and selected under clause (iii).
`(v) USE OF QUALITY OUTCOMES MEASURES- For payments beginning with 2016, the preponderance of measures used under this paragraph shall be quality outcomes measures described in clause (ii) and selected under clause (iii).
`(C) DATA USED IN COMPUTING SCORE- Such score for application for--
`(i) payments in 2011 shall be based on quality performance data for plans for 2009; and
`(ii) payments in 2012 and a subsequent year shall be based on quality performance data for plans for the second preceding year.
`(D) REPORTING OF DATA- Each Medicare Advantage organization shall provide for the reporting to the Secretary of quality performance data described in subparagraph (B) (in order to determine a quality performance score under this paragraph) in such time and manner as the Secretary shall specify.
`(E) RANKING OF PLANS-
`(i) INITIAL RANKING- Based on the quality performance score described in subparagraph (B) achieved with respect to a year, the Secretary shall rank plan performance--
`(I) from highest to lowest based on absolute scores; and
`(II) from highest to lowest based on percentage improvement in the score for the plan from the previous year.
A plan which does not report quality performance data under subparagraph (D) shall be counted, for purposes of such ranking, as having the lowest plan performance and lowest percentage improvement.
`(ii) IDENTIFICATION OF HIGH QUALITY PLANS IN TOP QUINTILE BASED ON PROJECTED ENROLLMENT- The Secretary shall, based on the scores for each plan under clause (i)(I) and the Secretary's projected enrollment for each plan and subject to clause (iv), identify those Medicare Advantage plans with the highest score that, based upon projected enrollment, are projected to include in the aggregate 20 percent of the total projected enrollment for the year. For purposes of this subsection, a plan so identified shall be referred to in this subsection as a `high quality MA plan'.
`(iii) IDENTIFICATION OF IMPROVED QUALITY PLANS IN TOP QUINTILE BASED ON PROJECTED ENROLLMENT- The Secretary shall, based on the percentage improvement score for each plan under clause (i)(II) and the Secretary's projected enrollment for each plan and subject to clause (iv), identify those Medicare Advantage plans with the greatest percentage improvement score that, based upon projected enrollment, are projected to include in the aggregate 20 percent of the total projected enrollment for the year. For purposes of this subsection, a plan so identified that is not a high quality plan for the year shall be referred to in this subsection as an `improved quality MA plan'.
`(iv) AUTHORITY TO DISQUALIFY CERTAIN PLANS- In applying clauses (ii) and (iii), the Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan's compliance with rules for such plans under this part.
`(F) NOTIFICATION- The Secretary, in the annual announcement required under subsection (b)(1)(B) in 2011 and each succeeding year, shall notify the Medicare Advantage organization that is offering a high quality plan or an improved quality plan of such identification for the year and the quality performance payment adjustment for such plan for the year. The Secretary shall provide for publication on the website for the Medicare program of the information described in the previous sentence.'.
The cut must be in setting the benchmark
But it looks like there is a recognition of some cost effective providers
It's also mind boggling in its complexity and lack of clarity. The method of calculating a quality performance score can likely be tweeked to generate whatever savings they need, just like much of the other government data is tweeked. The verbiage here appears to have created a very precise-sounding smokescreen behind which anything can happen.
The one thing we know is that this provision is there for the purpose of reducing the fees being paid to Medical Advantage companies. We know this because the president and others have been saying so. Furthermore, savings under this provision have already been taken into consideration as a partial offset to the estimated cost of the House plan.
Reading the information you provided makes the situation seem even scarier than it seemed before... but thanks again for posting it...
And people think businesses have all the answers to efficiency.
Dave.
One would have to have a copy of Medicare act as it now stands and compare each section.
Difficult, time consumning task.
I am very much in favor of good quality health care for everyone, but have no personal stake in it.
I am kind of anti-medical, and have not seen a doctor for more than 5 years, and probably only 10 visits since my children were born, most often from accidental injury.
A fall when painting, the ladder toppled.
A near fatal encounter, the tractor, the tree & me.
etc.
Being earnest and honest is great. But every job demands results. Let's hope for the best.
Are you talking about the same guy currently in the White House here?
...and, yes, I get your point, Charles....he may incorporate ideas in his efforts but it may just turn out to be "today's illusion."....I absolutely agree...
Lots of farming, Engineering/technolgy, some writers, some teachers, military only as necessary for defense of our nation. No policemen, no politicians, we vote, even send a few $, but we don't get close enough to tar ourselves. (smirk)
Extreme independents like us do not rise the top tier of wealth and are lucky to cling to middle class status, but do seem to avoid extreme poverty.
I have finally found a reference for Obama's remarks about Medicare Advantaqe.
January 11, 2009, on This Week with George Stephanopolis (ABC):
Obama quoted as saying:
"We’ve got to eliminate programs that don’t work, and I’ll give you an example in the health care area. We are spending a lot of money subsidizing the insurance companies around something called Medicare Advantage, a program that gives them subsidies to accept Medicare recipients but doesn’t necessarily make people on Medicare healthier.
And if we eliminate that and other programs, we can potentially save $200 billion out of the health care system that we’re currently spending, and take that money and use it in ways that are actually going to make people healthier and improve quality. So what our challenge is going to be is identifying what works and putting more money into that, eliminating things that don’t work, and making things that we have more efficient."
HR3200 does recognize that some of these programs are working.
I hope you are in one of the good ones.
I wonder how to find out.
Do you have any congressional connections?
The part where he said: "something called Medicare Advantage, a program that gives them subsidies to accept Medicare recipients but doesn’t necessarily make people on Medicare healthier," I don't believe his statement is accurate.
If you have old folks in your family you will usually be keenly aware of the value of the prescriptions they are taking. This medicine does make the patients healthier and, as I've said, it keeps them out of the hospitals.
Medicare Advantage provides drug coverage that Medicare (Part D) does not so - to the extent that this enables seniors to afford vital drugs that otherwise they could not - I believe the president mispoke.
I don't have any particular connections in Congress but I believe the Medicare Advantage plan that we have and that my wife, in particular, uses, is one of the better ones...
Obama's statement is absolutely true. I've forgotten the actual figures but it was like 900,000,000 overpayment to these insurance companies. And the Advantage plans paying for prescriptions is not really accurate as well.
I looked into getting an advantage plan this year and found that most at least, take the government plan and incorporate it after trimming the formulary. But then look at the huge costs one will wind up paying like $600 deductible on hospitalization.
After talking with the HMO reps I realized that I would be liable for substantially more costs with the Advantage plan and loose the privilege of going to the doctor of my choice.
If yuo can't afford the drugs under part D, an advantage plan will kill you. That $4200 deducible (commonly called the doughnut hole) is deadly. I hit the doughnut hole in June each year and have until about Dec 1 with zero pay from the policy. A three month supply of my insulin costs me $1,024 while in the second deductible. And the HMOs have the same black out period.
If you're using an Advantage plan, I am probably paying more than you for the supplement I have but the coverage is so much better and it actually pays more.
When I go to the medical facility, I know exactly what my co-payment will be, $00,00! And I strictly choose both the doctor and the hospital. Your plan may do better but here some of the plans restrict hospitalization to the small doctor owned hospital where if they keep you overnight, it causes them a major problem. So you can count on going home the same day as the procedure in most cases.
With the straight supplement, (I have the "F" plan), there is uniformity between my plan and everyone else's. The drug plans for all of them sucks rocks! And it was done that way because the insurance and drug companies wrote the legislation and presented it to congress 8:00 am, the day it was debated and passed. No one had time to read the bill. I understand from the Advantage sales people that the restrictions in the regular drug plan apply to all the Advantage plans as well.
I'd be very interested in just what Advantage company you have. Most of the information I have came from the sales people at AARP, United Health Care. If your results have been good, then by all means, keep that plan! My brother in law has a plan through Liberty and it isn't worth much to him. However, he is a veteran and gets most of his care there. Some companies wont take you for the Advantage plan if you go to the veteran's hospital.
-----1) HIGH QUALITY PLAN ADJUSTMENT- For years beginning with 2011, in the case of a Medicare Advantage plan that is identified (under paragraph (3)(E)(ii)) as a high quality MA plan with respect to the year, the blended benchmark amount under subsection (n)(1) shall be increased--
Looks like they recognize and are willing to work with the better Medicare Advantage Plans.
There must be one or two that are charging high prices and not delivering care that prompted Obama's remarks