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Post Published: Nov 4, 2009

Health Care



Health care law will deepen deficit

Published: August 22, 2011 Politico Publication: Politico

The White House sold “Obamacare” as an instrument for lowering health insurance premiums and reducing federal budget deficits. “Altogether,” President Barack Obama said, “our cost-cutting measures would reduce most people’s premiums, and bring down our deficit by more than $1 trillion over the next two decades.”

Studies, however, reveal a far different picture. Health care spending will increase because of Obamacare, according to a recent report from the Centers for Medicare and Medicaid Services. Premiums are set to increase for most Americans, and government actuaries now estimate the growth in the net cost of health insurance will increase by 14 percent — compared to 3.5 percent if Obamacare never passed.

Moreover, emerging evidence suggests that the health care program will deepen our future deficits.

Yet Obamacare purported to reduce future deficits because its tax increases and Medicare cuts would be large enough to exceed the cost of its health insurance subsidies and Medicaid expansion. Of course, former House Speaker Nancy Pelosi simultaneously warned against these pre-passage predictions, saying, “We have to pass the bill so you can find out what is in it.”

Now that the bill has passed, and experts have had an opportunity to analyze the law, it is becoming clear that Obamacare will be more expensive than advertised — adding to a deficit already crippling the economy.

So far, the main culprit is the law’s expensive health insurance subsidies, available to some people who lack employer-sponsored health insurance. “The massive federal subsidies are money on the table” Douglas Holtz-Eakin, former Congressional Budget Office director, wrote, “inviting a vast reworking of compensation packages, insurance coverage and labor market relations.”

In other words, when government offers a subsidy, it invites people to change their behavior and take advantage of it — even if this wasn’t the intent.

Beginning in 2014, tens of millions of employees will be eligible for these new subsidies. Many already have access to health insurance through their employers but are likely to find it more advantageous if this insurance is dropped, and they can instead have taxpayer health care subsidies and slightly higher wages.

While this creates a win-win for the employer and worker, it creates a lose-lose for the nation’s credit rating and taxpayers. Holtz-Eakin has calculated that previous projections may have underestimated Obamacare’s 10-year cost by roughly $1 trillion.

That’s more than the entire cost of the much maligned “stimulus.”

Several employer surveys have verified Holtz-Eakin’s concern. McKinsey & Co. found that 30 percent of employers — and 28 percent of large ones — said they will definitely or probably drop coverage after 2014. Roughly 57 percent of small companies now offering coverage are at least somewhat likely to drop health insurance, according to the National Federation of Independent Businesses, if employees begin to opt out of the employer-sponsored health plan and into subsidized coverage.

While Holtz-Eakin focused on Obamacare’s perverse incentives to get rid of some employer-based health care insurance outright, there will also be strong incentives for employees to have their employer reduce the contribution to health insurance to take advantage of federal subsidies, according to a new study by economists Richard Burkhauser, Sean Lyons and Kosali Simon.

Though the CBO estimates that Obamacare’s new spending will cost about $200 billion per year when the law takes effect, it assumed only a small change in behavior in response to the law. For this to happen, millions of businesses and workers are going to have to act contrary to their economic interests.

Obamacare cuts Medicare and spends those savings — plus hundreds of billions in additional deficit-spending — on new welfare programs. As Congress looks for ways to cut spending to get America back to AAA credit status, reducing Obamacare’s new spending for programs that have not yet even begun is an obvious place to start.

Obamacare, in fact, represents the largest expansion of the U.S. welfare state in nearly 50 years. At a time when the nation’s credit has been downgraded for the first time and our country is struggling to finance and reform existing entitlement programs, Obamacare’s creation of new entitlements increases dependency on government and pushes our country deeper into a fiscal crisis of Greek proportion.

As Congress and the president seek bipartisan ground to address the national debt, we must remember that the first step out of a hole is to stop digging.

Local View: Health care bill offers no real ‘reform’

Published: March 21, 2010 north_county_times Publication: North County Times


By DARRELL ISSA — 49th District congressman | Posted: Sunday, March 21, 2010 12:01 am

The time for choosing has arrived in Washington. For months, the phone lines at the Capitol have been jammed with constituent calls, and the halls of Congress have been teeming with concerned citizens, lobbyists and news reporters. The entire nation is counting votes to see whether Speaker Nancy Pelosi succeeds in a procedural sleight of hand to pass the president’s health care bill without having the House actually vote on the legislation.

There are plenty of reasons to oppose the president’s bill. It is rife with sweetheart deals like the “Louisiana Purchase” and the “Cornhusker Kickback” that serve no purpose except to buy the votes of U.S. senators in swing states. It will raise taxes by nearly $500 billion and cut Medicare by the same amount.

It will do nothing to decrease the number of malpractice lawsuits or set limits on out-of-control jury awards. It will not stop the wasteful practice of defensive medicine or reduce the cost of insurance. It will put the government between patients and their doctors.

Any of those reasons alone is sufficient to justify a vote against ObamaCare, but together they have created the worst piece of legislation written in our generation. If it passes, the federal government will have given itself powers never enumerated in the Constitution and never authorized by the people of the United States. And all at a time of intense economic stress on the small businesses that drive the American economy.

In recent weeks, I’ve heard from small business owners in Southern California who are at a complete economic standstill, unsure about what burdens the government is about to place on them and whether or not they will be able to keep their employees. The dilemmas they are facing at the ground level of our economy only reinforce the fact that the nation’s leadership in Washington is increasingly out of touch with reality.

One man who contacted my office has been a certified financial planner for more than 20 years. His business currently has four employees for whom he provides health insurance. This owner knows that ObamaCare will dramatically increase his costs, which will force him to evaluate whether or not he can keep all of his employees. At a time when California’s unemployment has passed 12 percent, Congress should not pass any bills that force small businesses to choose between laying off their employees and keeping their doors open.

Another Southern California company that will be harmed is an independent provider of consumer-directed health care accounts that employs 90 people in its Vista office. One of the company’s officers has told me that the health care bill is “very discouraging” for his firm. If ObamaCare passes, the company stands to lose many of its accounts once the mandates kick in. The loss of accounts will mean a loss of revenue, which of course means more job cuts for California workers.

A local kitchen design company that offers health insurance to its employees has cut its work force in half because of the economic recession. If the president’s bill passes, employers like this will be subjected to a $750 fine for each employee who chooses the government plan instead of the private plan the company currently offer. Mandates and fines like that could be just enough to put many similar employers out of business altogether. And these are just a few of the many small business owners who are worried about the negative effects of ObamaCare.

Nothing in President Obama’s plan for government-run health care does anything to help these small businesses. Rather, Congress is preparing to crush them under a 2,300-page bill that spends more than $800 billion and remakes one-sixth of the American economy. The people of California can’t afford this bill, and I will not support it.

Americans want health care reform that addresses the root causes of rising costs and protects the patient-doctor relationship. They want reforms that provide small businesses with smart incentives rather than severe penalties.

And they want Congress to pass these reforms out in the open, instead of behind closed doors with secret deals and strong-arm political tactics that intimidate members of Congress into saving the president’s domestic agenda instead of the jobs of hardworking men and women who elect them.

DARRELL ISSA, R-Vista, represents the 49th Congressional District, which covers large parts of North San Diego and Southwest Riverside counties. He is the ranking Republican member of the House Committee on Oversight and Government Reform.


The lackluster record of government-run health care

Published: March 18, 2010 Washington_Examiner Publication: The Examiner



Before the Democrats who control Congress push through a trillion-dollar expansion of government-run health care, they might want to know the facts about how efficiently the government has handled health care in the past, and how much bigger the government will grow once the bill becomes law.

When all is said and done, President Obama’s plan mandates dozens of new entitlement programs and creates scores of new government offices, bureaus, commissions, and programs, all of which will have to be funded, staffed and managed at taxpayer cost.

Moreover, an expansion of the federal bureaucracy at that rate will greatly increase the incidence of waste, fraud and abuse in health care. Already Medicare, which accounts for 14% of all federal spending, is rife with waste, fraud and abuse. Even Attorney General Eric Holder has said, “By all accounts, every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud.”

A recent analysis by the Government Accountability Office (GAO) estimated that federal subsidy programs cost taxpayers about $100 billion every year in improper payments, with Medicare and Medicaid accounting for more than half of that. Harvard Professor Malcolm Sparrow, a specialist in health care fraud teaching at the Kennedy School of Government, has estimated that as much as 20% of the federal health program budgets – or approximately $150 billion – is eaten up by improper payments every year.

No budget gimmick can hide that kind of wasteful spending from the American people, and no expansion of the government’s role in health care can mitigate the systemic problems that already exist.

This week, House Speaker Nancy Pelosi told reporters – and her undecided Democratic colleagues – that the bulk of the cost for the president’s plan will come from recovering wasteful spending in Medicare and Medicaid, an amount she projects will add up to $500 billion over the next several years.

Such assurances are disingenuous, however, in light of the evidence. In 2008, for instance, the Department of Justice recovered a meager $1.48 billion from Medicare and Medicaid fraud through enforcement programs that cost taxpayers $1.13 billion. Once these enforcement costs are subtracted, the government only recovered $350 million. At that rate, it would take the Justice Department more than 1,400 years to recover enough to pay for the president’s plan.

Government-run health care also runs much higher administrative costs per insured person than private insurance does. Using numbers from the Department of Health and Human Services (HHS), the wastefulness of bureaucratically-managed health care becomes staggering.

Each year, the government spends an average of $927 in administrative costs per person for Medicaid and $509 for Medicare. Private insurance, on the other hand, costs only $453 per person in administrative costs. Until the government can demonstrate an ability to get administrative costs under control for programs that it already runs, Americans should vehemently oppose any effort to give bureaucrats in Washington any more power to control the one-sixth of the U.S. economy that affects health care.

Republicans have long urged that the Democratic majority tackle issues such as waste, fraud and abuse in the government-run health care programs that already exist before undertaking any expansion of federal health programs or other large-scale health care overhaul. Remedying these problems will save taxpayer dollars and slow the rate of rising health care costs. However, Democrats have been quick to reject any solutions brought to the table by Republicans, including medical malpractice reform and tighter controls on waste, fraud and abuse.

The taxpayers are not deceived. They know that the government’s track record in managing healthcare has proven less efficient and more expensive than private insurance. They know that the President’s plan is a recipe for more waste, fraud, and abuse.

And they have sent consistent messages both in the polls and at the polling places that they do not support a scheme for bigger government with more control over their lives. Regrettably, the Democratic leadership in Congress is more concerned about giving the president a legislative win than they are about giving the American people the kind of responsible reforms they want.

Rep. Darrell Issa, R-CA, is the ranking minority member of the House Committee on Oversight and Government Reform.


Bipartisan Health Care Reform must Include Tort Reform


Published: February 25, 2010 Politico Publication: Politico


By REP. DARRELL ISSA | 2/25/10 5:17 AM EST


Now that his yearlong partisan push for government-run health care has so far failed to produce legislative results, President Barack Obama wants Republicans to join him for another White House summit to see if he can salvage his proposals. But unless the president and congressional Democrats address the need for tort reform as a critical component of cutting health care costs, a bipartisan solution seems unlikely.


The unsustainable path of rising costs is a serious national problem. Currently, health care spending exceeds $2.5 trillion per year. By 2019, it is expected to top $4.7 trillion per year. Any hope for cost containment would involve comprehensive medical malpractice reform to end the practice of defensive medicine, close the loopholes that allow frivolous lawsuits to clog up the system, and set reasonable limits on jury awards.


The president seems to think that eliminating wasteful spending alone would get Americans on track to more affordable coverage. But the government’s track record of recouping its losses from waste, fraud and abuse leaves something to be desired. In 2008, for example, the government recovered a meager $35 million from criminal prosecution of fraud once enforcement costs were factored in. Real savings would start when Congress tackles the billion-dollar problem of defensive medicine.


Defensive medicine — when doctors order unnecessary and usually expensive tests and procedures in order to avoid lawsuits — is a major contributor to skyrocketing health care costs. As much as $210 billion is spent on defensive medicine annually — equal to $700 for every U.S. man, woman and child. This helps drive up insurance premiums that are already too high for many Americans. And the excessive malpractice litigation inevitably leads to physician shortages — especially among obstetricians, neurosurgeons and emergency room physicians.


Fewer doctors mean reduced access to medical care for everybody. New Jersey, for example, will be short 2,800 family doctors and specialists by the year 2020, according to a recent report from the New Jersey Council of Teaching Hospitals. The reason for the shortage, council President Richard Goldstein says, is a “morale problem” because of the state’s “hostile” environment for doctors and the heightened threat of malpractice lawsuits.


As long as out-of-control malpractice premiums are built into medical costs, many will never be able to afford coverage. Shamefully, it is estimated that the cost of defensive medicine and the associated liability-based medical care costs account for at least 3.4 million uninsured Americans.


Moreover, the current system is studded with irresponsible lawyers’ fees associated with malpractice claims that do not involve injury or medical error. A large share of the awards goes to pad the pockets of plaintiffs’ attorneys. Recently, the Manhattan Institute concluded that approximately 10 cents of every dollar paid for health care services goes to cover malpractice premiums, defensive medicine and other costs associated with excessive litigation.


Tort reform that reduces frivolous lawsuits and caps outrageous jury awards is a critical component of any solution to bring the cost of health care within reach of every American. So far, however, the president has barely mentioned it.


If bipartisan support is what he’s after, the president needs to do more than host Republicans at the White House for a chat. He’s going to have to get serious about the damage being done to U.S. health care by frivolous lawsuits and the cost of defensive medicine, which real reforms could correct.


Rep. Darrell Issa (R-Calif.) is the ranking member of the Committee on Oversight and Government Reform.


Issa: Obama Must Push Tort Reform to Lower Health Costs


Published: February 25, 2010 Roll_Call2 Publication: Roll Call


As the administration and Congress try to hit the restart button on health care reform, it’s worth noting that one glaring omission from the debate has been tort reform. For all of the talk about making health care more affordable and lowering premiums and costs, it is inexplicable that this promising mechanism for cost-savings continues to be ignored by the president and Congressional Democrats.


Defensive medicine, frivolous lawsuits and multimillion-dollar jury awards in malpractice cases have helped contribute to the soaring costs of health care. President Barack Obama himself has acknowledged that defensive medicine taxes the health care system, saying, “I’ve talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs,” yet, in an apparent self-contradiction, the president emphatically told the American Medical Association that he would not support caps on medical malpractice jury awards — an effective element of tort reform that has already reduced lawsuits and brought down health care costs in the states that have implemented the caps.


Reversing course and rewriting his own narrative at a recent White House press briefing, Obama said, “If it’s established that by working seriously on medical malpractice and tort reform that we can reduce some of those costs, I’ve said from the beginning of this debate I’d be willing to work on that.”

Why is this pertinent? Because when House Oversight and Government Reform Committee staff recently made an inquiry about litigation costs, the president’s own Health and Human Services Department responded that malpractice litigation reform was “not a priority with [the Obama] administration, so there is no further information on the topic.”


When HHS says malpractice reform is not a priority of this administration, the president’s commitment to working with Congressional Republicans on a bipartisan basis seems insincere. A clarification from the administration would tell us if he truly desires bipartisan discussions or if this is just a public relations charade designed to make the American people think the White House is serious about finding bipartisan solutions.


The fact of the matter is that reining in defensive medicine can help reduce health care costs. A 2008 study by PricewaterhouseCoopers found that defensive medicine is a top area of wasteful spending in health care, accounting for $210 billion annually.


And according to the Congressional Budget Office, legislation providing for caps on damages would “significantly lower premiums for medical malpractice insurance” by 10 percent to 30 percent. California, Georgia, Texas and 36 other states provide proof that capping noneconomic damages and controlling the growth of medical malpractice lawsuits can dramatically cut liability insurance premiums, thus passing the savings on to the insured.


California was the first state to respond to the medical malpractice insurance crisis of the 1970s, when medical liability insurance premiums were so high that many physicians, particularly high-risk specialists such as OB-GYNs and neurosurgeons, were forced to close their doors. Abuse of the civil justice system, including malicious and frivolous malpractice litigation, had become so rampant that it was diminishing access to care for everybody. In 1975, California voters approved the Medical Injury Compensation Reform Act. MICRA caps noneconomic damages at $250,000, provides a statute of limitations on malpractice claims and allows for binding arbitration for disputing claims.


While medical malpractice premiums vary widely depending on location and specialty, rates in California are lower than in many other states. In Florida, for instance, premiums for OB-GYNs are as high as $214,893, whereas in California the average is $89,953. Premiums for other specialties including general surgery and internal medicine are also lower in California, sometimes as much as 50 percent less than in other states. In fact, MICRA has resulted in a stabilization of malpractice premiums, which have increased much more slowly than the national average. Since 1975, premiums nationwide have increased 420 percent, as opposed to just 168 percent in California.


Prior to the passage of tort reform in Texas, one in four doctors faced a medical malpractice claim every year. The liability crisis had grown such that in 2003, Texas voters approved Proposition 12, which limited noneconomic damages in medical malpractice lawsuits to $250,000. The caps have led to fewer lawsuits and lower liability insurance premiums for doctors. The average malpractice award has decreased from $1.2 million to $880,000, and Texas’ largest malpractice insurer has lowered rates repeatedly, equaling a more than 50 percent decrease in rates since 2003.


In 2005, the Georgia Legislature passed comprehensive medical liability reform that included $250,000 caps on punitive damages and $350,000 caps on noneconomic damages. Since then, the average number of medical malpractice claims has decreased by 39 percent, from more than 1,128 in 2004 to 683 in 2008. Additionally, professional liability insurance rates for physicians in the state have decreased 18 percent since the reforms were enacted.


The benefits of enacting tort reform now are clear. If the administration is serious about including real tort reform in a health care reform proposal, it should look to California, Texas and Georgia as case studies in medical malpractice reform that has lowered costs and reduced lawsuits. If the president wants proven bipartisan solutions that will substantially lower health care costs, he needs to focus on the facts and not his own ideological commitments or the special interests of trial lawyers. Tort reform works in the states that have tried it, and it will work nationwide to provide affordable, accessible coverage to every American.


Rep. Darrell Issa (R-Calif.) is ranking member of the Oversight and Government Reform Committee and a member of the Judiciary Committee

Dem Proposals: Legislative Delusion

Published: November 4, 2009 Politico Publication: Politico

After widespread disapproval of their 1,000-page proposal for government control of health care, congressional Democrats have responded by producing a 2,000-page bill that leaves many Americans wondering why these “reforms” seem oddly familiar to failed experiments already tried at the state level. Strange indeed is the fact that many states are working overtime to undo the damage wrought by earlier “reforms” that closely parallel the ones now being pushed in Washington.


Consider the evidence.


Soon after implementation of Tennessee’s TennCare program, a single-payer public health option launched in 1994, many employers dropped their employees’ private coverage benefit. As a result, 45 percent of new TennCare enrollees came from private plans, not from the uninsured. Within four years of TennCare’s creation, more than one-sixth of the Tennessee population was enrolled in TennCare, expanding the state’s cost to nearly one-third of its entire revenue. Tennessee’s experiment has done little other than present the United States with a clear warning that government-run health care is a costly endeavor that causes private employers to drop existing coverage and reduce the availability of a competitive private market for coverage.


Kentucky didn’t do much better with its mid-1990s reform attempt. The Bluegrass State set caps on insurance premiums, required a minimum level of coverage for all insurance packages sold in the state and implemented a community rating system that absorbed the cost of insuring patients with unhealthy habits into the general pool. Within three years of the first substantial reforms, 40 insurance companies left the state, leaving only two underwriters of individual private plans for more than 4 million people. Premiums skyrocketed for everybody, options decreased and a state with a 12 percent uninsured population ended up with 16 percent. Ten years later, most of the initial reforms have now been repealed. Former GOP state Rep. Mark Treesh concluded, “I think we tried to do the wrong thing too fast.”


Sound familiar?


The Empire State’s reform efforts have resulted in some of the highest costs in the nation. Each year, New York City residents pay an average of $9,000 for individual coverage and more than $26,000 for family coverage. This is in part because New York has 51 insurance mandates, some of which include podiatry coverage and hormone replacement therapy. Leading health care experts at both The Brookings Institution and The Heritage Foundation have concluded that the most expensive mandates increase insurance costs by as much as 20 percent. And yet the Democrats in Congress want Americans to believe that all their new mandates will actually reduce costs?


Massachusetts is fighting out-of-control cost increases despite having established an “exchange” — or state health insurance connector — similar to the one now included in one version of the Senate health bill. As originally designed for Massachusetts, the insurance connector was to be a marketplace for competition, but because the state sets unreasonably high coverage standards, there are few options and little competition. All of which, mind you, results in higher prices and less access to quality medical care. Because of the influx of newly covered individuals in the state, wait times to visit primary-care physicians can take more than 100 days in some rural areas. As predicted by those who oppose expanded government involvement in health care, Massachusetts is experiencing some of the worst health care rationing in the country.


For months, Democrats have been rejecting common-sense proposals for real health care reform that have worked on the state level. Texas, for instance, has drastically reduced the cost of health insurance by implementing serious tort reform that discourages frivolous lawsuits and excessive payouts. Furthermore, Utah has implemented a creative reform that allows for greater flexibility through defined-contribution plans, which increase options for employees and control costs for employers.


But these innovative solutions are nowhere to be found in the Democratic bills.


Rather, Democrats are hoping that failed experiments in expanding government control of health care at the state level will play out differently on the federal level. It might not fit Einstein’s definition of insanity — doing the same thing over and over again and expecting different results — but it doesn’t take a nuclear scientist to figure out that the Democrats’ plan suffers from a certain legislative delusion.


When Democrats propose unworkable ideological schemes that the American people reject, I’m ordinarily not concerned. This time, however, is different. If Democrats implement their political suicide pact through health care reform, innocent Americans struggling under an already difficult economy stand to suffer enormous harm that will reduce the quality of health care, drive private insurance out of business and add to an already exploding federal deficit.


A bipartisan healthcare proposal that makes good on officials’ promises

Published: October 14, 2009 The_Hill Publication: The Hill


When it comes to healthcare reform, most Republicans and Democrats agree on many of the key issues: protecting patient choice, promoting portability and providing tax incentives for small businesses and the self-employed.


There is another bipartisan proposal that, if enacted, would make good on the campaign promises of President Barack Obama and numerous congressional leaders — both Republicans and Democrats. Clearly, the time has come to give every American the opportunity to access the same health benefits plan that is available to members of Congress and all federal employees.


The Federal Employees Health Benefits Plan (FEHBP) is a system of private insurers that offers 14 nationwide and more than 300 state-specific plans with a wide array of deductible and co-pay options. Like other employer-based health benefits, the premiums are paid by a combination of employee payroll deductions and employer contributions.


FEHBP serves the healthcare needs of Congress and more than 8 million federal workers, retirees and their dependents, making it the single largest insurance pool in the nation. The negotiating and buying power that comes from a network with 8 million enrollees is immense, and federal employees regularly express overall satisfaction with the value and service of their health insurance.


This past summer, I introduced H.R. 3438, titled the Access to Insurance for All Americans Act of 2009, to open access for millions of uninsured Americans to the same healthcare choices that members of Congress have. The bill is simple to implement and low in cost. Since the FEHBP network already exists, adding new participants should prove easy and affordable. To enroll new members, a small initial investment by the federal government will be needed for the first year, after which all costs are covered by member premiums.


Three of the major burdens carried by the uninsured today are the high cost of go-it-alone insurance plans, the concern of denied coverage due to pre-existing conditions, and limited portability across jobs and state lines. By letting uninsured Americans join a pool already made possible by their tax dollars, their buying power increases and cost reductions would be realized across the board. When it comes to pre-existing conditions, my plan would guarantee coverage regardless of an applicant’s age or health status. Job or location changes will not alter coverage access.


But the primary reason my bill should garner overwhelming bipartisan support is that the idea has been bipartisan from the start.


The late Sen. Edward Kennedy (D-Mass.) addressed his party’s 1980 convention in one of the most rhetorically sophisticated speeches of modern politics. Conceding the nomination to Jimmy Carter after a hard-fought primary, Kennedy intoned: “I say it again, as I have said before, if health insurance is good enough for the president, the vice president, and the Congress of the United States, then it is good enough for all of you and for every family in America.”


Twenty-four years later, then-Sen. Tom Daschle (D-S.D.) spoke to the 2004 Democratic National Convention and said: “Every American should have the same healthcare options, the same price as members of Congress do.”


Secretary of State Hillary Rodham Clinton, then running for the Democratic nomination, told Chris Wallace in a 2007 “FOX News Sunday” interview that if she was elected every American would “have the same choices that are available to members of Congress, because we will open up the plan that members of Congress have.”


And during the 2008 presidential debate at Hofstra University, Obama promised to provide every American with “the option of buying into the same kind of federal pool that both Sen. (John) McCain (R-Ariz.) and I enjoy as federal employees.”


With this level of bipartisan support, there is no reason why H.R. 3438 shouldn’t become law. So far, however, my bill has been stalled in committee — seemingly, so that House Speaker Nancy Pelosi (D-Calif.) can mollify the far left with a bill that takes the nation ones step closer to single-payer government-run healthcare.


The American people clearly want healthcare reform, and Congress should not attempt to pass any plan that affects one-fifth of the American economy without considerable bipartisan support. The Access to Insurance for All Americans Act of 2009 would go a long way toward providing dependable, affordable coverage for millions of Americans who have no insurance because their only option is a cost-prohibitive, standalone policy.


It would also reassure American taxpayers that their elected representatives are willing to honor bold campaign promises once the election is over.

Issa is ranking member of the House Committee on Oversight and Government Reform.



Waste and Fraud Hard to Root Out

Published: September 21, 2009 Roll_Call2 Publication: Roll Call


Earlier this month, President Barack Obama predicated a $900 billion government expansion of health care on a promise to eliminate waste and abuse in Medicare.

“[W]e’ve estimated that most of this plan can be paid for by finding savings within the existing health care system — a system that is currently full of waste and abuse,” Obama said in his televised address to Congress.


In one regard, the president was right. Waste, fraud and abuse in government-provided health care are very real problems. In another, he was terribly wrong to suggest that we can pay for his plan solely by rooting out waste, fraud and abuse. Unless the president is ready to address the underlying spending programs that lead to this loss of taxpayer dollars, problems in the health care system will continue to run amok.


Last month, the Republican staff of the House Oversight and Government Reform Committee released a report titled “Medicare Experience Suggests Americans Should Expect Massive Fraud with Nationalized Health Care.” The report shed light on the rampant fraud that has kept Medicare on the Government Accountability Office’s High-Risk Series since 1990 and underscored why Obama should look at health care waste as a budget-busting threat and not a piggy bank to pay for reform.


If, after months of the health care debate, anyone still believes government-run health care can function with greater efficiency and less waste than the private sector, ABC News has done some very good reporting on Medicare that counters this erroneous notion. In one interview, a convicted criminal said he made about $8 million over seven years by fraudulently billing Medicare. The convict, now serving time in federal prison, seemed to like government-run health care. “We would make anywhere between a million to $2 million in a short time frame, maybe two, three months,” he explained. Bilking the government, he added, was a lucrative occupation. “Ferrari, Porsche, Lamborghini, exotic cars … I lived a good life.”


Of course, this man is just one among many crooks who defraud taxpayers. Thankfully, he got caught. Too many scam artists, however, get away.


Although Americans can’t expect the elimination of waste or the prevention of abuse to pay for health reforms, the president wasn’t stretching the truth when he talked about the amount of waste and abuse that occurs in government-run health care programs. Attorney General Eric Holder earlier this year estimated that “every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud.”


The Department of Justice, to its credit, has tried to protect taxpayers from a fleecing. In South Florida, federal agents recently conducted spot checks of 1,581 firms that billed Medicare for durable medical equipment. Of these firms, 491 — nearly a third — were fictitious storefronts submitting bogus bills to the government and stealing taxpayer dollars.


Despite this effort, in 2008 the government recovered only $1.48 billion in Medicare and Medicaid fraud. Once the costs of investigation and prosecution are factored in, the Department of Justice recovered a mere $350 million for U.S. taxpayers.


At that rate, it would take 257 years of recouping fraud to pay for just one year of the president’s $900 billion plan.


Cutting back on fraud is certainly a long-term goal of health care reform, but we can’t depend on it to pay for systemic reforms in health care.


Americans who struggle to pay for affordable insurance are worried about being denied coverage for pre-existing conditions, and about this economy cutting short their chance for portable, dependable and affordable health insurance even if they change or lose their jobs.


Many families fear a loss of health care choice, rising costs, higher premiums, and dropped coverage if the president’s scheme becomes law. Many rightly hear the president’s call to find “savings within the existing health care system” as code words for cutting Medicare services for seniors and raising health costs for middle-class Americans. The president’s too-good-to-be-true rhetoric on health care, coupled with his past vocal support for moving this country to a true single-payer, government-run health care system, doesn’t calm their fears.


Obama has promised to “seek common ground” on health care reform. He has warned participants in the health care debate: “If you misrepresent what’s in the plan, we will call you out.” The president should take a step toward fulfilling each of these pledges and present some honest answers about how he intends to pay for health care reform — cutting waste, fraud and abuse isn’t a serious or credible explanation.


Can Americans really expect the government to give them better coverage without paying for it? Refusing to talk about the tough choices Americans will have to make undermines the chance of real reform.


Rep. Darrell Issa (R-Calif.) is ranking member of the House Oversight and Government Reform Committee.


Presidential Lipservice to Choice and Competition

Published: September 15, 2009 NRO_logo Publication: National Review


President Obama wanted to set the record straight on his health-care agenda, so he made a trip to Capitol Hill last week. During his primetime address to a joint session of Congress, the president explained that his “guiding principle is, and has always been, that customers do better when there is choice and competition.”


I couldn’t agree more. The integrity of American democracy rests on customer choice and market competition. But many Americans are having a tough time believing President Obama when he announces his so-called “guiding principle.” And if his “guiding principle” sets his health-care agenda the same way it has his education policy, then there’s reason to anticipate a one-size fits all government program that doubles the cost to taxpayers, benefits liberal special interests almost exclusively, and delivers an inferior product to those it was designed to serve. Allow me to explain.


Earlier this year, President Obama signaled his intention to end the D.C. Opportunity Scholarship, a program that affords low-income children in high-crime, substandard public schools the chance to choose a quality education. By awarding up to $7,500 per student, the scholarship program has made it possible for 3,000 disadvantaged kids to attend private schools in the District of Columbia. In spite of the program’s demonstrated success and the overall satisfaction reported by both parents and students, President Obama and the Democratic majority in Congress want to kill it.


Why? Because the president believes that private schools are a threat to public education. Never mind that the taxpayers’ annual bill is $14,800 per student in the D.C. public school system — nearly twice the cost of the scholarship program. And forget that 75 percent of District residents support the program. And it doesn’t matter that the children are safer and better educated in the schools of their choice. And it’s irrelevant that the Department of Education’s analysis of the program gave it favorable reviews (the report was withheld by the Obama administration until after Congress axed the program).


The message is clear. The president and the teachers’ unions that support him don’t want choices for D.C. schoolchildren or competition for government-run schools. So much for his “guiding principle.”


In May, I joined House Republican Leader John Boehner (R., Ohio) and Rep. Buck McKeon (R., Calif.) in legislation to reauthorize the D.C. Opportunity Scholarship Program. In July, Sens. Joseph Lieberman (I., Conn) and Susan Collins (R., Maine) introduced similar legislation and called for an increase in funding. There is clearly bipartisan Congressional support for reauthorization, and intense support among D.C. families and respected community leaders.


When the president tells the American people that he’s for “choice” and “competition” in health-care reform, they should look very carefully at how he’s treated the most vulnerable children in his own back yard. No, the president isn’t really interested in choice and competition, in spite of his televised finger-wagging lectures to the contrary.


And if the president won’t support the opportunity for children to attend schools of their choice, what makes anyone think he supports the right of all Americans to be treated by doctors of their choice?


— Rep. Darrell Issa (R., Calif.), is the ranking member of the House Committee on Oversight and Government Reform.


Reform is Needed, but Don’t Use Medicare Model

Published: June 16, 2009 Roll_Call2 Publication: Roll Call


Somewhere between the health care extremes — no government involvement and total government control — real reform is possible. And reforming America’s health care system is one of the most pressing challenges that we face.


Serious problems have emerged. Skyrocketing administrative and liability costs, cumbersome interstate restrictions and the terrible reality that our nation’s poor receive primary care at the highest point of cost — emergency rooms — necessitate a thoughtful debate and comprehensive reform.


Currently, we spend more than $2.2 trillion on health care annually and yet 45 million Americans — 38 percent of whom are small-business owners, their employees and dependents — are kept from affordable coverage because of rising costs.


Since 1965, the percentage of the federal budget allocated to Medicare and Medicaid has grown out of control. Originally estimated at an annual cost of $12 billion by 1990, Medicare actually cost a whopping $107 billion that year. Likewise, Medicaid, which originally accounted for 2.9 percent of the total national health cost, rose to 15 percent by the year 2000, and the price tag keeps rising. In fact, the Congressional Budget Office projects that together the programs could consume as much as 20 percent of gross domestic product in the next generation.


Like every Member of Congress, I’ve been searching for a responsible solution. Such a solution must protect the patient-doctor relationship and allow the freedom to choose not only competitive insurance plans, but preferred doctors as well. It must ensure timely access to quality treatment, and it must avoid a government takeover that puts the important decisions about care and treatment in the hands of Washington, D.C., bureaucrats.


The key component of President Barack Obama’s plan for change is a government-run insurance option that would provide universal coverage at a staggering cost with limited options for the poor. Under the Obama/Speaker Nancy Pelosi (D-Calif.) scheme, the uninsured and underinsured will be enrolled in a plan modeled after Medicare — a program that will be bankrupt by the year 2018. Not content with only running the American auto, banking, mortgage and insurance industries, the president is now positioning himself to be our physician in chief.


How’s this sound for reform? Take one of the most fiscally problematic and bureaucratically bloated federal programs in modern history and replicate it on a universal scale. Mix it up with an apothecary’s dose of rhetorical hallucinogens, and package it nicely with the label of change and hope that the country buys it.


The president told us during his campaign that his plan would save every American as much as $2,500 per year on their health insurance premiums, but if his ability to estimate premium savings is anything like his ability to estimate job creation, I’m afraid we’re in for another unpleasant surprise.


Yet there are some areas where both parties are finding common ground. For instance, every American should be encouraged to purchase coverage through an incentivized tax structure.


For those who are unable to purchase coverage because of limited income, however, I support a voucher system that allows them to choose from an array of private plans on the open market. Rather than automatically enrolling underprivileged Americans in a plan they didn’t choose, I suggest empowering them to make decisions for themselves and their families, aided by a direct government subsidy when necessary.


Already, the federal budget includes the cost of primary care for the poor and underprivileged through Medicaid and other federal subsidies like the State Children’s Health Insurance Program.


What they are without, however, are the kinds of choices that President Obama promised — choices that Pelosi and every Member of Congress have. The choice to evaluate a range of competitive plans and determine which one meets his or her own needs. The choice to find your own doctor and change doctors when necessary.


We can reform the system — not just expand and repackage it — if we will hold fast to three basic principles. The private sector is more efficient and less costly than the public sector. The poor are better served by choice and assistance than by coercion and exemption. And Congress has a responsibility to enact responsible reforms that address long-term problems, not hasty legislation that limits the access of all Americans to timely, affordable and dependable medical care.


Rep. Darrell Issa (R-Calif.) is the ranking member on the House Oversight and Government Reform Committee.