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	<title>Comments on: Pantsuit-less Palin Provokes PINO Panic, Part II</title>
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	<description>We started this website because we believe Senator Hillary Clinton will be an excellent 44th President of the United States.</description>
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		<title>By: jbstonesfan</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256562</link>
		<dc:creator>jbstonesfan</dc:creator>
		<pubDate>Wed, 15 Jul 2009 19:35:15 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256562</guid>
		<description>The Swiss are neutral except for Nazis and Arab terror groups.</description>
		<content:encoded><![CDATA[<p>The Swiss are neutral except for Nazis and Arab terror groups.</p>
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		<title>By: Paula</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256559</link>
		<dc:creator>Paula</dc:creator>
		<pubDate>Wed, 15 Jul 2009 18:00:36 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256559</guid>
		<description>As wbboei has pointed out, the AP&#039;s Matthew Lee is pretty bad. That article he had today pushed every anti-HRC meme floating around, and was embarrassingly short of actual facts - for instance, it was Hillary&#039;s idea to bring in the envoys. They aren&#039;t &quot;eclipsing&quot; her.</description>
		<content:encoded><![CDATA[<p>As wbboei has pointed out, the AP&#8217;s Matthew Lee is pretty bad. That article he had today pushed every anti-HRC meme floating around, and was embarrassingly short of actual facts &#8211; for instance, it was Hillary&#8217;s idea to bring in the envoys. They aren&#8217;t &#8220;eclipsing&#8221; her.</p>
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		<title>By: admin</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256558</link>
		<dc:creator>admin</dc:creator>
		<pubDate>Wed, 15 Jul 2009 17:59:55 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256558</guid>
		<description>NEW ARTICLE IS UP.</description>
		<content:encoded><![CDATA[<p>NEW ARTICLE IS UP.</p>
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		<title>By: JanH</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256557</link>
		<dc:creator>JanH</dc:creator>
		<pubDate>Wed, 15 Jul 2009 17:18:08 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256557</guid>
		<description>15/07/2009 
    
Israel furious over Hamas leader&#039;s trip to Switzerland  
 
By Barak Ravid  

The Foreign Ministry is furious over news that Mahmoud al-Zahar, a senior Hamas official based in the Gaza Strip, recently headed a Hamas delegation to Switzerland for talks with Swiss diplomats. 

A senior Foreign Ministry official said the visit will further destabilize already shaky relations between Jerusalem and Bern, after Iranian President Mahmoud Ahmadinejad visited Switzerland in April for the &quot;Durban 2&quot; United Nations anti-racism conference. 

China&#039;s news agency broke the story of Zahar&#039;s visit nearly two weeks ago. 
 Advertisement 
 
Officials at the Israeli Embassy in Bern were surprised by the report, since they knew nothing about the June visit. The embassy has requested clarifications from the Federal Department of Foreign Affairs, but Israeli officials say the responses have not been satisfactory. 

One Jerusalem official said it was many days before the Swiss confirmed the Hamas visit to the embassy. 

Swiss officials told Israel&#039;s ambassador in Bern, Ilan Elgar, that the Hamas delegation was invited to Geneva by a nongovernmental research institute. 

The Foreign Ministry source, however, noted that Swiss diplomats, including the Swiss envoy to the Middle East, met with the delegation during a conference at the institute. 

When Elgar requested official clarification regarding the visa issued to the delegation, he was told by the Swiss foreign ministry, &quot;In Switzerland, Hamas is not considered a terrorist organization.&quot; 

Tensions between Jerusalem and Bern began to build about a year and a half ago, when the Swiss foreign minister went to Iran to sign a major gas purchase contract. 

In May, in the wake of Ahmadinejad&#039;s visit to Geneva and the official working meeting with him held by Swiss President Hans-Rudolf Merz, Israel recalled Elgar to Jerusalem for consultations in protest.  

haaretz.com/hasen/spages/1100299.html

---------------------------------

&quot;he was told by the Swiss foreign ministry, &quot;In Switzerland, Hamas is not considered a terrorist organization.&quot; 

I&#039;m speechless.</description>
		<content:encoded><![CDATA[<p>15/07/2009 </p>
<p>Israel furious over Hamas leader&#8217;s trip to Switzerland  </p>
<p>By Barak Ravid  </p>
<p>The Foreign Ministry is furious over news that Mahmoud al-Zahar, a senior Hamas official based in the Gaza Strip, recently headed a Hamas delegation to Switzerland for talks with Swiss diplomats. </p>
<p>A senior Foreign Ministry official said the visit will further destabilize already shaky relations between Jerusalem and Bern, after Iranian President Mahmoud Ahmadinejad visited Switzerland in April for the &#8220;Durban 2&#8243; United Nations anti-racism conference. </p>
<p>China&#8217;s news agency broke the story of Zahar&#8217;s visit nearly two weeks ago.<br />
 Advertisement </p>
<p>Officials at the Israeli Embassy in Bern were surprised by the report, since they knew nothing about the June visit. The embassy has requested clarifications from the Federal Department of Foreign Affairs, but Israeli officials say the responses have not been satisfactory. </p>
<p>One Jerusalem official said it was many days before the Swiss confirmed the Hamas visit to the embassy. </p>
<p>Swiss officials told Israel&#8217;s ambassador in Bern, Ilan Elgar, that the Hamas delegation was invited to Geneva by a nongovernmental research institute. </p>
<p>The Foreign Ministry source, however, noted that Swiss diplomats, including the Swiss envoy to the Middle East, met with the delegation during a conference at the institute. </p>
<p>When Elgar requested official clarification regarding the visa issued to the delegation, he was told by the Swiss foreign ministry, &#8220;In Switzerland, Hamas is not considered a terrorist organization.&#8221; </p>
<p>Tensions between Jerusalem and Bern began to build about a year and a half ago, when the Swiss foreign minister went to Iran to sign a major gas purchase contract. </p>
<p>In May, in the wake of Ahmadinejad&#8217;s visit to Geneva and the official working meeting with him held by Swiss President Hans-Rudolf Merz, Israel recalled Elgar to Jerusalem for consultations in protest.  </p>
<p>haaretz.com/hasen/spages/1100299.html</p>
<p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;</p>
<p>&#8220;he was told by the Swiss foreign ministry, &#8220;In Switzerland, Hamas is not considered a terrorist organization.&#8221; </p>
<p>I&#8217;m speechless.</p>
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		<title>By: JanH</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256556</link>
		<dc:creator>JanH</dc:creator>
		<pubDate>Wed, 15 Jul 2009 17:00:29 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256556</guid>
		<description>&quot;Eclipsed by a globe-trotting president&quot;

---------------------------

I am trying so hard not to laugh at that statement.  Bambi trots...yep that is very true.  But what kind of trotting does he do?  His kodak moments in Russia fell flat.  His economic knowhow is a joke and his policy polling is sinking fast.  His diplomatic ventures have garnered ridicule worldwide and it is Hillary who has had to save his and his bully advisors collective asses over and over again.

To my way of thinking, any media wannabe that thinks bambi is ready, competent and respected enough to solve any of the massive problems he has created both nationally and internationally has been brainwashed.</description>
		<content:encoded><![CDATA[<p>&#8220;Eclipsed by a globe-trotting president&#8221;</p>
<p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;</p>
<p>I am trying so hard not to laugh at that statement.  Bambi trots&#8230;yep that is very true.  But what kind of trotting does he do?  His kodak moments in Russia fell flat.  His economic knowhow is a joke and his policy polling is sinking fast.  His diplomatic ventures have garnered ridicule worldwide and it is Hillary who has had to save his and his bully advisors collective asses over and over again.</p>
<p>To my way of thinking, any media wannabe that thinks bambi is ready, competent and respected enough to solve any of the massive problems he has created both nationally and internationally has been brainwashed.</p>
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		<title>By: Mrs. Smith</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256555</link>
		<dc:creator>Mrs. Smith</dc:creator>
		<pubDate>Wed, 15 Jul 2009 16:43:36 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256555</guid>
		<description>#  wbboei Says:
July 15th, 2009 at 11:47 am

Sarah Palin having her own TV show would be rated number #1 indefinitely at any news network. TV is her best venue for public exposure and an equalizer to the talk shows taking pot shots at her.
———————————
Yes, but here is how you do it. Sara is the host of the show. She gets interesting people on and she also gets intellectual heavyweights who are dynamic as opposed to bookish. Their presence bolster her own credibility. Political discourse is the minor premise, not the major one. However, she uses her guests to highlight Obama gaffs and the complicity of big media–what they don t want you to know, etc. She would have brilliant African Americans like Thomas Sowell on to negate the media premise that this is a redneck movement. She could also have women of substance. The big question is where is the country going and what is the right path. That could be the closing statement.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Yes, of course, wbb. You are the detail guy, I am the conceptual idea person.. She could also appeal to the academics..having quarterly college political debates. (prizes including scholarship money) This would definitely cut into Obama&#039;s synchronicity with the college crowd (&#039;the believers&#039; sans experience) Topics like: Do You think Obama&#039;s election was predicated on Racism?&quot; Pro/Con... This real time discussion would help us cut through Obama, the media creation of the century, created by a sense of  Emotional Realism! [sigh] I have so many ideas to combat the junk political news from the propagandist media, I can hardly wait.</description>
		<content:encoded><![CDATA[<p>#  wbboei Says:<br />
July 15th, 2009 at 11:47 am</p>
<p>Sarah Palin having her own TV show would be rated number #1 indefinitely at any news network. TV is her best venue for public exposure and an equalizer to the talk shows taking pot shots at her.<br />
———————————<br />
Yes, but here is how you do it. Sara is the host of the show. She gets interesting people on and she also gets intellectual heavyweights who are dynamic as opposed to bookish. Their presence bolster her own credibility. Political discourse is the minor premise, not the major one. However, she uses her guests to highlight Obama gaffs and the complicity of big media–what they don t want you to know, etc. She would have brilliant African Americans like Thomas Sowell on to negate the media premise that this is a redneck movement. She could also have women of substance. The big question is where is the country going and what is the right path. That could be the closing statement.</p>
<p>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~</p>
<p>Yes, of course, wbb. You are the detail guy, I am the conceptual idea person.. She could also appeal to the academics..having quarterly college political debates. (prizes including scholarship money) This would definitely cut into Obama&#8217;s synchronicity with the college crowd (&#8217;the believers&#8217; sans experience) Topics like: Do You think Obama&#8217;s election was predicated on Racism?&#8221; Pro/Con&#8230; This real time discussion would help us cut through Obama, the media creation of the century, created by a sense of  Emotional Realism! [sigh] I have so many ideas to combat the junk political news from the propagandist media, I can hardly wait.</p>
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		<title>By: wbboei</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256554</link>
		<dc:creator>wbboei</dc:creator>
		<pubDate>Wed, 15 Jul 2009 16:17:19 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256554</guid>
		<description>Lets scratch this whole thing and go back to Hillarys plan.  That plan was for the people, whereas the one Obama wants, once he defined it will do what he always does reward special interests startting with GE which has a big piece of the action.</description>
		<content:encoded><![CDATA[<p>Lets scratch this whole thing and go back to Hillarys plan.  That plan was for the people, whereas the one Obama wants, once he defined it will do what he always does reward special interests startting with GE which has a big piece of the action.</p>
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		<title>By: wbboei</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256552</link>
		<dc:creator>wbboei</dc:creator>
		<pubDate>Wed, 15 Jul 2009 16:14:18 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256552</guid>
		<description>That Will Marshall is so full of bullshit.  Bambi represents the whole people whereas Congress represents partisan interest.  Spare us the history lesson, and look at the realitiy of this administration.  The problem with Obama is he does NOT represent the whole people.  He takes money from special interests and sells out the nation. Marshall the deluded speaks of a world and a president who does not exist.  This is not magic thinking, it is pure propaganda.</description>
		<content:encoded><![CDATA[<p>That Will Marshall is so full of bullshit.  Bambi represents the whole people whereas Congress represents partisan interest.  Spare us the history lesson, and look at the realitiy of this administration.  The problem with Obama is he does NOT represent the whole people.  He takes money from special interests and sells out the nation. Marshall the deluded speaks of a world and a president who does not exist.  This is not magic thinking, it is pure propaganda.</p>
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		<title>By: wbboei</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256551</link>
		<dc:creator>wbboei</dc:creator>
		<pubDate>Wed, 15 Jul 2009 16:08:03 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256551</guid>
		<description>Will Marshall is president of the Progressive Policy Institute.
--------------------&#039;
There is a lulu for you.  Or maybe a lolo as in sotero, soreto or whatever his last alias was. Chicken little calls in the seventh cavalery and the modern equivalent of George Armstrong Custer to rescue all these budget busting disaters while delusion last and before common sense sets in.

Markey and Waxman?  Two of the last people on earth to be setting macro policy or managing micro details.</description>
		<content:encoded><![CDATA[<p>Will Marshall is president of the Progressive Policy Institute.<br />
&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8211;&#8217;<br />
There is a lulu for you.  Or maybe a lolo as in sotero, soreto or whatever his last alias was. Chicken little calls in the seventh cavalery and the modern equivalent of George Armstrong Custer to rescue all these budget busting disaters while delusion last and before common sense sets in.</p>
<p>Markey and Waxman?  Two of the last people on earth to be setting macro policy or managing micro details.</p>
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		<title>By: rgb44hrc</title>
		<link>http://www.hillaryis44.org/2009/07/13/pantsuit-less-palin-provokes-pino-panic-part-ii/#comment-256550</link>
		<dc:creator>rgb44hrc</dc:creator>
		<pubDate>Wed, 15 Jul 2009 16:01:09 +0000</pubDate>
		<guid isPermaLink="false">http://www.hillaryis44.org/?p=1228#comment-256550</guid>
		<description>LOOKING FOR LEADERSHIP IN ALL THE WRONG PLACES
LOOKING FOR LEADERSHIP IN ALL THE WRONG FACES

Yet more calls for Obama to do more, more than sit on the sidelines.  This time it’s about health care. 

The money quote:

“The faltering momentum of health reform highlights the limits of President Obama&#039;s early tendency to set broad policy goals and let Congress sweat the details. This approach produced a $787 billion economic-stimulus bill that has yet to do much stimulating. It also led to the frenzy of legislative horse trading and deal cutting that weakened the Waxman-Markey climate bill.”

realclearpolitics.com/articles/2009/07/15/calling_dr_obama_to_save_health_care_reform_97468.html

Calling Dr. Obama to Save Health Care Reform
================================

By Will Marshall
July 15, 2009 

Health-care reform is in danger of dying on the congressional operating table. It&#039;s time to call in Surgeon-in-Chief Barack Obama.

The president isn&#039;t a miracle worker like the cranky protagonist on television&#039;s &quot;House.&quot; But he can refocus the health-reform debate on what really matters, and on the hard decisions that lawmakers, left to their own devices, would just as soon avoid.

Last week, Congressional leaders scotched a Senate proposal to pay for health care by ending an unlimited federal tax subsidy for employer-paid health coverage. A philosophical rift also widened between House liberals and more moderate Blue Dog Democrats. The former served notice that they would refuse to back any bill that does not include a strong &quot;public option,&quot; while the latter balked at supporting legislation that would compound the nation&#039;s debt crisis.

And in a letter to Congress, White House budget chief Peter Orszag warned that it&#039;s not enough for lawmakers to come up with ways to pay for health care reform: They must also tackle the structural roots of medical inflation, especially the widespread overuse of redundant or ineffective tests and procedures.

The faltering momentum of health reform highlights the limits of President Obama&#039;s early tendency to set broad policy goals and let Congress sweat the details. This approach produced a $787 billion economic-stimulus bill that has yet to do much stimulating. It also led to the frenzy of legislative horse trading and deal cutting that weakened the Waxman-Markey climate bill.

But revamping America&#039;s costly, wasteful and inequitable health-care system is simply too big and too important to leave to the vicissitudes of interest-group politics in Washington. That&#039;s why President Obama must intervene.

He could start by reminding Americans of the three main things health care reform must do:

1) Constrain the growth of medical costs;

2) Guarantee everyone access to affordable care; and

3) Pay for itself.

On the first point, Orszag is absolutely right: Reform must emphasize quality over quantity in the provision of medical services. He&#039;s called for a major federal investment in studies of the comparative effectiveness of various medical procedures, the cost of which often vary dramatically across the country

Republicans, apparently unwilling to set any limits on health-care consumption, have criticized the proposal. Its real problem, though, is that it probably would take a long time to &quot;bend the cost curve&quot; of health spending.

The most important structural reform now is to begin to nudge the entire health sector away from fee-for-service payments, which give providers a perverse incentive to maximize revenues by providing more services than patients actually need.

This is where liberal demands for a public option based on Medicare make no sense. With its fee-for-service structure and a long-term deficit exceeding $30 billion, Medicare is anything but a model of cost containment.

It&#039;s essential, instead, that health reform speed progress toward a better payment system modeled after successful &quot;integrated&quot; or &quot;accountable&quot; care organizations like the Mayo Clinic or Intermountain Health. Organizations like these may put doctors on salary, or they may charge patients a &quot;package price&quot; for a specific set of health care services. They also encourage providers to collaborate in managing their patients&#039; overall health. In these ways, they align providers&#039; incentives with the best interests of their patients and the system as a whole.

On the second question, access to affordable care, lawmakers seem to be making more progress. Any legislation will likely require that private insurers guarantee coverage to all without regard for pre-existing medical conditions. The insurance industry seems willing to go along, as long as all Americans are required to get health insurance - a mandate that will bring millions of young, relatively healthy people into risk pools.

Under the emerging system of so-called &quot;health exchanges,&quot; individuals could choose among competing private and public plans. Lawmakers will also likely add a modest employer mandate, less to financial coverage expansions than to assure that companies don&#039;t drop their existing coverage.

Finally, there&#039;s the third and most vexing question - how to pay for all of this. At a time when the United States is facing double-digit budget deficits and a swelling national debt, it&#039;s critical that we don&#039;t make things worse by borrowing hundreds of billions more to pay for universal coverage.

A lot of the money - but far from enough - will come from cuts in Medicare payments to hospitals. The best way to cover the balance would be to repeal or limit the tax inclusion for employer-paid health benefits. Not only would that raise big money - $320 billion over 10 years - but it would give employers an incentive to stop overpaying for inefficient and wasteful health insurance plans.

Rather than embrace this obvious &quot;two-fer,&quot; however, congressional leaders have gotten cold feet. They worry about opening the door to GOP demagoguery about &quot;taxing your health-care benefits.&quot; Moreover, a cap on the tax exclusion would encourage a necessary shift away from the bloated, unaffordable health plans many unions negotiated for their workers.

So Congress is now toying with income-tax surcharges on Americans with incomes over $350,000. Unfortunately, this approach doesn&#039;t raise enough money to fill the hole in financing health reform. In addition, taxing the richest Americans is a well we can only go to once. If we use that money for health care, it won&#039;t be available to help close Washington&#039;s enormous budget deficits.

President Obama ought to affirm the principle that the first place to look for savings to pay for health reform should be within the health-care system itself. Yes, it will take all of his considerable communications skills to convince the public that trimming the federal subsidy for health care will make the overall system sounder. One difficulty, of course, is that Obama opposed the subsidy cap during the campaign, and he has promised not to raise taxes on middle class families.

The president should also remind the Senate of his original plan to use revenues from trading carbon allowances to pay for health reform. To mollify powerful interests and win just enough votes for passage, the House climate bill gave most allowances away. The White House should put pressure on the Senate to adjust that balance.

Congress, by design, is the arena where parochial interests compete to shape national legislation to their liking. The White House, of course, is hardly immune to special-interest pressures. But the president represents the country as a whole and must act in the national interest. In this case, his job is to rally the large but diffuse majority of Americans who say they want sweeping health reform, and rivet their attention on Congress. Without such outside pressure, the odds grow daily that what emerges from Congress won&#039;t be health reform worthy of the name.

&amp;&amp;&amp;&amp;
Will Marshall is president of the Progressive Policy Institute.</description>
		<content:encoded><![CDATA[<p>LOOKING FOR LEADERSHIP IN ALL THE WRONG PLACES<br />
LOOKING FOR LEADERSHIP IN ALL THE WRONG FACES</p>
<p>Yet more calls for Obama to do more, more than sit on the sidelines.  This time it’s about health care. </p>
<p>The money quote:</p>
<p>“The faltering momentum of health reform highlights the limits of President Obama&#8217;s early tendency to set broad policy goals and let Congress sweat the details. This approach produced a $787 billion economic-stimulus bill that has yet to do much stimulating. It also led to the frenzy of legislative horse trading and deal cutting that weakened the Waxman-Markey climate bill.”</p>
<p>realclearpolitics.com/articles/2009/07/15/calling_dr_obama_to_save_health_care_reform_97468.html</p>
<p>Calling Dr. Obama to Save Health Care Reform<br />
================================</p>
<p>By Will Marshall<br />
July 15, 2009 </p>
<p>Health-care reform is in danger of dying on the congressional operating table. It&#8217;s time to call in Surgeon-in-Chief Barack Obama.</p>
<p>The president isn&#8217;t a miracle worker like the cranky protagonist on television&#8217;s &#8220;House.&#8221; But he can refocus the health-reform debate on what really matters, and on the hard decisions that lawmakers, left to their own devices, would just as soon avoid.</p>
<p>Last week, Congressional leaders scotched a Senate proposal to pay for health care by ending an unlimited federal tax subsidy for employer-paid health coverage. A philosophical rift also widened between House liberals and more moderate Blue Dog Democrats. The former served notice that they would refuse to back any bill that does not include a strong &#8220;public option,&#8221; while the latter balked at supporting legislation that would compound the nation&#8217;s debt crisis.</p>
<p>And in a letter to Congress, White House budget chief Peter Orszag warned that it&#8217;s not enough for lawmakers to come up with ways to pay for health care reform: They must also tackle the structural roots of medical inflation, especially the widespread overuse of redundant or ineffective tests and procedures.</p>
<p>The faltering momentum of health reform highlights the limits of President Obama&#8217;s early tendency to set broad policy goals and let Congress sweat the details. This approach produced a $787 billion economic-stimulus bill that has yet to do much stimulating. It also led to the frenzy of legislative horse trading and deal cutting that weakened the Waxman-Markey climate bill.</p>
<p>But revamping America&#8217;s costly, wasteful and inequitable health-care system is simply too big and too important to leave to the vicissitudes of interest-group politics in Washington. That&#8217;s why President Obama must intervene.</p>
<p>He could start by reminding Americans of the three main things health care reform must do:</p>
<p>1) Constrain the growth of medical costs;</p>
<p>2) Guarantee everyone access to affordable care; and</p>
<p>3) Pay for itself.</p>
<p>On the first point, Orszag is absolutely right: Reform must emphasize quality over quantity in the provision of medical services. He&#8217;s called for a major federal investment in studies of the comparative effectiveness of various medical procedures, the cost of which often vary dramatically across the country</p>
<p>Republicans, apparently unwilling to set any limits on health-care consumption, have criticized the proposal. Its real problem, though, is that it probably would take a long time to &#8220;bend the cost curve&#8221; of health spending.</p>
<p>The most important structural reform now is to begin to nudge the entire health sector away from fee-for-service payments, which give providers a perverse incentive to maximize revenues by providing more services than patients actually need.</p>
<p>This is where liberal demands for a public option based on Medicare make no sense. With its fee-for-service structure and a long-term deficit exceeding $30 billion, Medicare is anything but a model of cost containment.</p>
<p>It&#8217;s essential, instead, that health reform speed progress toward a better payment system modeled after successful &#8220;integrated&#8221; or &#8220;accountable&#8221; care organizations like the Mayo Clinic or Intermountain Health. Organizations like these may put doctors on salary, or they may charge patients a &#8220;package price&#8221; for a specific set of health care services. They also encourage providers to collaborate in managing their patients&#8217; overall health. In these ways, they align providers&#8217; incentives with the best interests of their patients and the system as a whole.</p>
<p>On the second question, access to affordable care, lawmakers seem to be making more progress. Any legislation will likely require that private insurers guarantee coverage to all without regard for pre-existing medical conditions. The insurance industry seems willing to go along, as long as all Americans are required to get health insurance &#8211; a mandate that will bring millions of young, relatively healthy people into risk pools.</p>
<p>Under the emerging system of so-called &#8220;health exchanges,&#8221; individuals could choose among competing private and public plans. Lawmakers will also likely add a modest employer mandate, less to financial coverage expansions than to assure that companies don&#8217;t drop their existing coverage.</p>
<p>Finally, there&#8217;s the third and most vexing question &#8211; how to pay for all of this. At a time when the United States is facing double-digit budget deficits and a swelling national debt, it&#8217;s critical that we don&#8217;t make things worse by borrowing hundreds of billions more to pay for universal coverage.</p>
<p>A lot of the money &#8211; but far from enough &#8211; will come from cuts in Medicare payments to hospitals. The best way to cover the balance would be to repeal or limit the tax inclusion for employer-paid health benefits. Not only would that raise big money &#8211; $320 billion over 10 years &#8211; but it would give employers an incentive to stop overpaying for inefficient and wasteful health insurance plans.</p>
<p>Rather than embrace this obvious &#8220;two-fer,&#8221; however, congressional leaders have gotten cold feet. They worry about opening the door to GOP demagoguery about &#8220;taxing your health-care benefits.&#8221; Moreover, a cap on the tax exclusion would encourage a necessary shift away from the bloated, unaffordable health plans many unions negotiated for their workers.</p>
<p>So Congress is now toying with income-tax surcharges on Americans with incomes over $350,000. Unfortunately, this approach doesn&#8217;t raise enough money to fill the hole in financing health reform. In addition, taxing the richest Americans is a well we can only go to once. If we use that money for health care, it won&#8217;t be available to help close Washington&#8217;s enormous budget deficits.</p>
<p>President Obama ought to affirm the principle that the first place to look for savings to pay for health reform should be within the health-care system itself. Yes, it will take all of his considerable communications skills to convince the public that trimming the federal subsidy for health care will make the overall system sounder. One difficulty, of course, is that Obama opposed the subsidy cap during the campaign, and he has promised not to raise taxes on middle class families.</p>
<p>The president should also remind the Senate of his original plan to use revenues from trading carbon allowances to pay for health reform. To mollify powerful interests and win just enough votes for passage, the House climate bill gave most allowances away. The White House should put pressure on the Senate to adjust that balance.</p>
<p>Congress, by design, is the arena where parochial interests compete to shape national legislation to their liking. The White House, of course, is hardly immune to special-interest pressures. But the president represents the country as a whole and must act in the national interest. In this case, his job is to rally the large but diffuse majority of Americans who say they want sweeping health reform, and rivet their attention on Congress. Without such outside pressure, the odds grow daily that what emerges from Congress won&#8217;t be health reform worthy of the name.</p>
<p>&amp;&amp;&amp;&amp;<br />
Will Marshall is president of the Progressive Policy Institute.</p>
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