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What does it take to get a wavering senator to vote for health care reform?

Here’s a case study.

On page 432 of the Reid bill, there is a section increasing federal Medicaid subsidies for “certain states recovering from a major disaster.” 

The section spends two pages defining which “states” would qualify, saying, among other things, that it would be states that “during the preceding 7 fiscal years” have been declared a “major disaster area.” 

I am told the section applies to exactly one state:  Louisiana, the home of moderate Democrat Mary Landrieu, who has been playing hard to get on the health care bill.

In other words, the bill spends two pages describing would could be written with a single world:  Louisiana.  (This may also help explain why the bill is long.)

Senator Harry Reid, who drafted the bill, cannot pass it without the support of Louisiana’s Mary Landrieu.

How much does it cost?  According to the Congressional Budget Office: $100 million.

1. 40% excise tax on health coverage in excess of $8,500 (individuals) / $23,000 (families).  Amounts are indexed for inflation by CPI-U 1% – begins in 2013 – $149 B tax increase
   
   
2. Additional 0.5% Medicare (Hospital Insurance) tax on wages in excess of $200,000 ($250,000 for joint filers) – begins in 2013 – $54 B tax increase
   
   
3. Impose annual fee on manufacturers and importers of branded drugs – begins in 2010 – $22 B tax increase
   
   
4. Impose annual fee on manufacturers and importers of certain medical devices – begins in 2010 – $19 B tax increase
   
   
5. Impose annual fee on manufacturers and importers of certain medical devices – begins in 2010 – $60 B tax increase
   
   
6. Cut in half (to $500K) the amount of an executive’s compensation that a health plan can deduct from its corporate income taxes – begins in 2013 – $600 million tax increase
   
   
7. Impose 5% excise tax on cosmetic surgery and similar procedures – begins for surgery in 2010 – $6 B tax increase!

Pity the poor Senate clerks.

Ezra Klein is reporting that Senate Majority Leader Harry Reid has seen the CBO scores for the Senate's health care bill, and is "very pleased." Of course he is: It's doubtful that we'd be getting a score today if he weren't; according to one of Klein's recent posts, the reason we didn't see the score last Friday, as originally expected, is that the CBO's numbers came back to Reid, but weren't what was hoped. As a result, the bill, according to Klein, was "tweaked and trimmed until CBO [gave] Reid the answer he's looking for." Indeed, this is often how the scoring process works: Legislators work closely with CBO to push and pull at various elements of the bill until the CBO's math produces the desired result. So given that Reid knows exactly what it will be in advance (he sees preliminary numbers), can choose to release the score or resubmit again, and has been working with the CBO to make sure the numbers are to his liking, it's hardly surprising to see that, on a high profile bill like this, Reid is happy with the result.

Yesterday, a federal panel decided that self-exams and some mammograms are no longer necessary for women in their forties and should only be administered every other year for those in their fifties and sixties. Despite being said to reduce cancer deaths by about 15% in women ages 39-59, the federal panel based their decision to change the guidelines because they concluded too much money was spent on “unnecessary tests.”

Sound familiar? That’s probably because it’s the same rationale for many of the decisions made by the government rationing boards in Britain and Canada.

And the results speak for themselves. Where mammograms are used much more infrequently than the U.S., breast cancer mortality rates are 9 percent higher in Canada and 88 percent higher in the United Kingdom!

Is this what we are to expect once we have government-run health care as well?

The United States Congress passed laws regarding Medicare and Medicaid that became de facto mandatory programs. States all the time require people to have driver’s licenses. I think that this is a bit of a spurious argument that’s being made by some folks.