Health Care pork to cause fiscal indigestion

During my eight years in the House of Representatives, I saw plenty of deals being negotiated, renegotiated, confirmed, reconfirmed, removed, undone, re-done, and finally cast in stone.  But, I have never seen deals like those secured by a handful of senatorial holdouts as the price for them to vote for the health care legislation being sought by the Obama Administration and which passed the Senate just before Christmas.  The few Senators who held out til the last minute ought to be inducted into the “Let’s Make a Deal” hall of fame. 

The list of pork the “Health Care Dealers” were able to wrest from the unsmiling grip of Senate Majority Leader Harry Reid was most impressive: 

  • The western cabal of Montana, North Dakota, South Dakota, Utah and Wyoming, benefitted from a lucrative provision that increased Medicare payments to hospitals and doctors in those states.
  • $100 million will go to an unnamed health care facility in a state which has only one “public academic medical and dental school.”  Both Pennsylvania and Connecticut potentially qualify for this largess.  It will be interesting to see which of the two embattled Senators from those states — Republican-turned-Democrat Arlen Specter or veteran Democrat Chris Dodd – will prevail.  The smart money’s on Dodd.
  • Doctor-owned hospitals in Nebraska secured an exemption from conflict-of-interest rules contained in the legislation that apply elsewhere in the country, and which would otherwise severely limit the doctors’ ability to make referrals.
  • Iowa’s senior Democratic Senator Tom Harkin made sure the Hawkeye State was not left out; hospitals in key Iowa counties will now qualify for enhanced Medicaid payments.
  • A formula used to calculate Medicare payments to hospitals in low-wage areas was rigged so that hospitals only in Connecticut and Michigan, both “blue” states, would receive higher payments.
  • The king of the health care lottery, however, was the final hold out — Nebraska’s Sen. Bill Nelson — who won a commitment in the final draft of the bill that will have the federal government forevermore pay the full cost of covering low income patients in his state added by the bill to the Medicaid rolls. 

Not even the Congressional Budget Office (CBO) is able thus far to put a precise price tag on how much “Nelson’s Windfall” will cost all of us taxpayers over the long run.  However, the CBO did surmise that the cost of just a handful of these parochial pork provisions cleverly woven into the many hundreds of pages of bureaucratic gobbledygook that is the health care legislation, added $1.2 billion to the overall price tag.

The president continues to maintain that this humongous piece of legislation will actually reduce the federal debt, which already exceeds $12 trillion.  This is possible, the Wizard of 1600 Pennsylvania Avenue tells us, at least in part because new efficiencies and cost-cutting measures will result in huge savings.  This is a claim made – but never fulfilled — by every president who ever has signed legislation creating or greatly expanding an existing government entitlement program.

The vehemence of the rhetoric in the final Senate debate was among the worst presented to the American people in many a year.  Rhode Island Democrat Sheldon Whitehouse accused Republicans of behaving like “fanatics,” “right-wing extremists” and “Aryan support groups.”  Republican Lindsey Graham of South Carolina compared the late-night vote buying entreaties master-minded by Majority Leader Reid & Company to “seedy Chicago politics.”  And so it went.

What the final piece of legislation that emerges from the House-Senate conference committee in January will look like, is uncertain.  What is certain, however, is that it will be deliberately complex, if not downright undecipherable, and massively expensive; and it will contain more quid pro quos than you could shake a stethoscope at.

36 comments Add your comment


December 28th, 2009
8:32 am

“The president continues to maintain that this humongous piece of legislation will actually reduce the federal debt,…”

Actually it is the CBO making the claim, the president is just repeating their claim. And per every Republican pundit in August & September, the CBO is the “Gold Standard” when it comes to budget projections. So if they say it will reduce the deficit, then it will reduce the deficit. Right?

In truth, the bill that passes & gets signed, assuming one does, is not the problem. The problem is the expansion of that bill that will take place in 2017, 2023 etc, etc, etc. Just like what happened with Social Security & Medicare/Medicaid/CHIP, presidents & Congress just keep adding to the programs. And both Republicans & Democrats are guilty, there are no innocents here.


December 28th, 2009
8:49 am

Jcon: I appreciate your comments. You made some great points. Everything that is being done in Congress peoople act like its the first time in history it has been done this way. It is just now people, regular folks like me get to see or even care what is going on in DC. Its all the same except now there is a Democrat making the decisions and replublicans dont like it. For them its OK for our nation to go bankrupt fighting wars and nation building in the middle east. But if we as a nation want to nation build here in our own back yard (community organizing) there is no way in he** we have money for that.

Chris Broe

December 28th, 2009
9:22 am

The crux of the Rx fix lay not in the K’s of text putting the Z’s on Congress. It’s about the dying, not the living. 90% of the trillion dollar Rx fix will be spent on the dying. We will pay anything to give the dying another few weeks of dying. Why, we can’t just stand there and let them die. Hook them up. Plug them in. All Dr. House, (or any supernatural being), needs is more time and he’ll save the patient. Perhaps a wiser pork project should be sacrificing lambs in a pyre to appease the angels, and then everything will be perfect.

We really believe that. That mystical mythology will save us from dying. And then we’ll live happily ever after for a few more days.

It’s our cultural mores which drive the illogic in our laws. The problem dear friends, is not in our scars, but in our elves.


December 28th, 2009
10:56 am

jcon: I’m not sure I trust the CBO anymore. In the past, their projections have usually been far lower than the actual cost of the programs they have evaluated. Some things just can’t be quantified when they get this complex.
Plus, I seem to remember the head of the CBO being called to a special “meeting” with the president the last time their projections showed numbers unfavorable to Obama’s plan. I liken that to being ‘taken out the woodshed’ and beaten. Ever since then, the CBO’s numbers seem to have supported the president’s goals.

Public Doc

December 28th, 2009
11:16 am

As a young physician who completed medical school in 2003 and did 99% of his medical training in the public hospitals in New Orleans (Charity), Atlanta ( Grady ) and in Baltimore. I have to disagree with Chris Broe, this isn’t for ‘the dying’ per se. Its a basic priciple in looking at health care disparities. “The dying” as you refer to them are such, because they don’t have access to the “Dr House’s” If you provide access to care, and preventive services they are no longer dying, especially if they have adequate care upfront.

Now as far as the pork in the bill. I will say as constituents it is our fault. We elected these ladies and gentlemen to speak for us, yet 85% of them don’t listen.
If there is to be coverage for all it should be coverage for all and money should not be earmarked for certain special interests. But the structure of our gov’t allows this to happen because we don’t speak up.


December 28th, 2009
11:30 am

Stumpy: What is your answer or solution to this problem? I hear people complain all day long without offering a better way to do something.

I feel it better to have CBO score a program than to just do a program (War in Irag) without figuring out a way to pay for it. Afterall the rich need their tax cuts.


December 28th, 2009
11:32 am

Public Doc: Thanks for your insight. This way of doing business in DC started way before Obama was in office. I agree that system is completely flawed and should be changed. The only way to change it is to elect someone who will work for the people. But they all say that until they get to DC and see how things really work.

Hillbilly Deluxe

December 28th, 2009
11:43 am

This is a prime example of why politicians, all politicians, disgust me so, that I often just want to puke.


December 28th, 2009
12:29 pm

Hey, Bob, Senator BEN Nelson is the jack@$$ from Nebraska. BILL Nelson is the jack@$$ from Florida. After a while they all start to look alike, don’t they?


December 28th, 2009
1:11 pm

As we can see, Obamacare is advancing through lies, deception, manipulation, intimidation, coercion and BRIBES (to be paid at our expense). And we can expect Obama and his comrades to use deception, gimmicks, creative accounting, smoke and mirrors to hide the trillions of dollars their scam will cost us.

Part of the deception is to minimize Congressional Budget Office (CBO) estimates of the legislation’s REAL costs. The CBO is an independent body that is respected demise. But the way the CBO was neutralized is disturbing and politically instructive. It shows how Obama and his comrades are using deception to force Marxism on us.

Legislative Reality vs, Political Reality, an article authored by Peter Suderman, identifies specific tactical maneuvers described by one of four different political strategies. One of the strategies entails shifting an expensive part of a bill to a completely DIFFERENT piece of legislation. The CBO can still analyze the expense but its finding will note a much less well known bill that will be unlikely to attract major attention. A CBO analysis of the high profile health bill will then appear to favor the bill.
Neutering CBO Estimates for Health Care

Honest Americans will have to pay billions just to cover BRIBES! We will also have to pay for insurance whether we want it or not, pay to insure those who don’t work, pay more for medicines and medical devices, pay for the hordes of ACORN-type bureaucrats needed to run Obamacare and to decide if we live or die, pay for the corruption that Obama and his comrades are creating, and pay, and pay, and pay.

As we can see, Obamacare is a Marxist scam. Imitating Hugo Chavez, Obama is imposing socialism/Marxism on us through lies, manipulation, intimidation, coercion and BRIBES to be paid at our expense.


December 28th, 2009
1:16 pm

We were wondering who REALLY wrote the House and Senate bills. We knew they were NOT written by our representatives. Our congressmen and senators have not even read them! They are just being manipulated, coerced and bribed at our expense into passing them.

It turns out the guidelines for the Obamacare scam are outlined in the 2007 book “Stand Up Straight: How Progressives Can Win,” written by Robert Creamer, a CONVICTED FELON who has worked on “progressive” (Marxist) ACORN projects with Obama for years. One of those projects is the Obamacare scam!

Creamer suggested in 2007 that a bogus health crisis be created! He outlined – point by point — the lies, manipulation, intimidation, and coercion we have witnessed from Obama and his comrades to force us to swallow the Obamacare scam!

Convicted Felon and Alinsky-style community organizer Bob Creamer is the husband of Socialist Progressive Democrat Jan Schakowsky. Creamer trained Organizers for Obama in 2007. He’s in Obama’s inner circle and was among the “distinguished” guests at the dinner party in the White House where the Salahis were declared “intruders.”

First Sergeant

December 28th, 2009
1:41 pm

AntonioSosa said “Honest Americans will have to pay billions just to cover BRIBES!”

You are a liar! Honest Americans don’t worry about bribes; we worry about things like being able work so that we can take care of our families. Honest Americans worry about having to send their family members to War. Honest Americans don’t go around spreading lies about their leadership and calling them names. These are just a few worries and attributes Honest Americans possess. You Sir, is no “Honest American.” You are a liar!!


December 28th, 2009
2:55 pm

First Sergeant said: “You are a liar! Honest Americans don’t worry about bribes”

Did that push your button Sarge? Did you even read the article? I don’t see any lies in Antonio’s post. There are, in fact, billions in outright bribes in this bill; just as Mr Barr describes in the article. This has been all over the news. That is billions of extra pork in the form of payoffs for votes added to an already expensive bill. If you’re not worried about the government overspending then you have your head in the sand.

And before you go there: I have been to war, and I am currently unemployed and trying to find a job. I fail to see how further stressing the economy with higher taxes for this garbage bill (with it’s billions in bribes) can do anything but destroy jobs and job growth.

Truth?: I wouldn’t consider it complaining. Just a statement of facts, since a good chunk of America is either ignorant of or deliberately ignoring the corruption in our government (regardless of which party is running it at any given time). The CBO is/was a great idea. Somebody has to do the job, but that organization must be completely objective. The CBO’s freedom from manipulation or pressure is suspect. And not just recently under Obama.
I sincerely wish I had a solution for corruption of this magnitude, but the problem is too large. The corrupt politicians too well entrenched. Even a full-scale revolution wouldn’t change the fact that people in power are arrogant, greedy and corrupt. That has been true throughout history.


December 28th, 2009
2:59 pm

Solution: term limits


December 28th, 2009
3:47 pm

I guess we are supposed to believe that Bob never got any pork! Ha,Ha

Public Doc

December 28th, 2009
3:57 pm

What seems to be missing from MOST of these discussions is how to provide adequate health care for the MILLIONS of American’s who lack it. Discussion after discussion tend to leave out those millions. We can argue for days, years, even EONS over the cost of healthcare.

As I provide care to HUNDREDS of un-insured, under-insured patients on a monthly basis, it seems their voices are being drowned out by those SCREAMING, Marxism, Socialism, etc etc.

How about we come up with REAL solutions to help our fellow Americans?

It angers me daily as I try to provide the best care I can, with limited resources to patients who want to work (but unable to find gainful employment that provides health benefits or they don’t make enough to pay the outrageous premiums that health insurance charges) and to patients who don’t qualify for State and Federal programs that provide basic coverage.

What other options are there to help them?
That’s what is missing from these discussions.


December 28th, 2009
4:47 pm

@ Public Doc

There is nothing that can be done to make health care affordable to millions of individuals . That will cut into profits . Anything that gets in the way of making a buck makes you socialist .Thus sadly you & I , public doc , are socialists .


December 29th, 2009
8:22 am

The Right Reverend Senator Doctor Tom Coburn from Oklahoma whined that he had more trouble with Medicare and Medicaid than he did private insurance companies. I’m sure he means he doesn’t get paid as much by M & M or for as many procedures as he does by the “private” insurance companies. Banks are failing all over the place, but I don’t believe I’ve seen any lists of doctors losing their practice because of a lack of financing.

To ignore the problems of our mixed up health care system is not right.


December 29th, 2009
8:44 am

Does not this sound like the end of the Roman Empire when their senate seats and the Caesars were auctioned off to the higest bidder. The progressive liberals have stooped below a snake’s belly in a wagon rut. I find the Nebraska and Louisana deal illegal and unethical. I demand my congress and the AG investigate that deals vigorously.

I have often said liberals can not lead and now my beliefs have been re-enforced. I am hoping the damaged created by these progressive liberal communists can be repaired when the conservatives retake the house and senate.


December 29th, 2009
8:47 am

Progressive liberals are not serious about healthcare. It is just about acquiring power. If you want cheaper health insurance then let the consumer cross state lines. But NOOOO! Why?


December 29th, 2009
8:54 am

Having watched my father struggle for YEARS in rural Montana to maintain a private practice in a small town of less than 10,000 residents, Barr you have NO idea what a challenge it is to retain physicians in the Mountain West states. Part of ensuring that patients in those states still have access to at least one physician within 50-100 miles of their home after this legislation passes is to increase Medicare payments to hospitals and physicians who continue to practice in those states out of a sense of duty and commitment to their patients who have no other doctor to treat them, rather than chasing the almighty dollar in a metropolitan area in a more populous state. Rural, small-town doctors are vital to the success of the proposed healthcare legislation. At a time when these states are struggling to retain doctors and keep smaller community hospitals open so that people don’t have to drive 100 miles to get to an emergency room, increasing medicare payments makes good fiscal sense to avoid a crisis that could result in higher mortality rates in these states, not just from acute illnesses, but from a lack of access to treat chronic ailments as well.


December 29th, 2009
9:44 am

Public Doc:
Compliments to your work, however healtcare IS NOT a right. I have a fundamental issue with paying for those that either made bad choices in life or are just too lazy to care about who pays “their” way. These never-do-wells make up the entitlement mentality. I made the right choices, worked hard, and want to enjoy the fruits of MY labor without the crooked, corrupt politicians wringing money out of MY hard work.

To Nono:
Maybe your dad wants to stay in rural Montana for some reason other than solving the healthcare woes of the backcountry. You know, he could MOVE to an area where doctoring is more profitable and make more money. Then, you wouldn’t have to despair about HIS choices.

Public Doc

December 29th, 2009
10:34 am

I see that is where we have to agree to disagree. I for one do believe that healthcare is a right. We all have fundamental issues that we disagree with, though this is not a forum to discuss it. I have a problem paying for a war ( 8 yrs and going ) that I don’t believe we have a valid reason for fighting ( unless MONEY is one ).
True there are some un-insured who made poor choices, but what bout those, who lost jobs because of some greey executive, who made the bad decision and along with the job goes their healthcare?
Though I care for the spectrum of un-insured and under insured, and some who have made extremely poor life decisions, there are those who by no fault of their own, ended up in this position.

Should you happen to be one of those unfortunate ones who lose your job and/or money, wouldn’t you like to have the opportunity to continue your healthcare so that you may be able to get back on your feet?

In response to your comment to Nono., some doctors actually want to stay in rural areas exactly for the reason he mentioned. That altruistic nature to care for those, who may not otherwise have access to quality care or the nearest specialist, or PCP is more than 50-100 miles away.
Being a doctor is not always about being profitable. But moreso living a comfortable life so that you my enrich the lives of others.

Rational Person

December 29th, 2009
10:37 am

“The western cabal of Montana, North Dakota, South Dakota, Utah and Wyoming, benefitted from a lucrative provision that increased Medicare payments to hospitals and doctors in those states.”

Come on, Bob, run your spellchecker. And maybe run your mind while you’re at it.

Rational Person

December 29th, 2009
10:40 am

Shaggy, why do right-wingers always go on about are just too lazy to care about who pays “their” way?

My grandfather was a blue-collar who worked hard as hell in the shipyards and in so doing helped win World War II. If not for Medicare, he would have had no medical care in his old age, and there are still many like him. Not every hard-working person has a good job with benefits.


December 29th, 2009
10:53 am

Shag is selfish. I don’t want any of my money paying for his police protection,his clean water or his education. Let him make and keep all of that hard earned money by just pulling up those bootstraps.


December 29th, 2009
11:01 am


You are interested in providing health coverage to all people. Had this been the mission of Obama and Congress, I think it would already be a done deal.

Our President and Congress chose, however, to make their mission reform of the entire health care industry. This is why things have become such a mess. Although your work is primarily with uninsured people, most people do have health insurance, and according to which poll you believe, 60% to 70% of Americans are happy with the system.

Had they chose to fix the problems rather than reform the system, their job would have been much easier.

And as for the CBO, their job is to do the math using the assumptions congress gives them. If congress says they will take $500 billion out of medicare, this is what the CBO must use. This does not mean the CBO believes it for one minute. They just do the math.


December 29th, 2009
11:13 am

Pulling the Roman Legion back from conquering the world would save some money for your beloved helpless and hapless

And dude said “our leadership” HAHAHAHAHHAHAHAHAHA. yeah…right. Lead this ya pansie.


December 29th, 2009
11:19 am

Healthcare is no more a right than food or shelter or clothing is.

It’s a good that requires the VOLUNTARY exchange of one’s labor. It is not to be coerced by one from another, just as a mugger has no natural right to the contents of my wallet, even if the SOB is dying of AIDS and you feel sorry for it.

Chris Broe

December 29th, 2009
11:46 am

90% of USA’s healthcare dollar is spent in the last 12 weeks of a patient’s life. (NEJM)

Public Doc

December 29th, 2009
12:30 pm

@Chris the reason for that is that those patients did not have access to care for PREVENTIVE services, and a lot of preventive services are not being covered by private and public insurance.


December 29th, 2009
1:04 pm

Someone may have already mentioned this, but the CBO is also having to report on “bad math”. Basically, the taxes start three years before the program does. So, they have to calculate 10 years of taxes against 7 years of expenditures. Of course that will look better. ONce you get past 10 years, though, it looks a lot worse. And yay, let’s pay three years worth of taxes and get NOTHING!

I know how to spend my money better than the government. This process is sickening.


December 29th, 2009
2:17 pm

doc, you make way too much sense for this board.

Chris Broe

December 29th, 2009
3:58 pm

80% of our healthcare dollar is spent during a patient’s last 11 weeks of life?


December 29th, 2009
4:59 pm

Let me ask a serious question, esp to public doc, if you agree about the 90% of healthcare $$ being spent in the last 11 weeks of a person’s life. You said the reason for that is that they did not have access to preventative medicine?

But regardless, we are going to die. While preventative medicine may delay it, won’t that just push the timeline of death back? Instead of a heart attack at 60 you die of cancer at 80…what is it about the preventative medicine that saves one dime of money from the last few weeks?

I am making an assumption that the costs are so high becauase of hospitalization, etc. I am not arguing, I just want to understand.

Public Doc

December 29th, 2009
7:34 pm

I agree to an extent but it really is multifactorial. Mainly patients who do have access to preventive services and even routine medical care. The discussion of advance directives, living wills, etc are never held.
If I had the chance to talk to every patient who is going through the dying process and help them to understand the process of dying. I would hope that very few of them would agreee to prolong suffering at the end of life.

Though we can not and should not attempt to predict when death occurs, physicians should have the opportunity to discuss this openly and frequently with patients, to understand what they want at the end of life.

Its also hard to counteract mass media’s obsession with youth and living longer but not living better.

Not a simple answer, to a not so simple question.