Obama Daily News Digest

WASHINGTON (Reuters) - Tackling high U.S. unemployment is a crucial challenge but the solution will not be delivered overnight, a top White House economic adviser said on Monday.

I was very pleased to join Secretary of State Hillary Rodham Clinton, Secretary of Health and Human Services Kathleen Sebelius, the President’s Senior Advisor Valerie Jarrett, ONAP Director Jeffrey Crowley, and Dr. Elly Katabira, President-elect of the International AIDS Society at the White House today for an event on the eve of World AIDS Day 2009.   World AIDS Day is an occasion to reflect on how far we have come in the fight against this epidemic, but also to remind ourselves of the important work we have yet to do in preventing and treating HIV.  

This year marks my first World AIDS Day as the U.S. Global AIDS Coordinator, although I have been working on HIV/AIDS issues for more than 25 years.  In addition to my work treating persons living with HIV and AIDS, I have held various roles in and outside of government working to respond to HIV/AIDS in the U.S. and around the world.  I was deeply humbled when the President appointed me to serve as the Global AIDS Coordinator.  We are just getting started, but President Obama has demonstrated solid leadership on domestic and global HIV/AIDS issues, and it is an exciting time to be a part of his team.

At today’s event, Secretary Clinton announced that the 2012 International AIDS Conference will be held in Washington, DC.  This momentous event is made possible by the Administration’s recent lifting of the entry ban for HIV-positive travelers to the United States. The full removal of the ban takes effect on January 4, 2010.  This entry ban was originally placed into effect in 1987 when there was little information on how HIV is spread, and was then codified by Congress.  Even after scientists had long proved that HIV/AIDS was not spread through casual contact with a person living with HIV, the entry ban remained in place.  Only a handful of countries worldwide prohibit HIV-positive travelers from crossing their borders, and the United States has been the only Western country to uphold this discriminatory policy.  Last year, Congress finally repealed the law mandating the travel ban, and the Obama Administration was able to remove the remaining regulatory barriers.

Hosting the International AIDS Conference in the United States is an important opportunity for the United States. This event draws scientists, policy makers, program officials, HIV-positive individuals and others from all over the world.  As the largest conference of its type, the International AIDS Conference attracts more than 25,000 participants and over 3,000 members of the media.  Welcoming conference attendees to our Nation’s capital will allow America to demonstrate our ongoing commitment to ending the HIV pandemic both in the United States and around the world.  Given that the conference is fundamentally a research conference, holding this event in such close proximity to the National Institutes of Health and other U.S. Government research facilities will also, hopefully, expand the level of scientific discourse between our scientists and researchers from around the world.
 
Hosting the conference in the United States will also enable us to showcase our efforts to respond to our domestic HIV/AIDS epidemic.  By 2012, the U.S. will have a National HIV/AIDS Strategy in place for the first time in our nation’s history.  We expect to have made new strides by then to better coordinate HIV prevention and care services across the U.S. Government, as well as to reduce HIV/AIDS disparities.  In addition, the conference will allow us to spotlight our ongoing and continued commitment to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the President’s Global Health Initiative.  

World AIDS Day is an important day to pause and reflect.  It is also an important day to look forward with renewed optimism and vigor.  Today’s announcement by Secretary Clinton is a sign of renewed commitment that gives us all hope as we move forward in the fight against HIV/AIDS and confront the many challenges ahead.

Eric P. Goosby, MD is the United States Ambassador at Large and Global AIDS Coordinator

WASHINGTON (Reuters) - A group of U.S. senators urged President Barack Obama Monday to back legislation requiring the renegotiation of the North American Free Trade Agreement and a long list of other trade pacts they blame for millions of lost U.S. manufacturing jobs.

Today, the Congressional Budget Office (CBO) released an analysis (pdf) of the Senate version health insurance reform – and it contains more good news about what reform will mean for families struggling to keep up with skyrocketing premiums under the broken status quo.

Like other recent analyses, the CBO report finds that lower administrative costs, increased competition, and better pooling for risk will mean lower premiums for American families. Among the findings:

Americans buying comparable health plans to what they have today in the individual market would see premiums fall by 14 to 20 percent.
Those who get coverage through their employer today will likely see a decrease in premiums as well.
And Americans who currently struggle to find coverage would see lower premiums because more people will be covered.

In addition to the welcome relief on costs, the CBO reports that Americans will also have better insurance options. The CBO assumes that many people will take advantage of these better options and "buy up" to purchase better plans than are currently offered in the individual market.

Not surprisingly, some of reform's opponents have already started trying to distort that finding to make false claims that reform will raise costs. So let's be clear: where the CBO does see premiums rising, it's not because Americans are paying more for the same coverage – it's that they’re making a choice to purchase better plans that weren't previously available to them.

In keeping with that finding, the CBO affirms the effectiveness of the grandfather policy, which will allow you to keep what you have if you like it. The report reads, "Moreover, if they wanted to, current policyholders in the nongroup market would be allowed to keep their policy with no changes, and the premiums for those policies would probably not differ substantially from current-law levels."

Finally, it’s worth nothing that for all the good news in the CBO report, the analysis doesn't even take into account all of the bill’s measures to control costs and improve coverage. So if anything, it understates the positive impacts of reform. For example, the CBO does not take into account policies like the catastrophic option available to young adults, and reinsurance provision, that would reduce premiums even further.

It also does not incorporate potential effects of the proposal on the level or growth rate of spending for health care. For instance, CBO’s analysis does not fully capture the effects of the excise tax on high-cost plans, which will bend the cost curve over the long-term. But it did provide a snapshot: for plans affected by the tax in 2016, premiums would be 9-12 percent lower than under current law.

The Thanksgiving holiday is over, and attention now turns to the Senate floor debate on its health insurance reform. Today’s Washington Post explores one aspect of this debate– and that's what the impact of health reform will be on our deficits and fiscal situation.

There are three things to keep in mind when assessing this issue.

First, according to the non-partisan Congressional Budget Office (CBO), the Senate bill (pdf) – and the House bill (pdf) – will reduce the deficit over the first 10 years, and then substantially reduce it by hundreds of billions of dollars in the second 10 years as well.  That would be up to ¼ percent of GDP. CBO scoring is, by design, conservative, and we should not take their assessment lightly. Contrary to what many thought when this process began, the health reform bills represent the biggest deficit reduction legislation since the 1997 Balanced Budget Act.

Second, we also need to understand the limits of CBO scoring. Some of the most auspicious reforms that health policy experts believe will transform the health care system from one that delivers more care at an increasingly growing price to one that delivers better care are not analyzed by CBO for the fiscal effects. Why? Since they have never been done before ordone in concert with each other, they are hard to assess.  For CBO, past results is an important indicator for future savings.  I know this firsthand, having served as the CMS Administrator when the agency implemented the Balanced Budget Act of 1997 (BBA). The BBA was first estimated to extend the Medicare Trust Fund's solvency through 2017, but by the end of the Clinton Administration, the savings in the BBA were re-estimated and found to have extended the life of the Trust Fund to 2029.

Ironically, while some opponents of reform have tried to dismiss the CBO scores as underestimating the costs of reform, the opposite is almost certainly the case. Indeed, Jon Gabel wrote a New York Times op-ed in August spelling out why both history and logic argue that the CBO almost always underestimates savings in reform of the health care system, and are likely doing so now solely by virtue of their methodology:

"The budget office's cautious methods may have unintended consequences in the current health care reform effort. By underestimating the savings that can come from improved Medicare payment procedures and other cost-control initiatives, the budget office leads Congress to think that politically unpopular cost-cutting initiatives will have, at best, only modest effects."

In addition to historic investments in health information technology, research into what works and what doesn’t, and prevention and wellness investments that were included in the Recovery Act, some of the key provisions under consideration in the health reform bills include:

Changing the way we pay hospitals, to discourage mistakes and unnecessary and costly readmissions.
Creating incentives in the payment system to reward quality of care rather than just the quantity of procedures.
Giving physicians incentives to collaborate in the coordination of patient care.
Reducing hospital-acquired infections and other avoidable health-center acquired conditions through rigorous reporting and transparency.
Imposing a fee on insurance companies offering high-premium plans — which would create a strong incentive for more cost-efficient plans that would help reduce the growth of premiums.
Establishing a Medicare commission — which would develop and submit proposals aimed at extending the solvency of Medicare, slowing Medicare cost growth, and improving the quality of care delivered to Medicare beneficiaries. 

These elements are included in the Senate bill, and they will be deliberated upon and strengthened and modified where necessary over the coming debate.

Third, health reform is necessary, but not sufficient to curing our fiscal problems. The growing cost of health care is the number-one, long-term fiscal challenge we face. If we do nothing, by 2017, 20 percent of GDP will be spent on health care – and eventually it will swamp the federal budget. Fiscally-responsible health insurance reform that does not add a dime to our deficits and that reduces the rate of health care cost growth will help put our nation on a more sustainable, long-term trajectory. In fact, just "bending the curve" – reducing the annually rate of health care cost growth — by 15 basis points (or .15 percent) is the equivalent of wiping out the entire actuarial deficit in Social Security.

So, it's essential that we get health care costs under control by wringing out the waste in the system. But it is not sufficient to plug the massive deficits built up over the past several years. The President understands that, and that’s why as part of the budget process for next year he has tasked the Office of Management and Budget and his entire economic team with exploring ways to reduce our medium-term deficits.

As the debate gets under way, there will be those who will find fault and raise serious questions; we welcome their considered critiques. But a little perspective is in order; the bill passed by the House and the one being considered in the Senate do more to take health care off its unsustainable course than anything in history. And the critics of these efforts rarely offer any alternatives. One thing is clear: doing nothing is not an option.

Nancy-Ann DeParle is Director of the Office of Health Reform

A Mitchell Research & Communications poll (600 LVs, 11/17-19, 22-24, +/- 4%) shows Attorney General Mike Cox (R) with a slim lead in the GOP gubernatorial primary in 2010, but a sizeable advantage in the open-seat race against Lt. Gov. John Cherry (D), the likely Democratic nominee. Gov. Jennifer Granholm (D) is not seeking a [...]

“That takes the attention off Senator Reid. You have a splitting of the resources and I believe that hurts the Republican cause.” - Scandal plagued Republican Senator John Ensign’s rationale for not resigning.

UNITED NATIONS (Reuters) - Iran’s plans to build 10 nuclear enrichment plants are unacceptable and may lead the international community to ratchet up the pressure on Tehran to halt the program, the U.S. envoy to the United Nations said on Monday.

WASHINGTON (Reuters) - President Barack Obama on Monday was prepared to announce he will deploy about 30,000 more U.S. troops to Afghanistan as part of a new strategy that will stress a U.S. intention to ultimately exit the country.

WASHINGTON (Reuters) - The United States on Monday said Honduras’ controversial election was a significant but not sufficient step in its efforts to restore democracy after a military coup five months ago.

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