Obama Urges Excise Tax on High-Cost Insurance

WASHINGTON — President Obama told House Democratic leaders at a meeting on Wednesday that they should include a tax on high-priced insurance policies favored by the Senate in the final version of far-reaching health care legislation, aides said. The White House has long expressed a preference for the excise tax on high-cost plans, which health economists say could be an important tool in controlling long-term health care spending for the government and for individuals and families. But House Democrats have resisted the idea, which is also strongly opposed by many organized labor groups — an important part of the party’s base — because the tax may hit a number of more generous union-sponsored health plans. The Senate proposal would impose a 40 percent excise tax on the cost of individual insurance policies above $8,500 and on family policies above $23,000, with higher thresholds for retirees and employees in high-risk fields like police officers. The tax would raise $149 billion over 10 years, according to the Congressional Budget Office. The Senate bill would cost $871 billion over 10 years, while the House bill would cost nearly $1.1 trillion. The meeting among Mr. Obama, Speaker Nancy Pelosi and top committee chairmen responsible for the health care bill came as Congressional leaders have stepped up efforts to reconcile differences between the House and Senate bills. Ms. Pelosi, emerging from the meeting, said she expected those differences to be worked out soon. “We have had a very intense couple of days with meetings in our leadership, meetings with our staff,” she said. “After our leadership meeting this morning, our staff engaged with the Senate and the administration’s staff to review the legislation, suggest legislative language. I think we’re very close to reconciliation.” Mr. Obama has mostly tried to avoid taking public positions on potential disputes between the chambers, to the point that some lawmakers, including some Congressional leaders, have complained that the White House has not provided enough guidance. Instead, the president and some of his advisers have talked circuitously about what they believe to be some of the more useful policy goals. The budget director, Peter R. Orszag, for instance, has repeatedly extolled the potential economic merits of the proposed tax on high-cost insurance plans, as well as an independent agency to recommend potential government savings in Medicare. Both of those ideas were included in the Senate bill, but not the House measure. Senate Democrats are generally believed to have greater leverage in the negotiations to reconcile the two bills because they cannot afford to lose a single vote and some centrists have warned that they would turn against the bill depending on how it changes. The Senate approved its bill on a party-line vote, 60 to 39, on Dec. 24. But the House does not have much wiggle room either. It approved its bill on Nov. 7 by a vote of 220 to 215, with just one Republican joining 219 Democrats in favor. That means Ms. Pelosi could spare just two votes without jeopardizing the bill’s chances. Among the big differences between the two bills are the provisions to pay for the legislation. Both measures rely on huge reductions to slow the growth in government spending on Medicare. The Senate also proposed an increase in the Medicare payroll tax for individuals earning more than $200,000 and couples earning more than $250,000. The House proposed an income surcharge on individuals earning more than $500,000 and couples earning more than $1 million. Joining Mr. Obama and Ms. Pelosi at the meeting on Wednesday were the principal authors of the health care bill: Representative George Miller of California, the chairman of the Education and Labor Committee; Representative Charles B. Rangel of New York, the chairman of the tax-writing Ways and Means Committee; and Representative Henry A. Waxman of California, chairman of the Energy and Commerce Committee. Representative Louise Slaughter of New York, the chairwoman of the House Rules Committee, also attended. Mr. Rangel, who has expressed frustration at the pressure on the House to defer to the Senate, said he appreciated Mr. Obama’s time and attention. “The president has been very patient with his time and understanding that we have to get 218 votes and we really have to be able to sell it — not just to our Democratic caucus, but to the American people,” Mr. Rangel said. “And we could not have asked the president to be more cooperative — even though he’s doing more listening than talking.” Mr. Obama may have little choice but to emerge from listening mode in the days ahead. Senate leaders return to Washington next week, and pressure will only mount on him to help broker the final differences between the bills.

New Health Rule: Quit Worrying About Your Health

By TARA PARKER-POPE

Stuart Bradford

Have you had your five to nine servings of vegetables today? Exercised for an hour? Cut back on saturated fat and gotten eight hours of sleep?
Dictating the rules for healthful living has become a cottage industry, with Web sites, talk shows and books (and health columns like this one) devoted to the dos and don’ts of staying healthy.
But when it comes to achieving these goals, many of us feel we are falling far short. Whether you’re a busy parent who can’t find time for exercise, a chronic dieter struggling to lose 20 pounds or a multitasker who gets by on six hours of sleep, it is virtually impossible to follow the rules.
Now Dr. Susan M. Love, one of the country’s most respected women’s health specialists, offers a new rule: stop worrying about your health.
In the new book, “Live a Little! Breaking the Rules Won’t Break Your Health” (Crown), Dr. Love makes the case that perfect health is a myth and that most of us are living far more healthful lives than we realize.
Dr. Love, a clinical professor of surgery at the David Geffen School of Medicine at the University of California, Los Angeles, says that failing to live by the various health rules is a major source of stress and guilt, particularly for women. For most of us, “pretty healthy” is healthy enough.
“Is the goal to live forever?” she said in a recent interview. “I would contend it’s not. It’s really to live as long as you can with the best quality of life you can. The problem was all of these women I kept meeting who were scared to death if they didn’t eat a cup of blueberries a day they would drop dead.”
The book, written with Alice D. Domar, a Harvard professor and senior staff psychologist at Beth Israel Deaconess Medical Center, explores the research and advice in six areas of health — sleep, stress, prevention, nutrition, exercise and relationships. In all six, they write, the biggest risks are on the extremes, and the middle ground is bigger than we think.
“Everything is a U-shaped curve,” Dr. Love said. “There may be times in your life when you’ve gotten too much of this or too little of that, but being in the middle is better, and most of us are probably there already.”
Take the issue of sleep. Most people believe that it’s best to get at least eight hours a day. But the studies on which this belief is based look at how much men and women sleep under ideal conditions — silence, darkness and no responsibilities other than taking part in a sleep study. These studies tell us how much people will sleep when they have nothing else to do, but they don’t tell us anything about how much sleep we really need on a daily basis or what will happen if we get less.
A 2002 report in Archives of General Psychiatry tried to address those issues by comparing sleep habits and mortality risk. The study found that people who slept seven hours a night were the least likely to die during the six-year study period. Sleeping more than seven hours or less than five increased mortality risk. It wasn’t clear from the study whether more or less sleep increased risk or whether an underlying health problem was affecting sleep habits, but the findings did call the old “eight hours” rule into question.
The reality is that individual sleep needs can vary. Some people need very little while others need more than the average. “The issue of sleep causes a lot of guilt by women,” Dr. Love said. “We need to be more realistic. If you’re sleepy all the time, you’re not getting enough sleep for you. If you’re fine on six hours, don’t worry about it.”
Likewise, while exercise is important, many people don’t place enough value on the fitness that comes from everyday tasks like lifting and chasing children, lugging groceries and cleaning house.
And there is nothing magic about losing weight. People who are obese or underweight have higher mortality rates, but people who are overweight are just as healthy as those of normal weight — and sometimes healthier. “The goal is to be as healthy and have as good of a quality of life as you can have,” Dr. Love said. “It’s not to be thin.”
Health experts agree that moderation is important and that people should not panic about their health habits. But Dr. Elizabeth Barrett-Connor, professor of family medicine at the University of California, San Diego, cautions against interpreting a relaxed health message as an excuse to overeat or stay sedentary. “I think the problem is the slippery slope,” Dr. Barrett-Connor said. “In the process of translating this message simply to the masses, they may feel they’ve been forgiven. They shouldn’t feel like they’re sinning, but they shouldn’t feel like this is a license not to try to do better.”
Miriam E. Nelson, director of the John Hancock Research Center on Physical Activity, Nutrition and Obesity Prevention at Tufts University, who has read the book, says it may help people realize that it is easier to be healthy than they thought. “There is a large part of the population that doesn’t do anything because they’ve been overwhelmed,” Dr. Nelson said. “This book could get them interested because it’s not so complicated anymore.”
Dr. Love said she and Dr. Domar decided to write the book because many people seemed to have lost sight of what it meant to be healthy. “The point of this is to use your common sense, and if you feel good, then you’re fine,” she said. “The goal is not to get to heaven and say, ‘I’m perfect.’ It’s to use your body, have some fun and to live a little.”

Source:http://well.blogs.nytimes.com/