Who the hell are you listening to Barry?

The House Ways and Means Committee and the Education and Labor Committee (two of three House Committees working together on health reform legislation) took the first step towards passage of health reform legislation in the House by voting on Friday to approve the "America's Affordable Health Choices Act of 2009" (H.R. 3200), which will be financed in part by a $540 billion surtax on high-income households. The House Energy and Commerce Committee is still meeting on the bill, with a combination of Republican and so-called "blue dog" Democrats seeking a number of key changes.

The "America's Affordable Health Choices Act of 2009" was amended separately by the House Ways and Means Committee and the Education and Labor Committee (so are no longer identical), but both include provisions for an employer mandate, individual mandate, creation of an Insurance Exchange, development of a government sponsored public plan, and insurance market reforms.

In a blow to the bills’ cost containment claims, Congressional Budget Office (CBO) head Douglas Elmendorf testified last Thursday that the bills, as currently structured, would more likely lead to an increase rather than a decrease in the health care cost spiral.

Over the weekend, a number of state governors voiced their concern about increased state costs for expansion of Medicaid. The House bill would increase Medicaid eligibility by about 11 million people with a 10 year cost in excess of $400 billion.

Last month, Aon Consulting asked more than 1,100 employers for their opinions about key issues in the health reform debate. Among the findings were:

• 93% favor continuing an employer-based health system to increase the insured population, but with a greater focus on wellness and chronic condition management and evidence-based medicine guidelines.
• 81% oppose having a national government-sponsored public health plan similar to Canada’s.
• 63% oppose an employer mandate.
• 54% say Congressional modification of ERISA preemption would lead them to reexamine their health coverage options. Another 22% would likely terminate group health coverage altogether.

Exactly who are the Representatives Representing? Their constituents or their "President"? Is the President leading a democracy of opinion or trying to democratize his opinion?