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Wednesday, March 3, 2010 | 2 a.m.
Dina Titus
Berkley
Related stories
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As President Barack Obama outlines today the next steps in health care reform, all eyes turn to the House, rather than the typically testy Senate, as the chamber facing the steepest climb to pass a comprehensive bill.
The slim margin that House Speaker Nancy Pelosi leveraged to pass the $1 trillion House health care bill in November has evaporated as her chamber prepares a possible vote on the less-costly but less-popular Senate legislation. Retirements, death and the loss of the lone Republican backer have diminished Democrats’ odds.
Many House Democrats, including Nevada Reps. Shelley Berkley and Dina Titus, do not like the Senate bill. The promise that it will be changed in subsequent legislation and through the reconciliation process brings only scant comfort.
Still, as November’s midterm elections approach, House Democrats are faced with two unsavory options: pass a bill they may not like or pass nothing at all.
“People feel like you’ve got to get something done,” Titus said last week as she and other Democrats gathered to celebrate passage of one small piece of health care reform — a bill that revokes the insurance companies’ antitrust exemption. “I feel that way.”
Republicans are capitalizing on this scenario, gearing up for campaign slogans to match either outcome — Democrats are do-nothings who, with control of the House, Senate and White House, failed to accomplish their goals, or they must answer for passing a health care bill the public has not yet embraced.
Sen. Mitch McConnell of Kentucky, the Republican leader, warned Tuesday of the campaigns to come. “I want to assure our Democratic friends that if they are somehow able to pass this bill in the House, it will be the issue in every race in America,” he said.
Titus and Berkley were both yes votes the first time around, contributing to the 220-215 victory when the House bill passed in November.
But both Nevadans have expressed deep skepticism with the Senate version of the bill, which they may now be asked to consider. They are particularly opposed to the Senate’s plan for a 40 percent excise tax on high-end health care plans — the so-called Cadillac plans enjoyed by unions, including those representing workers on the Strip.
“I don’t like an excise tax,” Berkley said.
Republican Rep. Dean Heller voted against the bill and is likely to do so again.
The White House and labor unions negotiated a new version of the Cadillac tax in January that did not snare as many workers, and Obama’s blueprint released last week pushed the tax threshold even higher so that it would hit those with plans valued above $10,200 for singles and $27,500 for families.
Titus said the president was moving in the right direction.
“Even though I don’t like taxing benefits ... that’s certainly an improvement over the Senate bill,” Titus said. But the changes have not sealed her support.
Polls show Nevadans overwhelmingly want changes in the health care system, but do not support the current legislation.
Figuring into the political calculations, the go-it-alone strategy by Democrats is a politically dicey one. A Gallup Poll last week shows Americans nationwide are opposed to using the majority-only reconciliation process to pass the legislation without Republican support. Yet polling in Nevada by Research 2000 shows a majority, 55 percent, supports a go-it-alone strategy by Democrats.
The math in the House is further vexed by the abortion issue. The House was able to win passage of its bill last year by including restrictions on federal funding for abortion, an amendment that is not included in the Senate bill. The House could lose several anti-abortion Democrats on the matter.
What is unknown is whether the House could pick up some fiscally conservative Democrats who voted against the costlier House bill but might prefer the Senate version. Or whether Obama’s new proposal today could break through the unified Republican opposition — by including tougher provisions on medical malpractice reform or reining in medical fraud and waste, as had been suggested by Republican Sen. Tom Coburn of Oklahoma at last week’s health care summit.
As Democratic leaders shore up support for the president’s renewed push on his signature domestic priority, Berkley and Titus must decide whether to fall in line.
The two for months have been pushing their leaders to move away from health care reform and focus on jobs and economic issues that are tops on voters’ minds, especially in recession-battered Nevada.
Titus appears to be leaning toward supporting the bill’s passage, but she also thinks supporting pieces of health care reform, as she did last week in helping to pass the antitrust bill, would be an accomplishment.
Titus likely faces a difficult election in November, in a district with a strong independent streak. She won her first term in 2008 with less than 50 percent of the vote.
Titus withheld her support from the bill in committee until she could win concessions that allowed her to vote yes when it came to the floor. But withholding her backing now could mean the difference between passage and failure. She is waiting for the president’s next move before deciding whether to support the legislation.
Berkley faces an easier re-election in a predominantly Democratic seat in the heart of Las Vegas. She is less likely to withhold her vote from her party’s highest-profile issue.
“If we get 90 percent of what I want — this 100-percent-or-nothing is what puts our government in a gridlock — I’m not going down that path,” she said. “I’m trying to be as bipartisan and solution-oriented as possible.”
Rule number 1 You cannot spend your way out of debt. This bill if passed will break the camels back. Putting 31 million more people on the program and claiming that you will save is stupidity gone to seed.
Government has lost touch with reality. Where is 1 trillion going to come from to pay for all this? And that number isnt even the full extent of it.
If there is 30 percent fraud in medicare, I would like to see the government fix that first before they expect us to fork over MORE money to expand their control over things.
CHANGE is only good if its an improvement. Spending money we dont have isnt an improvement.
Today Obama will announce his "pared down" $1.0 trillion health insurance package version 6.9, and will claim Republican support because he added the undercover patient idea to fight fraud.
Obama, Reid, and Pelosi will proceed to CRAM the destructive health insurance bill down unwilling citizens throat.
The announced price tag is around $1 trillion over 10 years for giving an entitlement to an estimate 25-30 million new people.
Benefits do not start until 2018. We start paying taxes now.
This $1 TRILLION will be paid for by
REDUCING Medicare and Medicaid benefits,
Adding millions in increased State payments,
heavy SALES TAX on basic health care services,
increased "COST SHIFTING" of government costs to private plans,
EXCISE TAX on private health care insurance plans,
PAYROLL TAXES will be increased by increasing the rate for households by taxing UNEARNED income like for capital formation dividends, interest, annuities - and rents and royalties.
We will pay increased taxes for ten year for just four years of benefits.
------------------------------------------------------
Still in the end up to 20 million will not be covered and private plan premium will go up.
There is NO COST Containment.
We are still paying for abortions
It will cost thousands for each person the government through a picking and choosing process will decide give free health insurance entitlement to.
Everybody else not picked for free health insurance will be conscripted to buy a plan.
Most of the actions rely on the need for future Congresses to actually make the changes like to Medicare.
I am sure that Titus will vote for that terrible ObamaCare bill.
She voted for the terrible Cash for Clunkers bill.
She voted for raising taxes on poor and low income families so that the middle class could get free health insurance for their children.
When Pelosi says "jump" then Titus will ask how high.
She will vote for the bill.
Congresswoman Titus needs to take the leap of faith and vote for the damn bill...again!
Joe Heck will ALWAYS be more against the bill than she is, so what's the sense in tap dancing?
Please Dina--take a risk, make history, seize the moral and economic imperative and vote for the bill!
Thanks as usual to Congresswoman Berkley!
Sgt. Rock-go back underneath your rock with the creepy crawlies.
Without this healthcare reform package we will spend much more than the projected trillion.
stgrock is of his rocker...
"I am sure that Titus will vote for that terrible ObamaCare bill."
Yep. That's her job; make a decision based on the wants and needs of her constituency, and vote accordingly. It's called a "representative Democracy". And she's smart as a whip, I'm sure she will vote for a health care reform bill that benefits the majority of Nevadans, which only die-hard NutJobs continue to call "ObamaCare".
"She voted for the terrible Cash for Clunkers bill."
Yes, that WAS so AWFUL!
http://www.time.com/time/business/articl...
"She voted for raising taxes on poor and low income families so that the middle class could get free health insurance for their children."
SUCH a weak, pathetic attempt to obfuscate.
I think stgrock is talking about SCHIP and the increased tax on TOBACCO. Yes, it's a crime;
SCHIP is an awful deal for the kiddies, and ciggies are SO GOOD FOR YOU!
"When Pelosi says "jump" then Titus will ask how high."
The silliest notion of all! I could see Dina popping Pelosi in the schnozz if she felt she deserved it... let's give Dina Titus some credit; she's a freshman Congresswoman, and has the ABSOLUTE BEST INTERESTS OF NEVADAN'S AT HEART. And, it is quite obvious she can think for herself;
http://www.lasvegassun.com/news/2010/jan...
Yes, DavidWayne, it is sadly true. The righties cannot see the forest for the trees.
Boy, stgrock climbed out from under his rocks really early this morning to bring you this anti-Health-Care rhetoric...
I think the Neo's are getting WORRIED!
What? Are the radical righties now worried? Are they afraid of what happens when health care reform passes and it passes with a number of provisions that have strong majority support? How will the GOP campaign against it?
Just pass the bill already and move forward with improving it by adding things like the public option that will give Nevadans more and better health care choices. I hope Dina delivers for us again.
"a decision based on the wants and needs of her constituency"
According to legit polls that means she will vote against the terrible ObamaCare.
Wow....thanks for the 411.
I was worry but she is going vote according to the wants and needs of her voters.
Her voters don't want it.
Her voters don't need it.
Heh. Yeah, "her voters don't want it"...
http://act.boldprogressives.org/cms/sign...
That's why 56% of Nevadans want the public option and 55% won't object to a package partly passed through reconciliation that actually benefits their families. What we don't want is a weak HMO/PhRMA bailout or any more GOP obstructionism.
"a decision based on the wants and needs of her constituency"
I want healthcare reform.
I need healthcare reform.
My wife wants healthcare reform.
My family needs healthcare reform.
My employees want healthcare reform.
My business needs healthcare reform.
Nevada wants healthcare reform.
America needs healthcare reform.
Who is going tho pay for this madness? Certainly not the Chinese.
Again...like I said...if you look at LEGIT polls...not koolaid polls with push-poll questions....Americans, including Nevadans, do not want ObamaCare and don't need ObamaCare.
Do we want healthcare reform? Yes
Is ObamaCare the "reform" that we need or want? The answer is a no. A majority of Americans have been rejecting for over a year now.
If Titus and Reid wants to vote and shove ObamaCare down Nevada's throat then they should not be surprise at the reaction that may could in Nov.
Again, Titus voted for Cash for Corporations and Cash for Clunkers.
She voted to raise taxes on poor and low income families so that the middle class can get free health insurance.
She will probably will vote for this horrible ObamaCare that will cut billions in Medicare, has tons of special deals for all kinds of poeple but not regular Nevadans, it will increase taxes, increase premiums and lower health care quality.
Who wants that?
Who needs that?
Titus will vote to shove this down our throats.
People like RSN, gmag, and me are real constituents who need and want real health care reform. I don't have to be paid by a radical right think tank to say it, and I don't have to regurgitate the same ol' (false) GOP talking points.
The only reason why the public is against it is because of the multitude of lies the Republicans have told and keep telling. For the people whose premiums keep rising and those without healthcare this is needed. The Democrats are damned if they do and damned if they don't..so they might as well get it done. It is the right thing to do. Let the party of no keep saying no. When healthcare reforms proves to be the right thing to do...people will remember who was against it.
"Yep. That's her job; make a decision based on the wants and needs of her constituency, and vote accordingly."
"The only reason why the public is against it is because of the multitude of lies the Republicans have told and keep telling. For the people whose premiums keep rising and those without healthcare this is needed. The Democrats are damned if they do and damned if they don't..so they might as well get it done."
If that's the flipping case then the dems should present the bill to the public saying this is what we *will* pass in January of 2011 if you keep us in office. Let the public vote in November 2010. If all you believers in "the public" supports healthcare reform are right, you will win even more seats. After all President BO has said, "that's why we have elections." Fine.
If you all do this and the public agrees, then so be it, my side has legitimately lost the debate. But give the public a chance to actually decide, something beyond a poll.
What the House and Senate have crafted is not health care reform. It is huge, complex, legislation that probably no one understands, and will bankrupt our already broke country. Sure, we all want health care reform, but this is not it.
The Republicans are being called the party of NO. They are actually listening to the citizens of this country (for once). Poll after poll after poll shows that most Americans are smart enough to see through this obama scam and government take over.
Please contact your elected representatives and strongly tell them - "no obamacare - start from scratch!"
stgrock posted awhile back about how he had had a hospital stay AND HAD NO INSURANCE!
That's RIGHT! stgrock was NOT RESPONSIBLE ENOUGH
to have paid up A HEALTH INSURANCE POLICY!
Well, it turns out THE BILL WAS QUITE HEFTY!
What did "the rock" do? Well, first of all, he went to the hospital billing department to CLAIM POVERTY! They lowered his charges, but he still
OWED A RATHER LARGE SUM OF DOUGH-RAY-ME!
So, how did our comic-book-hero weasel his way out of having a huge debt on his books?
HE WENT OUT AND BEGGED FOR IT!
That's right, stgrock and his ilk think that CHARITIES should pick up health care bills for those who FAIL TO PAY THEIR PREMIUMS!
Wow! For a man that espouses all things "conservative", (read; PERSONAL RESPONSIBILITY!)
I just for the life of me can't see how "the rock" rationalizes BEGGING AND PLEADING as a panacea to the Health Care Crisis.
BTW... when he changed his name from jfnance32,
our boy James fancied himself a COMIC BOOK HERO!
http://en.wikipedia.org/wiki/Sgt._Rock
I agree RSN:
I want healthcare reform.
I need healthcare reform.
My wife wants healthcare reform.
My family needs healthcare reform.
My employer wants healthcare reform.
My business needs healthcare reform.
Nevada wants healthcare reform.
America needs healthcare reform.
We have been victims of heathcare company ABUSE for too long and we should stand up and say we are not going to take it anymore.
Future lies and says "Benefits do not start until 2018. We start paying taxes now."
Access to Affordable Coverage for the Uninsured with Pre-existing Conditions
The Patient Protection and Affordable Care Act will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions. This provision is effective 90 days after enactment, and coverage under this program will continue until new Exchanges are operational in 2014.
Access to Quality Care for Vulnerable Populations
The Patient Protection and Affordable Care Act makes an immediate and substantial investment in Community Health Centers to provide the funding needed to expand access to health care in communities where it is needed most. This $10 billion investment begins in 2010 and extends for five years.
No Pre-existing Coverage Exclusions for Children
The Patient Protection and Affordable Care Act eliminates pre-existing condition exclusions for all Americans beginning in 2014, when the Exchanges are operational. Recognizing the special vulnerability of children, the Managers' Amendment prohibits health insurers from excluding coverage of pre-existing conditions for children, effective six months after enactment and applying to all new plans.
Re-insurance for Retiree Health Benefit Plans
The Patient Protection and Affordable Care Act will create immediate access to re-insurance for employer health plans providing coverage for early retirees, effective 90 days after enactment. This re-insurance will help protect coverage while reducing premiums for employers and retirees.
Closing the Coverage Gap in the Medicare (Part D) Drug Benefit
The Patient Protection and Affordable Care Act will reduce the size of the "donut hole," raising the ceiling on the initial coverage period by $500 in 2010.
The Patient Protection and Affordable Care Act will also guarantee 50 percent price discounts on brand-name drugs and biologics purchased by low and middle-income beneficiaries in the coverage gap, beginning July 1, 2010.
Small Business Tax Credits
The Patient Protection and Affordable Care Act will offer tax credits to small businesses beginning in 2010 to make employee coverage more affordable.
Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage; later, when Exchanges are operational, tax credits will be up to 50 percent of premiums. The full credit will be available to firms with 10 or fewer employees with average annual wages of $25,000, while firms with up to 25 or fewer employees and average annual wages of up to $50,000 will also be eligible for the credit.
Here's some more, Future:
Ensuring Value for Premium Payments
The Patient Protection and Affordable Care Act will establish standards for insurance overhead and require public disclosure to ensure that enrollees get value for their premium dollars. The Managers' Amendment tightened these standards, requiring plans in the individual and small group market to spend 80 percent of premium dollars on clinical services and quality activities, and 85 percent for plans in the large group market. Health insurance plans that do not meet these thresholds will provide rebates to their policyholders. This provision takes effect in 2011 and applies to all plans, including grandfathered plans, with the exception of self-insured plans.
Patient Protections
The Patient Protection and Affordable Care Act protects patients' choice of doctors by allowing plan members to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before and woman sees an ob-gyn, and ensuring access to emergency care. This provision takes effect six months after enactment and applies to all new plans.
Extension of Dependent Coverage for Young Adults
The Patient Protection and Affordable Care Act will require insurers to permit children to stay on family policies until age 26. This provision takes effect six months after enactment and applies to all new plans.
Free Prevention Benefits
The Patient Protection and Affordable Care Act will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage. This provision takes effect six months after enactment and applies to all new plans.
Beginning on January 1, 2011, Medicare beneficiaries will receive a free, annual wellness visit and will have all cost-sharing waived for prevention services.
No Lifetime Limits on Coverage
The Patient Protection and Affordable Care Act will prohibit insurers from imposing lifetime limits on benefits. This provision takes effect six months after enactment and applies to all new plans.
Restricted Annual Limits on Coverage
The Patient Protection and Affordable Care Act will tightly restrict insurance companies' use of annual limits to ensure access to needed care, effective six months after enactment for all new health plans. These tight restrictions will be defined by the Secretary of Health and Human Services. When the Exchanges are operational, the use of annual limits will be banned.
Protection from Rescissions of Existing Coverage
The Patient Protection and Affordable Care Act will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact. This provision takes effect six months after enactment and applies to all new plans.
So many benefits, it takes up THREE Sun comments to prove you wrong:
Prohibits Discrimination Based on Salary
The Patient Protection and Affordable Care Act will prohibit group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. This provision takes effect six months after enactment and applies to group health plans.
Public Access to Comparable Information on Insurance Options
The Patient Protection and Affordable Care Act will enable creation of a new website to provide information on and facilitate informed consumer choice of insurance options.
Health Insurance Consumer Information
The Patient Protection and Affordable Care Act will provide assistance to States in establishing offices of health insurance consumer assistance or health insurance ombudsman programs to assist individuals with the filing of complaints and appeals, enrollment in a health plan, and, eventually, to assist consumers with resolving problems with tax credit eligibility. This provision is effective beginning with fiscal year 2010.
Appeals Process
Under the Patient Protection and Affordable Care Act, all new health plans will implement, within six months of enactment, an effective process for appeals of coverage determinations and claims. And, states will provide an external appeals process to ensure an independent review.
I think SgtRock has been dinged by this one before:
He's quoting a general Nevada poll, not a poll of Titus' actual constituents.
Regardless, we elect people to make the right decision, not to govern by poll numbers.
And now we get to vote them out when they make bad decisions.
Healthcare reform was on the ballot in 2008 and it won.
I voted for healthcare reform because I need healthcare reform.
For the last 20 years I have needed healthcare reform. That's why I voted for it in 1992 and 2008.
The same forces are out working for the health insurance industry with the same ole lies. Not this time! Enough!!
Healthcare reform was on the ballot in 2008 and reform won.
This bill isn't Healtcare reform, it is an addtional Trillion dollar tax on the American.
If it passes, it will be interesting to see how the people on Medicare handle a $500 billion dollar reduction in benifits.
you guys call it health reform, the people who see the bill for what it is, call it a health insurance bailout. If i was a drug maker, health insurance CEO, i'd be preparing for my big bonus !
Charlie Rangel has contributed large amounts of money to Dina Titus over the past couple of years.
Why? Was he buying her support or something? Did Charlie know things were going to come crashing down on him and he was buying protection?
Hmmm. Typically Sgt. Rock isn't silent for so long.
If the Repubs are so concerned about health care, why wasn't it addressed in the first six years of the Bush admin?
Hey Larry. Read the news. Titus returned that money to Rangel.
How come Larry isn't asking republicans to return money that they got from Ensign?
The Rightwing Warmongers are crying again. They would rather spend on wars then anything for the good of the people.
Medicare isn't getting cut. The overcharging of health insurance companies for medicare plus plans will be reigned in.
The President we elected is speaking on the subject right now.....
http://www.whitehouse.gov/live/president...
Heller has government health insurance. He even has a government-employee nurse in the Capitol Building to help him. So, since he has it, why not the rest of us? Could it be that Heller hates Nevadans? he certainly has contempt for them.
I think gmag has blown a head gasket.
The bill makes larges cuts into Medicare via the phantom fraud and abusive items (if you believe that crap, I got a bridge to sell you).
The bill takes away a Medicare benefit for all Americans except for a few states where the Senators sold their souls..I mean..their votes for their states protections. Reid screwed over Nevada and did not get this protection.
The bill protects unions and government workers from a health insurance tax that other regular workers will have to pay.
The bill increases taxes on many health related entities will increase premiums.
The bill adds new mandates on health insurance companies which will increase premiums.
The "exchanges" do not happen until many years down the road.
The bill forces young people to buy insurance or they have large fines and if they lie about then they will go to jail.
It raises the rates on young people too.
The full BS to not to have insurance and wait until you are sick to buy insurance does not happen until years out.
The bill makes the Federal government determine what is in insurance plans and the structure against how claims will be paid and declined. For instance, they could set up a rule where you are denied coverage because it will cost to much and they consider that they are not worthy of the coverage.
The only reason why in a 10 year period that the bill reduces the deficit by some $100 billion (so small for a 10 year period) is because the costly benefits start in years 5 and 6 but the cuts and tax increases start now.
Remember these are the same people who said Medicare was not going to cost that much.
They are sooooo many reason why this bill sucks.
But if Titus thinks Cash for Clunkers and Cash for Corporations is great then she will probably vote for this garbage too.
She is a pink district that just was red a few years ago.
Even koolaid drinkers who can read legit polls know she is big trouble if she votes again for ObamaCare.
I am betting that she wants to come back to Nevada. She probably hates DC. She wants to come back to teaching.
She will vote for ObamaCare and probably lose in Nov.
Sue Lowden's Record of Illegally Cutting Health Benefits
http://www.harryreid.com/ee/index.php/ne...
Charlie Rangel has contributed large amounts of money to Dina Titus over the past couple of years.
Titus returned $1,000 of the money to Rangel.
Why? Was he buying her support or something? Did Charlie know things were going to come crashing down on him and he was buying protection?
"Not a con" is trying to con us by stating that Medicare isn't getting cut and that the overcharging of health insurance companies for medicare plus plans will be reigned in.
When?
Today? No...
Yesterday? No...
Last week? No...
Last month? No...
Last year? No...
If there is 500 Billion dollars of fraud and waste in Medicare, it is criminal that it has not been already cleaned up by the Obama Administration...
Tell you what you Liberal blowhards, I will support the Obama Health Care Plan with a public option as soon as the Obama Administration cleans up Medicare.
I am keeping a tally of monies lost:
Year 2009 - $ 500,000,000,000.00
Jan 2010 - 45,000,000,000.00
Feb 2010 - 45,000,000,000.00
March 01 - 1,500,000,000.00
March 02 - 1,500,000,000.00
March 03 - 1,500,000,000.00
Obama Lost- $ 594,500,000,000.00
When the Obama Administration finds it, please let me know.
Comment removed by moderator. Comment contained a personal attack.
YOUR PRESIDENT would never buy health care votes!
While you were eating your cheap-as-you-can-find fattening Wednesday night supper, Obama was attempting to buy votes by wining, dining, smoking, and spending our tax dollars to BUY VOTES for the fiasco known as "health care reform." The attendees are listed below. He also bought a vote by naming the brother of an "undecided" Dem. as judge to circuit court. CORRUPTION AT ITS BEST.
Jim Matheson, D-Utah, voted "NO" last summer for so-called "health care" bill; this past fall he was "undecided"...tonight he is being wined and dined by Obama...who announced the following at a White House dinner party:
Obama just named his brother, Scott Matheson, as judge to circuit court - an apparent attempt to BUY Jim Matheson's health care vote.
Contact the following Dems - who need to hold FIRM and VOTE NO against the health care fiasco:
CONGRESSMAN LINCOLN DAVIS
202-225-6831
CONGRESSMAN HERSETH SANDLER
202-225-2801
CONGRESSMAN FRANK KRATOVIL
202-225-5311
CONGRESSMAN BETSY MARKEY
202-225-4676
CONGRESSMAN JIM MATTHESON
202-225-3011
CONGRESSMAN HEATH SHULER
202-225-6401
CONGRESSMAN JOHN TANNER
202-225-4714
CONGRESSMAN SCOTT MURPHY
202-225-5614
CONGRESSMAN JASON ALTMIRE
202-225-2565
CONGRESSMAN BOYD
202-225-5235
Contact these Dems and tell them to stand FIRM in opposition to the health care fiasco.