Sunday, September 20, 2009

9/18/09 - Liability and Health News Update

Baucus Releases Bill: No Public Option; What doctors think

by Donna Baver Rovito, Editor, "Liability and Health News Update"

This LIABILITY UPDATE/Health Care Focus "newsletter" is a free service which I provide, as a volunteer, to help supply medical liability reform and other health care news and information, legislative updates, and political insight to physicians, patients, liability reform and quality health care advocates. NO ONE pays me to do this.

I am not employed by any physician or health care reform advocacy or liability reform organization, political party or candidate, although I volunteer for several. I am a quality health care, physician and patient advocate, breast cancer survivor, physician's spouse, journalist, political noisemaker, mom, and freelance writer. I am not, nor will I ever claim to be, unbiased, unlike many in the mainstream media.

Most information in this newsletter is copied and pasted from other sources, and will always be identified with links. Opinions and clarifications are my own, and do not reflect the official position of any physician or patient advocacy organization or tort reform or health care reform group unless stated as such. My opinions are placed in double parentheses ((xxxxxx)), italicized and appear in blue. This Update is emailed to approximately 10,000 health professionals, physician and patient advocates, and others interested in ensuring access to quality medical care. It also appears on the following BLOG (when I remember to post it):

If you'd prefer not to receive these periodic updates about health care issues in America, please hit "Reply" and put "Unsub health group" in the subject line and I'll remove your email address immediately.


If you would like to be added to or removed from the Liability Update/Health Care Focus Information Network, or if you have information about a physician relocating, retiring early, giving up medicine, private practice or curtailing services due to the medical liability crisis please email

HOUSEKEEPING NOTICE - The demise of my computer caused me to lose some of my most recent email lists - if you've previously been asked to be removed from a list, or your email address has changed, please notify me at and I apologize for any inconvenience....DBR




Baucus Releases Bill: No Public Option

Public Option Lite - The Baucus plan would make insurance even more expensive.

Baucus unveiling health bill without GOP on board

No Republican support for Senate health plan,0,7857187.story

Breaking down the Baucus bill

FACTBOX: Details of Baucus plan for healthcare reform

Press Release: Baucus's Plan To Lower Health Care Costs

Million Med March

White Coats to Congress Rally

45% Of Doctors Would Consider Quitting If Congress Passes Health Care Overhaul

Grim Prognosis From Doctors Opposed To Health Care Plan

Poll Finds Most Doctors Support Public Option

My medical oath requires no government oversight

Doctors Offer Senators Their Opinion on Health Care Reform

State's largest doctors' group campaigns on reform proposals

Tom Coburn Educates a Government Option Advocate

White House Sued Over Free Speech Violations in Healthcase Battle:

GOP Senate doctors on health care road show

The doctors in the House – but not all are on duty when it comes to reform

How the GOP wants to fix health care

Rep. Tom Price admonishes govt-takeover of healthcare

U.S. Rep. Phil Gingrey shares thoughts about health care

From the American College of Surgeons

A Doctor Responds To Obama's NYT Op-Ed's_NYT_Op-Ed/

Dr. Victor Greco interview

AMA backs House health system reform bill that includes Medicare pay overhaul

Specialty Physicians Unhappy with AMA RepresentationPoll of physicians shows negative view of American Medical Association

A Doctor's Plan for Legal Industry Reform

Paging Dr. Galt Health Care from the Producer's Perspective

Rx for money woes: Doctors quit medicine



One headline says doctors approve of the President's health care plan. Another says doctors are quitting the AMA for supporting it. Another says that what doctors REALLY want is a single payer plan. Another says that doctors will stop practicing if the government takes over health care. ARGH!

So what the heck is going on with America's doctors?

I'll tell you - the same thing that's going on with everyone else.

Anyone who attempts to pigeonhole doctors AS A COHESIVE GROUP on any political or social issue is, well, SILLY.

Or dishonest. Or both.

Doctors have widely ranging political and social opinions JUST LIKE everybody else - trust me, I know. I've been advocating for medical liability reform on behalf of hardworking doctors for almost 10 years now - and I've caught as many rocks as roses from physicians who either agree or disagree with me.

That's why I find statements of alleged unconditional physician support from EITHER SIDE of the health care debate to be disingenuous nonsense. To hear David Axelrod state that all the doctors and nurses support the President's plan after last Wednesday's speech nearly made my head explode. (Which would have been really bad, since I didn't have my duct tape handy...) I caught myself screaming at the television "No, they DON'T!" Not ALL of them, anyway.

To be fair, though, hearing other groups accuse the AMA of not representing America's physicians any longer because its leaders support the broad goals of the President's plan makes me equally annoyed.

Getting doctors to agree on anything other than their desire to provide quality care to their patients is like "herding cats." It can't be done. That's why, in addition to the AMA and scores of specialty societies, there's a brand new crop of physician advocacy organizations on ALL sides of the health policy debate. And some of the smaller groups that have been around for a while are suddenly making noise and getting headlines.

NO ONE can claim, honestly, to have the support of "America's doctors." In fact, doctors probably vary MORE WIDELY than policy makers and the public on how health care can best be delivered - because it's WHAT THEY DO.

Oh, and they're probably even more fiercely individualistic than most of the population of the country. Gullible Koolaid drinkers generally don't have what it takes to get through medical school, residency, and the 90 hour work weeks most physicians put in.....

Sadly, though, that's part of the problem, too - because it's impossible to get physicians to agree on anything, it's also impossible to get them to speak with a unified voice on behalf of their patients. And that's a shame, because NO ONE can advocate for patients with more credibility than doctors (OK, except for nurses.)

So....what can you do? Join up with the groups that you agree with - there are many of them, and several are featured in the items which follow.

Join a demonstration, call and write your legislators and ask your family, office staff and patients to do the same. But don't just sit back and let the debate rage on around you - not only your own future, but the your PATIENTS' future, is at stake here.

And JOIN THE AMA, too (or REFRAIN from canceling your membership), even if you DON'T agree with them on everything, because it's the biggest and most established voice for America's doctors and still has the most clout.

AMA policy reflects the combined positions of its nationwide membership, through their elected representatives, and its leadership, also selected by its membership. If you don't like the policies, GET INVOLVED. But be aware that America's physicians are Republicans, Democrats, Independents, Green Party, etc....and the AMA's policies have to reflect a WIDE RANGE of political and social opinion. Basically, just like the government, it's majority rules. So BECOME the majority if you disagree with current policy positions.

And be honest enough to admit to yourself that you AGREE with them on the broad strokes of quality patient care, the preservation of the doctor-patient relationship, and the necessity of having doctors help set health policy at every level of government.

OK, the FIFTH bill is out there now, from the Senate Finance Committee We're still waiting to see the President's bill, though....lots of stories follow about the Senate Finance Committee bill, which was supposed to be bipartisan but isn't. After that, lots more stories about where various groups of doctors stand on all this, including details about the Million Med March on Oct. 1.

Stay engaged and informed - this debate is likely to go on for a while...


((To the Senate's credit - at least this bill, ONLY 223 pages, appears to be written in ENGLISH....DBR))

Baucus Releases Bill: No Public Option
By Mary Agnes Carey, KHN Staff WriterSep 16, 2009

Senate Finance Committee Chairman Max Baucus today unveiled a health care bill that would require most individuals to have health insurance. Insurance companies could not deny health coverage based on a pre-exisiting medical conditions or place yearly or lifetime limits on coverage.
Related Content
America’s Health Future Act of 2009" (pdf)
Press Release from Senate Finance Committee

People who earn as much as 133 percent of the federal poverty level ($14,440 for an individual, $29,400 for a family of four) would be eligible for Medicaid, the government insurance program for the poor. The measure includes a health insurance 'exchange' where people could buy insurance and a system of health care "co-ops" rather than a government-run health insurance plan.

Subsidies would help low-income workers purchase health insurance and small businesses would receive tax credits to help offset the cost of providing coverage.

The bill is projected to cost $856 billion over 10 years. It would be paid for with an excise tax on high-end health insurance policies, lower payments to the Medicare Advantage program and with fees on medical device manufacturers, clinical labs, drug makers and health insurance companies. Baucus negotiated the plan with five other finance committee members - including three Republicans - but no one in the GOP has endorsed the package.


From the Wall Street Journal
Public Option Lite
The Baucus plan would make insurance even more expensive.

Senate Finance Chairman Max Baucus finally unveiled his health-care plan yesterday to a chorus of bipartisan jeers. The reaction is surprising given that President Obama all but endorsed the outlines of the Baucus plan last week. But the hoots are only going to grow louder as more people read what he's actually proposing.

The headline is that Mr. Baucus has dropped the unpopular "public option," but this is a political offering without much policy difference. His plan remains a public option by other means, imposing vast new national insurance regulation, huge new subsidies to pay for the higher insurance costs this regulation will require and all financed by new taxes and penalties on businesses, individuals and health-care providers. Other than that, Hippocrates, the plan does no harm.

The centerpiece of the Obama-Baucus plan is a decree that everyone purchase heavily regulated insurance policies or else pay a penalty. This government mandate would require huge subsidies as well as brute force to get anywhere near the goal of universal coverage. The inevitable result would be a vast increase in the government's share of U.S. health spending, forcing doctors, hospitals, insurance companies and other health providers to serve politics as well as or even over and above patients.

The plan essentially rewrites all insurance contracts, including those offered by businesses to their workers. Benefits and premiums must be tailored to federal specifications. First-dollar coverage would be mandated for many services, and cost-sharing between businesses and employees would be sharply reduced, though this is one policy that might reduce health spending by giving consumers more skin in the game. Nor would insurance be allowed to bear any relation to risk. Inevitably, costs would continue to climb.

Everyone would be forced to buy these government-approved policies, whether or not they suit their needs or budget. Families would face tax penalties as high as $3,800 a year for not complying, singles $950. As one resident of Massachusetts where Mitt Romney imposed an individual mandate in 2006 put it in a Journal story yesterday, this is like taxing the homeless for not buying a mansion.

The political irony here is rich. If liberal health-care reform is going to make people better off, why does it require "a very harsh, stiff penalty" to make everyone buy it? That's what Senator Obama called it in his Presidential campaign when he opposed the individual mandate supported by Hillary Clinton. He correctly argued then that many people were uninsured not because they didn't want coverage but because it was too expensive. The nearby mailer to Ohio primary voters gives the flavor of Mr. Obama's attacks.

And the Baucus-Obama plan will only make insurance even more expensive. Employers will be required to offer "qualified coverage" to their workers (or pay another "free rider" penalty) and workers will be required to accept it, paying for it in lower wages. The vast majority of households already confront the same tradeoff today, except Congress will now declare that there's only one right answer.

The subsidies in the Baucus plan go to people without a job-based plan and who earn under three times the federal poverty level, or about $66,000 for a family of four. Yet according to a Congressional Budget Office analysis we've seen, the plan isn't much of an improvement over the current market.

Take a family of four making $42,000 in 2016. While government would subsidize 80% of their premium and pay $1,500 to offset cost-sharing, they'd still pay $6,000 a year or 14.3% of their total income. A family making $54,000 could still pay 18.1% of their income, while an individual earning $26,500 would be on the hook for 15.5%, and one earning $32,400 for 17.3%. So lower-income workers would still be forced to devote huge portions of their salaries to expensive policies that they may not want or be able to afford.

Other Democrats want to make the subsidies even bigger, but Mr. Baucus told reporters on Monday that, "We're doing our very best to make an insurance requirement as affordable as we possibly can, recognizing that we're trying to get this bill under $900 billion total." Another way of putting this is that he is hiding the real cost of his bill by pinching pennies to meet a less politically toxic overall spending number. In that sense, the House health bill which clocked in at $1.042 trillion because it was more generous upfront was more honest, though not by much.

Like the House bill, Mr. Baucus uses 10 years of taxes to fund about seven years of spending. Some $215 billion is scrounged up by imposing a 35% excise tax on insurance companies for plans valued at more than $21,000 for families and $8,000 for individuals. This levy would merely be added to the insurers' "administrative load" and passed down to all consumers in higher prices. Ditto for the $59 billion that Mr. Baucus would raise by taxing the likes of clinical laboratories and drug and device makers.

Mr. Baucus also wants to cut $409 billion from Medicare, according to CBO, though the only money that is certain to see the budget ax is $123 billion from the Medicare Advantage program. Liberal Democrats hate Advantage because it gives 10.2 million seniors private options. The other "savings" come from supposedly automatic cuts that a future Congress is unlikely to ever approve that is, until this entitlement spending swamps the federal budget. Then the government will have no choice but to raise taxes to European welfare-state levels or impose drastic restrictions on patient care. Or, most likely, both.

To sum up, the Baucus-Obama plan would increase the cost of insurance and then force people to buy it, requiring subsidies. Those subsidies would be paid for by taxes that make health care and thus insurance even more expensive, requiring even more subsidies and still higher taxes. It's a recipe to ruin health care and bankrupt the country, and that's even before liberal Democrats see Mr. Baucus and raise him, and then attempt to ram it all through the Senate.

Printed in The Wall Street Journal, page A22


Baucus unveiling health bill without GOP on board
By ERICA WERNER (AP) – 8 hours ago

WASHINGTON — Sen. Max Baucus' decision to release his long-awaited health care overhaul bill with no Republicans on board dims the chances for a bipartisan compromise on President Barack Obama's top domestic priority.

The Senate Finance Committee chairman insisted Tuesday that he'll keep negotiating with the three Republicans and two fellow Democrats who've been in closed-door talks with him for months on the bill he was to reveal Wednesday. Baucus, D-Mont., said he hopes that by the time the committee votes on the bill, as early as next week, Republicans will be there.

But for now, despite numerous gestures to Republicans, Baucus has fallen short in his quest to assemble a coalition of senators from both parties behind his proposal. Obama also hoped for bipartisan support behind plans for reshaping the nation's $2.5 trillion health care system to hold down costs and cover the uninsured.

"The door's always open — always hoping that somebody, all six, will be on the bill," Baucus told reporters Tuesday evening after the latest meeting of his so-called Gang of Six senators. "We're just going to keep the door open, keep working, keep discussing."

Many of the details in the Baucus' bill were already known. Unlike more liberal versions passed by three committees in the House and by the Senate's Health Committee, it shunned liberals' call for the government to sell insurance and relied instead on co-ops to offer coverage in competition with private industry.

Baucus' approach includes a requirement for individuals to buy insurance, with financial penalties for those who don't. Rather than a mandate for larger businesses to provide coverage for employees, they would be required to defray the cost of any government subsidies for which their employees would qualify.

The bill is expected to cost about $880 billion over 10 years, and it tracks closely with the goals Obama laid out in his speech to Congress last week.

Baucus has been working for months with his committee's top Republican, Sen. Chuck Grassley of Iowa, along with GOP Sens. Mike Enzi of Wyoming and Olympia Snowe of Maine. In the end, Democrats believe Snowe may be the only one to support the bill, though she wasn't committing to that Tuesday night.

"Hopefully at some point through the committee process we can reach an agreement," she said.
Enzi said he was not yet ready to declare his position. Grassley applauded Baucus' effort at bipartisanship, but contended that Senate Democratic leaders and the White House had imposed an "artificial deadline" on the negotiators and that Democratic leaders "haven't made a commitment to back a broad bipartisan bill through the entire process."

"It looks like we're being pushed aside by the Democratic leadership so the Senate can move forward on a bill that, up to this point, does not meet the shared goals for affordable, accessible health coverage that we set forth when this process began," Grassley said in a statement.
He cited Republican concerns over cost, taxpayer funding for abortion services, medical malpractice lawsuits and subsidies for illegal immigrants in any health care bill.

"We've been clear from the start that we're willing to stay at the table," Grassley added. "There's no reason not to keep working until we get it right."

Even as he's failed to win over Republicans, Baucus also faces opposition from liberals on his committee. Some of them want a public plan in place of co-ops, and several have also expressed concerns about whether Baucus, in his effort to keep his bill's price tag down, has done enough to make health coverage affordable for working-class and low-income Americans.

"The way it is now there is no way I can vote for the package," Sen. Jay Rockefeller, D-W.Va., said Tuesday on a conference call with reporters, becoming the first Finance Committee Democrat to voice outright opposition.

Release of Baucus' bill sets the stage for what could be a lengthy and contentious drafting and voting session to begin next week, with numerous amendments expected both from the right and from the left. Following that, Democratic leaders in the House and the Senate are aiming for floor action in the fall.

Associated Press writers David Espo, Charles Babington and Ricardo Alonso-Zaldivar contributed to this report.

Copyright © 2009 The Associated Press. All rights reserved


No Republican support for Senate health plan
Finance Committee Chairman Max Baucus (D-Mont.) pushes on with hope but no guarantee of bipartisan support down the line.,0,7857187.story
By Janet Hook and Peter Nicholas
September 16, 2009

Reporting from Washington and Pittsburgh - Senate Democrats' most concerted quest for a bipartisan compromise on healthcare collapsed Tuesday as finance committee Chairman Max Baucus (D-Mont.) announced he would move ahead with his long-delayed proposals without any guarantee of Republican support. ((I understand why they're in a hurry from a POLITICAL standpoint - but shouldn't something this important be allowed to take as much time as is needed to get it right?))

Baucus also took a blow from his own party's left, as a senior Senate Democrat declared that too many concessions had been made and that he would not support the emerging bill because it did not include a public insurance option.

"I cannot agree with [Baucus] on this bill," said Sen. John D. Rockefeller IV (D-W.Va.), a senior finance committee member who has been briefed on the proposal. "There is no way, in its present form, that I will vote for it."

The Baucus plan, which scales back President Obama's ambitious proposals both in scope and cost, is considered a likely template for the measure that will ultimately clear the Senate. It has been designed to allay the concerns of moderate Blue Dog Democrats as well as Republicans.

After the negotiations broke down, Sen. Charles E. Grassley of Iowa, the senior Republican on the finance committee, accused Senate Democratic leaders of lacking a commitment to bipartisanship."I'm disappointed because it looks like we're being pushed aside by the Democratic leadership so the Senate can move forward on a bill that, up to this point, does not meet the shared goals for affordable, accessible health coverage that we set forth when this process began," said Grassley in a written statement.

Congressional Democrats and the White House had been doubting Grassley's commitment to negotiations after he sent a fundraising letter last month pledging to defeat "Obamacare."

The Finance Committee is scheduled to begin voting on its provisions next week. Baucus said he hoped that by the time the panel finishes amending and debating the bill, the measure will have gained some Republican backing.

But a last-minute session with his GOP counterparts -- the latest in a months-long string of such negotiations -- broke up late Tuesday with no commitment of Republican support.At the same time, the White House was ramping up pressure on the Senate to act -- even if that meant scaling back Obama's expectations of the legislation.David Axelrod, Obama's senior political advisor, met Tuesday with Senate Democrats to underscore the political risks of failing to revamp the healthcare system. According to Baucus, he cited polls showing public demand for changes -- and increasing support as people learn details of what Democrats are trying to do. ((Actually, I'm PRETTY SURE that polls are showing that the more people learn about the proposed plans, the LESS they approve...))

Rockefeller said after the meeting with Axelrod that he would find it "very distressing" if the White House reduced its strategy to "just a question of passing something so you can say you did healthcare reform."

To amplify his message outside Washington, Obama is scheduled to do five television interviews on Sunday -- with ABC, CBS, CNN, NBC and Univision -- to promote his healthcare initiative. He will also appear on David Letterman's show Monday.

The Baucus version of a healthcare overhaul would significantly scale back the cost and scope of legislation approved by two House committees and another in the Senate. And it would shun the public option preferred by many Democrats.Baucus was still revising key provisions of the bill Tuesday, including curbs on funding for abortion and on benefits for illegal immigrants. But the broad outlines were clear.

Like the version pending in the House, the Baucus proposal would require all individuals to have health insurance, make Medicaid available to more poor people, provide subsidies to help middle- and lower-income people afford private coverage, and set up marketplaces for individuals and small businesses to buy insurance at competitive rates.

But the Baucus bill costs less than $880 billion over 10 years, compared with the $1-trillion measure in the House.

The cost-cutting changes Baucus made to win favor with deficit hawks in the Senate have fueled fresh complaints from liberals such as Rockefeller and Sen. Ron Wyden (D-Ore.) who worry that, in the absence of a public option, there is no guarantee that affordable insurance will be available to people of modest means who do not qualify for subsidies.

At the same time, however, some of the most fervent supporters of the public option Tuesday signaled a willingness to compromise, and the president himself continued to show flexibility as he barnstormed for action.

Bill Samuel, director of government affairs for the AFL-CIO, said in an interview that the public option remained the preferred solution. But he also said, "If people bring forward an idea that they can credibly argue achieves the same results -- breaking the stranglehold of insurance companies -- we'll look at it."

Obama addressed an AFL-CIO convention in Pittsburgh on Tuesday and reiterated his support for the public option. But he continued to avoid making it nonnegotiable.Setting up a government-run plan to compete with private health insurers and act as a brake on rising premiums is a good idea, Obama said, one that would "offer Americans more choices, and promote real competition, and put pressure on private insurers to make their policies affordable and treat their customers better."

Rallying the union audience, Obama described the healthcare system as a blight on the nation. He described it as "broken" and prone to "sucking up all the money.""How many more workers have to lose their coverage?" he asked. "How many more families have to go into the red for a sick loved one? How much longer are we going to have to wait?"It can't wait," he said.
Copyright © 2009,
The Los Angeles Times


Breaking down the Baucus bill
9/17/09 5:13 AM EDT

Senate Finance Committee Chairman Max Baucus (D-Mont.) worked for months to find common ground with Republicans on health care reform — but when he released his long-anticipated proposal Wednesday, the real problem quickly came into focus.

He set the stage for a titanic struggle within his own party.

Reaction from congressional Democratic leaders was lukewarm to worse, progressives were downright hostile and Republicans were scornful of what they described as brazen government grab.

But Baucus may have provided lawmakers with the only viable blueprint for winning support across Congress, because he sought to find elements that pleased all sides.

“There are honest and principled differences on all of us working for reform, and this package may not represent all of our first choices,” Baucus said. “But at the end of the day, we all share a common purpose: that is to make the lives of Americans better tomorrow than they are today and to get health care reform done, which means the time for action is now.”

The next challenge for Baucus and the Senate leadership is to get the bill out of the Finance Committee — but after that, Senate Majority Leader Harry Reid (D-Nev.) will need to merge the Finance bill with one approved in July by the Senate Health, Education, Labor and Pensions Committee.

Even Reid, who has generally supported Baucus’s efforts, sounded less than pleased, saying he needs to be convinced the bill is right for Nevada on a proposed Medicaid expansion. House Speaker Nancy Pelosi (D-Calif.) dug in on the element dear to her liberal caucus — the public insurance option — and whacked the Baucus bill for shunning it. Baucus has made the challenge clear for Democrats, who now must choose between competing visions of health reform: an employer mandate versus fees on employers, a public insurance option versus nonprofit insurance cooperatives, and taxes on millionaires versus industry and people with expensive health care plans.

The proposal capped months of closed-door discussions that, in the end, produced no immediate Republican support — and critical comments from negotiators Chuck Grassley of Iowa and Mike Enzi of Wyoming, both of whom complained about “artificial deadlines” from the White House and Democratic leaders to push through a bill, as Grassley said.

Baucus put the cost of his bill at $856 billion. It would require nearly all Americans to carry insurance and employers to help cover the costs of providing government subsidies, while prohibiting insurance companies from dropping or denying coverage for people with pre-existing conditions.

The Congressional Budget Office estimated the bill would cost $774 billion over 10 years and cover 94 percent of Americans. It would leave 25 million people uninsured in 2019 — a third of whom are illegal immigrants — compared with 17 million in the House bill. ((Excuse me? I thought the entire justification for ALL of these plans was that we needed to provide coverage to everyone?))

The analysis came in $82 billion lower than Baucus had thought it would, suggesting there could be room for senators to make adjustments. However, any expenses added to the bill must be offset with new revenue, making the task politically difficult.

Another looming battle between Baucus and fellow Democrats is over how to pay for the bill — especially since the Finance bill came in at least $100 billion cheaper than the House bill. The House would pay for health reform in part by taxing high earners, families who make at least $1 million, but Baucus proposed an excise tax on insurers for their top-of-the-line plans. And Republicans think both plans cost too much.

“Bipartisanship on Capitol Hill is the equivalent of a child looking for the unicorn,” Rep. Anthony Weiner (D-N.Y.) said, referring to the months of negotiations between Baucus and three Republican senators on the committee — none of whom has embraced his bill.

Weiner, an outspoken defender of the public option, said the Baucus bill would be “dead on arrival” in the House — a far stronger claim than that of his party’s leaders in that chamber.

“It has been said that the Senate is the cooling saucer of our democracy,” Weiner said. “At this point, it is more akin to the meat locker. ... The Senate proposal will not pass muster in the House.”
But Baucus aides said there is plenty for progressives to like: tax credits to purchase insurance for families with incomes of $88,200 or less, immediate creation of a high-risk pool to provide coverage to the uninsured and people with pre-existing conditions, an expansion of Medicaid, and Medicare coverage for annual prevention and wellness checkups.

“It is common sense. It is a balanced bill. It certainly is a bill that can pass,” Baucus said. “And the choice now is up to those on the other side of the aisle — if they want to vote for it or not.”


FACTBOX: Details of Baucus plan for healthcare reform
Wed Sep 16, 2009 1:50pm EDT

(Reuters) - Senate Finance Committee Chairman Max Baucus on Wednesday released his long-awaited proposal to overhaul the U.S. healthcare system, President Barack Obama's top domestic priority.

The Baucus plan -- with a price tag of $856 billion over 10 years -- calls for sweeping insurance market reforms and payment system changes, as well as requirements for all citizens and legal residents to buy insurance.

It does not include a controversial government-run "public" insurance option but calls for non-profit cooperatives to create competition in the insurance market and reduce costs.

Following are details of the Baucus proposal:

* Creates state-based exchanges where individuals and small businesses can shop for insurance.
* Four categories of minimum benefits would be offered through the exchange. A separate policy offering catastrophic coverage for young adults, a so-called "young invincible" plan, would be offered.
* Beginning in 2013, insurance companies would no longer be able to exclude people from coverage based on pre-existing conditions. Limited-benefit plans and lifetime limits on coverage would be barred. Insurers would be prohibited from rescinding health coverage.
* Provides for the sale of national plans with uniform benefits across state lines. ((National plans from whom? Private insurers? Or the "co-op?"))

* The proposal does not contain a new government healthcare plan to compete with private plans, which is backed by Obama and liberal Democrats but opposed by Republicans and health insurers.
* The proposal provides for the creation of non-profit "consumer operated and oriented" plans or cooperatives.
* Federal loans would be provided to help with start-up costs and federal grants would be provided to meet state solvency requirements.
* The cooperatives would compete with private insurers in the non-group and small-group insurance markets.

* Beginning in 2013, all U.S. citizens and legal residents would be required to obtain health coverage.
* Provides a sliding scale of tax subsidies to help low and middle income people, up to 300 percent of poverty-line income, buy health insurance. People in the 300 to 400 percent range of poverty-line income would get credits if premiums exceed 13 percent of income.
* Cost-sharing subsidy available for those between 100 and 200 percent of poverty-line income.
* The proposal allows an exemption for those who cannot afford coverage.
* For taxpayers between 100 percent and 300 percent of poverty-line income, a penalty of $750 per individual with a maximum $1,500 per family would be imposed if they fail to obtain coverage.
* For those with income above 300 percent of the poverty line, a penalty of $950 per individual with a maximum of $3,800 per family would be imposed if they fail to obtain coverage.
* Medicaid, the healthcare system for the poor, would be expanded so everyone up to 133 percent of poverty-line income could qualify.
* Employers would not be required to offer health insurance but firms with 50 or more full-time workers would pay a fee for employees who get policies subsidized by federal tax credits.
* No fee would be imposed for workers enrolled in Medicaid.

* An excise tax of 35 percent would be levied on insurance companies for health plans above $8,000 for singles and $21,000 for families. The tax would apply to self-insured and group-market plans but not to plans sold in the individual market. Threshold would be indexed for inflation.
* Health insurance providers collectively would pay an annual fee of $6 billion starting in 2010. The fee would be allocated by companies' market share.
* Pharmaceutical companies collectively would pay an annual fee of $2.3 billion, allocated by market share.
* Medical device makers collectively would pay an annual fee of $4 billion, allocated by market share.
* Clinical laboratories collectively would pay an annual fee of $750 million. The fee would be allocated by market share with an exemption for small firms.

(Reporting by Donna Smith in Washington; Editing by John O'Callaghan)
© Thomson Reuters 2009 All rights reserved


((This is quite long, but fairly detailed and worth the time....))

Press Release: Baucus's Plan To Lower Health Care Costs
Sep 16, 2009

The following is a press release sent Sept. 16 from the Senate Finance Committee.

Washington, D.C. – Senate Finance Committee Chairman Max Baucus (D-Mont.) today introduced the America’s Health Future Act, landmark health care reform legislation to lower costs and provide quality, affordable health care coverage. The Chairman’s Mark will make it easier for families and small businesses to buy health care coverage, ensure Americans can choose to keep the health care coverage they have if they like it and slow the growth of health care costs over time. It will bar insurance companies from discriminating against people based on health status, denying coverage because of pre-existing conditions, or imposing annual caps or lifetime limits on coverage. The bill would improve the way the health care system delivers care by improving efficiency, quality, and coordination. The $856 billion dollar package will not add to the federal deficit.

The Finance Committee will meet to begin voting on the Chairman’s Mark next week.
"The cost of America’s broken health care system has stretched families, businesses and the economy too far for too long. For too many, quality, affordable health care is simply out of reach,” said Baucus. “This is a unique moment in history where we can finally reach an objective so many of us have sought for so long. The Finance Committee has carefully worked through the details of health care reform to ensure this package works for patients, for health care providers and for our economy. We worked to build a balanced, common-sense package that ensures quality, affordable coverage and doesn’t add a dime to the deficit. Now we can finally pass legislation that will rein in health care costs and deliver quality, affordable care to the American people.”

Provisions included in the legislation to ensure Americans have quality, affordable, health care coverage would:
Create health care affordability tax credits to help low and middle income families purchase insurance in the private market;
Provide tax credits for small businesses to help them offer insurance to their employees;
Allow people who like the coverage they have today the choice to keep it;
Reform the insurance market to end discrimination based on pre-existing conditions and health status;
Eliminate yearly and lifetime limits on the amount of coverage plans provide;
Create web-based insurance exchanges that would standardize health plan premiums and coverage information to make purchasing insurance easier;
Give consumers the choice of non-profit, consumer owned and oriented plans (CO-OP);
Standardize Medicaid coverage for everyone under 133 percent of the federal poverty level.
Provisions included in the legislation to improve the quality of care, increase efficiency within the health care system, and lower health care costs would:
Shift incentives in Medicare to reward better care, not just more care;
Increase the number of primary care doctors in the system;
Aggressively fight fraud, waste, and abuse in Medicare;
Encourage all of a patient’s doctors to coordinate care and reduce duplication and waste;
Create incentives for health care providers to improve quality by using safer, more cost effective health technology like electronic medical records; and
Increase health care research so doctors know what care works best for which patients.
Provisions included in the legislation to promote preventive health care and wellness would:
Provide annual “wellness visits” for Medicare participants and their doctors to focus on prevention;
Eliminate out-of-pocket costs for screening and prevention services in Medicare;
Create incentives in Medicare and Medicaid for completing healthy lifestyle programs;
Increase federal Medicaid funding for states that cover recommended preventive services and immunizations for enrollees at no extra cost; and
Provide free tobacco cessation services for pregnant women in Medicaid.

The Congressional Budget Office estimates the Chairman’s Mark would make a $XXX ((ummmm....don't want to be difficult or whiny here, but shouldn't there be a NUMBER in that spot? This is exactly how the press release appeared on the link...)) billion investment in the health care system over ten years. That investment would be fully paid for mostly through increased focus on quality, efficiency, prevention and adjustments in federal health program payments, without adding to the federal deficit. A summary of the Chairman’s Mark follows below. The full text of the America’s Health Future Act is available at 2009/091609 Americas_Healthy_Future_Act.pdf

"The America’s Health Future Act” - Providing Quality Coverage to All Americans

Americans who like their health insurance and want to keep it can do so. For the millions of Americans who don’t have or can’t afford employer-provided coverage, or who are being denied coverage due to a pre-existing condition, the Chairman’s Mark reforms the individual and small-group markets, making coverage affordable and accessible.

Individual Market Reforms – The Mark would require insurance companies to issue coverage to all individuals regardless of health status; insurers would no longer be allowed to limit coverage based on pre-existing conditions. Limited variation in premium rates would be permitted for tobacco use, age, and family composition. Variation in rating would be allowed between geographic areas, but would not differ within a geographic area.

Small Group Market Reforms – Rating rules for the individual market would also apply to the small group market, as defined by states. This would include groups of one to 50 employees, but could include companies with up to 100 employees, depending on current state law.

Health Insurance Exchanges – The Mark would make purchasing health insurance coverage easier and more understandable by using the Internet to present consumers with available plans. The Mark would create state-based web portals, or “exchanges” that would direct consumers purchasing plans on the individual market to every health coverage option available in their zip code. The exchanges would offer standardized health insurance enrollment applications, a standard format companies would use to present their insurance plans, and standardized marketing materials. The exchanges would have a call center for customer support. The exchanges would also enable users to determine whether they are eligible for health care affordability tax credits or public programs and would enable consumers without access to the Internet to enroll through the mail or in person in a variety of locations. ((This ALMOST sounds like competition - but it's still limited by artificial barriers between states. Imagine how expensive groceries or any other product would be if we were only permitted to buy whatever is produced in our own state....))

Small Group Purchasing Through SHOP Exchanges − Under the Chairman’s Mark, small businesses would have access to state-based Small Business Health Options Program (SHOP) exchanges. These exchanges – like the individual market exchanges – would be web portals that make comparing and purchasing health care coverage easier for small businesses. ((But only within state barriers...))

Transitioning to a Reformed Insurance Market – Once the insurance market reforms take effect, people who want to keep the insurance they have today can do so. Plans would be allowed to continue to offer the coverage they offer today and this coverage would be grandfathered. These grandfathered plans would only be available to those people who are enrolled today or, in the case of a small employer, to new employees and their dependents. People who qualify for the health care affordability tax credits in the reformed market would not be able to use the credits to purchase grandfathered plans. Tax credits would be offered only to purchase plans created in the reformed market that meet the new benefit standards. ((Thereby "encouraging" people into the newly government regulated plans....))

Transitioning for Rating Requirements − Federal rating rules for the individual market (other than for grandfathered plans) would take effect by January 1, 2013. Federal rating rules for the small group market would be phased in over a period of up to five years, as determined by each state, with approval from the Secretary of HHS.

Medicaid – The Chairman’s Mark would standardize Medicaid eligibility for all parents, children, pregnant women and childless adults at or below 133 percent of the Federal Poverty Level (FPL), or $30,000 a year for a family of four ($14,400 for an individual), beginning in 2014. Individuals between 100 percent of FPL and 133 percent of FPL would be given the choice of enrolling in either Medicaid or in a private health insurance plan offered through a health insurance exchange. The federal government would provide additional funding to states for services for newly eligible Medicaid beneficiaries. The Chairman’s Mark would also guarantee prescription drug benefits to all Medicaid beneficiaries. ((That sounds expensive...))

Prescription Drug Benefits – Medicare beneficiaries who enroll in the Medicare Part D prescription drug program will receive significant help purchasing prescription drugs when they hit the coverage gap portion, or “donut hole” of the benefit. Instead of paying 100 percent of their drug costs in the gap, Part D beneficiaries with low to moderate incomes will receive a 50 percent discount on the price of brand-name drugs covered by their plan. The discount makes expensive medicines more affordable and helps beneficiaries stay on treatments that their doctors prescribe.

Children’s Health Insurance Program – The Chairman’s Mark would not make changes to the Children’s Health Insurance Program (CHIP) until after September 30, 2013, when the current reauthorization period ends. Then, states would be required to provide children between Medicaid eligibility levels and at least 250 percent of FPL with wraparound coverage to supplement the core benefit package available through the exchange. These additional services would be the early and periodic screening, diagnosis and treatment (EPSDT) services available to children in Medicaid. Current CHIP cost-sharing protections would continue to apply. CHIP benefits under this new form of delivery would be equally as or more generous than the current structure.

Addressing Health Care Disparities – The Chairman’s Mark would require federal health programs to collect uniform data on race, ethnicity, gender and disability to help program administrators and researchers work to end disparities among these groups.

Promoting Maternal and Child Health – The Chairman’s Mark would provide funding to states, tribes and territories to develop and implement one or more evidence-based Maternal, Infant and Early Childhood Visitation programs. Program options would provide training and consultation aimed at reducing infant and maternal mortality and its related causes by producing improvements in prenatal, maternal and newborn health, child health and development, parenting skills, school readiness, juvenile delinquency and family economic self-sufficiency.

Making Coverage Affordable

The cost of health insurance has increased five times faster than wages over the last eight years. Estimates show that just seven years from now, most Americans will spend nearly half their income on health insurance. American businesses pay nearly three times more than our major trading partners for health care benefits. Unaffordable coverage prevents these companies from competing in the global market. The Mark makes coverage more affordable by providing tax credits for low and middle-income individuals and small businesses, and by strengthening public programs.

Options for Standard Benefits – The Mark creates four benefit categories for the reformed health insurance market: bronze, silver, gold and platinum. No policies (except grandfathered policies) would be issued in the individual or small-employer market that do not comply with one of the four categories. All insurers would have to offer coverage in the silver and gold categories. ((SO....what's left to cover in the platinum plan, and what's eliminated in the bronze category? The following is a pretty comprehensive list of what will have to be covered...)) All plans would be required to provide primary care and first-dollar coverage for preventive services, emergency services , medical and surgical care, physician services, hospitalization, outpatient services, day surgery and related anesthesia, diagnostic imaging and screenings, including x-rays, maternity and newborn care, pediatric services (including dental and vision care), prescription drugs, radiation and chemotherapy, and mental health and substance abuse services. Plans would not be allowed to set lifetime limits on coverage or annual limits on any benefits. Plans would have out-of-pocket limits at least equal to the limits for Health Savings Accounts (HSAs), which will be $5,950 for an individual and $11,900 for a family in 2010.

Health Care Affordability Tax Credits –The Mark would provide an advanceable, refundable tax credit for low and middle-income individuals to subsidize the purchase of health insurance. Beginning in 2013, tax credits would be available on a sliding scale for individuals and families between 134-300 percent of FPL (Federal Poverty Level) to help offset the cost of private health insurance premiums. Beginning in 2014, the credits are also available to individuals and families between 100-133 percent of FPL. The credits would be based on the percentage of income the cost of premiums represents, rising from three percent of income for those at 100 percent of poverty to 13 percent of income for those at 300 percent of poverty. Individuals between 300-400 percent of FPL would be eligible for a premium credit based on capping an individual’s share of the premium at a flat 13 percent of income. A cost-sharing subsidy would be provided to limit the amount of cost-sharing that individuals and families between 100-200 percent of FPL have to pay. Undocumented immigrants are prohibited from benefiting from the credit. ((And how will that be enforced?))

Small Business Health Care Affordability Tax Credits – This proposal would provide a tax credit to small businesses that offer health insurance to their employees. In 2011 and 2012, eligible employers can receive a small business credit for up to 35 percent of their contribution. Once the exchanges are up and running in 2013, qualified small employers purchasing insurance through the exchanges can receive a tax credit for two years that covers up to 50 percent of the employer’s contribution. Small businesses with 10 or fewer employees and with average taxable wages of $20,000 or less will be able to claim the full credit amount. The credit phases out for businesses with more than 10 employees and average taxable wages over $20,000, with a complete phase out at 25 employees or average taxable wages of $40,000.

Cafeteria Plan Changes - This proposal creates a Simple Cafeteria Plan – a vehicle through which small businesses can provide tax-free benefits to their employees. This change would ease the participation restrictions and include self-employed individuals as qualified employees. The proposal also exempts employers who make contributions for employees under a simple cafeteria plan from pension plan nondiscrimination requirements applicable to highly compensated and key employees. Finally, the proposal allows for qualified long-term care insurance to be provided under a cafeteria plan to the extent the amount of such contributions does not exceed the eligible long-term care premiums for the contract. This proposal is effective beginning on January 1, 2011.
Consumer Owned and Oriented Plan (CO-OP) – The Mark creates authority for the formation of the Consumer Owned and Oriented Plan (CO-OP). These plans can operate at the state, regional or national level to serve as non-profit, member-run health plans to compete in the reformed non-group and small group markets. These plans will offer consumer-focused alternatives to existing insurance plans. Six billion dollars of federal seed money would be provided for start-up costs and to meet solvency requirements.

Personal Responsibility – The Mark would create a personal responsibility requirement for health care coverage, with exceptions provided for a variety of reasons including religious conscience (as defined in Medicare) and an exemption for undocumented workers.

Individuals who fail to meet the requirement are subject to a penalty. If an individual’s income is between 100 and 300 percent of poverty, the penalty for failing to obtain health coverage is $750 per person per year with a maximum of $1,500 per family. If an individual’s income is above 300 percent of poverty, the penalty for failing to obtain coverage is $950 per person per year with a maximum of $3,800 per family.

Exemptions from the penalty will be made for individuals where the full premium of the lowest cost option available to them (net of subsidies and employer contribution, if any) exceeds ten percent of their adjusted gross income (AGI); those below 100 percent of FPL; any health arrangement provided by established religious organizations comprised of individuals with sincerely held beliefs (e.g., such as those participating in Health Sharing Ministries); those experiencing hardship situations (as determined by the Secretary of Health and Human Services); and an individual who is an Indian as defined in section 4 of the Indian Health Care Improvement Act. Additionally, in 2013, individuals at or below 133 percent of FPL will be exempt from the penalty. When making these determinations, income from individuals not subject to the mandate should not be considered.

Responsibility for Employers – The Mark would not require employers to offer health insurance. However, effective January 1, 2013, all employers with more than 50 employees who do not offer coverage will have to reimburse the government for each full-time employee (defined as those working 30 or more hours a week) receiving a health care affordability tax credit in the exchange equal to 100 percent of the average exchange subsidy up to a cap of $400 per total number of employees whether they are receiving a tax credit or not.

As a general matter, if an employee is offered employer-provided health insurance coverage, the individual would be ineligible for a health care affordability tax credit for health insurance purchased through a state exchange. An employee who is offered coverage that does not have an actuarial value of at least 65 percent or who is offered unaffordable coverage by their employer, however, can be eligible for the tax credit. Unaffordable is defined as 13 percent of the employee’s income. A Medicaid-eligible individual can always choose to leave the employer’s coverage and enroll in Medicaid. In this circumstance, the employer is not required to pay a fee.

Strengthening Coverage of Preventive Services in Medicare and Medicaid

For the nearly one in three Americans covered under Medicare or Medicaid, the Chairman’s Mark makes critical investments in policies that will promote healthy living and help prevent costly chronic conditions like diabetes, cancer, heart disease, obesity and mental illness. Preventive screenings enable doctors to detect diseases earlier when treatment is most effective averting more serious, costly health problems later. Providing Personalize Prevention Plan and Wellness Visit - The Chairman’s Mark provides Medicare beneficiaries with a free visit to their primary care provider every year to create and update a personalized prevention plan to address health risks and chronic health problems and to design a schedule for regular recommended preventive screenings.
Improving Access to Preventive Services - The Mark eliminates out-of-pocket costs for recommended preventive services for Medicare beneficiaries. Beneficiaries will no longer face financial deterrents for seeking preventive care. The Chairman’s Mark also encourages states to cover preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) and immunizations recommended by the Advisory Committee on Immunizations (ACIP) to adults enrolled in Medicaid. States that opt to cover recommended services and immunizations without cost-sharing would receive a one percent increase in the federal share of the FMAP reimbursement rate for those services. All states would be required to provide comprehensive tobacco cessation services to pregnant women enrolled in Medicaid.
Moving Toward Patient-Centered Care - The Chairman’s Mark creates a new state option and rewards states for providing chronically ill individuals enrolled in Medicaid with a health home. Participating enrollees will receive comprehensive care coordination and management, transitional care and, if relevant, referral to community-based programs and social services. States that take up this option will receive an enhanced match for two years.

Rewarding Healthy Lifestyles - The Mark establishes an initiative that will reward Medicare and Medicaid participants for healthier choices. Funding will be available to provide participants with incentives for completing evidence-based, healthy lifestyle programs and improving their health status. Programs will focus on lowering certain risk factors linked to chronic disease such as blood pressure, cholesterol and obesity.

Reforming the Health Care Delivery System

Medicare currently reimburses health care providers on the basis of the volume of care they provide. For every test, scan or procedure conducted, providers receive payment – regardless of whether the treatment contributes to helping a patient recover. Medicare must move to a system that reimburses health care providers based on the quality of care they provide. The Chairman’s Mark includes various proposals to move the Medicare fee-for-service system towards paying for quality and value. These proposals include the following: Hospital Value-Based Purchasing - The proposal would establish a value-based purchasing program for hospitals starting in 2012. Under this program, a percentage of hospital payment would be tied to hospital performance on quality measures related to common and high-cost conditions, such as cardiac, surgical and pneumonia care. Quality measures included in the program (and in all other quality programs in this section) will be developed and chosen in cooperation with external stakeholders. ((That's a little vague, isn't it?))

Physician Value-Based Purchasing - This provision would strengthen and expand the Physician Quality Reporting Initiative (PQRI) program, including requiring all eligible health professionals to participate by 2011. It would also improve the Medicare physician feedback program and penalize physicians who utilize significantly more resources than their peers. ((Well, that sounds like a good way to cut back on defensive medicine costs....if substantive tort reform was in the bill. Oh, it's mentioned, later, but not in a way that will actually reduce medical liability premiums or the practice of defensive medicine.....))

Medicare Home Health Agency and Skilled Nursing Facility Value-Based Purchasing - CMS is currently testing value-based purchasing models for these providers. Building on this effort, this provision would direct the Secretary to submit a plan to Congress by 2011 related to home health providers and 2012 related to skilled nursing facilities outlining how to effectively move these providers into a value-based purchasing payment system.

Quality Reporting for Other Providers - This provision would set providers – long-term care hospitals, inpatient rehabilitation facilities, PPS-exempt cancer hospitals and hospice providers – on a path toward value-based purchasing by requiring the Secretary to implement quality measure reporting programs for certain providers. Providers who do not successfully participate in the program would be subject to a reduction in their annual market basket update.

Encouraging Collaboration Among Health Care Providers

Patients receive the best possible care when doctors collaborate and work together to coordinate care. Current payment systems often discourage such care coordination. When providers in different settings – like doctor’s offices, hospitals, nursing homes and rehabilitation facilities – work together, patients benefit from receiving better care and costs in the system are lower. Payment for Accountable Care − To encourage providers to improve patient care and reduce costs, the Mark would allow high-quality providers that coordinate care across a range of health care settings to share in savings they achieve to the Medicare program. CMS Innovation Center - This provision would establish an Innovation Center at the Centers for Medicare & Medicaid Services (CMS) that would have the authority to test new patient-centered payment models that encourage evidence-based, coordinated care. Payment reforms that are shown to improve quality and reduce costs could be expanded throughout the Medicare program.

National Pilot Program on Payment Bundling - The Chairman’s Mark would direct the Secretary to develop a voluntary pilot program encouraging hospitals, doctors and post-acute care providers to achieve savings for the Medicare program through increased collaboration and improved coordination of patient care by allowing the providers to share in such savings. Reducing Avoidable Hospital Readmissions - To improve quality of care, this provision would direct CMS to track national and hospital-specific data on the readmission rates of Medicare participating hospitals for certain high-cost conditions that have high rates of potentially avoidable hospital readmissions. Starting in 2012, hospitals with readmission rates above a certain threshold would have payments for the original hospitalization reduced by 20 percent if a patient with a selected condition is re-hospitalized with a preventable readmission within seven days or by 10 percent if a patient with a selected condition is re-hospitalized with a preventable readmission within 15 days.

Infrastructure Investments: Tools to Reduce Costs and Improve Quality

Efforts to reduce costs and improve quality in the health care delivery system will require equal efforts to modernize the system with new tools that support coordinated quality care. Investments in the health care infrastructure are essential to creating a more effective, efficient delivery system. Strengthening the Quality Infrastructure - Additional resources would be provided to the Department of Health and Human Services (HHS) to strengthen the quality measure development processes for purposes of improving quality, informing patients and purchasers, and updating payments under federal health programs. Specifically, the Secretary of HHS would be directed to develop a national quality strategy; establish an interagency working group on health care quality; provide additional resources for quality measure development and endorsement; and establish a process for HHS to work with external stakeholders, such as the National Quality Forum, to select quality measures to be included in Medicare value-based purchasing and pay-for-reporting programs. Research and Information − The Mark would invest in research on what treatments work best for which patients and ensure that information is available and accessible to patients and doctors, such as through the establishment of an independent institute to research the effectiveness of different health care treatments and strategies. These provisions are carefully crafted so that patients would never be denied treatment based on age, disability status or other related factors as a result of the research findings. Transparency - To increase transparency, the Chairman’s Mark would provide patients with information about physician-industry relationships – so called “physician payment sunshine,” close loopholes in physician self-referral laws that allow conflicts of interest, ((this is the part where they accuse doctors of deliberately scheduling unnecessary tests and procedures at their own facilities, and come up with lots of "greedy doctor" reasons to prohibit physician ownership of freestanding medical facilities....)) and provide patients and families with more information about nursing home facilities and hospital charges to help them make better decisions. The Chairman’s Mark would also require drug manufacturers and distributors to report information they already collect regarding the number and type of drug samples given to physicians. ((Right - because those "greedy doctors" can't be trusted not to sell them on the street, or something....)) The Mark would also require the nation’s hospitals to make their average charge information for commercial payers and self-pay patients available to the public.

Strengthening Primary Care and Other Healthcare Workforce Improvements

Primary care physicians play a critical role in our health care system. They are vital to reducing costs and improving quality in the health care system. Primary care doctors provide preventive care, help patients make informed medical decisions, assist with care management, and help coordinate with a patient’s other care providers. Despite their critical function, primary care doctors receive significantly lower Medicare payments than other doctors, which has played a role in the current shortage of primary care providers. Promoting Primary Care – To encourage more primary care doctors to be part of the system, the Chairman’s Mark would provide primary care practitioners and targeted general surgeons with a Medicare payment bonus of ten percent for five years. Health Care Workforce − Ensuring America’s health care system has a sufficient supply of health care professionals to meet the demands of a changing and aging population is essential to maintaining focus on high-quality, cost efficient care. To strengthen the health care workforce, the Mark would be increase graduate medical education (GME) training positions through a slot re-distribution program for currently unused training slots and priority would be given to increasing training in primary care and general surgery. ((This is the first acknowledgement I've seen of the need for general surgeons...)) The proposal would also encourage additional training in outpatient settings and ensure communities retain vital training slots if a hospital closes. It would establish a Workforce Advisory Committee made up of external stakeholders tasked with working with HHS and other relevant federal agencies to develop and implement a national workforce strategy. The Chairman's Mark establishes competitive demonstration grant programs designed to help low-income individuals obtain the education and training needed for well-paying, high-demand health care jobs. The Mark also includes demonstration grants for up to six states to develop training and certification programs for personal and home care aides.

Ensuring Beneficiary Access and Payment Accuracy in Medicare

The Chairman’s Mark ensures that Medicare beneficiaries will continue to have access to physicians and other critical health care providers. The Mark also improves the accuracy of Medicare payments to providers. Reducing overpayments to providers saves money for seniors and taxpayers without limiting beneficiary access. Physicians – Due to the flawed Sustainable Growth Rate (SGR) formula, physician payments are scheduled to be reduced by 22 percent in 2010. To ensure that Medicare beneficiaries continue to have access to physician services, the Chairman’s Mark replaces the impending cut with a positive update next year. ((This is the reason the AMA stayed at the table, folks. Disagree with their overall support of HR3200 all you like, but the AMA's board of trustees has ALWAYS fought to repair that flawed formula - and, as you can see, this bill STILL DOESN'T FIX IT. In fact, although every other aspect of the bill looks YEARS into the future, physician medicare payments are only dealt with for ONE YEAR?))

Medicare Advantage – Private insurers that participate in Medicare should bring value to the program and to beneficiaries. The Chairman’s Mark would improve the value of Medicare Advantage by reforming payments so that they appropriately reimburse insurers for their costs and promote plans that offer high quality, efficient health care for seniors. Specifically, the Mark would transition current Medicare Advantage payments which are based on statutory benchmarks to payments based on competitive bids from the insurers. It would eliminate overpayments to Medicare Advantage plans and addresses the inequitable distribution of rebates paid to plans by making any extra payment contingent on plan performance. Under the Mark, plans would be eligible for bonus payments based on their performance on quality measures and the operation of evidence-based care management programs. Plans that provide care at lower costs than traditional Medicare would also be eligible for an efficiency bonus. Rebates and bonuses paid to MA plans would need to be used to provide additional benefits that are not covered under Medicare. The Mark would preserve plans’ ability to offer benefit packages that differ from or supplement traditional Medicare. The Mark would add important protections and transparency for beneficiaries by limiting cost sharing for certain services, like chemotherapy and skilled nursing care, and by creating more consistency in the extra benefits that plans can offer beneficiaries throughout the country. Medicare Disproportionate Share Hospital Payments - This provision would require the Secretary to update hospital payments to better account for hospitals’ uncompensated care costs. Starting in 2015, hospitals’ Medicare Disproportionate Share Hospital (DSH) payments would be reduced to reflect lower uncompensated care costs relative to increases in the number of insured.

Home Health Payment Reform - The Secretary would be directed to improve payment accuracy through rebasing home health payments in 2013 based on an analysis of the current mix of services and intensity of care provided to home health patients. It would also establish a 10 percent cap on the amount of reimbursement a home health provider can receive from outlier payments, which are designed to help providers cover the costs of treating sicker patients. The Chairman’s mark would also reinstate an add-on payment for rural home health providers from 2010-2015.
Hospice Reform - Based on recommendations by the Medicare Payment Advisory Commission (MedPAC), this provision would require the Secretary to update Medicare hospice claims forms and cost reports. Based on this information, the Secretary would be required to implement changes to the hospice payment system to improve payment accuracy. The Secretary would also impose certain requirements on hospice providers designed to increase accountability in the Medicare hospice program.

Appropriate Payment for High-cost Imaging Services - Because payment rates for imaging services should reflect the rate by which they are used, the Mark would increase the utilization rate assumption for advanced imaging equipment. In addition, the Mark pays more accurately for multiple imaging services performed during a single patient visit.

Updating Outpatient Payments for PPS-Exempt Cancer Hospitals - The Secretary of Health and Human Services would be directed to update payment rates for outpatient care provided by cancer hospitals that are exempt from the prospective payment system.

Rural Health Care Protections

The Chairman’s Mark includes several provisions to ensure rural health care facilities and providers have the resources they need to continue delivering quality care in their communities. Specifically, the Mark would extend and improve many rural access protections, including the following:

FLEX Grants for Health Care in Rural Communities - The Medicare Rural Hospital Flexibility Program provides grants that rural health care providers can use to improve the quality of health care, and to strengthen health care networks. Funds can be used for services ranging from ambulance transport to the development of small local hospitals. The Chairman’s Mark will extend the FLEX Grant program through 2012, and will add a new component that Flex grant funding to be used to support rural hospitals’ efforts to implement delivery system reform programs, such as value-based purchasing programs, bundling, and other quality programs.

Extend Hospital Outpatient Department Hold Harmless for Small Rural Hospitals - Small rural hospitals that are not sole community hospitals (SCHs) can receive additional Medicare payments if their outpatient payments under a new payment system are less than under the prior reimbursement system. The Chairman’s Mark would ensure that small rural hospitals receive 85 percent of the payment difference in 2010 and 2011.

Reasonable Cost Reimbursement for Laboratory Services in Small Rural Hospitals - Certain rural areas with low population densities used to receive reasonable cost reimbursement for laboratory services, but this policy ended in 2008. The Chairman’s Mark would reinstate reasonable cost reimbursement, thus improving access to laboratory services for those in rural communities.

Extend Rural Community Hospital Demonstration Program - The Centers for Medicare & Medicaid Services has been conducting a demonstration program to test the feasibility of reasonable cost reimbursement for small rural hospitals. The Chairman’s Mark extends the program for two years and expands eligible sites to additional rural states.

Extend Medicare Dependent Hospital Program - Small rural hospitals with a high proportion of patients who are Medicare beneficiaries receive special treatment, including higher payments. This assistance for Medicare dependent hospitals (MDHs) is scheduled to expire in September 2011. In order to protect access to health care in rural communities, the Chairman’s Mark will extend crucial support to MDHs for an additional two years.

Temporary Medicare Hospital Payment Improvements - The Chairman’s Mark would temporarily increase payment for certain low-volume hospitals, ensuring that rural hospitals are adequately reimbursed for serving their communities.

Community Health Integration Models in Certain Rural Counties - The 2008 demonstration project allowed eligible rural entities to develop and test new models for the delivery of health care services in order to improve access to, and integrate the delivery of, acute care, extended care and other essential health care services to Medicare beneficiaries. The Chairman’s Mark will expand the 2008 project to more eligible counties, and will also allow physicians to participate in the demonstration project.

Transparency and Accountability for Insurance Companies

The provision improves the transparency of insurance products to ensure that individuals know what they are purchasing, the services which are covered and the associated out-of-pocket costs. ((Our office manager tells me that most of our patients don't have a CLUE what's offered in their plans - and that it isn't because that information is unavailable to them...)) The Mark creates standards that will ensure that each individual receives an outline of coverage which is presented in a uniform format that does not exceed 4 pages in length and does not include print smaller than 12-point font. The Mark would also require insurance companies to publish the share of their premium revenue that is used for administrative expenses and not medical benefits. ((That might actually create some real competition.)) In addition, the Mark would impose new requirements on insurers to meet standards for the electronic exchange of payment and other health care information with hospitals, doctors and other providers. By 2014, insurers must comply with standards for certain transactions or face a penalty fee assessed annually by the Secretary of Health and Human Services and collected by the Secretary of the Treasury. The fee would represent the inefficiency cost that an insurer imposes on the health care system when its electronic transactions with providers are not conducted in a standard way.

Combating Fraud, Waste, and Abuse

Reducing fraud, waste, and abuse in Medicare and Medicaid will reduce costs and improve quality throughout the system. The Medicare improper payment rate for 2008 was 3.6 percent, or $10.4 billion, and the National Health Care Anti-Fraud Association estimates that fraud amounts to at least three percent of total health care spending, or more than $60 billion per year. The Chairman’s Mark will combat fraud, waste, and abuse by requiring the review of health care providers prior to granting billing privileges, leveraging technology to better evaluate claims, educating providers to promote compliance with program requirements, monitoring programs more vigilantly, and penalizing fraudulent activity swiftly and sufficiently.

Ensuring Medicare Sustainability

Sharply rising costs throughout the health system threaten Medicare’s sustainability in the long term. If costs are not constrained, the Medicare program will be insolvent by 2017. To ensure the fiscal solvency and sustainability of the Medicare program, the Chairman’s mark includes the following provisions.

Revisions to Annual Market-Basket Adjustments for Part A Providers - The provision would reduce annual market basket updates for hospitals, home health providers, nursing homes, hospice providers, long-term care hospitals and inpatient rehabilitation facilities, including adjustments to reflect expected gains in productivity.

Part B Productivity Adjustments - This provision would reduce payment updates for Part B providers by an estimate of increased productivity.

Reduce Part D Premium Subsidy for High-Income Beneficiaries – This provision would reduce the premium subsidy under Part D for beneficiaries with incomes at or above the Part B income thresholds.

Medicare Commission - The Chairman’s Mark creates a 15-member, independent Medicare Commission tasked with presenting Congress with comprehensive proposals to reduce excess cost growth and improve quality of care for Medicare beneficiaries. In years when Medicare costs are projected to be unsustainable, the Commission’s proposals will take effect unless Congress passes an alternative measure. Congress would be allowed to consider an alternative proposal on a fast-track basis. The Commission would be prohibited from making proposals that ration care, raise taxes, or change Medicare benefit or eligibility standards.

Medical Malpractice - The Chairman’s Mark would express the Sense of the Senate that health care reform presents an opportunity to address issues related to medical malpractice and medical liability insurance. The Mark would further express the Sense of the Senate that states should be encouraged to develop and test alternatives to the current civil litigation system as a way of improving patient safety, reducing medical errors, encouraging the efficient resolution of disputes, increasing the availability of prompt and fair resolution of disputes, and improving access to liability insurance, while preserving an individual’s right to seek redress in court ((and personal injury lawyers' ability to collect high contingency fees - oh, wait, isn't that actually THERE? It might as well be...)) The Mark would express the Sense of the Senate that Congress should consider establishing a state demonstration program to evaluate alternatives to the current civil litigation system. ((Which will take a good 10 years to be planned, awarded, implemented, carried out, analyzed and studied ad nauseum before anything that works would actually be legislated upon....if ever. Plus, we already KNOW what works...ask Texas...))

Financing an Investment in Quality, Affordable, Health Care

High Cost Insurance Excise Tax - Beginning in 2013, this proposal would levy a non-deductible excise tax of 35 percent on insurance companies and plan administrators for any health insurance plan that is above the threshold of $8,000 for singles and $21,000 for family plans. The tax would apply to the amount of the premium in excess of the threshold. The tax would apply to self-insured plans and plans sold in the group market, but not to plans sold in the individual market. The threshold would be indexed for inflation, and a transition rule would increase the threshold for the 17 highest cost states for the first three years.

Increasing Transparency in Employer W-2 Reporting of Value of Health Benefits - This proposal would require employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W-2. This would be effective beginning in 2010. This proposal has a negligible revenue impact over ten years.
Limit Health FSA Contributions - This proposal would limit the amount of contributions to health Flexible Spending Accounts (FSAs) to $2,000 per year, beginning in 2013.

((From the IRS webpage "For 2008, if you have self-only HDHP coverage, you can contribute up to $2,900. If you have family HDHP coverage, you can contribute up to $5,800. For 2009, if you have self-only HDHP coverage, you can contribute up to $3,000. If you have family HDHP coverage you can contribute up to $5,950." So the contribution limits will GO DOWN under this plan....other than a desire to see such plans disappear, why might that be the case?))

Eliminate Deduction for Employer Part D Subsidy - This proposal would eliminate the deduction for the subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees. This would be effective beginning in 2011.

Standardize the Definition of Qualified Medical Expenses - Beginning in 2011, this proposal would conform the definition of qualified medical expenses for Health Savings Accounts (HSAs), health FSAs, and HRAs to the definition used for the itemized deduction. An exception to this rule would allow amounts paid for over-the-counter medicine with a prescription to still qualify as medical expenses.

Increase the Penalty for Use of HSA Funds for Non-qualified Medical Expenses - This proposal would increase the additional tax for HSA withdrawals prior to age 65 that are not used for qualified medical expenses from 10 percent to 20 percent, beginning in 2010.

Corporate Information Reporting - This proposal would require businesses that pay any amount greater than $600 during the year to corporate providers of property and services to file an information report with each provider and with the IRS. Information reporting already is required on payments for services to non-corporate providers. This applies to payments made after December 31, 2011.

Non-profit Hospitals - This proposal would establish new requirements applicable to nonprofit hospitals beginning in 2010. The requirements would include a periodic community needs assessment.

Pharmaceutical Manufacturers Fee - This proposal would impose an annual flat fee of $2.3 billion on the pharmaceutical manufacturing sector, beginning in 2010. This non-deductible fee would be allocated across the industry according to market share and would not apply to companies with sales of branded pharmaceuticals of $5 million or less.

Medical Device Manufacturers Fee - This proposal would impose an annual flat fee of $4 billion on the medical devices manufacturing sector, beginning in 2010. This non-deductible fee would be allocated across the industry according to market share and would not apply to companies with sales of medical devices in the U.S. of $5 million or less. The fee does not apply to sales of Class I products under the FDA product classification system. Health Insurance Provider Fee - This proposal would impose an annual flat fee of $6 billion on the health insurance sector, beginning in 2010. This non-deductible fee would be allocated across the industry according to market share. Clinical Laboratories Fee - This proposal would impose an annual flat fee of $0.75 billion on clinical laboratories, beginning in 2010. This non-deductible fee would be allocated across the industry according to market share and would not apply to clinical laboratories with revenue of $500,000 or less


((Doctors speaking out for what they believe in - what a beautiful thing....))

Million Med March

A physician grassroots movement to re-establish honor, dignity and worth to the medical profession. Join us in Washington DC on October 1, for the Million Med March.
October 1, 2009.
Washington DC - Washington Mall, in front of the Smithsonian Castle at 12:00 pm.

The MillionMedMarch believes that healthcare reform must be composed of the Three Pillars:
Single Payor System - The Patient Being The Single Payor.
Tort Reform
National Practitioner Data Base Reform
Health Insurance Reform is one of the most essential pillar in the healthcare. Whether it is a third party or government insurance, reform is
essential to allow for affordable and accessible healthcare without meddling or interference in the relationship between the physician and the patient.-->

The MillionMedMarch supports a stronger Physician-Patient Relationship where the Patient is the initial Payor. Private and government insurance can become involved, and can deal directly with the patient. The MillionMedMarch believes that when the Patient is the Single Payor, the patient pays what the market allows for any particular service. The patient will be directly involved in the decision making and would have an equal stake in keeping the care affordable and without the added expense of unnecessary testing by practicing insurance medicine. This will increase the strength of the patient-physician relationship, making each responsible to the other, as well as increases the responsibility of the patient to seek out the best medical care they can find. This also forces the physician to provide the best medical care at the most competitive prices. The MillionMedMarch believes this will reduce the need for unnecessary insurance interference and rewards competency and efficiency for providing quality and timely healthcare.

The MillionMedMarch strongly supports Tort Reform. The cost of healthcare continues to be unnecessarily and frivolously high in direct response to the practice defensive medicine. Therefore, Tort Reform must be an essential pillar for our quest to reduce the cost of healthcare by reducing unnecessary tests and procedures.

The MillionMedMarch demands reform of the National Practitioner Data Base (NPDB). Physicians may not be suspended nor reported to the NPDB prior to the full due process of law including an opportunity to a fair hearing of the charges by the accuser and a thorough defense of the physician’s actions, and exhaustion of all administrative and legal remedies. Prior to submission, all NPDB entries must be reviewed by an independent board of physician peers free from any ties to the accusing hospital, state or local medical societies.

We invite policy makers to work directly with Physicians to reform America's Healthcare. We pledge to protect the best interest of our patients, improve the delivery of healthcare and pledge to continue to honor the Hippocratic oath that we all have taken.

Respectfully Yours, America's Physicians

MillionMedMarch Flyer
Download the MillionMedMarch Flyer. You're free to download and print as many copies as you wish.
Download MMM Flyer...

Take action now. The Association of American Physicians and Surgeons has fought since 1943 to protect the private practice of medicine. You should work to make sure the AMA stands up for private contracting and your rights as a physician, but the AAPS is doing it now by filing lawsuits and warning the public. You can make sure your local or state medical society or specialty society sends representatives to the AMA who will fight for your practice as well.
Vist AAPS online...

If you haven't already, you should join Sermo. There is a great discussion on the MillionMedMarch. Please join the discussion.
Go to Sermo...

There are several great discussion on Medscape. Get to know what your colleagues are saying about healthcare.
Go to Medscape...

Free Our Healthcare Now
President Obama and Congress are pushing "reform" that will move America closer to government-run system like Canada or Britain. If the succeed, most Americans will no longer be able to keep insurance they have. Instead, they will be forced into government-run health insurance market, with most people enrolled in a government-run health plan.
Sign Petition Now!...

From "Docs4PatientCare"
White Coats to Congress Rally

Thursday, September 10, 2009, 5:45 PM (ET)Over 1,000 Doctors on Capital Hill opposing government takeover of health care.


Thanks to all of you who joined us in DC and for those of you who could not make it, we hope you will join us next time. We learned many things during our visit, but 2 major points in particular need to be stated.

In order to have the most impact and influence with policy makers the following needs to be accomplished IMMEDIATELY!!!!

1. We need CRITICAL MASS of physicians across the nation on the same message. It is
imperative that every one of us contacts every physician we know to discuss this issue
and urge them to get involved now by joining "D4PC" and donating so we can promote
our message as effectively and broadly as possible.

2. Congress members are most interested and influenced by hearing from physicians
AND patients from "their" districts. We MUST barrage all Congressmen, especially the
"Blue Dog" Dems across the country with emails/faxes/phone calls NOW. Time is
critical!! You know the talking points. These Congress members are heavily involved in
the healthcare reform legislation and want and need to hear from you. Furthermore,
they are likely to decide the fate of this legislation. I have provided the link of contact
information to these officials. Talk to your patients about this issue and urge them to
do the same.

click here for the upgraded Target 92 list to now include all vulnerable and Blue Dog Democrats. Blue Dogs are in blue. Here's the .xls and .pdf versions. Everything you need to email their staff, write letters, make phone calls and send faxes, both to their district and Capitol Hill offices.

3. You need to contact your 2 Senators and urge them to pressure "key" Senators like:
Grassley(Iowa), Enzi(WY), Snowe(Me), and Collins(Me) to maintain their position and
not yield to the Senate leadership on the bill coming out of their chamber. Please do
this even if your Senators agree with us. They need to pressure their colleagues on
the other side.

4. We need assistance in getting to physicians in the districts of these vulnerable
Congress members. Please try to provide us with contact numbers/emails of local
medical societies and/or physician leaders who can motivate colleagues to action.
Please direct them to our website: and/or

5. Every ACTION alert, video piece we send must in turn be sent to your contacts so
information has the best chance of going viral.

Thank you,


Practicing US physicians uniting to represent the interests and concerns of both patients and doctors in the healthcare reform debate. D4PC endorses the concept of needed healthcare reform, but we recognize it can only be accomplished by proceeding in a cautious and responsible manner. Our recommendations will enable us to reach this goal without requiring the nationalization of the entire American healthcare system.

Docs4PatientCare Proposed Alternatives for Effective Healthcare Reform:
There is no logical reason to hastily pass this legislation by a predetermined deadline. We have one chance to get this right.
Bring "all" stakeholders together to help assure a meaningful and sustainable reform by considering many recommendations and proposals.
Adopt a patient-centered approach to healthcare reform that empowers patients and promotes freedom of choice.
Use the power of government to assist the uninsured obtain health coverage through modification of the tax code, such as tax credits and vouchers.
Reduce high insurance premiums by opening up patient risk pools across the entire nation, thereby diffusing risk.
Allow the individual/family to be the "owner" of the policy making their health care coverage portable and available if they lose their job or move to a new place of employment. This will eliminate exclusion from the new employer's plan for a “pre-existing” health issue and also eliminate a waiting period to qualify for enrollment.
Encourage and expand Health Savings Accounts. Tax-Free savings vehicle for planned and/or unexpected medical expenses.
Tort Reform. The costs to our healthcare system secondary to the practice of defensive medicine are over $100 billion annually, or $2,000 per family.
Insurance Reform. Guarantee insurability due to pre-existing illness. Eliminate Insurance company antitrust exemption.
((Most people aren't even aware of the fact that the insurance industry operates WITHOUT anti-trust oversight due to a decades-old exemption which no one has the courage to repeal...that means that it's perfectly legal for them to get together to set prices, covered items, etc., while it's ILLEGAL for doctors to get together to discuss what reimbursement they will accept, how to improve patient care, etc....))


45% Of Doctors Would Consider Quitting If Congress Passes Health Care Overhaul

View Enlarged Image

Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted, a new IBD/TIPP Poll has found.

The poll contradicts the claims of not only the White House, but also doctors' own lobby — the powerful American Medical Association — both of which suggest the medical profession is behind the proposed overhaul.

It also calls into question whether an overhaul is even doable; 72% of the doctors polled disagree with the administration's claim that the government can cover 47 million more people with better-quality care at lower cost.

The IBD/TIPP Poll was conducted by mail the past two weeks, with 1,376 practicing physicians chosen randomly throughout the country taking part. Responses are still coming in, and doctors' positions on related topics — including the impact of an overhaul on senior care, medical school applications and drug development — will be covered later in this series.

Major findings included:

• Two-thirds, or 65%, of doctors say they oppose the proposed government expansion plan. This contradicts the administration's claims that doctors are part of an "unprecedented coalition" supporting a medical overhaul.

It also differs with findings of a poll released Monday by National Public Radio that suggests a "majority of physicians want public and private insurance options," and clashes with media reports such as Tuesday's front-page story in the Los Angeles Times with the headline "Doctors Go For Obama's Reform."

Nowhere in the Times story does it say doctors as a whole back the overhaul. It says only that the AMA — the "association representing the nation's physicians" and what "many still regard as the country's premier lobbying force" — is "lobbying and advertising to win public support for President Obama's sweeping plan."

The AMA, in fact, represents approximately 18% of physicians and has been hit with a number of defections by members opposed to the AMA's support of Democrats' proposed health care overhaul.

• Four of nine doctors, or 45%, said they "would consider leaving their practice or taking an early retirement" if Congress passes the plan the Democratic majority and White House have in mind.
More than 800,000 doctors were practicing in 2006, the government says. Projecting the poll's finding onto that population, 360,000 doctors would consider quitting.

• More than seven in 10 doctors, or 71% — the most lopsided response in the poll — answered "no" when asked if they believed "the government can cover 47 million more people and that it will cost less money and the quality of care will be better."

This response is consistent with critics who complain that the administration and congressional Democrats have yet to explain how, even with the current number of physicians and nurses, they can cover more people and lower the cost at the same time.

The only way, the critics contend, is by rationing care — giving it to some and denying it to others. That cuts against another claim by plan supporters — that care would be better.

IBD/TIPP's finding that many doctors could leave the business suggests that such rationing could be more severe than even critics believe. Rationing is one of the drawbacks associated with government plans in countries such as Canada and the U.K. Stories about growing waiting lists for badly needed care, horror stories of care gone wrong, babies born on sidewalks, and even people dying as a result of care delayed or denied are rife.

In this country, the number of doctors is already lagging population growth.

From 2003 to 2006, the number of active physicians in the U.S. grew by just 0.8% a year, adding a total of 25,700 doctors.

Recent population growth has been 1% a year. Patients, in short, are already being added faster than physicians, creating a medical bottleneck.

The great concern is that, with increased mandates, lower pay and less freedom to practice, doctors could abandon medicine in droves, as the IBD/TIPP Poll suggests. Under the proposed medical overhaul, an additional 47 million people would have to be cared for — an 18% increase in patient loads, without an equivalent increase in doctors. The actual effect could be somewhat less because a significant share of the uninsured already get care.

Even so, the government vows to cut hundreds of billions of dollars from health care spending to pay for reform, which would encourage a flight from the profession.

The U.S. today has just 2.4 physicians per 1,000 population — below the median of 3.1 for members of the Organization for Economic Cooperation and Development, the official club of wealthy nations.

Adding millions of patients to physicians' caseloads would threaten to overwhelm the system. Medical gatekeepers would have to deny care to large numbers of people. That means care would have to be rationed.

"It's like giving everyone free bus passes, but there are only two buses," Dr. Ted Epperly, president of the American Academy of Family Physicians, told the Associated Press.

Hope for a surge in new doctors may be misplaced. A recent study from the Association of American Medical Colleges found steadily declining enrollment in medical schools since 1980.
The study found that, just with current patient demand, the U.S. will have 159,000 fewer doctors than it needs by 2025. Unless corrected, that would make some sort of medical rationing or long waiting lists almost mandatory.

Experiments at the state level show that an overhaul isn't likely to change much.

On Monday came word from the Massachusetts Medical Society — a group representing physicians in a state that has implemented an overhaul similar to that under consideration in Washington — that doctor shortages remain a growing problem.

Its 2009 Physician Workforce Study found that:

• The primary care specialties of family medicine and internal medicine are in short supply for a fourth straight year.
• The percentage of primary care practices closed to new patients is the highest ever recorded.
• Seven of 18 specialties — dermatology, neurology, urology, vascular surgery and (for the first time) obstetrics-gynecology, in addition to family and internal medicine — are in short supply.
• Recruitment and retention of physicians remains difficult, especially at community hospitals and with primary care.

A key reason for the doctor shortages, according to the study, is a "lingering poor practice environment in the state."

In 2006, Massachusetts passed its medical overhaul — minus a public option — similar to what's being proposed on a national scale now. It hasn't worked as expected. Costs are higher, with insurance premiums rising 22% faster than in the U.S. as a whole.

"Health spending in Massachusetts is higher than the United States on average and is growing at a faster rate," according to a recent report from the Urban Institute.

Other states with government-run or mandated health insurance systems, including Maine, Tennessee and Hawaii, have been forced to cut back services and coverage.

This experience has been repeated in other countries where a form of nationalized care is common. In particular, many nationalized health systems seem to have trouble finding enough doctors to meet demand.

In Britain, a lack of practicing physicians means the country has had to import thousands of foreign doctors to care for patients in the National Health Service.

"A third of (British) primary care trusts are flying in (general practitioners) from as far away as Lithuania, Poland, Germany, Hungary, Italy and Switzerland" because of a doctor shortage, a recent story in the British Daily Mail noted.

British doctors, demoralized by long hours and burdensome rules, simply refuse to see patients at nights and weekends.

Likewise, Canadian physicians who have to deal with the stringent rules and income limits imposed by that country's national health plan have emigrated in droves to other countries, including the U.S.

Tomorrow: Why most doctors oppose the government's plan — in their own words.

Grim Prognosis From Doctors Opposed To Health Care Plan

Doctor opposition to health care overhaul proposals is broad and deep, revealing concerns not just about soaring costs, declining care, possible rationing and a lack of limits on malpractice suits, but also about government competence and motives, detailed responses to a new IBD/TIPP Poll show.

As reported Wednesday, 65% of the 1,376 practicing physicians who responded to a mailed questionnaire over the last two weeks said they opposed health care plans that have emerged from the administration and Congress. Just 33% supported them.

Perhaps the most shocking result: 45% of these professionals said they would consider closing their practices or retiring early if the reforms now under consideration were enacted.

The questionnaires were sent out Aug. 28 to 25,600 doctors nationwide. The sample was purchased from a list broker, Lake Group Media of Rye, N.Y. One hundred of those responding were retired, and their answers were not included in the final results.

Our poll also invited those taking part to tell us the reasons why they didn't like the health care reforms — or, in the minority of cases, why they did. The outpouring of written responses IBD received — about 1,300 in all — was stunning.

Doctors Speak Up

Those in Washington would do well to pay attention to the 65% who don't like reforms, whom we will quote today. (Tomorrow we will give space to the minority of doctors who support reform.)
These opposing physicians' opinions will be significant for the upcoming debate over health care, since any program that's passed will depend greatly on the support of doctors.

That includes the new plan unveiled Wednesday by Sen. Max Baucus. This plan, which Baucus estimates will cost an estimated $856 billion over 10 years, includes health care "co-ops" to compete with private insurers, and will likely require large tax hikes on many Americans — including the middle class.

Given the proliferation of plans, we wondered: What is it that bothers doctors so?

21 Objections

In combing through the responses, we identified no fewer than 21 separate issues doctors felt either weren't addressed or weren't solved by proposed reforms. The issues are many, but boil down to three big categories: costs, controls and courts.

One complaint was common: Doctors feared any government reform would turn into a kind of "socialized" medicine. Some were quite blunt: "I oppose socialism in all its forms or incarnations ... government should be shrunk drastically, not expanded."

"No government 'option' or government-run program should be allowed," said another doctor. "It would ultimately lead to total government takeover of health care, with high costs and low quality."

The strong convictions of some came from a direct experience with socialism. "We came from a socialist country and we know socialized systems do not work!!!" wrote one emphatic physician.
Still others were adamant that any nationalized health care scheme — and a significant number see the plans emerging from Congress and the White House as just that — is against basic American constitutional law.

"This unconstitutional plan gives sovereignty over our bodies to unelected, unaccountable, ignorant bureaucrats," went one response along these lines. "Every governmental micromanagement of our lives has failed in its objective, and caused moral and economic bankruptcy."

But constitutional concerns were eclipsed by anger over the lack of tort reform — mentioned by hundreds of respondents. Physicians say they practice too much defensive medicine, which drives up costs, just to protect themselves from lawsuits.

The costs of this are enormous, though hard to precisely quantify. Estimates range from $100 billion to $200 billion in total added costs to both doctors and patients. Doctors in some specialties, such as neurology, pay as much as $250,000 a year for malpractice insurance.

Fear Of Lawyers

A number of our respondents used identical wording for why they didn't support health care reform: "No tort reform."

"The more lawsuits against doctors, the more testing is done," said one respondent, uttering a frequent complaint. "The government never interferes with lawyers — why? They are afraid, or they're all lawyers."

A big issue for others was efficiency. They fear government control would mean massive waste and interference with their practices. "All the efficiency of the post office, all the compassion of the motor vehicle bureau," quipped one doctor.

Another looming worry: exploding costs. With expectations that the government will spend upward of $1 trillion on reform, doctors fear the inevitable controls, including rationing, that will come to rein in costs down the road.

"A government-run plan will be too expensive and will not be effective," according to one physician. "The plan will expect doctors to take a lower fee for a given service. The private plans will follow, and outpatient medical services will be forced out of business."

This is "typical government, throwing trillions of dollars in one swoop to 'fix' the system," said another. "They need to slow down, dissect the system and fix it properly."

"There will be mandated protocols, long waits, rationing of care, infringement upon a doctor's right of conscience, abortion paid for by (tax) dollars, with eventual euthanasia and infanticide," said still another, voicing the ethical concerns of many.

The federal government's notorious lack of success in running enterprises of any size, let alone one as big and complicated as a health care system — was also cited frequently.

"Health care in the VA (Veterans' Administration) shows how well government can render care," said one. "It is disgraceful."

Gov't Can't Run Diddly

Others pointed to the troubles with government-run Medicare, Medicaid and Social Security, which are all verging on insolvency and now account for an estimated $51 trillion in unfunded liabilities over the next half-century.

Government-funded rail was a favorite foil — so was the Cash for Clunkers program. The House health bill "is 1,200-plus pages of miniature and legalese," joked one eye-sore physician. "Please recall 130 pages of forms for each 'cash for clunkers' transaction!"

"Government control? Give me a break," said another. "Look what they've done to Social Security, the Post Office, the bailouts, etc. Medicare and Medicaid are not paying doctors enough, and the paperwork to participate is huge."

Other irate docs agreed: "Government has proven unable to manage many other programs, including Social Security, Medicare, and the postal service. Why do they think they can (run) a health care program?"

"Government health care will wipe out the private insurance companies," said another. "Most of the doctors in private practice will give up ... because of a low reimbursement from the government. The Medicare, Medicaid program is a good example of government-run health care."

Still others railed against what they saw as the real villains: insurance companies. Anger at insurance companies, which are now the main brake on health care costs, was plentiful.
"Between the government and insurance companies, I now only collect 28% to 30% of billed charges. No other business can function at that rate," this doctor added.

As many noted, all of the plans now being discussed would require massive tax hikes — and debt.

Foreign Experience

Many of those who opposed the plan had a unique perspective: They had practiced or lived under national health care systems in other countries.

Their comments about the experience were often scathing. To paraphrase progressive journalist Lincoln Steffens, they have seen the future — and it doesn't work.

"I trained and worked in Canada prior to coming to the U.S.," went one typical letter. "The same arguments were used in Canada to launch 'universal health care.' It is anything but universal and free."

Others had similar complaints.

"I did two years of training in Canada — disaster. When the government needed money, it decided patients with a stroke would not get a hospital bed. I had to have interns carry hemiplegic (a condition in which half a patient's body is paralyzed) patients to their families' cars."

"I am a former Canadian and I am a physician," added another. "I know a lot about government-run health care. If it's so good, then all members of Congress, the president and all federal employees should be the first to try it."

'Real Horror Stories'

Yet another: "I don't believe Congress has the requisite knowledge to know what to do with health care. After experiencing Britain's health care system firsthand, I cannot feel anything positive about government-run health care."

"I grew up and was trained in Romania," still another physician said. "At the time, it was a communist country with a socialist medical system. The system continued after the communist regime fell. I find this socialist health care system a complete disaster with real horror stories being heard every day with huge limitations in health care and huge bureaucracy."

Others argued passionately on behalf of the quality of the U.S. health care system — while admitting it has faults.

"I have firsthand experience with European and Canadian national health plans — they stink," said one physician. "My medical training was at the Mayo Clinic where people came from all over the world. Why did they come? Because we have the best (care) in the world."

That was echoed by many others who wondered why 18% of the U.S. economy needed to be put under direct government control to cover the 40-million-plus uninsured — and how we could care for millions more people, while supposedly cutting costs, without increasing the number of physicians.

More Taxes, Debt

As many noted, all of the plans now being discussed would require massive tax hikes — and debt — for little real benefit.

"It will take away consumer choice, drive up health care costs, and drive down health care quality," said one. "It will sharply increase the demand for health care providers and sharply decrease the supply as doctors like me will retire early and students will avoid the field."

"No need to overhaul the whole system," summed up one doctor. "Just find a solution to the 47 million that have no insurance."

"Unless the government uses magic tricks," argued another, "it is impossible to care for 47 million uninsured people and lower the cost."

The disgust with the notion of a government-run system was almost palpable in some comments:
"The U.S. government is already bankrupt. Its health care plan is too expensive," said one typical comment. "The government will end up rationing health care. Taxes will surely go up for the middle and upper class. We are in a recession."

He added: "This is not a good time to increase government expenditures and increase taxes."

Friday: A second opinion — from the doctors who support reform.

((Clearly MANY physician groups oppose the public option, so what's with this? Skewed studies and polls aside, of course....and it's always good to know exactly what questions were asked....))

Poll Finds Most Doctors Support Public Option
by Joseph Shapiro
September 14, 2009

Majority Of Physicians Want Public And Private Insurance Options
NotesThe survey was designed and conducted by Drs. Salomeh Keyhani and Alex Federman of Mount Sinai School of Medicine. Over the summer of 2009, they surveyed a random sample of more than 2,000 physicians. Credit: Alyson Hurt / NPR

As A Public Option, Doctors Don't Mind Medicare

((Interesting title - makes me think one of the questions might have had to do with whether or not we should discontinue Medicare, which seems to be a question those who support the public option LOVE to ask...rather indignantly, really....))

Sep. 14, 2009

Among all the players in the health care debate, doctors may be the least understood about where they stand on some of the key issues around changing the health care system. Now, a new survey finds some surprising results: A large majority of doctors say there should be a public option.

When polled, "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September.

Most doctors — 63 percent — say they favor giving patients a choice that would include both public and private insurance. ((Yes, but did the question include MEDICARE as a "public option???)) That's the position of President Obama and of many congressional Democrats. In addition, another 10 percent of doctors say they favor a public option only; they'd like to see a single-payer health care system. ((And that same 10% has been around forever.....only goes to show the doctors can be wrong, too....)) Together, the two groups add up to 73 percent.

When the American public is polled, anywhere from 50 to 70 percent favor a public option. So that means that when compared to their patients, doctors are bigger supporters of a public option. ((Once again, is Medicare included in the questions as a "public option?"))

Doctors' Support For Public Option 'Broad And Widespread'

The researchers say they found strong support for a public option among all categories of doctors. "We even saw that support being the same whether physicians lived in rural areas or metropolitan areas," says Federman.

"Whether they lived in southern regions of the United States or traditionally liberal parts of the country," says Keyhani, "we found that physicians, regardless — whether they were salaried or they were practice owners, regardless of whether they were specialists or primary care providers, regardless of where they lived — the support for the public option was broad and widespread."

Keyhani says doctors already have experience with government-run health care, with Medicare. And she says the survey shows that, overall, they like it. "We've heard a lot about how the government is standing in between patients and their physician," Keyhani says. "And what we can see is that physicians support Medicare. So I think physicians have sort of signaled that a public option that's similar in design to Medicare would be a good way of ensuring patients get the care that they need."

The survey was published online Monday by the New England Journal of Medicine. It was funded by the Robert Wood Johnson Foundation, a health care research organization that favors health reform.

AMA Doctors Also Support Public Option

The survey even found widespread support for a public option among doctors who are members of the American Medical Association, a group that's opposed to it. The AMA fears a public option eventually could lead to government putting more limits on doctors' fees. ((Well, that shoots the credibility of THIS study out of the water - THE AMA ENDORSED HR3200 WITH A PUBLIC OPTION. So they don't even have their facts right about THAT...))

"The American Medical Association has traditionally been probably the loudest voice for physicians across the United States," says Federman. "And part of our reason for doing this research was really to get at the real voice of physicians as opposed to the voice of one physician organization."

Keyhani and Federman belong to another, smaller group, the National Physicians Alliance. It supports a public option, and Keyhani has spoken publicly about her own support for a public option. ((Well, then, no bias here....oh, WAIT....))

What Would A Public Option Look Like?

It's hard to know for sure what doctors mean when they speak about a public option, says Dr. James Rohack, president of the AMA.

"Because when I say public option, or you say public option, it means different things to different people, kind of like the Rorschach ink blot test — when you look at it, to some people it means one thing, to other people it means the other thing."

Politicians in Washington turn to the AMA for support and guidance, even though fewer than a third of practicing doctors belong to the lobbying group.

The AMA's own position on a health overhaul has, at times, been hard to pinpoint. In July, it praised the bill that came out of the House of Representatives. That bill included a public option. But the AMA made it clear that what it really liked was that it eliminated cuts in doctors' fees from Medicare. ((Actually, there were a LOT of things the AMA liked about the bill - all in keeping with the AMA's policy to provide quality health care to everyone. Do I smell a couple of AMA-haters here?))

"And so I think that's why we need to be very clear about what does the AMA articulate for," says Rohack. "It's to make sure that everyone has coverage that's affordable, that's portable and that is quality — that is, it covers the things you need to cover because you've got a medical condition or developed a medical illness."


My medical oath requires no government oversight
By Marc Siegel

If President Obama thinks he's smarting from a rough August, he should try being a doctor. After all, we've taken quite a few shots in this health care debate, including a few from the president himself. When Obama accused physicians of
taking out tonsils or performing amputations just for the money, he offended all doctors, not just ear, nose and throat specialists or vascular surgeons.

With Congress back in session, questions about the sincerity and moral direction of the proposed health insurance reforms are again front and center. I won't weigh in here on what shape any reform should take, or what incentives insurers or employers or even individuals have in this debate. But I can speak for the many physicians watching with jaws agape as we have been maligned as money-grubbers intent on simply "playing defense" with medicine.

We already have our moral directive. And, at the risk of contradicting our president, we have our incentive, too: the patient.

What drives doctors

I am guided by egalitarian principles. I was taught in medical school and residency to treat all patients the same, regardless of income level, VIP status, their gender or the color of their skin. My obese patients receive the same level of care as my thin patients, my old patients the same as the my young. I distinguish only in terms of conditions or medical risks, not in terms of demographic entitlements.

I was trained to never give up hope in curing a patient until hope is truly lost. This is my religious and moral imperative; it requires no government oversight.

My principles run contrary to the idea of meeting with a 65-year-old to discuss specific ways I may withdraw care. Perhaps it's not a death panel, but a measure in one House bill pushes care in ways that cause me discomfort.

On the other hand, meet Zane Pollard, a pediatric ophthalmologist in Atlanta who works in a Medicaid clinic and literally saves children's sight or performs surgeries — often without payment. Pollard wrote a letter, published in the American Thinker in August and well-circulated since, that shows what is being done to help the uninsured rather than what is not being done: "I operate on at least two illegal immigrants each month who pay me nothing, and the children's hospital at which I operate charges them nothing also." Pollard notes that such treatment is delivered in "every community in America."

Taking sides

Some doctors will gladly stand beside the president and applaud his efforts, insisting that the government needs to upend our current system. Others, like me, are skeptical that the government can, or should, become involved in such a heavy-handed way. But neither the president nor members of Congress should use the physician as a pawn in this legislative chess game. And that's what we've become.

I don't receive moral guidance on how to practice medicine from presidential decree, but am led instead by the Oath of Maimonides. The great 12th century rabbi and physician wrote, "The eternal providence has appointed me to watch over the life and health of thy creatures. May I never see in the patient anything but a fellow creature in pain."

It might be good politics to vilify the insurance industry, or drug makers or even doctors. But my-way-or-the-highway didn't work so well for the last president. And based on the reaction across America today, it isn't working in this health care debate either.

Marc Siegel is an internist, an associate professor of medicine at NYU Langone Medical Center and a member of USA TODAY's board of contributors. He is author of the new eBook Swine Flu, The New Pandemic.
Posted at 12:15 AM/ET, September 14, 2009 in
Forum commentary, Medical Issues - Forum, Siegel

Doctors Offer Senators Their Opinion on Health Care Reform

More than 11,000 doctors from around the country who connected on a medical Web site called Sermo signed a petition outlining several issues they think are critical parts of health reform. The petition was delivered to the 100 Senate offices Tuesday.

By Jim Angle Tuesday, September 08, 2009

Doctors made the rounds of Senate offices Tuesday -- not to treat lawmakers but to implore them to listen to physicians on health care reform.

"A number of us don't feel like we've had much input in this debate," one doctor said.

More than 11,000 doctors from around the country who connected on a medical Web site called Sermo signed a petition outlining several issues they think are critical parts of health reform, including tort reform, transparent billing, insurance reform and changing the payment systems to encourage preventive medicine.

The petition was delivered to the 100 Senate offices Tuesday, including that of Sen. Tom Coburn, who is also a doctor.

"I agree with you we hadn't heard from the medical community," the Republican said. "We've heard from a lobbying arm that's interested in money, not patients and not physicians." ((I'm guessing Sen. Coburn isn't a member of the AMA....))

The petition comes a day before President Obama addresses a joint session of the Congress in an attempt to rally a fractious Democratic Party and persuade Republicans to drop their opposition.

To win the support of doctors, tort reform is key. Some, such as orthopedic surgeons, can pay up to $80,000 a year in malpractice insurance. Obstetricians have it even worse. They can pay astronomical sums of more than $200,000 a year. But insurance is only half the cost.
"There's been a number of surveys which have shown that up to a third of all tests and procedures that are done aren’t necessarily in the best interest of the physician or the patient," said Dr. Daniel Palestrant. "They are done to protect both parties from liability."

Nevertheless, tort reform isn't part of any of the congressional proposals so far, including the massive one in the House.

"If we are putting everything on the table as the president says to try and improve health care, it would seem suspicious that in a 1,200-page bill, the word tort reform or malpractice isn't mentioned once," Palestrant said.

In fact, some Democrats, including former Democratic National Committee Chairman Howard Dean acknowledges the party was reluctant to cross trial lawyers because they contribute so heavily to Democratic candidates.

But some say that has to change.

"I think the time has come for the Democrats to say alright, we're going to have to take on one of our own here," said Democratic strategist Bob Beckel. "They are going to have to contribute because it is true that runaway lawsuits have caused insurance premiums to go up."

Beckel says that would be a smart political move that would give Democrats more credibility and quiet down Republicans, as he put it. He also says a lot of Democrats are thinking about such a move as a way to breathe new life in the health reform debate.


State's largest doctors' group campaigns on reform proposals
Texas Medical Association says it's in favor of health care reform but wants Congress to 'do it right.'
By Mary Ann RoserAMERICAN-STATESMAN STAFF Tuesday, September 15, 2009

The state's largest doctors' organization is mounting a campaign with posters, brochures and lapel stickers that say "Slow Down," "Wrong Way" and "Me and my doctor, we know best on health care reform."

But if that sounds like the Texas Medical Association, with nearly 44,000 members, is against health care proposals touted by President Barack Obama and the Democrats, that is not what the campaign means, association officials said.

"The TMA is not opposed to health care reform at all," said Dr. William Fleming, a Houston neurologist who is the association's president. "Rather than rush a deal that's flawed, we would rather have the legislators do it right. We support affordable, quality health care for all citizens, no matter who they are."

The association is one of the latest health care industry groups voicing support for health care reform on the one hand and then picking at details they dislike on the other.

Obama sought to avoid that by quickly passing a health care reform plan. But after members of Congress went home in August for their recess and got an earful, the debate — and the lobbying — intensified.

Fleming said it is not the association's goal to be a road block to reform. But it has concerns.
Chief among them are proposals for a government-sponsored insurance program for uninsured people, known as the "public option"; plans to cut physician payments to Medicare; and what the association says is a need for medical malpractice reform like what the Texas Legislature and voters approved in 2003, according to an association position letter.

The name of the campaign is "Me and My Doctor: We Know Best."

Anne Dunkelberg, associate director of the Center for Public Policy Priorities, which advocates expanding programs for low- and middle-income Texans, said the campaign's name suggests the proposals would interfere with the doctor-patient relationship when she sees them reducing interference.

The name "plants the seed that there is some kind of issue there," she said.

She also said the association's message seems mixed.

"The fact you're not seeing a campaign that's really in support or in opposition to reform is not surprising, given how diverse TMA's membership is," Dunkelberg said.

Fleming said the association has found much to rally around. Insurers should not be allowed to drop people with pre-existing medical conditions or seek ways to exclude coverage when a major medical problem arises, he said.

Obama said in a speech on health care to Congress last week that he would pilot some malpractice reform proposals, but Fleming said the association doesn't want Texas to lose its reforms.

Doctors have flocked to Texas since 2003, but not everyone is pleased that it has become harder to sue doctors and collect damages in Texas. Some consumers have complained about not being able to find a lawyer to take a malpractice claim, and Alex Winslow, executive director of the nonprofit consumer advocacy group Texas Watch, said there are other problems.

"If you measure success in this country in terms of insurance company profits, it has been successful," Winslow said. "But if you measure success in terms of access to care, health care costs and coverage of the uninsured, it's been a failure. We continue to have the highest rates of uninsured in the country, higher costs of care, and underserved communities continue to struggle to attract doctors."

Since Obama's speech, the Texas Medical Association has sent the packets to 25,000 members and is taking orders for more, said spokesman Brent Annear. It is making them available to doctors when they speak to civic groups and other organizations and has stickers and brochures with postcards doctors can distribute to patients. The postcards addressed to Obama and members of Congress urge them to "slow down and get it right" on health care reform.

Fleming declined to reveal the campaign's cost.; 445-3619

Tom Coburn Educates a Government Option Advocate

This is from a late August town hall meeting in Bentonville, Arkansas. Senators Tom Coburn (R-Oklahoma) and John Barrasso (R - Wyoming) were traveling the country...


White House Sued Over Free Speech Violations in Healthcase Battle: Doctors & Patient Groups Say White House Intended to Shut Up Opponents

WASHINGTON, Aug. 27 /PRNewswire-USNewswire/ -- The Office of the President and other White House officials are defendants in a free speech lawsuit filed by a prominent physician group, and a non-profit advocate for inner-city poor.

The White House has "unlawfully collected information on political speech," thereby illegally using the power of the White House to chill opposition to its plans for health care reform, according to the complaint filed in District Court for the District of Columbia, by the Association of American Physicians and Surgeons (AAPS) and the Coalition for Urban Renewal and Education (CURE)
The lawsuit was prompted by the White House solicitation for the public to report any "fishy" comments to ''

Although the White House slightly revised its data collection procedure last week, the email address still exists, the illegal activity continues, and is part of an "unlawful pattern and practice to collect and maintain information" on the exercise of free speech, which "continues in violation of the Privacy Act and First Amendment even if the Defendants terminate a particular information-collection component due to negative publicity."

The lawsuit outlines how the White House has employed a form of "bait-and-switch" tactic of accusing the Plaintiffs and other opponents of spreading misinformation about the Administration's goals for health care reform, and thereby refusing to 'come clean' about its real agenda.

The lawsuit outlines that the White House knew that the data collection would chill free speech, and in fact, intended to do just that:

"43. As part of their effort to advance the White House healthcare
reform agenda, Defendants have accused opponents (including
Plaintiffs) of spreading misinformation on issues such as whether
(a) health reform would provide public funding for abortions, (b) put
"death panels" in place to deny care to the elderly or infirm,
(c) amount to a government takeover of healthcare, and (d) increase
healthcare costs..the Defendants and the administration have spread
misinformation, semantics, and disinformation on these topics.....
"45. By denying and continuing to deny that healthcare reform
legislation includes "death panels" that make individual life-or-death
decisions on the elderly or infirm, the Defendants and the current
administration have ignored and implicitly denied and continue to
ignore and implicitly to deny both that their healthcare reform agenda
involves rationing healthcare..."

"My hate mail started shortly after the White House issued the 'fishy' request," said Kathryn Serkes, Director of Policy and Public Affairs for AAPS. "We were quite visible and vocal before then, so it doesn't seem like a coincidence. Who did they share their data with? With whom might they share it?"

AAPS and CURE demand that the White House remove all information already collected, and further, be prohibited from collecting any personal data in the future.

NOTE: AAPS is a non-partisan professional association of physicians dedicated since 1943 to protection of the patient-physician relationship. CURE, founded by Star Parker, serves poor and inner-city communities through church, individual, and market-based solutions to poverty.
The case number is Civil Action No. 09-1621-EGS. The full text of the complaint is available on request .

SOURCE Association of American Physicians and Surgeons (AAPS)
Related Links:


((Something tells me the doctors in Congress might know a LITTLE more about health care than the lawyers and other politicians in Washington....))

GOP Senate doctors on health care road show
Posted: August 28th, 2009 01:58 PM ET

(CNN) — The only two medical doctors currently in the Senate, both Republicans, are using the August congressional recess to take their two-month old, twice weekly health care reform Webcast on the road across America's heartland — an itinerary that appears designed to pressure on some of their more moderate Democratic Senate colleagues from Nebraska, Arkansas, and Louisiana.
"I think we may bring a little bit more judgment and credibility to what's really going on in this debate and the problems in health care," Oklahoma Sen. and family practice physician Tom Coburn told CNN.

Along with Sen. John Barrasso of Wyoming, an orthopedic surgeon, Coburn launched "The Senate Doctors Show" in early July. Twice a week, the two doctors sit down and film a roughly 20-minute segment where they answer questions about health care reform submitted by the public via Facebook, Twitter, e-mail, and through "man-on-the-street" video interviews of Capitol Hill visitors.
This week, the two men hit the road. Wednesday, Coburn and Barrasso were in Omaha, Nebraska where they visited an intensive care unit and taped an episode of their Webcast with a live audience. Thursday, the two men split the day between a morning town hall in Bentonville, Arkansas and two afternoon events in northern Mississippi — another taping of their production with a live audience and a hospital visit. Friday, the two doctors are set to join fellow Republican Sen. David Vitter of Louisiana and three House Republicans from the state at a town hall meeting in Kenner, Louisiana. Vitter will also join Coburn and Barrasso on a tour of a New Orleans medical facility.

Three of the four states for this week's tour don't appear to be coincidental.

"I don't think it is a surprise that the Coburn and Barrasso health tour has made stops in Nebraska, Arkansas and now Louisiana," says CNN Political Editor Mark Preston. "This is clearly an effort to put pressure on the Democratic senators who represent these three states."

Democratic Sens. Ben Nelson of Nebraska, Blanche Lincoln of Arkansas, and Mary Landrieu of Louisiana are considered potential swing votes on the final version of the health care bill being weighed by Congress.

Coburn pointed out that Mississippi has two Republican senators, but also conceded that politics is playing some role in the choice of the other stops in this week's road show. "We would love for the people of Arkansas and Nebraska to know the details" of the health care reform bills under consideration in Congress, Coburn said.

Pointing to his own health care reform legislation co-sponsored with Republican Sen. Richard Burr of North Carolina and rejected by Democrats during a committee markup, Coburn rejected the suggestion that Republicans have not offered their own affirmative proposals for reforming the nation's health care system.

Coburn said the reform legislation he co-sponsored would increase coverage and save government at the state and federal levels billions of dollars over the first seven years.

The family practice physician also said he does not support non-profit health insurance cooperatives which are under consideration by a bipartisan group of negotiators in the Senate Finance Committee as an alternative to a public health insurance option favored by many House Democrats. The co-ops are "a disguise of a government-run program," in Coburn's view because "on a regional basis, it's still going to have the same mandates being dictated to us by the federal government."

"There are other ways to solve this problem without the federal government running it," Coburn said, pointing to his own bill with Burr.


The doctors in the House – but not all are on duty when it comes to reform
Melissa SuranJuly 23, 2009

WASHINGTON – It’s still far more common to find a doctor in a hospital, but it’s not very hard to find a doctor in Congress – and not all of them are working on healthcare issues.

From Rep. Ron Paul, R-Texas, to Rep. Tom Price, R-Ga., it seems that making the shift from the lab coat to a suit coat isn’t all that unusual. Currently, there are 16 physicians in Congress – including two serving in the Senate. Surprisingly, only seven of them sit on committees working on health-care reform, and they don’t include big names like Paul, a libertarian who ran for president in the Republican primary campaign last year. Since the majority of the House doctors are Republicans, it comes as no surprise that many are against the changes sought by President Barack Obama for a health system that many believe is broken. “I left the practice of medicine, I left caring for patients for over 20 years for precisely this moment in public policy,” said Price, who is a trained orthopedic surgeon. Price said that during his time as a practicing physician, government interference in doctor-patient relationships is what caused him the most problems. Because of public-health programs like Medicare and Medicaid, not everyone has access to the care they need, he said.

“Former patients of mine are unable to find a doctor to care for them because of intervention of the federal government,” said Price, whose colleagues on the Education and Labor Committee include Reps. Bill Cassidy, R-La., and Phil Roe, R-Tenn., both doctors. Even so, Price is against the reform legislation, which he referred to as a “one-size-fits-all” proposal, giving the government even more power over health-care decisions. “You’re going to give 97 percent of the American people access to health care,” Price said, addressing the Democrats in committee. “You know what they’ll have access to? They’ll have access to an opportunity to get in line.”

Not everyone agrees with Price. Rep. James McDermott, D-Wash.,, a psychiatrist who serves on the Ways and Means committee, is all for a universal health care system and he’s not alone.

Doctors aren’t the only medical caregivers on call on Capitol Hill. There are also three nurses – two registered and one licensed practical nurse – all Democrats serving in the House of Representatives. Unlike the doctors, all three nurses are members of committees involved in health care reform. ((Gee. THAT makes sense.)) Rep. Carolyn McCarthy, D-N.Y., serves alongside Price on the Education and Labor Committee. “We’ve been trying to do something about health care since the early 60s and it kept getting put off,” said McCarthy, who worked as a registered nurse for 32 years. “Patients are already waiting hours to see a doctor; patients are already waiting to go to an emergency room.” McCarthy said, “its a disgrace that so many children cannot get health care. If we as a nation cannot take care of our children, who is supposed to?”

((Actually, there are about 12 million Americans who are entitled to an existing program - most of them children - like Medicaid or SCHIP - who just aren't enrolled. Whose fault is THAT?))

So far, congressional committees have approved three bills – one in the Senate and two in the House – but nothing is certain. Nevertheless, the Congress caregivers can all agree on one thing: the current health-care system is in need of some major surgery.


((Rep. Price is also DR. Price, an orthopedic surgeon.))

How the GOP wants to fix health care
By REP. TOM PRICE 7/30/09 4:35 AM EDT

Thursday marks the anniversary of the most significant piece of health care legislation in our nation’s history. It was on this day in 1965 that President Lyndon B. Johnson signed Medicare into law, ensuring government health care for seniors. Forty-four years later, Congress is debating another monumental act that may affect the health coverage of every American.

Contrary to what the president has tried to convince the American people of, while we oppose his misguided ideas, Republicans are committed to positive health reform. No one in Congress finds the status quo acceptable.

Having practiced medicine for more than two decades, I personally know that the status quo must not stand. Whether coming from the federal government or an insurance company, the third-party decision making that drives our health care delivery system is increasingly distancing patients from quality care.

Going down the path of more government will only compound the problem. While the stated goal remains noble, as a physician, I can attest that nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare. Because of Washington’s one-size-fits-all approach, its flawed coverage rules and broken financing mechanisms, seniors are increasingly having care rationed while federal health spending spirals out of control.

And though newly eligible Medicare patients struggle even to find a doctor who can accept them, the president appears immovable in his belief that what is needed to fix health care is more government involvement. His proposal can only be described as a government takeover of health care.

From a government-run plan that will eviscerate private insurance to prescriptive coverage regulations that require all plans to meet a government definition of care to bureaucratic boards that will decide which treatments are appropriate and who is eligible, the proposal before the House would hand over to Washington nearly every decision that should be made by patients and their physicians.

Put simply, the president’s vision of reform would do irreparable harm to an American health care system that, for all its faults, provides the world’s greatest care.

To build support, the president continues to hang his hat on a false choice, asserting that Americans are doomed to either the status quo or a government takeover of health care. Yet there is a third way that puts patients in charge. We can achieve reform that lowers costs and ensures the highest quality of care without handing over personal medical decisions to unaccountable bureaucrats.

Thursday, the Republican Study Committee has introduced legislation to positively reform our health system. The Empower Patients First Act relies on the principle that, by increasing patients’ control over their health decisions, we will make coverage more affordable, accessible and responsive, while offering more choices and the highest-quality care.

The bill seeks to achieve universal coverage by ensuring there is no financial reason to go without health insurance. By offering responsible tax incentives, patients will be empowered to purchase the care that best fits their needs.

The legislation also moves ownership of health plans from a third party to patients. When insurers are forced to be responsive to individuals, we will see the industry move to a more patient-centered model we should all seek.

Further, the bill provides for robust pooling mechanisms so patients may unite with the purchasing power of millions. This will lower costs for Americans while ensuring those with pre-existing conditions have a market in which to purchase affordable care.

As cost continues to be a sticking point in reform, the Empower Patients First Act tackles other drivers of health costs by breaking down barriers that outlaw the purchase of health care across state lines and by providing meaningful liability reform. With the creation of new health courts that take into consideration the expert opinions of medical specialty societies — those who actually know what caring for patients is like — we will see a dramatic drop in the costly practice of defensive medicine.

Finally, with federal deficits spiraling out of control, our legislation is paid for. By requiring a 1 percent annual step-down in discretionary spending, plus other efficiencies, we tell Americans that providing access to quality, affordable health care should be a priority in our budget, not just one more thing added to the deficit.

While the president will no doubt continue to put up straw men whom he can finger as promoting the status quo, it is important to appreciate that real, positive reform will take place only if we can have an honest dialogue. The Republican Study Committee has offered a solution that American patients can support. We only hope the president will drop the false choices and pick up some of our common-sense ideas.

Rep. Tom Price of Georgia is chairman of the Republican Study Committee. Before being elected to Congress, he practiced orthopedic surgery for nearly 25 years.

Read more:

((And check out this terrific video!))
Rep. Tom Price admonishes govt-takeover of healthcare


((Rep. Gingrey is also DR. Gingrey, an Ob/Gyn...))

U.S. Rep. Phil Gingrey shares thoughts about health care
by Kevin Myrick

download Segment 1: Rep. Phil Gingrey talks about his entrance into politics and what its like being a United States Congressman.

download Segment 2: Rep. Phil Gingrey discusses personal responsibility in understanding costs in health care

download Segment 3: Rep. Phil Gingrey talks Health Savings Plans

U.S. Rep. Phil Gingrey has been a very busy man. Throughout this month, Gingrey has participated in six town hall meetings about health care reform, eight roundtables, multiple tours and seven speeches around the district that includes Carrollton, Cartersville, Cedartown, Kennesaw, Marietta and Rome.

The Republican from Marietta heard a variety of opinions. While some of his constituents want health care reform, others fear government intrusion into the health care system. Gingrey has made it clear that he opposes President Barack Obama’s plan. He said the answer for the nation as a whole lies not in government control but in the people.

Gingrey advocates better health insurance coverage choices for the people. He wants greater control over prices and costs to come from the end consumer and not providers. He believes competition in the market place will save the industry from the problems at what he said is his current view “at the 30,000 foot level of medicine instead of the one on one with a patient delivering a baby.”

That’s why he has proposed transparent medical records, protecting people’s privacy, and giving patients a way to go online and check out data on doctors where consumers live.“These things would help a person be an intelligent shopper, just like you go to Consumer Reports to find out what the best flat screen television is or what the best digital partners, whatever they call this” he said, holding up his Blackberry pulled from his pocket. “PDA, PDQ, I don’t know. But shop in the same manner. Because what in the world is more important than picking a doctor or a hospital or the best pediatrician for your child?”

Gingrey’s congressional office in Marietta resembles a doctor’s office more than it does that of an elected official, which is fitting, since he was a practicing obstetrician-gynecologist.

A quick glance at the bookshelves in his office finds a variety of conservative literature, but it also includes Thomas Friedman’s “The World is Flat,” a book about the changing global economic landscape and how America’s place in the world as industrialized leader has changed completely. To keep with his ideology the televisions around the office space are permanently kept on the Fox News Channel. But why give up a private practice as an OB-GYN in the Atlanta area?

“I do ask myself that from time to time,” Gingrey said. “I morphed into it. It wasn’t like when I was in college or even in high school I thought I’d one day like to be a United States congressman or any other elected official, but I did recognize leadership abilities in me and others recognized it in me.”

Gingrey has been too busy to miss his practice since joining Congress in 2003. He’s been vocal about a number of issues from domestic energy production to the nation’s need to pay down the debt the federal government has accrued. Coming down against the Democrat’s plans for health care reform in H.R. 3200, or America’s Affordable Health Choices Act of 2009, Gingrey said the bill would be disastrous for places like Rome where the health care industry has become a mainstay of the community.

“You’re going to have a real crisis in manpower at medical providers,” Gingrey said. “You’re just not going to have the best and brightest youngsters coming out of Darlington, Berry and Shorter Colleges and all around the state of Georgia going into the medical profession.”

He also said that “people, my children and grandchildren aren’t going to go into the medical field.”

Gingrey also addressed questions about his campaign contributions amid the health care debate.

He said he doesn’t believe a single cent of money that has been donated to his campaign through political action committees has any influence over his voting record.AFLAC has ranked amongst his top five campaign contributors, according to campaign finance reports.

In 2008 alone, individuals who work at AFLAC and political action committees representing the insurance firm gave $18,100 to his campaign. Individual contributions were reported at $8,100 and political action committees gave $10,000. Already individuals working at AFLAC have donated $5,000 to his 2010 re-election campaign.Individuals connected to the Harbin Clinic donated $10,875 and ranked the fifth highest donor to his re-election campaign in 2008.

“A larger contribution, maybe one that approaches what an individual can give, you always always worry about the possibility that someone gains more influence than John Q. Public,” Gingrey said. “I always think about that when someone donates a check to me that approaches the limit. You want to make sure that there’s no quid pro quo and that there’s no promise.”

He did agree that campaign contributions are an unfortunate part of how members of Congress are sent back to the “sausage factory,” as Gingrey called Washington. Part of that sausage factory is being clogged up by the health care debate, and what he said he has come to realize is that money alone will not save America from the health care system crippled by costs.

Where Gingrey falls on health care reform can be summed up easily: He wants the least amount of government control in the system as possible, but he wants to put into place what he sees as sensible solutions that lowers costs to providers and consumers.

But the view from 30,000 feet up is much different than the view on the ground, doctor to patient. And the possible solution to many of these problems lies in the form of a bill he’s co-sponsored with Rep. Tom Price of the Georgia 6th Congressional District.Among the things he favors are health savings and liability reform.

“There are certain things we want to do. We want to reform the insurance industry, and we want as many people as possible to have health insurance coverage,” he said.

Click here to see information about HR 3200.


From the American College of Surgeons

On August 20, the American College of Surgeons and 18 other surgical organizations sent a letter to President Obama expressing concern about his recent comments regarding the care that surgeons provide. The College had issued similar statements previously on August 12 and July 25.

The joint letter allowed the surgical community to collectively respond to comments the President had made suggesting that a surgeon's decision to remove a child's tonsils was based not on medical judgment, but, rather, on a desire to make money.

In addition, the letter corrected the President's more recent comments at a town hall meeting in which he implied that surgeons make decisions about amputations based on the amount of money they are paid for that procedure.

President Obama incorrectly stated that surgeons make between $30,000 and $50,000 for an amputation, when Medicare actually reimburses surgeons between $740 and $1,140 for a leg amputation.

The letter goes on to express dismay at the possibility that the President's remarks could undermine the trust between surgeons and their patients--especially when patients are faced with potentially life-threatening conditions.

To view a copy of the letter, go to


A Doctor Responds To Obama's NYT Op-Ed's_NYT_Op-Ed/
Tuesday, September 01, 2009
August 17, 2009
by G. Wesley Clark, MD

Mr. President, I just read your op-ed in the
New York Times. You must either be incredibly ignorant (e.g., pediatricians performing tonsillectomies, surgeons being paid $50,000 for an amputation), or else you believe that Americans are incredibly stupid.

You justify a hasty and massive healthcare "reform" to save money, by spending an additional trillion dollars. You would fix a "broken" and broke Medicare system by adding another 47 million beneficiaries to government programs while arguing this will reduce overall costs.

I've itemized your inaccurate claims, with my comments in italics.

You assert that your healthcare reform will:
Force insurance companies to insure pre-existing conditions. That's like allowing bettors to wait till after the race has been run, to place their bets. That won't cut costs.
Eliminate lifetime limits on coverage. Unlimited lifetime coverages must increase premiums to pay for them and will raise total costs.
Require insurance companies to pay for routine examinations, preventive care, and screening tests like mammograms and colonoscopies. Once again, how can you be insured against a sure thing? The only way my company can pay for a colonoscopy is to add enough onto the premium to pay for it, plus their overhead.
Make Medicare more efficient, so tax dollars won't enrich insurance companies. Insurance companies do not derive income from Medicare, because it is a federal program. Incidentally, its costs per patient have increased much faster than private insurance.
Cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid. These programs have been in effect over 40 years -- and I've seen the waste and inefficiency for most of that interval. Did you just find out about the waste and inefficiency now, and why hasn't something already been done about it?

You claim that:
"If you like your health care plan, you can keep your health care plan." But didn't you just imply this week that Medicare Advantage subsidizes insurance companies and should be eliminated to save money?
"If you like your doctor, you can keep your doctor." But large numbers of doctors have indicated that they will quit or retire if this plan is enacted
"You will not be waiting in any lines." Maybe you won't but we will. Your plan will add up to 47 million new insureds, with no increase in the supply of primary care physicians that are already in short supply.

We physicians live with our healthcare system, all day and every day. We care about being able to heal. We hate disputing with insurance companies, and especially with government bureaucrats. Certainly changes in insurance practices are needed, and would have occurred long ago, absent a government record of 60 years of meddling with the market.

As you say, "...let's disagree over issues that are real, and not wild misrepresentations" such as those in your op-ed, "that bear no resemblance to anything that anyone has actually proposed."
And I agree, this is about America's future: whether Americans will remain free, or be ruled by an increasingly intrusive and authoritarian statist government.

G. Wesley Clark, MD


((This is an interview on a local PA TV station with a former president of the PA Medical Society and one of the smartest people I know.....))

Dr. Victor Greco interview


AMA backs House health system reform bill that includes Medicare pay overhaul
President Obama and others call the support crucial and historic, but some medical societies are rejecting the legislation.
By David Glendinning, AMNews staff. Posted July 27, 2009

Washington -- The American Medical Association has thrown its support behind a Democratic national health system reform measure making its way toward the House floor, so far the first comprehensive bill that addresses Medicare physician pay.

On July 16, the AMA announced it would support America's Affordable Health Choices Act, comprehensive legislation officially introduced two days earlier by House Democratic leaders and closely based on a discussion draft unveiled a month before that. The three House committees with primary jurisdiction over health care moved quickly to approve the legislation for House consideration, with two of the panels passing their versions July 17.

The AMA is supporting the legislation partly on the strength of its Medicare payment reform plan, which would spend an estimated $245 billion over 10 years to align physician rates more closely with the costs of providing care. But the Association also backed the bill because it would use health insurance market reforms to cover most Americans, offer a choice of plans to consumers through a health insurance exchange, dedicate new money to boost primary care services and address physician work force problems.

"We are committed to passing health reform this year, consistent with principles of pluralism, freedom of choice, freedom of practice and universal access for patients," said AMA President J. James Rohack, MD, in announcing the AMA endorsement. He was echoing reform principles reaffirmed by the House of Delegates at its Annual Meeting in June.

Dr. Rohack said the AMA decided to back the bill after its authors made several key changes to the original discussion draft. Although the legislation still includes a public plan option, it no longer would require Medicare-participating physicians to accept the new plan's patients. It also would not prohibit balance billing of those patients or ban doctors from privately contracting with patients.
The AMA does not consider the pending bill to be a finished product, Dr. Rohack said. By remaining at the table, the Association aims to push lawmakers to include medical liability reforms missing from the measure and reconsider the bill's ban on self-referral for new physician-owned hospitals.

((Yeah...good luck with that, despite the tiny little bone the President threw out in his speech last Wednesday. I disagree that the AMA will be able to get these provisions into the final bills, since lawyers are running the show - but I urge physicians NOT TO CANCEL THEIR MEMBERSHIP in the AMA if they're upset or disappointed with this position. This is political, not ideological, and you can CHANGE AMA policy by getting involved. The LAST thing American medicine needs is for the only significant voice for physicians to be weakened by an internal dispute....see the Commentary at the beginning of this newsletter for more on that....))

President Obama cheered the support and noted that physicians have joined nurses in backing reform this year.

Rep. John Dingell (D, Mich.) called the AMA endorsement a milestone in reform and said such a level of physician support indicates that the bill would not threaten the doctor-patient relationship. "The historical significance of the AMA's support should not be underestimated," he said, noting that the Association has not always been in favor of reform efforts.

Some reject public plan, mandates

Several other physician organizations lined up to support the House legislation. The American Academy of Family Physicians is backing the measure, in part, for including primary care bonuses, though it would like to see those incentives boosted. For similar reasons, the American College of Physicians said it expects to back the bill once it is out of the final committee.

The House Energy and Commerce Committee counted about another dozen physician organizations among the list of bill supporters, including the American College of Obstetricians and Gynecologists and the American College of Surgeons.

But not all doctors are on board with the House bill.

Led by the Medical Assn. of Georgia, seven other state and local medical societies and three surgical specialty societies signed a July 21 letter to Congress that opposes the legislation. Two former AMA presidents, Donald J. Palmisano, MD, and William G. Plested III, MD, also signed the letter. The inclusion of a government-sponsored public insurance plan option that would compete with private plans is a major reason for these physicians' opposition. They also reject individual and employer insurance mandates in the bill.

"We adamantly oppose the following as inconsistent with quality medical care and the principles of freedom and liberty that lie at the heart of our form of government and our society," the letter said. The Texas Medical Assn. drafted its own statement, saying it could not support a bill that would create another government-payer health plan when existing federal plans work so poorly.

Twelve members of the GOP Doctors Caucus wrote a July 17 letter to AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, urging the Association to reconsider its support of the legislation. The bill would work against physician priorities by using a government-run plan to drive out private insurance competition, force Medicare-based rates on doctors and prompt many physicians to close their doors for good, they said.

"Based on the endorsement of this legislation, we fully believe that the AMA has lost touch with the vast majority of physicians in this country," the caucus letter said.

Dr. Rohack acknowledged that some physicians and lawmakers are opposed to the AMA's show of support but said many others are enthusiastically in favor. By consistently following its four guiding reform principles, the AMA will best be able to advocate for all physicians, he said.
Cost concerns threaten time line

The plan by House Democratic leaders to move the health system reform bill to the floor before the congressional August recess sustained a major blow when new concerns arose over long-term health spending.

At a July 16 appearance before the Senate Budget Committee, Congressional Budget Office Director Doug Elmendorf said none of the bills before lawmakers includes the necessary system changes to keep long-term health spending in check. Although Obama has called for the need to "bend the cost curve" when implementing health reform, this would not occur under the current plans. "The curve is being raised," Elmendorf said.

GOP leaders pounced on the statement, calling on Democratic leaders to scrap the bill and start over with a new bipartisan proposal and a new time line. Conservative House Democrats who make up the Blue Dog Coalition were able to slow down a markup of the bill in the House Energy and Commerce Committee over concerns that the long-term-spending issue was not being addressed.

Obama responded to the revitalized assault on the Democratic bill, saying in a July 21 news conference that opponents are simply following the time-worn tactic of delaying reform with the intention of killing it. "But make no mistake, we are closer than ever before to the reform that the American people need, and we're going to get the job done."


The House plan

House Democratic health system reform legislation has gained the support of the AMA and several other physician organizations, though some state and specialty medical societies oppose it. The bill includes numerous major reforms that would impact physicians.

Medicare payment: Rebases the physician pay formula and gives doctors a pay increase in 2010 instead of a 21.5% cut. Establishes a new formula, starting in 2011, that allows annual spending targets to grow based on a rate of the gross domestic product plus 1%, with GDP plus 2% for evaluation and management services and preventive care. Provides a 5% Medicare bonus for physicians in primary care specialties.

Health insurance reform: Implements a national health insurance exchange that includes a government-sponsored, national public plan option financed only through premiums. Prohibits insurers from denying coverage based on preexisting conditions; establishing annual or lifetime limits; or basing premiums on anything other than age, geography or family size. Establishes an essential benefits package that all plans must offer.

Health care affordability: Offers scaled, income-based credits for the purchase of health insurance to people earning up to 400% of the poverty level. Caps annual out-of-pocket spending to prevent bankruptcies from medical costs. Expands Medicaid to all people earning up to 133% of the poverty level.

Coverage responsibility: Requires individuals who do not qualify for a hardship exemption to obtain health coverage or pay a penalty of 2.5% of modified adjusted gross income above a specified level. Requires employers who do not qualify for a small business exemption to offer health insurance to their workers or pay a phased-in penalty of up to 8% of their payroll.

Physician work force: Boosts funding for the National Health Service Corps, primary care physician training, and scholarships and loan forgiveness for physicians who work in underserved areas. Redistributes unused graduate medical education residency slots to train more primary care doctors.

Physician-owned hospitals: Prohibits self-referral of Medicare patients by physician-owned hospitals that did not have a Medicare agreement in place by Jan. 1, 2009.

Source: House Energy and Commerce Committee

Specialty Physicians Unhappy with AMA RepresentationPoll of physicians shows negative view of American Medical Association

American Society of Medical Doctors (ASMD) today released additional results from a nationwide, nonpartisan poll* of physicians showing that 86 percent of specialty doctors feel that the American Medical Association has become too political and has lost touch with the doctors it is supposed to represent.

Chairman of the ASMD, Alfred O. Bonati, M.D., said that, "Quality representation of doctors in Washington, DC has never been more important than it is today. Sadly, an overwhelming majority of specialty physicians believe that this group has lost touch."

Dr. Bonati cited a disconnect between doctors' professional priorities and the representation offered by the AMA: "The AMA is putting the future of our profession at risk by supporting health-care reform proposals that would slowly-but-surely erode the ability of doctors to honor our pledge - the Hippocratic oath - by creating a new government-run insurance plan."

"Ask any doctor who has been denied or given minimal reimbursement by Medicare or Medicaid for a course of treatment that best fits the needs of a patient and that patient's family whether the government understands our oath," Bonati said. "We know that they do not."

The poll also revealed that a full 99 percent of specialty physicians believe that trial lawyers have a negative impact on medicine in the United States.

"The fact that medical liability reform is not part of the current health-care reform proposals in Congress is stunning to me and to most doctors," Bonati said. "This gaping hole in so-called reform efforts must be addressed."

Initial results of the poll, released last week, revealed that:

70 percent of specialty doctors oppose current Congressional and White House proposals for health-care reform;
66 percent believe that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients; and
More than 60 percent would not accept new patients with government insurance (including 27% who would not accept any patients on the new government plan).

*The poll was conducted on August 7(th), 2009, by WRS Opinion Research on behalf of the ASMD. Detailed results can be found at

Dr. Bonati is the head of The Bonati Institute and creator of the patented Bonati Procedure for laser spinal surgery. He lives and practices medicine in Hudson, Florida.

Contact: Holly Pitt Young
(202) 449-8665
SOURCE The American Society of Medical Doctors
((By all means, support the ASMD - but you should ALSO be a member of the AMA...))


((This is VERY funny cutting-edge sarcasm - we need to keep a sense of humor during this debate....))

A Doctor's Plan for Legal Industry Reform
My modest proposal to rearrange how lawyers do business.

Since we are moving toward socialism with ObamaCare, the time has come to do the same with other professions—especially lawyers. Physician committees can decide whether lawyers are necessary in any given situation.

At a town-hall meeting in Portsmouth, N.H., last month, our uninformed lawyer in chief suggested that we physicians would rather chop off a foot than manage diabetes since we would make more money doing surgery. Then President Obama compounded his attack by claiming a doctor's reimbursement is between "$30,000" and "$50,000" for such amputations! (Actually, such surgery costs only about $1,500.)

Physicians have never been so insulted. Because of these affronts, I will gladly volunteer for the important duty of controlling and regulating lawyers. Since most of what lawyers do is repetitive boilerplate or pushing paper, physicians would have no problem dictating what is appropriate for attorneys. We physicians know much more about legal practice than lawyers do about medicine.

Following are highlights of a proposed bill authorizing the dismantling of the current framework of law practice and instituting socialized legal care:

• Contingency fees will be discouraged, and eventually outlawed, over a five-year period. This will put legal rewards back into the pockets of the deserving—the public and the aggrieved parties. Slick lawyers taking their "cut" smacks of a bookie operation. Attorneys will be permitted to keep up to 3% in contingency cases, the remainder going into a pool for poor people.

• Legal "DRGs." Each potential legal situation will be assigned a relative value, and charges limited to this amount. Program participation and acceptance of this amount is mandatory, regardless of the number of hours spent on the matter. Government schedules of flat fees for each service, analogous to medicine's Diagnosis Related Groups (DRGs), will be issued. For example, any divorce will have a set fee of, say, $1,000, regardless of its simplicity or complexity. This will eliminate shady hourly billing. Niggling fees such as $2 per page photocopied or faxed would disappear. Who else nickels-and-dimes you while at the same time charging hundreds of dollars per hour? I'm surprised lawyers don't tack shipping and handling onto their bills.

• Legal "death panels." Over 75? You will not be entitled to legal care for any matter. Why waste money on those who are only going to die soon? We can decrease utilization, save money and unclog the courts simultaneously. Grandma, you're on your own.

• Ration legal care. One may need to wait months to consult an attorney. Despite a perceived legal need, physician review panels or government bureaucrats may deem advice unnecessary. Possibly one may not get representation before court dates or deadlines. But that' s tough: What do you want for "free"?

• Physician controlled legal review. This is potentially the most exciting reform, with doctors leading committees for determining the necessity of all legal procedures and the fairness of attorney fees. What a wonderful way for doctors to get even with the sharks attempting to eviscerate the practice of medicine.

• Discourage/eliminate specialization. Legal specialists with extra training and experience charge more money, contributing to increased costs of legal care, making it unaffordable for many. This reform will guarantee a selection of mediocre, unmotivated attorneys but should help slow rising legal costs. Big shot under indictment? Classified National Archives documents down your pants? Sitting president defending against impeachment? Have FBI agents found $90,000 in your freezer? Too bad. Under reform you too may have to go to the government legal shop for advice.

• Electronic legal records. We should enter the digital age and computerize and centralize legal records nationwide. All files must be in a standard, preferably inconvenient, format and must be available to government agencies. A single database of judgments, court records, client files, etc. will decrease legal expenses. Anyone with Internet access will be able to search the database, eliminating unjustifiable fees charged by law firms for supposedly proprietary information, while fostering transparency. It will enable consumers to dump their clunker attorneys and transfer records easily.

• Ban legal advertisements. Catchy phone numbers such as 1-800-LAWYERS would be seized by the government and repurposed for reporting unscrupulous attorneys.

• New government oversight. Government overhead to manage the legal system will include a cabinet secretary, commissioners, ombudsmen, auditors, assistants, czars and departments.

• Collect data about the supply of and demand for attorneys.Create a commission to study the diversity and geographic distribution of attorneys, with power to stipulate and enforce corrective actions to right imbalances. The more bureaucracy the better. One can never have too many eyes watching these sleazy sneaks.

• Lawyer Reduction Act (H.R. -3200). A self-explanatory bill that not only decreases the number of law students, but also arbitrarily removes 3,200 attorneys from practice each year. Textbook addition by subtraction.

Enthusiastically embracing the above legal changes can serve as a "teachable moment" and will go a long way toward giving the lawyers who run Congress a taste of their own medicine.

Dr. Rafal is a radiologist in New York City.


Paging Dr. Galt
Health Care from the Producer's Perspective
by Robert Tracinski, editor

"Much of the debate over the health-care bill starts and stops in the wrong place. It dwells on the experiences of health-care consumers—but the story actually begins with the producers of health care, the doctors, nurses, hospitals, drug companies. Without these producers, no health care is available for the consumers to buy—at any price. So we need to begin by looking at the current legislation from the perspective of the producers.

So far, President Obama's efforts in that direction merely betray the inability of a lifelong leftist to see private enterprise in any terms other than the standard Marxist caricatures about "greed" and exploitation. He made that jarringly clear in his attacks on doctors, whom he has characterized as unscrupulous hacks who cut off limbs for lucre.

"Let's take the example of something like diabetes, one of—a disease that's sky-rocketing, partly because of obesity. Partly because it is not treated as effectively as it could be. Right now if we paid a family—if a family care physician works with his or her patient, to help them lose weight, modify diet, monitors whether they are taking their medication in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000, immediately the surgeon is reimbursed."

That part about surgeons being paid fabulous sums of money for amputations turns out to be a total fabrication. The actual reimbursement for such a procedure is less than $1,000. Obama also explained for us the workings of the tonsillectomy racket. "So if you come in, and you've got a bad sore throat, or your child has a bad sore throat, or has repeated sore throats. The doctor may look at the reimbursement system, and say to himself, "You know what, I make a heck of a lot more money if I take this kid's tonsils out." Now that may be the right thing to do, but I'd rather have that doctor making those decisions, just based on whether you really need your kid's tonsils out, or whether it might just make more sense just to change—maybe they have allergies, maybe they have something else that would make a difference.

Thus speaks our national physician-in-chief to his new apprentice, your doctor. What kind of policies does this outlook lead to? The Obama administration just announced a plan to reduce already low Medicare reimbursement rates for cardiologists and oncologists, deliberately starving out these specialists and decreasing their incomes in order to encourage more doctors to become general practitioners.

This is a timely reminder of what the current legislation really means. By deliberately inducing a shortage of physicians in crucial specialties, just as the "silver tsunami" of baby boomers comes roaring into old age, the administration has reminded us that their goal isn't just to cut costs. They seek to impose a kind of central planning on the medical industry through such measures as adjusting reimbursement schedules to reflect the latest decree from Washington, DC, about the proper ratio of specialists to general practitioners.

Vilifying physicians is a tactic that has always backfired on advocates of socialized medicine, because the American people have an enormous and well-earned respect for their doctors. The average person knows his doctor as a trusted and respected figure, the person who delivered their babies or cured grandma's cancer. We know our doctors, and in the current debate we can sit down and talk to them and ask them what they think—and if you do that, you're likely to get an earful. I sat down recently with a local Charlottesville physician, Dr. Gary Helmbrecht—who also happens to be one of my wife's obstetricians. (I had last talked to him when he performed the ultrasound I described in a previous article.)

Dr. Helmbrecht confirmed my sense of what the health-care crisis is not. It is not a crisis in the availability or quality of care in this country. The actual experience of patient care, he says, is "exemplary." The process in which a patient notices a problem, goes to a doctor, undergoes medical tests, gets a diagnosis, and receives treatment is well-oiled. He gave an example of a woman he had recently treated, who had reported a problem with her pregnancy—and was then able to secure appointments that same day with three different specialists, leaving his office at the end of the day with medications in hand. (See a similar story about Dr. Helmbrecht here.) When a patient has a problem and needs to be treated, "It gets done."

he also pointed out that this is about more than just known treatments for known problems. The current system also allows for a "free entrepreneurial spirit." Dr. Helmbrecht's specialty is prenatal diagnosis, and he and his partner were leaders in the use of nuchal translucency screening—a way of using a certain physical marker in an early ultrasound to assess the risk of Down Syndrome and other chromosomal defects. Many of their customers were other doctors' patients who were referred to them for this special screening. But now, he says, other physicians are catching up, so his practice is trying to stay on the "front end of the curve" by purchasing new ultrasound machines that give them better, clearer pictures and more information. They can do this because there is no big bureaucracy they have to answer to. A big institution would have a "capital equipment committee" to make that kind of decision, but in Dr. Helmbrecht's case, he and his partner can make a major decision just with a conversation in the hallway between appointments. "We are the capital equipment committee."

Now compare that to the Medicare story above. That's the direction the "public option" is taking us: greater control of the entire health-care system from Washington, DC, which will seek to control physicians' spending and manipulate their priorities. Consider, for example, the proposals for a government board that would establish "guidelines" about which procedures are "cost-effective" and which are not. That creates a bias in favor of known, established procedures and against any kind of innovation. New treatments, after all, are often more expensive, and precisely because they are new, their benefits are less well-established. So under a government-controlled system, forget about pioneering tests and new ultrasound machines.

But the biggest threat is that the whole goal of the current legislation is to control costs by imposing Medicare-like reimbursement rates as standard payment for physicians. The problem? Medicare cuts its costs by reimbursing physicians and hospitals at low-ball rates that are generally unprofitable. The hospitals make up for the shortfall through "cost shifting"—charging higher rates to the rest of us to make up for the money they're losing on Medicare patients. But once the whole system is run by government, there will be nowhere left to shift the costs to.

Dr. Helmbrecht talked about what that would do to practices like his. At Medicare-level reimbursement rates, "we can't even cover our expenses." The result, he says, would be "catastrophic." Large, state-connected institutions (like the University of Virginia Medical Center) may survive, but community hospitals (like Martha Jefferson Hospital) and a whole constellation of private practices associated with them will be wiped out.

And it gets worse. Dr. Helmbrecht pointed to a little-discussed fact. There is already a shortage of doctors, which will only get worse as the baby boomers age. So providing free or subsidized health care to millions of new people would cause a surge of demand for doctors' services, just as unprofitable reimbursement rates are driving them out of business. It is a prescription for immediate shortages—a problem that would then have to be solved through government rationing.

Dr. Helmbrecht had much more to say about the problems with the current system and what actually should be done about it. But the overall conclusion I took from our conversation is that the current health-care bill was designed with no consideration for the way an independent private medical practice works, for the economics of how doctors are to make a living and be rewarded for their work.

There has been no thought on this subject because the left doesn't care about the rights of the producers of health care. They focus only on the demands of the consumers. Dr. Helmbrecht related a recent case in which he drove down to Charlottesville from a conference in Northern Virginia to perform an emergency procedure to save a woman's pregnancy. He interrupted his trip and got on the road late at night because he is the only doctor in the area who performs that procedure. But you have to ask, he said: "Where's the motivation?"

Under the current system, he said, "If you work hard for the patient, the funding follows." But what will happen if that is no longer true?

In Ayn Rand's timeless novel Atlas Shrugged, the mysterious hero John Galt is a symbol of the man whose productive energy is withdrawn from the world in protest against living as the despised pawn of the state. But Ayn Rand was aware that the disappearance of the men of talent did not always happen as a deliberate act of protest; it is often just the natural outcome of any system that punishes hard work, ambition, and independent thought, discouraging and demoralizing men with those life-giving qualities. This is what some people have started referring to as "going Galt." If we accept such a system in the medical profession, we could find ourselves paging Dr. Galt—and getting no answer."


Rx for money woes: Doctors quit medicine
Some physicians, fed up with the costs of their practice, are ready to hang up their stethoscopes and shift careers.
By Parija B. Kavilanz, senior writer
Last Updated: September 14, 2009: 4:06 AM ET

Dr. Tara Wah closed her ob/gyn practice in Tallahassee, Fla., last year, saying that she could no longer "afford" to stay in business. Wah currently is not practicing medicine.

NEW YORK ( -- Some 5,000 patients suddenly found themselves without an ob/gyn last November when Dr. Tara Wah closed her practice in Tallahassee, Fla.

Wah, 55, informed her patients in a letter that she could "no longer afford to make ends meet."

After 24 years, "I'm working longer hours than ever," she wrote. "Insurance payments for patient care have stayed virtually the same for the last 15 years, while the cost of doing business, including health insurance, staff salaries and supplies have risen."

The rising
cost of malpractice insurance, particularly for her specialty, was the straw that broke the camel's back.

"My malpractice insurance was $125,000 a year, and going up," said Wah. "The only way to get the extra money was to cut back on my salary."

But it wasn't always like that. Being a doctor was once thought to be a path to a cushy lifestyle. Six years after she started practicing, Wah hit her "peak" income year in 1990. Then she took a pay cut every year from 1993 onward, to eventually take no salary for two months prior to permanently shutting her office.

Wasted skills

Wah no longer practices medicine. Instead, she designs and repairs jewelry. "I feel guilty. I dream about [medicine]," she said. "[But] I am so angry. I think, 'What a waste of my training.' "

Wah's situation sheds light on a troubling trend of physicians leaving medicine for a career outside of health care, said Kurt Mosley, a staffing expert with Merritt Hawkins & Associates, a physician search and consulting firm.

A first-ever survey of 12,000 primary care physicians conducted last October by Merritt Hawkins and the Physicians' Foundation, an organization that represent the interests of physicians, showed that 10.1% of respondents planned to seek a job outside of health care in the next one to three years.

"That is a big number. It's just very sad," said Mosley, especially in light of the
shortage of primary care doctors in the United States today.

The American Medical Association said it is aware of this trend, citing the survey, but said it does not have data to show how many doctors have already prematurely exited the profession.
Regardless, Mosley said it's a waste of training, skill, talent and money when a doctor leaves the profession in mid-career.

It takes a minimum of 10 to 12 years of training to become a doctor. In Wah's case, she underwent 10 years of training, including medical school and residency, before she entered the workforce.
While some enter medicine because they believe it pays well, most choose it as a career because they feel it's their calling.

"For many it's not about the money. They have a passion for it, to take care of people," said Mosley. "It's not easy to feel that passionately for another career after medicine."

Waste of taxpayer money

It's also a waste of taxpayer money when a physician opts out. "We are all paying out of our pockets to produce doctors," said Mosley.

That's because medical residency programs are mostly funded by Medicare to the tune of $9 billion to train about 100,000 residents annually, according to the Medicare Payment Advisory Commission.

"It's Medicare that funds hospital costs to house residency programs, pay salaries of residents and sometimes pay faculties' salaries," said Mosley.

Dr. Patricia Perry, 44, a dermatologist based in Burbank, Calif., operates a solo practice. She mostly performs medical procedures such as skin biopsies.

Perry said she's "seeking to get out" of her profession because she's fed up with insurance reimbursement challenges while struggling to cover other costs associated with being a doctor.
"When you get to a point where you feel unappreciated and you're arguing with people about being paid, it takes away the passion for what you do," Perry said.

Daryl Richard, a spokesman for insurer UnitedHealthcare (
UHC), said his company is taking steps to address some of providers' concerns.

"We agree 100% that there is too much paperwork" tied to reimbursement claims, he said.
Richard said UnitedHealthcare offers a Web-based application to all of its providers that will enable the company to adjudicate claims to determine a reimbursement and a patient's out-of-pocket expense "by the time the patient makes it to the (doctor's) front desk."

"This takes away some of the unknown for both providers and consumers," he added.

Perry pays $2,500 a year in malpractice insurance. "I am licensed in three states. To maintain my license I have to pay a fee every one to two years in each state," she said. She also pays a considerable amount of money every year to attend annual trade conferences required by her specialty to update and hone her skills.

She said many physicians are scared to speak out about their money woes because they don't want to be perceived as "greedy."

"I have news for you. You are already being perceived that way," she said.

Dr. Kenneth Cohn, a general surgeon with an MBA who tours the country advising doctors on non-clinical job options, says there's a high-level of angst among U.S. physicians. "There's absolutely a greater number who are looking for other job opportunities," he said.

It's a reality that we have to deal with, Cohn said. The implication of it on the health care system, he said, is that doctors may have to increasingly use nurse practitioners and physicians assistants to
fill in the gaps. They may also need to look to newer delivery concepts such as medical homes, in which doctor take more of a managerial role in a patient's health care.

'Insurance company is dictating what I do'

Dr. Douglas Evans, 50, a pediatrician based in St. Joseph, Mo., said he's considering a mid-career change if insurer-provider relations aren't reformed.

"I had a young football player in my office [this week]. His symptoms indicate a problem with his neck," he said in an example. "But I have to get authorization from his insurance company first to get an X-ray or an MRI. It's an example of how insurance companies dictate to me what I have to do."

Evans is frustrated that this process will delay treatment by several days.

"My first concern is that he's young and has his career in front of him," he said. "My second concern is that there's a predatory lawyer out there," meaning that if his patient's condition worsens while he waits to get authorization, it could expose him to a malpractice suit.

And Evans said insufficient reimbursement from insurers is posing a heavy financial burden on his practice.

"You can't go to Wal-Mart (
WMT, Fortune 500) and pay half the price for a loaf of bread and take the whole bread," he said. Still, he said many doctors have a hard time turning away patients for this reason alone, and end up absorbing the costs.

He warns that unless things improve, only those providers who can't afford to do something else will be left in the system. "I am looking for something that's still science related, like teaching biology at a university," said Evans.

Wah is disillusioned and disappointed, but maybe not completely bitter.

"For the young doctors who are just getting started, I want to say don't give up," she said.

"After taking some time off , I might be able to do some volunteer work," she said. "I do love medicine, but I'm not [mentally] in a place right now to come back."

First Published: September 14, 2009: 4:04 AM ET


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1 comment:

  1. What will GOP do to health care utilization rates likely to remain depressed due to a proliferation of insurance plans that include higher out-of-pocket costs for patients or worse,
    l think the healthcare market sector will drop and could impact other sectors.