Wednesday, September 30, 2009

9/29/09 - ALERT - Call PA legislators TODAY to save Mcare Fund

9/29/09 - Liability and Health News ALERT
CALL PA legislators TODAY to save Mcare Fund

by Donna Baver Rovito, Editor, "Liability and Health News Update"
Author, "Pennsylvania's Disappearing Doctors"

****If you WANT TO RECEIVE Liability and Health News Update directly to your email, please email and put "Subscribe" in the subject line.****

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, 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 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):




Pennsylvania Budget Update - Nothing is law yet, and the laws are still being written, despite the fact that the Governor wants things done by Sunday.

That means PA's physicians, hospitals, podiatrists, health care professionals and PATIENTS still have a chance to impact whether or not the state absorbs the funds we've paid into the Mcare Fund to help them balance the state budget.

When I called legislative leaders, I was told by several offices that they were getting A LOT of phone calls about the Mcare Fund. That's great, and MANY THANKS to those of you who called.

If you called and left your name and address (for which they ALL asked), you can't really call again - but you CAN pass the information to a colleague, family member, friend or patient. PLEASE help us keep the calls coming - it might make them nervous enough to reconsider taking physician and hospital premium dollars intended to cover future medical liability claims to balance the state budget.

If you didn't call last week, PLEASE CALL NOW. It takes less than 10 minutes to make the five or six phone calls we've asked you to make - the numbers follow. Call your own state representative and senator, too. If you don't know who they are, use the PA Medical Society's Capwiz feature to find out:

A few pieces which mention the Mcare Fund follow - in light of the broader battles being waged about the budget, the state's acquisition of funds from "those greedy doctors" who deserve to be ripped off anyway frankly hasn't gotten much ink. In fact, unless you were LOOKING for it, you might not know at all, except for the efforts of your physician advocacy organizations...and little old me, of course....

HERE's the argument you need to use, though, an argument which is effective because it's TRUE - without the Mcare funding the state plans to take, future malpractice claims which occurred during the years Mcare was in effect (and it still IS) will likely be billed directly to PA's doctors - and what young doctor in his or her right mind would agree to practice medicine in a state which plans to CHARGE THEM for past medical malpractice claims? The Governor's longterm plan for the Mcare Fund relies on the surplus to cover the unfunded liability - it's still on their own Office of Health Care Reform web site:, despite current plans to absorb the fund.

If new doctors don't want to practice here (currently only 15-20% of the doctors we train here stay here, down from 50% a decade ago), and PA doctors continue to age.....who, exactly, will take care of patients in Pennsylvania?

Please make the calls today, and pass this along to everyone you know who might care about access to quality doctors here in Pennsylvania....

Lots of info follows about national health care reform as well, including efforts by several physicians' groups to impact reform at the national level....

MANY THANKS for the phone calls and the kind words over the past several days.


Pennsylvania doctors, hospitals oppose use of malpractice funds in state budget
By David Wenner
September 24, 2009, 11:33AM
Add doctors and hospitals to list of those of who feel the state budget is being balanced at their expense.

Lobbyists for both groups say they believe the current budget agreement will rely on about $800 million that had been set aside to help pay medical malpractice judgments against doctors, hospitals, nursing homes and nurse midwives.

Dr. Dan Glunk, president of the Pennsylvania Medical Society, sent a letter to state senators urging them to reject an $800 million transfer. "We believe this is legally wrong, bad public policy and a breach of faith with Pennsylvania patients and doctors," Glunk wrote.

Gov. Ed Rendell, who created one of the funds that helps cover medical malpractice costs, has said those costs have fallen in recent years and has proposed using some of the money for purposes such as helping the uninsured.

Although Rendell and legislative leaders announced a budget agreement late last week, details remain unavailable.


From the PA Medical Society website:
Capitol Insight Action Alert: Sept. 23, 2009
((This extremely valuable publication is generally provided to members only - I'm assuming the emergent nature of the issue before us is the reason it appears on the public side of the website, and therefore, sending it along as well....))

State Budget Balanced with Physician Dollars?
Tell Lawmakers NO!

The members of the legislative conference committee on the state budget may meet as early as Friday morning. On the table is more than $100 million of your money paid to the state mandated Mcare Fund for your liability insurance coverage.

This most recent budget proposal takes your premium dollars to help balance the state budget—in essence, a “physician tax.”

The Pennsylvania Medical Society is pursuing all avenues in the courts and in the halls of our state capitol to stop this legislative raid on health care dollars.

Your calls can make the difference.

In the next 24 hours, please call all of these conference committee members

Rep. Dwight Evans—(717) 783-1540
Rep. Todd Eachus—(717) 787-2229
Sen. Robert Mellow—(717) 787-6481
Sen. Dominic Pileggi—(717) 787-4712
Sen. Jake Corman—(717) 787-1377
Your message: “I strongly urge you to oppose any proposal that uses my Mcare insurance premiums to balance the state budget.” Be sure to tell them where you practice.

Also, please call and thank Rep. Sam Smith at (717) 787-3845 for having the courage to be the only conferee who opposes using our money to balance the state budget.

Thank you for speaking up to save health care dollars.

Last Updated: 9/23/2009


From the Keystone Chapter of the American College of Surgeons
Message From the President:

I am writing to personally encourage you to call members of the legislative conference committee on the state budget and strongly urge them to oppose any proposal that uses your Mcare insurance premiums to balance the state budget.

The most recent budget proposal takes the more than $100 million of the surplus balance in the Mcare Fund—a surplus that only exists because physicians and other health care providers have paid excess Mcare assessments.

Your calls can make the difference!

Please call these conference committee members:

Rep. Dwight Evans—(717) 783-1540
Rep. Todd Eachus—(717) 787-2229
Sen. Robert Mellow—(717) 787-6481 CORRECTION
Sen. Dominic Pileggi—(717) 787-4712 CORRECTION
Sen. Jake Corman—(717) 787-1377
Collin Myers, MD, FACS



from the American Academy of Family Physicians

Physicians' Mcare Funds in Jeopardy!
Urge Your Legislators to Oppose the MCare Raid!

Will the General Assembly destabilize the physician practice environment in Pennsylvania?

A budget deal being hammered out right now in the General Assembly would take the more than $100 million of the surplus balance in the Mcare Fund--a surplus that only exists because physicians and other health care providers have paid excess Mcare assessments.

This is ON TOP OF the already agreed upon taking of OVER $700 million in the Health Care Provider Retention Account to balance the budget.

The Pennsylvania Academy of Family Physicians is asking all of its members to contact their state legislators, both State House and State Senate members.

Tell your elected members of the General Assembly that that you OPPOSE using money you paid to the Mcare Fund to balance the state budget. Tell them that it is wrong to balance the state budget on the backs of health care providers.

A budget deal could be finalized any day, your immediate involvement is imperative. Please contact your legislators IMMEDIATELY.


Budget pulls from medical surplus
Friday, Sep. 25, 2009
David Wenner
The (Harrisburg) Patriot-News
Add doctors and hospitals to the list of those of who feel the state budget is being balanced at their expense.

The budget agreement would use about $800 million that had originally been set aside to help pay medical malpractice judgments against doctors, hospitals, nursing homes and nurse midwives.

The Pennsylvania Medical Society, which represents doctors, is especially upset. It contends doctors would lose $100 million from the Mcare program, which helps cover malpractice expenses.

Doctors pay into the fund, and a surplus has grown as malpractice claims have dropped in recent years.

Amy Kelchner, a spokeswoman for Gov. Ed Rendell, said the Mcare payments were collected according to a formula created years ago with input from doctors and hospitals. But she acknowledged the formula can produce a surplus, and a surplus now exists. The administration wants to use some of that money to help address the state’s financial crisis.

An additional $700 million would be taken from the Health Care Provider Retention Fund.

The fund is designed to keep doctors in the state, and its money comes mainly from a cigarette tax and a surcharge on speeding tickets. Rendell created it early in the decade to help doctors and hospitals cope with soaring medical malpractice costs, which many doctors said might force them to leave the state.

But malpractice claims and expenses have dropped in recent years, resulting in a surplus there, too.

What to do with that surplus has led to conflict between Rendell and health care providers.

Doctors and hospitals have argued that a substantial portion of the surplus should stay with Mcare, which provides $500,000 of malpractice coverage on top of the $500,000 in private coverage doctors must carry.

There are plans, which doctors and hospitals support, to phase out Mcare and allow health care providers to obtain all their malpractice coverage on the private market.

But providers emphasize that malpractice claims often arrive years after an incident and require additional years to resolve.

They say the Mcare fund must be preserved to cover these future claims, known as a “tail.” Otherwise, the state’s doctors will have to pay — a situation they say would make Pennsylvania unattractive to young doctors.

Rendell has agreed that some of the money should be used to cover the future claims. But he also wanted some of the money to be used to expand state coverage for the uninsured.

Kelchner said Rendell laid out a plan months ago to cover future Mcare costs and help the uninsured but found little support from health care providers or legislators.

Given that situation, there has been significant support among lawmakers to use the surplus to balance the budget, she said.

Read more:


from Rasmussen, the polls people:
Health Care Reform
Support for Health Care Plan Hits New Low
Monday, September 28, 2009

Just 41% of voters nationwide now favor the health care reform proposed by President Obama and congressional Democrats. That’s down two points from a week ago and the lowest level of support yet measured.

The latest Rasmussen Reports national telephone survey finds that 56% are opposed to the plan.

Senior citizens are less supportive of the plan than younger voters. In the latest survey, just 33% of seniors favor the plan while 59% are opposed. The intensity gap among seniors is significant. Only 16% of the over-65 crowd Strongly Favors the legislation while 46% are Strongly Opposed.

For the first time ever, a slight plurality of voters now express doubt that the legislation will become law this year. Forty-six percent (46%) say passage is likely while 47% say it is not. Those figures include 18% who say passage is Very Likely and 15% who say it is Not at All Likely. Sixty percent (60%) are less certain.

Sixty-eight percent (68%) of Democrats say the plan is at least somewhat likely to become law. Sixty-one percent (61%) of Republicans disagree. Among those not affiliated with either major party, 34% say passage is at least somewhat likely while 58% say it is not.

The overall picture remains one of stability. Today’s record low support for the plan of 41% is just a point lower than the results found twice before. With the exception of a slight bounce earlier this month following the president’s nationally televised speech to Congress to promote the plan, support for it has remained in the low-to-mid 40s since early July. During that same time period, opposition has generally stayed in the low-to-mid 50s.

Intensity has been with the opposition from the beginning of the public debate. Currently, among all voters 23% Strongly Favor the legislative effort and 43% are Strongly Opposed.

Also, from the beginning of the debate, the has been a huge partisan divide. Currently 75% of Democrats favor the plan. Seventy-nine percent (79%) of Republicans are opposed, as are 72% of the unaffiliated.

Rasmussen Reports will continue to track support for the plan on a weekly basis (see day-by-day numbers).

As Scott Rasmussen, president of Rasmussen Reports, wrote recently in the Wall Street Journal: “The most important fundamental is that 68% of American voters have health insurance coverage they rate good or excellent … Most of these voters approach the health care reform debate fearing that they have more to lose than to gain.” A Rasmussen video report shows that 53% of those with insurance believe it’s likely they would have to change coverage if the congressional plan becomes law.

Despite strong efforts by the White House to counter that belief, including many comments by the president himself, there has been no change for months in the number who fear they will be forced out of their current coverage.

Polling released last week shows that 58% of uninsured voters favor passage of the health care plan. However, 35% of the uninsured are opposed. The divide fell largely along partisan and ideological grounds.

If the plan passes, 24% of voters say the quality of care will get better, and 55% say it will get worse. In August, the numbers were 23% better and 50% worse.

Fifty-four percent (54%) say passage of the plan will make the cost of health care go up while 23% say it will make costs go down. In August, 52% thought the plan would lead to higher costs, and just 17% thought it would achieve the stated goal of lowering costs.

While many credit or blame the town hall protests for building opposition to the plan, it appears they were simply a reflection of public opinion rather than a creator of it. This sense is confirmed by the fact that Obama’s approval ratings fell more in June and July before stabilizing in August.

One thing that did change during the month of August is that public perception of the protesters improved. Most voters came to believe that the purpose of the town hall meetings was for members of Congress to listen rather than speak. That’s partly because just 22% believe Congress has a good understanding of the legislation.

While some Democrats have charged that opposition to the president’s plan is based upon racism, just 12% of voters agree.

Voters overwhelmingly believe that every American should be able to buy the same health insurance plan that Congress has. Most favor limits on jury awards for medical malpractice claims and think that tort reform will significantly reduce the cost of health care. Forty-eight percent (48%) want a prohibition on abortion in any government subsidized program while 13% want a mandate requiring abortion coverage.

The health care debate has produced a difficult political environment for Democrats. Several incumbent Democratic senators currently are behind in their reelection bids including Senate Majority Leader Harry Reid in Nevada, Chris Dodd in Connecticut and Michael Bennet in Colorado.

Republicans appear to have a better shot than expected at hanging on to the New Hampshire Senate seat, and GOP incumbents lead in both North Carolina and Iowa. The races for soon-to-be-vacant Senate seats in Missouri and Ohio are neck-and-neck, and longtime incumbent Democratic Senator Barbara Boxer polls under 50% against two potential 2010 challengers in California. Appointed Democratic Senator Kirsten Gillibrand holds a very narrow lead over former Governor George Pataki in a hypothetical match-up for New York State’s 2010 Senate race.

Democrats also trail in the 2009 governor’s races in New Jersey and Virginia. Incumbent Democratic governors in Iowa and Ohio face tough challenges next year. In New York's gubernatorial race, the fate of the Democrats appears to depend on which of two nominees they choose.

The health care debate has become one focal point for voters frustrated by a string of government actions. Voters overwhelmingly opposed the bailout of the financial industry and the bailout and takeover of General Motors.

Please sign up for the Rasmussen Reports daily e-mail update (it’s free) or follow us on Twitter or Facebook. Let us keep you up to date with the latest public opinion news.

FOX News Poll: Americans Prefer Current System to Obama's Health Care Plan,2933,551520,00.html
Thursday, September 17, 2009
By Dana Blanton

Aug. 12: Opponents of health care reform voice their opinions during the town hall meeting at the Casselton Fire Department in Casselton, N.D.
Most Americans see no upside for their family in the health care reforms being considered in Washington and don't believe President Obama when he says his plan won't add "one dime" to the federal deficit. The majority of Americans believe they will have to make changes to their health care coverage if the president's plan is passed.

These are just some of the findings of a new FOX News poll released Thursday.

More Americans would rather Congress do nothing than pass Obama's plan: 46 percent to 37 percent of people polled say they prefer the current health care system to the one the president has proposed.

Similarly, more people oppose — 48 percent — the health care reform legislation being considered right now than favor it — 38 percent. While most Democrats — 65 percent — favor the reforms, majorities of Republicans — 79 percent — and independents (55 percent) oppose them.

Click here to see the full poll results.

This is not surprising given less than one in four Americans (22 percent) think they would be better off under the reforms, and many (60 percent) think they will probably have to make changes to their health coverage despite Obama's assurances that they will not have to. In addition, a sizable majority (67 percent) thinks the president's plan will increase the national deficit.

By more than three-to-one, Americans say if they were sick they would rather be covered by a privately-run health insurance plan (62 percent) than a government-run plan (20 percent).

Opinion Dynamics Corp. conducted the national telephone poll of 900 registered voters for FOX News from Sept. 15 to 16. The poll has a 3-point margin of error.

Senate Finance Committee Chairman Max Baucus, D-Mont., introduced a health care bill on Sept. 16 that does not include a government-run health insurance option (or "public option") to compete with private health insurance companies. Critics of the public option insist the idea is to move the country closer to a government-run system by forcing private insurers out of business. The public is divided on whether passage of a so-called "public plan" would eventually put private health insurance companies out of business: 52 percent think it would, while 41 percent disagree.

Baucus' proposal requires all individuals to buy health insurance. Some 42 percent of Americans agree with this proposal, while a 54-percent majority disagrees and thinks the government should not be able to require even those Americans who can afford it to have health insurance.

Click here to see the raw data.


Morning Bell from the Heritage Foundation
Sept. 29, 2009
This morning the Senate Finance Committee will resume their markup of Chairman Max Baucus (D-MT) health care bill. Thanks to Sens. Chuck Schumer (D-NY) and Jay Rockefeller (D-WV) the focus today will be on whether or not the Democrats on the committee can find enough votes to include a government-run insurance program. Just like Speaker Nancy Pelosi’s (D-CA) preferred public plan, Rockefeller’s plan would set price controls for health reimbursements at 5% above Medicare reimbursement rates. If the public plan was opened to all individuals and families, 103.4 million Americans would end up on the public plan, 88.1 million of whom would first lose their existing private coverage.

It is unclear at this point if centrist Democrats in Congress are really ready to force this many people out of their existing private care and into government-run health care. But even if the public option is not included, there are still plenty of regressive job killing taxes and invasions of privacy in the Baucus plan that makes it terrible public policy

Taxes Families - Under the plan, everyone will have to have health insurance by 2013. The mandate will apply to all adults and their dependents under age 18. Those who failed to buy insurance would be forced to pay an annual tax between $750 and $3,800 per year. Those who fail to pay the tax could be jailed for up to one year. Worse, 7.7 million households would face a 35% excise tax on their health insurance. 94% of these households would be paying a higher tax rate on their health insurance than they would be paying on their income

Taxes Businesses - Employers with more than 50 employees that don’t offer health coverage would have to pay a penalty for each employee who qualifies for new federal subsidizes under the bill. To stay in business employers will be forced to cut jobs and cut wages.

Taxes the Sick - The Baucus bill imposes higher taxes on manufacturers and importers of medical devices, health insurance companies, clinical laboratories, manufacturers and importers of drugs. In effect, the Baucus proposal would tax the sick to subsidize insurance for the healthy, and many of the taxes would be imposed on the same people “helped” by the subsidies

Invades Your Privacy - The Baucus bill enforces both its individual and employer mandates by deputizing the Internal Revenue Service. To enforce these provisions, the bill would therefore require individuals, health insurers, employers, and government health agencies to report detailed health insurance information on all Americans to the IRS, adding significant administrative costs and reducing privacy protections. The IRS would also be required to report personal income data to state exchanges, insurance companies, and employers because premium credits and out-of-pocket limits would depend on income

Quick Hits:

More than a dozen states are moving to pass state constitutional amendments that would outlaw Obamacare’s individual mandate.
Senate Majority Leader Harry Reid (D-NV) has secured a special deal protecting Nevada from the costs of expanding Medicaid under the Baucus bill.
((THAT is outrageous....why should only HIS state get a pass on higher Medicaid costs....?))


Senate healthcare bill unscathed after first week
Fri Sep 25, 2009 5:02pm EDT
By John Whitesides
WASHINGTON (Reuters) - A broad healthcare overhaul emerged unscathed on Friday from the first week of Senate committee debate, with Chairman Max Baucus keeping fellow Democrats in line and shielding key elements from Republican attacks.

Four days of sometimes contentious battle in the Democratic-controlled Senate Finance Committee left the main tenets of Baucus's bill untouched and gave reform advocates hope that Republican Senator Olympia Snowe would back the final version.

Snowe, a member of the bipartisan "Gang of Six" negotiators who failed to reach agreement on the plan before the panel's debate, was the only Republican to cross over and side with Democrats on several votes during the week.

Her support would be a big step toward winning approval in the full 100-member Senate, where Democrats have little margin for error with a 60-vote majority -- exactly the number needed to clear Republican procedural hurdles.

"The battle lines are taking shape," said Len Nichols, director of the health policy program at the New America Foundation. "The Democrats appear very disciplined, and it's pretty clear that Snowe might still support this thing -- which is what they need."

Baucus's proposal, one of five healthcare bills pending in Congress, closely mirrors President Barack Obama's plans to rein in costs, tighten regulations on insurers and expand coverage to many of the 46 million uninsured people living in the United States.

Baucus won every key fight during the first week of debate. He protected the White House's $80 billion deal with drugmakers and kept Democrats together to preserve an individual requirement to buy insurance and reject Republican efforts to block some cuts in the Medicare insurance program for seniors.

Baucus had brought his fellow Democrats on board before the debate by incorporating into the bill a package of Democratic amendments aimed at making insurance reforms more affordable for workers.

Snowe crossed party lines to support Baucus on the vote on the individual insurance mandate and on other votes, but the other Republican "Gang of Six" negotiators -- Charles Grassley and Mike Enzi -- stayed in the Republican camp.


"They need a breakthrough moment where they find some middle ground, and I still think at the end of the day they will find it," Bob Blendon, a health policy and political analyst at Harvard University, said of lawmakers working on healthcare.

"There is no reason for people who are going to move over and compromise to do it early," Blendon said. "You have your maximum advantage by taking your time. The people who are going to compromise haven't done it yet."

The Senate panel renews debate on Tuesday with a battle over Democratic amendments to add a government-run "public" insurance option in the bill -- the only one of the five pending healthcare measures in Congress without it.

The public option is favored by Obama as a way to create competition and lower insurance costs, but critics say it could undermine the private insurance industry.

Democratic Senators Charles Schumer and John Rockefeller, who will bring up the public option in committee, say it may have a hard time passing the more conservative Senate Finance panel but will have stronger backing in the full Senate and House of Representatives.

"The committee is what starts the debate and gets people thinking," Schumer told reporters. "As the process moves on, for the public option and for some other things, it gets better and better."

In the House, where Speaker Nancy Pelosi has promised a final bill will include a public option, Democratic leaders met on Friday to work on blending the chamber's three pending bills into one measure for floor action.

They said they were making progress on trimming the total cost to $900 billion -- all three bills were at $1 trillion or more.

"We are narrowing the number of issues we have to deal with," House Speaker Nancy Pelosi told reporters. She said they were looking at proposals in the two Senate committees, including a tax on high-cost insurance policies included in the Finance bill.

She said no decisions had been reached and the group would meet again next week.

(Editing by David Alexander)


((So....what are doctors thinking about all this? The AMA's position has changed a bit.....))

From the AMA

All sorts of legislative terms are being tossed around in this discussion about reforming our health system. But there's one main definition you need to know, because it may mean the difference between real health system reform and Congress choosing to kick the can down the road and delay real reform.

There is a budget rule known as "PAYGO". This is short for "Pay As You Go," meaning that any bill that increases federal spending needs to be offset by either reducing other spending or increasing revenue. However, this rule can be set aside for any given bill with the support of 60 U.S. senators. Setting aside this rule is known as "waiving the budget act."

This is important to understand, because physicians have some serious issues with the legislation (PDF) that the Senate Finance Committee has put forth, including the fact that the bill does not adequately address the 21 percent Medicare payment cut physicians are facing on Jan. 1, 2010.

The legislation includes provisions to avoid that cut, but without permanently repealing Medicare's sustainable growth rate (SGR) formula, physicians will continue to face annual cuts that will erode the viability of their practices and reduce access and choice for America's seniors. A recent poll by the AMA, AARP and the American Nurses Association found that nearly 90 percent of people age 50 and older are concerned that the current formula threatens their access to care. Permanently repealing it is critical to our goal of ensuring security, stability and access for seniors. Read more about the bill on the blog AMA President J. James Rohack, MD has started, "On the Road with Dr. Rohack."

As the bill begins to move through the legislative process, we'll keep you informed with more ways to get involved. And you can always use the Physicians' Grassroots Hotline at (800) 833-6354.

P.S.: Regardless of the ultimate direction of health system reform legislation, it is more clear than ever that physicians' voices must be a central part of the conversation. To ensure that your voice is always heard, the American Medical Association Political Action Committee (AMPAC) offers political education programs every year to AMA members, spouses and medical society staff members.

Whether you want to learn more about what campaigns are really like (Campaign School), or see if you have what it takes to run for office yourself (Candidate Workshop), both programs offer intensive, hands-on training for physicians to participate in the political process.

AMPAC covers lodging, meals, tuition and course materials-a significant benefit of AMA membership. For 2010 dates and an application, visit AMPAC online. For more information, please contact Jim Wilson, AMPAC political education programs manager, at or (202)789-7465.

((I attended the AMPAC campaign school in April and recommend it HIGHLY....))

Letter from the AMA to Sen. Max Baucus

September 21, 2009
The Honorable Max S. Baucus
Senate Committee on Finance
219 Dirksen Senate Office Building
Washington, DC 20510

Dear Chairman Baucus:

On behalf of the physician and medical student members of the American Medical Association (AMA), I want to thank you for your leadership and significant efforts to advance our mutual objective of achieving comprehensive health system reform this year.

We are encouraged that the Chairman’s mark (America’s Healthy Future Act of 2009) includes several provisions consistent with our policy. In general, we support the provisions in the mark that reform the health insurance market to provide more choice and better access to affordable coverage for individuals and small businesses, including provisions relating to guaranteed issue, guaranteed renewability, modified community rating, pre-existing condition limitations, nondiscrimination based on health status, adequacy of provider networks, and transparency. We also support: tax credits that are inversely related to income, refundable, and payable in advance to low-income individuals who need financial assistance to purchase private health insurance; establishing health insurance exchanges that offer more affordable choices; enhancing Medicaid coverage as a safety net; coverage for prevention and wellness initiatives without co-payments or deductibles; and establishing an independent institute to conduct clinical comparative effectiveness research.

The AMA has serious concerns about several provisions in the mark.

Medicare Physician Payment Formula

We deeply appreciate your support for a permanent repeal of the sustainable growth rate (SGR) during the full Senate’s consideration of health system reform legislation. While the AMA appreciates that the mark would avoid a 21 percent cut in Medicare physician payments in January, a permanent repeal of the SGR must be enacted this year. Continuation of the SGR would subject physicians to cuts of 40 percent over the next several years. Permanently repealing the SGR formula is critical to the goal of ensuring security, stability, and access for seniors.

Independent Medicare Commission

The AMA has serious concerns with the authorities granted to the Independent Medicare Commission in the mark and we look forward to working with you on significant changes to the proposal. Physicians are already subject to a spending target and additional payment penalties under other provisions in the mark. Creating a second target system could subject physician services to multiple payment cuts in a single year. Further, the provision does not appear to apply equally to all health care stakeholders. This presents a serious inequity if spending reductions are to be found from only a fraction of the program.

Medicare spending targets must reflect appropriate increases in volume that may be a result of policy changes, innovations that improve care, greater longevity and unanticipated spending for such things as influenza pandemics. Congress should also retain the ability to achieve a different level of savings than proposed by the Medicare Commission to adjust for new developments that warrant spending increases.

Physician Quality Reporting Initiative

We appreciate the proposed improvements to the Physician Quality Reporting Initiative (PQRI) to require timely feedback and establish an appeals process. The AMA does not support a mandatory PQRI or penalties for physicians who do not successfully participate. Based on our experience with the PQRI to date, this program is fraught with administrative problems that have made it extremely difficult to assess whether a physician has successfully participated, and due to these problems penalties would be unwarranted. Further, not all physicians are currently eligible to participate in the PQRI due to the lack of approved measures for their service mix.

Physician Outlier Proposal

Given the limited experience the Centers for Medicare and Medicaid Services has had implementing the provider resource use reports authorized under current law, we believe it is unwise to authorize financial penalties on physicians identified as outliers. Private and state insurance programs have experienced serious problems with the accuracy and validity of episode grouper methodologies to “profile” physicians.

Medicare/Medicaid Enrollment Fee

Physicians should not be subject to the proposed $350 enrollment fee for participation in Medicare and Medicaid. While some may view the fee as a minor expense, we believe that it has the potential to discourage physician participation in the program. We understand that the intent of the proposed enrollment fee is to cover the cost of screening measures intended to curb potential fraud and abuse activities, particularly by unscrupulous durable medical equipment suppliers. Physicians are already subject to multiple fraud and abuse review processes by Medicare contractors, recovery audit contractors, and the Office of Inspector General, and the type of measures being proposed in the mark simply add a new burden on physicians whose reimbursement under Medicare already fails to keep pace with increasing practice costs.

Primary Care and General Surgery Bonuses

The AMA supports primary care and general surgery bonus payments treated as a funded workforce investment that is not offset through a reduction in payments to other physicians. We strongly encourage you to identify other pay-fors to fully fund the proposed bonuses that do not make across-the-board cuts to other Medicare physician services.

Physician-Owned Hospitals

We oppose the proposal to eliminate the whole hospital exception to the Stark self-referral law. Physician-owned hospitals have achieved the highest quality scores in some markets and have been shown to provide more net community benefits through uncompensated care and taxes than not-for-profit competitors as a share of total revenues. In addition, a recent study by the Center for Studying Health System Change found that physician-owned hospitals do not adversely affect general hospitals’ ability to care for patients. Limiting the viability of physician-owned hospitals will reduce access to high-quality health care and have a destructive effect on the economy in communities these hospitals serve. Proposed limits on existing physician-owned hospitals would put them at a competitive disadvantage, making it difficult for them to respond to the health care needs of their local communities. The provisions would also effectively shut down many physician-owned hospitals currently under development. We urge that this provision be removed from the mark.

Once again, the AMA is grateful for your leadership. We support many of the provisions in the mark to reform the insurance market and ensure affordable coverage for all Americans and look forward to working closely with you and your colleagues to resolve our outstanding concerns.

Michael D. Maves, MD, MBA


From the American College of Surgeons

This morning, the Senate Finance Committee began their "mark-up" of health care reform legislation. Before the mark-up began, the American College of Surgeons, along with 19 surgical organizations, sent a letter to Senate Finance Committee Chairman Max Baucus (D-MT) indicating that we could not support the bill that he brought to the Senate Finance Committee. The surgical organizations highlighted the lack of a permanent fix to the Medicare physician payment system, the lack of substantive medical liability reform and our opposition to the creation of a Medicare Commission that would take decisions regarding Medicare out of the hands of elected Congressional officials. A full copy of the letter, which includes all of surgery's concerns with the Baucus bill, can be found here. The Senate Finance Committee mark-up is expected to last several days. We will continue to keep you updated as the health care reform debate continues in Washington.

((For reasons unknown, I cannot seem to copy and paste the letter here, so please click on the pdf at to read it....sorry...))


L.D. Britt, M.D., FACS, Chair of the ACS Board of Regents
John L. Cameron, M.D., FACS, President of the American College of Surgeons
Andrew L. Warshaw, M.D., FACS, Chair of the ACS Health Policy and Advocacy Group
Christian Shalgian, ACS Director, Division of Advocacy and Health Policy


((And many physicians are taking their own action....bravo to all of them for their commitment!))!.aspx

Doctors fed up with Obama, massive march planned 10/01/09!
by DefendUSx September 25, 2009 01:49

From MedScape:

Physicians Are Talking About: The Million Med March on Washington

"I'm tired, mad as hell, and just not going to take it anymore," says Richard Chudacoff, MD, a gynecologist from Las Vegas. "I am going to Washington, DC. At noon, on Thursday, October 1, 2009, I will be on the Mall with a few other physicians."

Dr. Chudacoff is not talking about vacation plans. Rather, he intends to unite with other physicians in what he calls the Million Med March.

"We simply decided that we will not work that day and perhaps the day before and maybe even the day afterward," says Dr. Chudacoff. "Perhaps we will show the country that physicians are worth more than a $5 copay; that physicians are more important than a mid-level healthcare worker; and that our profession is needed, our services are required, and our practice is a calling to be respected, not a trade that is to be negotiated to the lowest bidder."

A letter posted by Dr. Chudacoff on in June has been spreading like wildfire across the Internet, finding its way to personal blogs, discussion groups, and professional forums. On June 23, it was posted to Medscape's Physician Connect (MPC), a physician-only discussion group, where it sparked a flurry of responses. A number of MPC postings suggest that Dr. Chudacoff will have plenty of company on October 1.

"Finally, something constructive," says a dermatologist. "I'll see you in DC on October 1. Some of the office staff, including our nurse, expressed a wish to be there too. Bring spouses and friends and anybody else who actually cares about healthcare in the US."

"I have cleared my schedule and plan to attend," responds a vascular surgeon. "I think this type of grassroots action, unaffiliated with hospitals, insurance companies, or the AMA, is likely to get the most sympathetic attention."

"This is the best proactive effort I have heard from physicians," says an MPC family medicine physician. "Actions speak louder than words."

"I can be there without changing my schedule," adds an anesthesiologist. "I was just terminated from my office-based practice where I have been for 7 years."

One physician's decision to take a stand and unite with his fellow colleagues has given doctors a simple way to show the public and elected officials that healthcare, for them, is not a political agenda. It is their life and livelihood. And in recent weeks, the partisan discussions in the Senate and House of Representatives on healthcare legislation have seemingly marginalized -- and at times even maligned -- physicians.

"I was for nationalized healthcare," says a family medicine physician, "but I thought that meant providing a safety net for needy Americans. But this monster of a bill is something quite different."

"Politicians and payers have turned our profession into a political football," retorts an anesthesiologist.

President Obama's recent tonsillectomy remark, in which he insinuated that doctors make medical decisions based on what they would be paid for a procedure rather than the best treatment for the patient, has further incensed physicians. "As a hard-working, conscientious physician, I am offended. It's like racial stereotyping. Only now it's about a group that is mostly overworked, tired, and saving people's lives," retorts a family medicine practitioner.

If the president is looking for greed within the healthcare system, Dr. Chudacoff suggests that he not take aim at primary care physicians. Chudacoff adds, "Medicine is going corporate, and we physicians are just flipping burgers so corporations have an improved bottom line."

Although fair compensation is an important issue among the organizers of the Million Med March, it is not the only issue. Medicine has become a toxic environment in which to work. Dr. Chudacoff underscores the situation. "Quality of care suffers with less time to see patients and less reimbursement received when we do see patients. We cannot do pro bono work as we have in the past because we have to see an ever increasing number of patients. This extra work is forced upon us when insurance companies, especially Medicare and Medicaid, constantly refuse to pay us in a timely fashion for our time and efforts. And then once we do see patients, our clinical acumen is stifled as we must follow a cookbook approach to patient care. It is time that we stand up for ourselves."

A vascular surgeon comments, "We can lead the way to real reform. Now is clearly the time to act, not just type."

On July 10, an MPC contributor and one of the supporters of the Million Med March launched a Website,, to build support for the October event. The site announces a physician grassroots movement to re-establish honor, dignity, and worth to the medical profession. "The Million Med March movement has taken off, on so many sites, and within so many communities. Why now? The debate on national healthcare has forced this conversation, and this conversation has pushed us over the tipping point."

The mandate as stated on the Million Med March Website includes the following points:

•Services must be adequately reimbursed so that we may spend more time with our patients and not be forced to see an unsafe number of patients to pay for increased business costs.

•Less money must go into the hands of insurance companies' administrative costs, and more money must go towards patient care and medical research.

•We must abolish third-party payers or prevent a single-payer system for office visits and medical services; these services are costly to the patient, physician, and society as a whole.

•Our patients need access to brand-name drugs that are as affordable in the United States as in Canada and Mexico.

•We must have medical malpractice reform, with caps on all damages, so that we can practice without the fear of needless and unwarranted lawsuits that only benefit attorneys.

Some MPC contributors voice concern that the Million Med March scheduled for October will occur too late to have any meaningful impact on healthcare reform. "The health reform bill is going nowhere," says an anesthesiologist. "Let's make a major statement between its failure and the next attempt to marginalize the docs."

A plastic surgeon adds, "Stand up for our profession and come to DC."


A physician grassroots movement to re-establish honor, dignity and worth to the medical profession. That its sole mission is to protect the relationship between the doctor and the patient.
Washington DC - John Marshall Park October 1, 2009 starting at 12:00 p.m.

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

Several speakers are scheduled to speak at the event including prominent colleagues and politicians.

Immediately following the rally, we will march towards the Capitol building along Pennsylvania Avenue.

The March will end at the Upper Senate Park where everyone will disperse to meet their State representatives.


Mission Statement
We are an organization of concerned physicians committed to the establishment of a health care system that preserves the sanctity of the doctor-patient relationship, promotes quality of care, supports affordable access to all Americans, and protects patients' freedom of choice.

From the Docs4PatientCare news blog:
Physician Evaluation of Baucus Bill, American Thinker
posted by Tod Rubin - Saturday, September 26, 2009

September 17, 2009
Senator Baucus: what $856 billion buys you
By Linda Halderman, MD

On September 16, 2009, Senate Finance Committee Chairman Max Baucus (D-MT) offered some of the details of the healthcare reform proposal that will be presented for debate. The Senator's 223-page summary of the proposal, "America's Healthy Future Act," provided additional details for his committee members.

During the press conference, Senator Baucus called the proposal "one of the largest pieces of social legislation since the Depression."

He described the mandate that would be imposed on every American: buy health insurance or face an IRS-enforced penalty of up to $3,800 per family. Annual tax returns would be used to "ensure compliance" (Subtitle D-Shared Responsibility, page 28).

Forcing individuals to buy coverage regardless of its cost would be made simpler, he claimed, by another provision of the plan: no insurance company could offer lower premiums to applicants with good health (Rating Rules in the Individual Market, page 4).

For example, a healthy woman who exercises regularly and doesn't abuse drugs could not pay less for the same plan offered to a morbidly obese, sedentary man with liver disease from chronic alcohol use. Policies could not be discounted for health, only for age-but not to an extent that would allow the youngest policyholders a deep discount.

$856 billion would protect Medicare, promised Senator Baucus during his press conference. Within minutes of that statement, however, he admitted that funding for the proposal would come from eliminating Medicare Advantage payments. Medicare Advantage is private, choice-based coverage within the federal program. It is currently selected by over one third of Medicare Part D enrollees-more than nine million seniors.

When a reporter asked if Medicare payments to doctors and hospitals would be addressed by the $856 billion legislation, Senator Baucus quickly responded.

"It's not part of healthcare reform, what Medicare pays doctors."

For business owners, the Senator outlined a new payroll tax of $400 per employee. The alternative to paying the penalty would be offering generous health benefits to every worker.

But not too generous, thanks to another new tax described in the Senate Finance Committee Chairman's 223-page summary:

For workers with health insurance valued at over $8,000 per year, any coverage above that amount would be taxed at a rate of 35 percent (page 199).

Senator Baucus called this a "tax on insurance companies," something that would bring about "consequences on the way employees get insurance."

The $8,000 limit on employer coverage would have to include amounts contributed to flexible savings accounts (cafeteria-style plans). These pre-tax accounts, used by employees to cover co-pays and out of pocket expenses, would be limited to $2,000 per year so that the federal government could tax all additional amounts saved.

Medicaid would be dramatically expanded to cover those with higher incomes than current criteria. But this would not impact the states significantly, Senator Baucus claimed, despite the fact that states are on the hook for paying up to half of new coverage costs.

$856 billion, it seems, does more than simply fulfill our "moral obligation" to pass the type of reform described by Senator Baucus. It buys a new set of government-enforced obligations for American citizens of every age, health and employment status.

Dr. Linda Halderman was a Breast Cancer Surgeon in rural central California until unsustainable Medicaid payment practices contributed to her practice's closure. She now serves as the healthcare policy advisor for California's Senator Sam Aanestad while continuing to provide trauma and emergency services in rural communities.
September 2009 (18)
August 2009 (15)
Copyright © Docs4PatientCare 2009. All Rights Reserved. Powered by RootsHQ


From Take Back
“Max Tax” (Baucus bill) hurtling through Congress
Saturday, September 26, 2009 at 02:49PM
Transparency having become an early casualty in the process of driving through “health care reform” despite rising opposition, the Senate Finance Committee chaired by Max Baucus (D-MT) is marking up a shell bill, a 200+ page outline.

Some think the strategy is to take the product, merge it with the product of the Senate Health, Labor & Pensions (HELP) Committee, and tack it on as an amendment to a bill imposing a tax on certain recipients of bailout funds. Conceivably, the transformational change of one-sixth of the economy could be enacted in two weeks (The Foundry, Heritage Foundation 9/22/09). Then the bureaucrats could set to work on the 100,000+ pages of regulations.

Senator Baucus called the proposal “one of the largest pieces of social legislation since the Depression.”

The individual mandate would force every American to buy approved insurance, or face an IRS-enforced penalty of up to $3,800 per family, writes Linda Halderman, M.D. (American Thinker 9/17/09). Or perhaps it would be only $1,900, since the Committee accepted amendments by Sen. Schumer (D-NY) and Sen. Snowe (R-ME).

Baucus proposed a new payroll tax of $400 per worker not provided with generous health benefits. Along with a 35% tax on too-generous health coverage exceeding $8,000 per year, with the $8,000 limit to include flexible savings accounts (cafeteria plans).

His $856 billion proposal would protect Medicare, Baucus said at a press conference. Then he said that financing would come partly from eliminating Medicare Advantage payments, noted Dr. Halderman.

Baucus had urged the Centers for Medicare and Medicaid Services (CMS) to look into “scare tactics” by Humana, which was informing its beneficiaries that they could lose their Medicare Advantage benefits. The Wall Street Journal called it “bullying tactics,” America’s Health Insurance Plans called the CMS action a “gag order,” and even AARP called it a “selective and inappropriate use of its regulatory powers” (NY Times 9/22/09).

The Humana mailing was “misleading and confusing to beneficiaries, who may believe that it represents official information about the Medicare Advantage program,” said Jonathan Blum, acting director of a CMS regulatory office, and former senior aide to Sen. Baucus. CMS is not investigating AARP for its political advocacy. On its website, AARP states as “fact” that “none of the health care reform proposals being considered by Congress will cut Medicare benefits or increase your out of pocket costs” (Wall St J 9/24/09)

The Baucus bill was stripped of a few of the most contentious elements in an effort to attract Republican support: the “public option,” an employer mandate, and Medicare payments for counseling seniors about “end-of life care.” The Congressional Budget Office (CBO) estimated a 10-year cost of $774 billion, and estimated it would cover 94% of “Americans” by 2019, leaving 25 million people—one-third of them illegal aliens—without coverage., writes John Iglehart (N Engl J Med 9/24/09).

Lacking initial support, it is proceeding along “the sort of winding path often followed by major legislative initiatives,” writes Iglehart.

Initial CBO analysis says the Baucus bill would not add to the deficit because its costs would be covered by a tax on “Cadillac” insurance plans, a slowing of the growth of Medicare and Medicaid payments to nonphysicians, and new fees on clinical laboratories and medical-device manufacturers.

Insurers would be required to cover everyone without discrimination on the basis of health status or caps on annual or lifetime coverage.

John Goodman notes the following effects in an article entitled “Baucus Declares War on the Middle Class”:

The threshold for the 35% excise tax on “Cadillac” insurance is indexed to the consumer price index (CPI), not the medical price index (MPI), which grows three times as fast. Eventually, all insurance will exceed the cap and be taxed.
“Credible” employer coverage might cost $13,000 for a family. The maximum the employee can be required to pay is 13% of income, or $6,500 if income is $50,000. The employer must pay the rest (out of reduced wages). The full cost that must be paid by workers, either in premiums or reduced wages, after adjusting for taxes, amounts to 26% of his income.
If the worker qualifies for Medicaid, the employer faces no increased costs. Thus, there is an incentive to hire the poor, and not to hire the middle class.
Millions of families will be forced to move from private plans, which provide a broad choice of physicians, to Medicaid and S-CHIP plans with much more limited access.
David McKalip, M.D., notes the following effects on physicians, from the version of the bill available to him:

Capitation will become the dominant mode of payment.
Doctors would have to be a “Medicare-enrolled physician” to order services that would result in any cost to the Medicare program.
Doctors will be penalized for going over budget, and no statistically valid samples will be used. At the same time, the cost of procedures and devices they order will be driven up by taxes.
Doctors will be made to pay $350 each into a fund to pay for “screening” programs to cover unannounced and random site visits to check for “waste, fraud, and abuse.” Doctors may be prevented from practicing in a “fraud-prone” specialty, or required to put up a $500,000 surety bond.
Medicare funds are redistributed from specialists to primary-care physicians.
Estimates of the effects of “health care reform” bills ignore the effects of other pending legislation, such as the Waxman “cap and trade” bill. Higher unemployment caused by this bill would increase the number of uninsured. The Kaiser Family Foundation estimates that for every percentage point increase in unemployment (the loss of 1.54 million jobs), the number without health insurance rises by 1.1 million. Using projected job loss figures from Heritage, this could mean more than 820,000 losing their health insurance annually. New health problems are also highly correlated with job loss—including hypertension, heart disease, diabetes, alcohol-related problems, and low birth-weight babies (National Center for Public Policy Research, September 2009).

Although Democrats may be staking everything on passage, Iglehart notes: “The reform effort could be derailed at any point along this treacherous path, and the future of Obama’s presidency could hinge on the outcome.

Additional information:

“We Don’t Have to Choose Between the ‘Status Quo” and the Democrats’ ‘Reform Plan’: an Alternate Better Plan,” Take Back Medicine 8/11/09.

From Take Back
An Open Letter to America’s Physicians

June 25, 2009

Doctors of America,

Your profession is facing a certain death and only you can stop it – with your patients at your side. Congress and Obama are proposing to turn doctors into servants of the state, insurance companies, hospitals, and everyone except who matters most: the patient. We will be turned into bean counters, computer entry clerks, dutiful “providers” and will not resemble anything like a “professional”[1].

This letter is long, because there is much to report and much to say. But know this, as a physician, you will not want the kind of medical care that your junior colleagues will provide you when you need it. You must lead the way so our valued Medical profession can be rescued from this abyss and we can usher in a new golden age of medicine using genomics, cancer vaccines, implantable devices, nanotechnology, new pharmaceuticals and good old-fashion time with the patient!

I speak to you as a private practice neurosurgeon who is active in organized medicine and who has worked on the board of my state medical association and at the AMA for years*. I can tell you with certainty that there is one and only one goal of those who would “change” our health system: pay doctors less and force them to provide less medical care. That is why the President has put this item at the top of his goals for health system reform: “reduce costs”. How will Congress do this? They will create rationing boards that are unelected and unaccountable to anyone. Already the Federal Coordinating Council on Comparative Effectiveness has been created and given over $1 billion to spend. They have not one actively practicing doctor on the council and each one is a senior management Federal Employee. They will create so called “quality and efficiency goals” and force doctors to follow them through a “pay for performance” model. Those doctors who serve as dutiful servants to all third parties will be treated somewhat less badly than everyone else. Those who have the audacity to prescribe medical care to their patients based on their professional training and experience and in the best interests of their patient will be chased out of practice.

The bottom line is that doctors will be forced to do what they are told. Doctors will be forced to comply. One need look no further than your current practice environment and to ideas circulating in Congressional committees. Already we have seen “quality” (cookbook medicine) and efficiency (rationing) ratings for doctors that assign a star if you comply. If you are deemed a “good doctor” by the insurance company or the government, you will be paid a little more than another doctor. But at what cost? You must hire staff to make sure the quality measures are reported. You will be told to practice in a defacto capitated model where any dollar spent on patients above the arbitrary threshold of a government or corporate bureaucrat will lead you to be labeled “inefficient” – and penalized. You must buy an electronic medical record system to report your data to the government. Congress says they will give you up to $44,000 over 5 years to do so (if you are a “meaningful user”) but the actual cost is $120,000 over 5 years. If you don’t buy the system that will feed your practice data to bureaucrats – you will be penalized $42,500. I know I will take the penalty since it costs me less and keeps big brother out of my office (mission accomplished for the government – they just “reduced costs”).

Already, hospitals are hungrily pushing a “bundled payment” system so hospital based docs will be paid only if the hospital agrees! Hospital based doctors will be slaves to the hospitals. Global payment for management of chronic diseases are proposed so that a doctor will be paid once for a patient with diabetes and similar diseases. This is all occurring in Massachusetts where their health care reforms of 2006 (individual mandates, subsidized health insurance, state boards and health insurance exchanges) are failing more so every day. This is the model for national health system reform.

Congressman Tom Price is a doctor from Georgia who is fighting for patients and doctors in Congress now. He is right when he says we must not allow a “public option”, “mandates” or allow the “government to define quality”. America must empower our patients financially with good tax relief, health savings accounts, high deductible insurance. We should not grant further power to insurance companies and the government. The problems that the government and insurance companies propose to solve were created by them over the last many decades and we are being asked to grant them more power[2]? Enough is Enough!

Now doctors are told they may “volunteer” to report quality data to earn up to an extra $1,000 from the government. Few have. Soon doctors will be told they must report data to avoid a cut in payment –as was done to hospitals a few years ago and 98% compliance was achieved. Then, as is currently done in hospitals, doctors will be told you must meet a “performance threshold” to avoid a payment cut. This is the same kind of “volunteerism” that was envisioned in “Animal Farm” when the dictator happily announced that people could volunteer to work the crops on Sunday and they were under no obligation to do so, but those who did volunteer could avoid a cut in their rations!

The problem is that this “Pay for Performance” model has been convincingly shown to produce no improvement in outcome for patient. What it does do is to force doctors to spend unpaid time in front of a computer to enter orders, respond to pop-up windows, follow protocols and help the hospital code better (so they get paid better on your work). It causes doctors to avoid non-compliant and high risk patients to ensure that they get a good “report card”. It has a disproportionately negative impact on low income patients and minorities who frequently have more complicated medical problems and will be avoided by doctors –just to make the grade. It turns out that compliance with these measures had been shown to do nothing to improve patient outcomes and has had many adverse effects when doctors over-comply and push bad medical practice on inappropriate patients – for a report card score.

Compliance with these so called quality measures is nothing more than an excuse to find a way to pay doctors less and to create a schism between patients and their doctors. This is not quality, this is cost control through bureaucratic overload. I was in the room at the AMA meeting June 13, 2009 when President Obama pointed out that we would not be allowed to have effective tort reform, but if we simply followed “best practices” then we would somehow find a way to lessen our exposure. He didn’t explain how this will work, but I will here. I was here when he said doctors should not be bean counters but should be healers, yet he proposes to turn us into the biggest bean counters around! This is how you will be treated less badly than your colleagues:

Comply. If you comply with reporting – you won’t be hurt as badly.

Comply. If you comply with government defined “quality” – you might escape a sanction..

Comply. If you comply with rationing protocols – you will be paid slightly more than another doc, but still far less than you should.

Comply. If you follow a so called “best practice” and are labeled a “meaningful user” and a good doctor – you might get a little tort relief.

Comply. If you do what you are told, and keep your mouth shut we may let you keep your licensee, your practice, and your participation on the provider panel - but not your dignity and not your profession.

Comply. Comply. Comply.

I am a professional. I will not comply with cookbook medicine and rationing to satisfy politicians who have made promises that can not be kept. Medicare has an $86 trillion unfunded liability. Instead of reform of that insolvent program, we are asked to ration care. We will be FORCED to ration care and deny valuable treatments to our seniors and to withhold life saving care in the hospital when the government determines they don’t meet the threshold for cost of treatment under a “quality adjusted life year” as is used in Britain now[3].

I am a professional and I will not be told how to practice medicine by a hospital administrator, a corporate CEO or government committee.

I am a professional and I will not be used as a rationing tool to save money for others.

I am a professional and I will set my prices and give my patients the time they deserve to make medical decisions that benefit them.

I am a professional and I can’t be replaced by a nurse practitioner or other provider that claims to be able to practice medicine at a cut rate.

I am a professional and I will work to make sure I hold my colleagues to the high standards we expect of each other and not accept sham peer review and “disruptive physician” star chambers.

But like you, I am also compassionate and will work to make sure that government and charity assistance is there for the needy – and not merely an economically unsustainable entitlement that benefits no one even though they are “covered”. I will provide charity when I can afford to stay in practice for those who are truly in need – not forced to provide free care to anyone the government chooses.

Because I am an American, I am rising up to stop this so called health system reform train. I ask you to join me, because as it turns out DOCTORS ARE THE MOTOR THAT DRIVES THE TRAIN – if we stop providing care, the train stops. If we call to our patients and tell them they are in danger, they will come to our aid. Now is the time for bold action and we must use the tools our forefathers gave us to do so: freedom of speech, freedom of assembly and freedom to petition our government. That is why hundreds of thousands of Americans are marching in the streets in July against government-run medicine. They need your help and your leadership.

So I am calling on you to join your patients, me and other doctors around our nation who want to save your profession from the bureaucrats, bean counters and politicians. Here is how you can help.

Join the fight. Sign up to volunteer at Go to

Spread the word. Write a letter to your patients. Host a town hall meeting in your community together with local groups. They love when doctors come to speak and they will welcome you. Tools will be available for you to use at
March on Congress in Your Community. There are “Healthcare Freedom Tea Parties” organized in Florida on July 2nd ( and nationally on July 17 at Congressional offices ( Join up. Speak there. Bring friends.

Keep the Pressure on Congress and in the Public all summer. You will need to call your Congressman and write them. You will need to write letters to the editor, op. ed. pieces and volunteer for radio shows. Our speakers bureau at can help.

Join the AAPS. 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.

Take Control of Your Medical Staff Officers. Tell them to stand up for your rights and true quality care. Tell them to stop allowing administration to place endless protocols, computerized work and nonsensical forms on your practice. Have your medical staff hire its own attorney – don’t use the hospital attorney. Incorporate separately from the hospital.

Consider donating. I am writing for myself, so won’t be specific. But it is hard to win against a well funded political machine on blood sweat and tears. Find a group that supports this cause and help them financially.

Consider dropping third party payer contracts and Medicare. At what point will you leave the medical police state? When you are fully chained and in control. You won’t be able to leave then. I have dropped United, Medicaid and am working to drop others – not for the money, but to avoid the control they would place on my practice.
This is your last chance. I hope you will join your patients, your fellow doctors and me and rise up to rescue medicine and usher in a new golden age of medicine that comes from a truly free market.

Then you will be able to trust your doctor when you need them, and your patients will too.


David McKalip, M.D.

*Dr. McKalip is a private practice brain and spine surgeon in St. Petersburg, Florida. He is the President-elect of the Pinellas County Medical Association, President of the Florida Neurosurgical Society, serves on the Board of the Florida Medical Association (FMA) and is on the Florida Delegation to the AMA’s key policy making body, the House of Delegates. He serves as the Chairman of the Council on Medical Economics for the FMA and lead the effort to write a health system reform plan for the FMA that focuses on individual financial empowerment of patients. Dr. McKalip founded Doctors for Patient Freedom and is working to ensure that individual savings, choice and competition create better and more affordable medical care for Americans. Dr. McKalip has written and spoken on the unintended consequences of expanded government and corporate control of health care financing and medical decision making including rationing, cookbook medicine, unsustainable economic models for government and unaffordable or unavailable private insurance products and financing options for patients.”

[1] Dr. William Plested, a liberty-loving past president of the AMA stood apart from many and pointed out the characteristics of our Profession in 2006.

Long years of intensive education and training established by the members of the profession;
Standards of behavior and ethics established by the members of the profession;
Disciplinary procedures and actions that are established and enforced by the members of the profession and, The valuation of professional services established by the members of the profession.
[2] While an insurance mandate may sound good at first, it is soon to be followed by a mandate for doctors to take the insurance – no matter what it pays or what onerous regulations it imposes on medical practice. The state of Massachusetts now must spend $869 million to subsidize people to buy insurance, there are long waits for primary care doctors, the public hospitals are being paid less and there is intense pressure to impose cost control policies on doctors like bundling, global payments and efficiency measures!

[3] Dr. Ed Annis warned us of this when, the night after President Kennnedy gave the worse speech of his career in support of Medicare, in an empty Madison Square Garden he warned Americans about Medicare. “This Bill would put the government smack into your hospitals! Defining services, setting standards, establishing committees, calling for reports, deciding who gets in and who gets out-what they get and what they don't-even getting into the teaching of medicine-and all the time imposing a federally administered financial budget on our houses of mercy and healing. It will create an unpredictable burden on every working taxpayer. It will undercut and destroy the wholesome growth of private voluntary insurance and prepayment health plans for the aged which offer flexible benefits in the full range of individual needs. It will lower the quality and availability of hospital services throughout our country. It will stand between patients and their doctors. And it will serve as the forerunner of a different system of medicine for all Americans." Medicare was killed that year and was only passed on a slim margin in 1965 with President Johnson trading on the image of the “martyred President” and using his classic strong arm tactics.

((This was emailed to me, but I cannot find it posted on Rep. Marchant's website - apologies if this is being mistakenly attributed to the Congressman....))

U.S. Congressman Kenny Marchant
Proudly Representing the 24th District of Texas
Special Bulletin: September 23, 2009

10 Facts Every American Needs to Know about the Baucus Bill

Here are the top 10 facts every American should know about Senator Baucus’ proposed government takeover of health care:

1. Medicare Cuts Mean Reduced Benefits, Fewer Choices for Seniors. The Baucus plan cuts Medicare by nearly $500 billion, slashing coverage millions of seniors depend on. These benefit cuts will ultimately eliminate choices currently enjoyed by seniors today. Doug Elmendorf, the head of the nonpartisan Congressional Budget Office, told the Senate Finance Committee yesterday he “expected the Medicare Advantage plans to lose 2.7 million enrollees over the next decade” as a result of the Baucus plan.

2. Individual Mandate Results in Hefty Tax Increase for Millions of Americans. The Baucus plan mandates that every American buy health insurance or pay a hefty new tax to Washington of up to $1,900 per year. This new tax will take another $20 billion hard earned dollars from working families. Especially during a recession, this new tax will place another large burden on the family budget.

3. No Junk Lawsuit Reform to Reduce Health Care Costs. The Baucus plan includes only a “Sense of the Senate” with respect to the very pressing issue of junk lawsuit reform. Serious changes are needed to reduce costly, unnecessary defensive medicine practiced by doctors trying to protect themselves from a feeding frenzy of trial lawyers. The Baucus plan misses an opportunity for real reform.

4. New Taxes Harm Small Businesses, Costs Jobs. The Baucus plan saddles small businesses that have more than 50 employees with a new tax of up to $199,600 per year if they do not provide health coverage to their employees. Census data compiled by the Small Business Administration, however, reveals that the Baucus “small business exemption” – for businesses with fewer than 50 employees – will still subject many small employers to new taxes and mandates. In fact, this so-called “exemption” could still subject 220,000 small businesses that employ 44% of all small business employees and 22% of the entire private sector workforce to the new taxes and mandates. The 220,000 small businesses targeted by the Baucus plan employ 26.4 million employees and provide those employees $982 billion in wages annually.

5. Higher Health Care Costs for Working Families. The Baucus plan would actually raise insurance premiums for working families, not lower them. In a letter to Chairman Baucus, the nonpartisan Congressional Budget Office stated, “premiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market…” Meanwhile, a recent study published in Health Affairs found that a government-run plan similar to the one being proposed in House Democrats’ bill could cause annual insurance premiums for a family of four to increase by more than $4,500.

6. $420 Billion in New Tax Increases on Families & Small Businesses. The Baucus plan includes a host of new taxes on American families and job creators. Taxes on individuals who are uninsured, taxes on employers that do not offer health insurance coverage, and taxes on health care products like wheelchairs and other medical devices and insurance are just some of the more than $420 billion in new tax increases included in the bill. At a time when families and small businesses are already struggling to make ends meet, new taxes of this magnitude would only further slow the economy and raise the cost of care for those patients who need it most.

7. Lower Wages and More Unemployment. The Baucus plan would impose a new $27 billion tax on employers, including small businesses, that cannot afford to provide health coverage or that don’t offer coverage. The effect of this type of tax, similar to a payroll tax increase, would ultimately fall squarely on workers in the form of lower wages or reduced employment. In fact, the Tax Policy Center concluded that “economists generally believe that the burden of payroll taxes is borne by workers in the form of lower wages, regardless of whether the tax is levied on the employer or the employee.” The tax proposed in the Baucus plan will likely have the same effect.

8. Higher Taxes on American Manufacturers. In order to find revenue to “pay for” his plan, Senator Baucus included massive new taxes on various industry segments in the health care sector. These new taxes include $17.2 billion tax on pharmaceutical manufacturers, a $30 billion tax on medical device manufacturers, and a $45 billion tax on health insurers. These massive tax increases on American manufacturers will be passed on to American families, and they will make the cost of health care more expensive. These tax increases will also serve as a major disincentive for innovation, capital investment and job creation. With some Senate Democrats clamoring for additional – and costly – subsidies, how many more tax increases will be added before it goes for a vote in the Senate? When will Democrats reveal what other tax increases they have in store for American working families and employers?

9. A Lack of Support From Senate Democrats. Key Senate Democrats have voiced concern about the Baucus plan, including Senator Jay Rockefeller (D-WV,) who said “there is no way” he would support it “unless it changes in the amendment process by vast amounts.” What’s more, Senator Bill Nelson (D-FL) described the Medicare cuts in the Baucus plan as “intolerable” in remarks on the Senate floor last week, while Senator Ron Wyden (D-OR) “complained the legislation would ask working Americans to commit as much as 13% of their income to buy basic insurance,” calling it a “real hit on middle-class families.”

10. Is the Baucus Plan Written in Invisible Ink? While House Democrats have marked up legislation in three different committees, the Senate Finance Committee is taking a different approach. The Committee is working off of a framework document that summarizes what they would like to do, but doesn’t offer specifics on how it would be done. That leaves big questions about just how this plan will work and doesn’t allow for a full and transparent debate on the plan. At a time when the American people are asking their legislators, “Have you read the bill?” the clear answer among Senate Finance Committee members will be “no.”

BONUS: House Republicans have offered fiscally responsible solutions to make health care more affordable and accessible for every American. Our proposals recognize the need to implement reforms that build on what works in health care, rather than replacing it with a one-size-fits-all government-run system.

I am honored to represent the 24th District of Texas, and appreciate your interest in my e-newsletter. Please contact my District or DC office with any further questions you may have or visit my website at You can also become my Facebook friend here or follow me on Twitter at

Kenny Marchant
Member of Congress


From the Heritage Foundation

September 25, 2009
The Baucus Health Bill: A Medicare Physician Payment Shell Game
by Dennis G. Smith
WebMemo #2629
My colleagues, this is our opportunity to make history. Our actions here, this week, will determine whether we are courageous enough and skillful enough to change things for the better.

--Senator Max Baucus, addressing the Senate Finance Committee on September 22, 2009

For all of the bold talk of reform, the provisions of the Senate Finance Committee bill are simply more of the same. This is evident in the way the committee is evading the systemic problems that Congress created with its updates to its flawed Medicare physician fee schedule.

Since the federal government apparently cannot ensure beneficiary access in the current Medicare program--and since government price controls like those used in Medicare do not work--trapping more Americans into such a system through a government health insurance plan does not make sense.

Medicare Payment Update

Medicare reimburses doctors and other medical professionals for their services according to a congressionally created fee schedule that is annually adjusted by the Sustainable Growth Rate (SGR) formula. Enacted in the 1990s, the SGR is primary evidence of how Congress tries and ultimately fails to "bend the curve" of the health care costs in Medicare.

The idea is relatively simple: If Medicare spending grows faster than our overall economy (which is almost always the case), then payments to Medicare providers are to be reduced proportionately to keep expenditures in line over a period of time. Each year, the Centers for Medicare and Medicaid Services estimates how much the physician fee schedule update will have to be reduced the following year in order to meet the target Medicare expenditures on physician payment. The 2010 update, for instance, reflects expenditures from April 1, 1996, to December 31, 2009.

A Political Volcano

If the SGR update goes into effect in 2010 as planned under current law, it will result in massive Medicare payment cuts. But every year, Congress--under both Democratic and Republican leadership--routinely blocks the cuts from going into effect for a year or two at a time. At the same time, House and Senate leaders have left intact the underlying requirement to keep doctor payment below the rate of GDP growth.

Subsequently, the necessary cumulative cut in Medicare payments grows bigger. Without a change to current law, payments to physicians would be reduced by 21.5 percent as of January 1, 2010, and by an additional 5.5 percent each year from 2011 through 2014 (and a small reduction in 2015).[1]

The Baucus Proposal

In his opening statement to the Senate Finance Committee on September 22, Chairman Baucus acknowledged the failure to address the problem: "On one point, I want to acknowledge up front that we did not do as much to correct the payment of doctors under the incredibly misnamed 'Sustainable Growth Rate.' The SGR needs to be fixed permanently."[2]

But instead of fixing the SGR, the Senate Finance Committee bill repeats the prior pattern by providing a payment increase for 2010 and then pretending it did not happen. The reason for this one-year change in the update is obvious: Fixing the problem long-term would cost $200 billion over 10 years.[3] Steny Hoyer (D-MD), the House majority leader, rightfully called the Senate Finance Committee proposal a fa├žade.[4]

Earlier this summer, the American Medical Association told its members that Congress would "erase" the SGR problem.[5] Fat chance.

The Price of Price Controls

The SGR issue should be appropriately viewed as a microcosm of current efforts to overhaul the health care system. The inclusion of the SGR provisions in the Senate and House bills is a tactical admission that Medicare beneficiaries' access to care is being threatened--potentially a form of rationing. Two years ago, when proposed SGR reductions were more modest than they are now, a poll of physicians found that 60 percent would limit the number of Medicare patients they accept and 14 percent would stop seeing Medicare patients entirely if these cuts went into effect.[6]

The SGR does not even accomplish the objective it was created to achieve: to bend the cost curve in Medicare. Payments to physicians continue to exceed overall economic growth. Two years ago, Dr. Cecil B Wilson testified that "spending targets cannot achieve their goal of restraining volume growth by discouraging inappropriate care. Spending targets apply to a whole group and, therefore, do not provide an incentive at the individual physician level to control spending. In addition, they do not distinguish between appropriate and inappropriate growth because they apply across-the-board to all services. In addition, spending target systems are based on the fallacious premise that physicians alone can control the utilization of health care services, while ignoring patient demand, government policies, technological advances, epidemics, disasters, and the many other contributors to volume growth."[7]

Special Interest Lobbies

In addition to the budget problem, fixing the SGR poses a problem for seniors as well. Physicians are paid out of Medicare Part B, the Supplementary Medical Insurance Trust Fund (SMI) portion of Medicare. Even though SMI is heavily subsidized by taxpayers, non-disabled Medicare enrollees are required to pay 25 percent of Part B costs. (Originally, beneficiaries paid 50 percent of the costs.) So if physician payments go up, the cost of the entire program goes up, increasing the amount of the 25 percent share that beneficiaries must pay.

Congress enacted a temporary "hold harmless" provision to shield most seniors from a premium increase in 2010 because they will not receive an increase in their Social Security benefits. The cost, however, is passed along to other Medicare beneficiaries. Of course, now that that reality approaches, Congress is considering spending another $2 billion to pick up the tab.

Central Planning Failures

As SGR and the history of Medicare demonstrate, the federal government has constantly intervened in the payment systems and increased massive cost shifting. The classic scenario is constantly repeated: Politicians over-promise (more benefits, lower costs to the beneficiary), the budget hemorrhages, politicians apply a tourniquet to stop the fiscal bleeding, and the short-term fixes create even greater long term problems.

History, not hysteria, is why so many Americans (especially seniors) are skeptical of the political promises of more while achieving budget neutrality. Government cannot deliver more services for less than the value of what is being provided. Government surpasses the private sector only in its ability to hide the true cost by forcing someone else to pick up the tab. Someone has to pay, which means politicians are constantly trying to pass the burden around like a hot potato among providers, beneficiaries, current taxpayers, and future taxpayers. Whoever is left with the unwanted cost protests, and the contest starts all over again.

The very idea that government is more efficient than the private sector is comical. Why did so many state and local governments get out of the direct delivery of health care services in the 1960s and 1970s? Because of government inefficiencies.

Medicare's SGR problem is another chapter in the big book of government central planning, an epic failure and a fountain of unintended consequences.

Dennis G. Smith is Senior Fellow in the Center for Health Policy Studies at The Heritage Foundation.

[1]2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, May 12, 2009, p. 22, at (September 24, 2009).

[2]Press release, "Opening Statement of Senator Max Baucus (D-Mont.) at Today's Mark-Up of the America's Healthy Future Act," September 22, 2009, at (September 25, 2009).

[3]Douglas W. Elmendorf, director, Congressional Budget Office, letter to Charles B. Rangel, chairman, Committee on Ways and Means, U.S. House of Representatives, July 17, 2009, at (September 25, 2009).

[4]Corey Boles, "Rep Hoyer Calls for 10-Year Fix for Medicare Payments,", September 22, 2009, at
itle=update-rep-hoyer-calls-for-10-year-fix-for-medicare-payments (September 25, 2009).

[5]American Medical Association, "AMA Support for H.R. 3200: Answers to Frequently Asked Questions," July 20, 2009, at
/HR3200FAQs_72009_AMA.pdf (September 24, 2009).

[6]Medical News Today, "60% of Physicians Would Limit Number of New Medicare Patients If Scheduled Payment Cut Is Enacted, AMA Survey Finds," June 7, 2007, at (September 24, 2009).



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