Monday, October 5, 2009

Liability and Health News Update - Call the White House and the State House TODAY

10/5/09 - Liability and Health News ALERT
Call the White House and the State House TODAY

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

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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.




THREE action requests today, folks, with thanks in advance for your help.

ONE - Call the White House to tell the President that the 50 hand-picked doctors meeting with him in support of his health care plans do not speak for America's doctors. More info follows from The White House phone number is 202-456-1414.

TWO - Call the State House, and tell Gov. Rendell, Sen. Scarnati and Rep. McCall that it would be unconscionable to drain the state's Mcare Fund to balance their budget. Details follow right after my Commentary.

THREE - Please call your members of Congress on Tuesday, as part of National Call Congress Day, sponsored by the same people who brought us the Hands off My Health Care bus tour. Call your US Representative and your two Senators - in PA, that would be Arlen Specter and Bob Casey. Tell them health care reform is too important and too complex to rush. Tell them you want to READ THE BILLS. Tell them THEY SHOULD read the bills. Details follow

By now you've likely all heard that there is STILL no budget deal in the PA Capitol. There is, apparently, a "new plan," but no one's releasing the details yet....

The noise being made by PA's taxpayers, not for profit organizations and other groups HAS been heard in Harrisburg, and various aspects of the state budget deal have been changed in order to accommodate what people are making the most noise about.

The noise we've made so far about what a HUGE mistake it would be to raid the state's Mcare fund has not yet caused legislators to pull raiding the fund off the table - but it IS making them nervous. Legislators' offices have received HUNDREDS of phone calls from people demanding that the state insurance fund that is supposed to pay medical liability claims NOT be taken away to balance the budget.

YOU have made that difference, and if we keep making noise, we just may force them to look elsewhere for the money to balance their budget. If you've called your legislators, please call them again.


If you haven't made any calls yet, PLEASE DO IT TODAY. Contact information follows in the first item.

Please call your personal state representative and senator, as well as legislative leaders. It's easy to find them through the PA Medical Society's Capwiz feature, that allows you to access contact information for your own legislators by entering your zip code:

If we keep making noise, we just may force them to look elsewhere for the money to balance their budget. Or, here's a novel thought - maybe they could CUT THEIR EXPENSES, the way taxpayers and small businesses and doctors' offices have had to do in order to make ends meet. They are, after all, the largest full time legislature in the nation, with one of the largest budgets - and yet, they are the only state legislature in the nation which hasn't been able to come to an agreement on next year's budget. So they're still looking for places to "find" more money - except that it's YOUR money they want to use to fund....well, really necessary stuff like new sports stadiums....

Here's a quick primer on the Mcare Fund for the many new readers of Liability and Health News Update who are not medical professionals who've been listening to me expound on medical liability reform and the Mcare Fund for years...with my apologies for not doing this sooner.

Docs and other health care professionals who already know this stuff, please feel free to skip a couple of paragraphs.

Mcare (not an abbreviation for Medicare, although it IS confusing) is a state-run medical liability "insurance company," in which doctors, hospitals and other health care professionals in Pennsylvania are REQUIRED BY LAW to participate. If doctors and hospitals don't pay into Mcare, they lose their licenses to practice medicine - they also lose their licenses if they don't also pay commercial medical liability insurance companies for a primary layer of coverage. So doctors and hospitals in PA have to buy TWO layers of malpractice insurance - half from a commercial company, and the other half directly from the state of Pennsylvania.

The Mcare Fund covers the cost of malpractice awards that are OVER $500,000. The state doesn't run Mcare exactly like an insurance company, though - real insurance companies must have cash reserves and assets which ensure that they can pay out on both current and future claims. Mcare has no mandated cash reserves; it is essentially a "pay-as-you-go" system.

Doctors and hospitals are assessed an Mcare "surcharge" each year, based on the paid claims from the previous year, as well as their annual commercial malpractice premiums. Just as an example, a general surgeon in PA paid around $20,000 to Mcare last year (in addition to close to $100,000 in commercial malpractice premiums.) The percentage of the annual surcharge changes annually, based on the amount of paid claims - so if there are unusually high payouts in a given year, the following year's surcharge is higher.

During the height of PA's medical liability crisis, when commercial malpractice premiums were rising between 20 and 50% each year (and totaled over 200% over several years), the state conceived a way to help doctors and hospitals to continue to provide medical care in PA (although we lost MANY fine medical professionals, maternity wards and even some trauma centers as a result.) A portion of what people pay for moving violations (speeding, etc.) was devoted to the Mcare Fund - about $44 million a year. Then, a dedicated tax of $.25 per pack was passed on all cigarettes sold in PA, and that money was placed into the Mcare Fund as well.

These added sources of revenue to the Mcare Fund were created so that the state could provide an "abatement" on the annual Mcare surcharges that PA's doctors and hospitals were required to pay. Even though the state wasn't able to reduce skyrocketing commercial medical liability premiums, they were able, through these new revenue sources, to reduce the amount doctors and hospitals paid for the state-run "insurance" company. The highest risk specialists, ob/gyns, general surgeons, neurosurgeons and orthopedic surgeons, who pay the highest commercial premiums (some neurosurgeons pay over $200,000 a year for coverage) were given a 100% abatement of their Mcare surcharge - or roughly 20% of their total medical liability premiums..

They still had to pay their outrageously high commercial premiums, but not paying the state helped many of them who might otherwise have been forced to leave Pennsylvania to keep practicing here. Other physicians were granted a 50% abatement. It helped A LOT. (Well, partly because doctors were forced to practice medicine in Pennsylvania the for year they received the abatement, as well as the FOLLOWING year, or they would have to pay it back plus penalties - but the whole indentured servitude issue is moot at this point....)

But the abatement program ended in 2008, because Gov. Rendell wanted to use surplus monies in the fund to create a new state-run health insurance company to cover PA's uninsured, and told the state Senate that he would veto any measure to continue the abatement program that wasn't attached to a comprehensive health insurance plan. Along with the Democrats in the House, Gov. Rendell effectively blocked passage of the abatement in 2008, using doctors (and their patients) as political pawns to get what he wanted. He didn't get the insurance plan - but PA's doctors and hospitals didn't get their abatement, either, and so were forced to pay the full cost of their Mcare surcharges.

The moving violation fees and the cigarette tax dollars continued to flow into the Mcare account, ALONG WITH the physicians' and hospitals' payments (in effect, paying into the fund TWICE), creating a surplus that even Republican senators who'd opposed the governor's plan to use the monies for health insurance for the uninsured couldn't resist tapping into it to balance the state budget. (Personally, I would have preferred to see it used to buy insurance for the uninsured, if we HAD to lose it. At least it would have been used for something vaguely resembling healthcare....)

So there's no longer an abatement (and no longer a financial reason for PA physicians who can't afford their malpractice premiums to keep practicing here), but there ARE still claims in the Mcare "pipeline." Medical malpractice cases have to be filed within two years of the alleged injury; then, they can take 5-10 years to reach a settlement or a courtroom. (Yes, I agree, the system stinks - for everyone. Well....everyone except the lawyers....) Since there are no cash reserves in the Mcare Fund, and if the state takes both the existing Fund and its funding sources (the moving violation fee and the cigarette tax) for the general budget, as those cases reach their conclusion, there won't be any money in the fund to PAY them. And if that happens, it's not unreasonable to assume that the state will simply BILL THE DOCTORS AND HOSPITALS to cover the costs.

Experts estimate that there's a potential $1.6 BILLION unfunded liability in Mcare that will come due in the next 5-15 years. It had been hoped by the medical community that the surplus in the Mcare Fund, fed annually by doctors' and hospitals' premiums and the dedicated taxes, would be kept available to cover those future expenses. In fact, the Governor's own Office of Health Care Reform website spells out the plan that would have accomplished that. At least, it was still up on the site last week....

Billing PA's doctors and hospitals for that unfunded liability, even over several years, would crush the state's medical economy, and serve as a major deterrent to young doctors to practice medicine here. Why would any young doctor with half a brain (and they all have fairly substantial brain power, thank you very much) come to a state which plans to impose an annual surcharge to pay off medical liability claims for injuries incurred before they ever applied for a Pennsylvania medical license? It doesn't take a brain surgeon to figure out that young doctors would stay away from Pennsylvania in DROVES....the young doctors we train here already leave the state in alarming numbers....

Bottom line - monies in the Mcare Fund were supposed to have been devoted to either compensating injured patients for medical mistakes, or helping doctors and hospitals to cover the high costs of medical liability insurance. Neither of these issues has gone away. Malpractice premiums in Pennsylvania are still among the highest in the nation, and there are still unfiled cases which will require eventual payment from the Mcare Fund.

To be fair, I can see how legislators might believe it's OK to take the tax dollars paid into the Mcare fund if they perceive (mistakenly) that the funding is no longer needed for that purpose. However, I CANNOT see how it is acceptable, in anyone's vision of right, wrong or expedient, to take doctors' and hospitals' premium dollars, paid in good faith into a fund that is SUPPOSED to protect their patients if a medical mistake occurs, for general expenditures.

That would be like, well, taking the money you paid into your government-run health insurance company and using it to, say, build sports stadiums....Not that we currently PAY money into a government-run health insurance company, so that couldn't happen....oh, WAIT.....

Remember the Social Security lockbox? WHAT lockbox, you may say?

Something to think about, isn't it?

Please call your state legislators today - and while you're on the phone, dial up the White House, too, to tell the President that not EVERY doctor and not EVERY patient agree with the concept of government-run health care....scroll down for instructions, the phone number, and an extremely informative video of Congressman Tom Price, MD.

Then, read the op-ed from the Wall Street Journal by three former Presidents of the AMA, including the brilliant and charismatic Dr. Donald Palmisano, who are NOT on board with existing health care reform plans.

Actually, the AMA and the American College of Surgeons, both of which endorsed HR3200, have problems with the Senate Finance Committee Bill and have NOT endorsed it at this point.

THANK YOU ALL for your commitment to quality health care and for the kind words and encouragement you've offered during the current "subscription" process for continued receipt of Liability and Health News Update.

I honestly had no idea there were so many of you out there reading and appreciating my little email newsletter until the subscription requests and supportive comments starting bombarding my "in" box. I'm touched and humbled by your appreciation and faith, and will endeavor to keep it up as long as the service is needed.

If you haven't subscribed yet, please do so soon. This is one of the last newsletters I will send to the "old" list.

Thank you all.



From our friends at the Pennsylvania Medical Society:
Budget Deal Starting to Unravel

Put Lawmakers and the Governor on Notice: Don't Balance the Budget With a Tax on Physicians

Lawmakers are still struggling this week—possibly into the weekend—to cobble together a deal on the state budget. Your calls are part of the public outcry that’s making them sweat and the deal unravel.

Teetering on the edge of the table is more than $100 million of your money paid to the state mandated Mcare Fund for your liability insurance coverage. Diverting your premium dollars to balance the budget is a profound violation of trust—both to physicians and to their patients.

This breach of faith will have repercussions far beyond the Mcare Fund. Imagine trying to recruit young physicians to come to Pennsylvania after they find out Pennsylvania has created, in essence, a “physician tax.”

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

Please take a few minutes to call these legislators and Gov. Ed Rendell—and if you've already called, call again:
Gov Ed Rendell—(717) 787-2500
Sen. Joseph Scarnati, Senate President Pro Tempore—(717) 787-7084
Rep. Keith McCall, House Speaker—(717) 783-1375

Your message: “Don’t use any of my liability insurance premiums to balance the state budget.” Be sure to tell them where you practice.Thank you for speaking up to save health care dollars.

Last Updated: 10/2/2009

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:

Your message: “I strongly urge you to oppose any proposal that uses Mcare insurance premiums to balance the state budget.” Be sure to tell them where you practice. (Or where you live.)

Also from the PA Medical Society website:
How Can Legislators Oppose Tobacco Tax, Yet Support of Mcare Fund Raid?

Opposing a tax on smokeless tobacco and cigars while supporting the raid of the Mcare Fund makes no sense, Pennsylvania Medical Society President Daniel J. Glunk, MD, wrote to Senate Republicans on Oct. 2, 2009.

The Senate Republican caucus has declared its opposition to the smokeless tobacco and cigar tax proposed by Democrats in the state House of Representatives. Yet, the caucus has not opposed using more than $100 million from the Mcare Fund to balance the state budget.
This money was paid by physicians as an insurance premium and using it in any other way amounts to a tax on physicians.

“Where I come from, a tax is a tax. What the physician community, and I personally, cannot understand is your insistence on a new tax on health care providers and hospitals—and by extension patients—while you oppose taxing smokeless tobacco and cigars,” Dr. Glunk wrote.

The Pennsylvania Medical Society is aggressively campaigning to preserve the money in the Mcare Fund. The physician community has rallied to the cause as well, inundating legislators with phone calls and emails. The Society thanks physicians and others who have taken action on this vital issue.

Last Updated: 10/2/2009


from the PA Medical Society website:
Mcare Fund Raid Facts and Misconceptions

The proposed Mcare Fund raid to balance the state budget has rightfully angered Pennsylvania physicians. I hope the information below will clear up any misconceptions you may have about the Fund. This information will help you talk to your legislators about Mcare. Daniel Glunk, MD, President, Pennsylvania Medical Society

Misconception (in black)
Fact (in red)

The Mcare Fund balance is made up of cigarette tax revenues or Auto CAT Fund surcharges.
Mcare Fund balance resulted from excess premiums paid by physicians, hospitals, nurse midwives, podiatrists, and nursing homes.

The Mcare balance is excess money that is not needed to pay claims.
The Mcare Fund says that if claims payouts exceed
annual assessments, the balance can be used to shield providers from premium spikes.

The Mcare Fund balance is available to balance the budget.
The Mcare Fund balance is the subject of
ongoing litigation and may be required to be used to lower Mcare assessments.

Physicians have received nearly a billion dollars in Mcare abatements.
Although the legislature granted $946 million in abatements between 2003 and 2007, the Rendell administration only transferred $330 million from the Health Care Provider Retention Account to the Mcare Fund to pay for them. To a large extent, physicians paid for their own abatements through inflated Mcare assessments.

Raiding the Mcare Fund balance will have little impact on future assessments charged to physicians and hospitals.
The Mcare Fund has an
unfunded liability of $1.66 billion. Every penny taken to balance the budget will have to be recouped from health care providers to retire that shortfall.

Taking money from the Mcare Fund to balance the budget isn’t a "big deal."
Physicians and injured patients trust the state to run the Mcare Fund for their benefit. Raiding the Fund is a fundamental breach of faith, and will destroy any remaining belief in the Mcare Fund’s integrity.


ACTION ALERT: Call the White House on Monday October 5th!
Congressman Tom Price, M.D. is urging everyone to call the White House this Monday October 5th.

The White House phone number is 202-456-1414.

Let the President know that you do not want government medicine.

CLICK HERE for video of Dr. Price explaining what to do on Monday.

Here is what Dr. Price is asking us to do:

1. CALL THE WHITE HOUSE ON MONDAY! The President is meeting with a handpicked group of docs who agree with him. He needs to hear from doctors inthe community who disagree with him. CALL ON MONDAY TO: 202-456-1414

2. Encourage your Physician Colleagues to do the same. Forward this email toyour medical associations, post the phone number of doctor dining roombulletin boards and talk to your colleagues in the corridor.


((Updated Alert from Take Back Medicine Sunday evening:))

Physicians MUST Take Action MONDAY!

Tomorrow, President Obama is meeting with 50 physicians (one from each of the 50 states) at the White House. It is thought that he is going to use this as an opportunity to show that he and physicians are working on a unified front on health care. I ask you to let your voices be heard loud and clear on Monday by taking the following action steps:

1. Call the White House (202-456-1414) and say that these physicians visiting the White House are not speaking for the majority of physicians. Tell the White House to let the President know that you are opposed to any public option or mandate.

2. It is imperative that all doctors across this country contact the local media in your community. This includes newspapers, radio, and T.V. Inform the media that these 50 physicians don't speak for the majority of physicians. You can find your local media contacts here:

These action steps need to be done first thing Monday morning. We are doing all we can to get the word out that the physicians meeting at the White House do not represent the majority of physicians in this country. We need your help!

Thank you for all that you are doing! Keep up the fight!

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Wall Street Journal
OCTOBER 4, 2009, 7:03 P.M. ET
What We Would Have Told Obama
Though we weren't invited to the White House, here are better ideas to increase coverage for the uninsured.


We aren't among the doctors invited to a Rose Garden event today to "join the President in pushing for health insurance reform this year and [who] have offered their help and support," as a White House press release put it. It's unfortunate only supporters of the president's plans will be there. Mr. Obama has missed an opportunity to learn more about the real issues facing patients and doctors and to formulate a plan that truly puts patients in control with doctors as trusted advisers.

The United States has the best health care in the world today, and thanks to the ever-expanding frontiers of science and medical innovation the brightest days are ahead. It is true that there are Americans who fall through the cracks of our medical system every day—and as a caring nation, we must do what we can to expand access to medical care to those who need it. But this can be accomplished without a costly and inefficient government overhaul of the entire system. One easy reform would be to enable individuals to buy policies offered in any state, not just where they live. This will enhance competition. But more government-run health insurance will only lead to disaster.

Today, Medicare already reimburses doctors less than what many of their treatments cost to provide. Now the government is saying that additional Medicare cuts are coming—thus forcing doctors to try and make up the difference in volume, by seeing more patients. If you ask patients about this, they understand that more volume means less time with the doctor. That's something that all patients and doctors should oppose. In time, it will be difficult to find a physician.
If the goal of reform is to provide the best possible patient care, let's take the government-controlled "public option"—and any legislative trick that could lead to a public option—off the table. It will result in long waiting lines to see a doctor, substandard care, and an end to medical discovery.

There are many other ways to expand access to health care for uninsured Americans. We could strengthen incentives to purchase low-cost health savings accounts, provide tax credits for individuals and families buying health policies on their own, and extend subsidies for those who need financial help. Also, the right of patients to privately contract with physicians to ensure they have the medical care they want, without penalty—regardless of what the government pays—must be recognized and protected. Today, if a doctor wants to bill a patient for additional payment over the Medicare reimbursement, he has to withdraw from Medicare entirely for two years. A patient who agrees with this arrangement can't receive any Medicare money for that service, either.

We need to maintain a plentiful supply of medical expertise. But cuts in payments and bureaucracy could mean fewer individuals entering the medical field—and a dearth of health-care professionals down the road as specialists retire early or limit their practice. Every patient wants to be taken care of by the best medical professional possible. A patient with cancer wants to see a doctor who has had years of training in oncology and is knowledgeable about the latest ways to beat the cancer. But in some provisions in the proposed legislation (such as the medical home model of HR 3200), physician assistants and nurse practitioners may get the authority to make important medical decisions.

The federal government should also continue its investment in medical research through agencies like the National Institutes of Health, and it should better reward innovative discovery in the private sector with tax incentives and patent protection. Americans are living longer, healthier lives thanks to the trillions of dollars in public and private research investment in medical devices, pharmaceuticals, and advanced surgical techniques. We must not put future progress in jeopardy.

Finally, the nation needs comprehensive medical malpractice reform. It is the surest and quickest way to slow down the rising cost of health care. Statistics from private insurers, as well as a Justice Department report of 2007, indicate that upwards of 80% of malpractice cases are closed without payment—and when there is a trial, the physician-defendant wins 89% of the time. Yet these lawsuits, even when dismissed or closed without payment, cost doctors time and money, and encourage defensive medicine. This adds billions to the cost of medical care. It also increases malpractice insurance premiums, the costs of which get passed on to patients. In too many cases, the malpractice environment forces doctors to leave communities, depriving patients of their trusted medical advisers or specialists whom they might need in an accident or other crisis.
The drive to reform health care has led to an acrimonious and often divisive debate. Yet we still believe that doctors, patients and legislators working together with goodwill can improve the medical system and extend its benefits to all Americans.

Dr. Palmisano, president of the American Medical Association from 2003-2004, is spokesman for the Coalition to Protect Patients' Rights, a group of more than 10,000 physicians. Drs. Plested and Johnson were presidents of the American Medical Association from 2006-2007 and 1996-1997 respectively.

((And here's a personal note from Dr. Palmisano, with whom I once had the distinct honor of sharing a podium - on the West Lawn of the Capitol. VERY cool....))

The comments are starting to come in, both to my DJP Update list, and to the postings at the Wall Street Journal online.

After you read the article Op-Ed in Wall Street Journal by 3 former AMA presidents re: HSR), consider adding your comments online at the WSJ.Article:

To post comments at WSJ:Go to:
Let the world hear it directly from the practicing doctor!
Donald J. Palmisano, MD, JD


from our friends at Doctor's Advocate:


The Rose Garden today becomes the Garden of Gethsemane.

Several physicians will travel to Washington D.C. today to voice their “support” for the White House’s health care reform proposals. This public relations opportunity could be a natural stepping stone for participating physicians to be nominated as a “Best Doc” in their city’s cultural magazine.
Their move, however, is a slap in the face to the physicians and patients who so desperately need the health care reform bill to include medical liability tort reform.

But then, there are always those doctors who are willing to take a day off to earn big bucks as expert witnesses against other doctors, and there are plenty who partner up with personal injury law firms to validate “medical malpractice.”

Call the White House today at 202-456-1414 to let the Obama Administration know that you will not support its health care proposals until it includes a provision to stop personal injury lawyers and unscrupulous patients from filing frivolous lawsuits. ---------------------------------------------------------------

Don’t let frivolous lawsuits destroy your career, your practice, and your family.

Call Doctor's Advocate today at 888-362-8202 or email to learn how you can stay in the exam room and out of the courtroom!

© Copyright 2009 Doctor's Advocate. All rights reserved.
Contact Doctor's Advocate:888-362-8202 Copyright © 2006-2009 Doctor's Advocate

House, Senate Leaders Prepare for Floor Debate
Shailagh Murray and Lori Montgomery
Washington Post Staff Writers Friday, October 2, 2009; 10:43 AM

The long quest to reform the nation's health-care system entered uncharted legislative territory early Friday when a key Senate panel wrapped up work on its bill and House and Senate leaders prepared for historic floor debates.

The Senate Finance Committee, the fifth and final congressional panel to contribute to the legislation, dispensed with its last amendment at 2:08 a.m., sending President Obama's top domestic policy initiative to a threshold that has eluded presidents since Harry S. Truman. As the panel completed the measure that is expected to form the backbone of health-insurance reform legislation, a political consensus large enough to carry the plan to final passage appeared to emerge.

In a statement issued early Friday, Obama hailed the bill authored by Senate Finance Committee Chairman
Max Baucus, calling it "another milestone in our effort to pass health insurance reform." As a result of lawmakers' work, "we are now closer than ever before to finally passing reform that will offer security to those who have coverage and affordable insurance to those who don't," he said.

"We have a long way to go," Obama said, but he expressed confidence that Congress would pass a reform package "this year."

Baucus (D-Mont.) delayed a committee vote on the overall bill until next week, though he said he has enough support to pass the package out of committee. The bill, which Senate Majority Leader
Harry M. Reid (D-Nev.) will merge with a Senate health committee measure, appears to meet the reform criteria Obama laid out last month in an address to Congress.

"We can all be very proud of what we have achieved here," Baucus said as the committee's work drew to a close, after churning through 564 amendments.

"This bill will lower taxes for more than 42 million Americans and reduce the federal deficit," he said in announcing the completion of work on the package. "This bill will protect Medicare benefits for seniors. This bill will significantly expand health coverage."

The battle lines for the remainder of the debate were clearly drawn during the committee's deliberations and centered on how the bill would affect the middle class.

Republicans on the panel said the measure was riddled with revenue provisions that would violate Obama's 2008 campaign promise not to raise taxes on middle-class Americans. "There are going to be a lot of people whose taxes are increased by this legislation," said
Sen. Michael D. Crapo (R-Idaho).

Democrats said broad support for reform would drive the effort forward. "Every Democrat, from the most liberal to the most conservative, realizes that it serves America's interest and our own interest to pass a bill," said
Sen. Charles E. Schumer (D-N.Y.).

The Finance Committee's package seeks to dramatically reshape the health insurance system by improving coverage for those who have it and making it more affordable for the millions of Americans who do not. It would prohibit private insurers from denying coverage based on preexisting conditions and bar them from limiting benefits, either annually or over a lifetime.
For the uninsured, the measure would create state-run insurance exchanges, where low- and moderate-income people without access to affordable coverage through an employer could shop for policies and apply for federal subsidies to mitigate the cost of premiums. And the bill would vastly expand Medicaid, the government health program for the poor, adding more than 10 million people over the next decade, according to the nonpartisan Congressional Budget Office.

One final piece of committee business was among the most significant: a measure that would have the effect of exempting 2 million people from the requirement to buy insurance and remove any possibility that people could face criminal penalties if they did not do so. The amendment was one of the few to garner broad bipartisan support.

Another area of consensus was the bipartisan opposition to creating a government plan that would compete with private insurers. The defection of five Democrats on a "public option" proposal offered Tuesday by
Sen. John D. Rockefeller IV (D-W.Va.) underscored the reservations among moderate Democrats of venturing too far from the private, employer-based system that has long defined the nation's health coverage.

The Congressional Budget Office initially pegged the cost of expanding coverage under the Finance Committee's proposal at $774 billion over the next decade, making the package far cheaper than the $1 trillion plan House leaders proposed and the only bill that meets Obama's demand to keep costs under $900 billion. Baucus has said that adjustments made during two weeks of deliberations are likely to bring the final cost closer to that mark.

Baucus's staff members spent much of Thursday negotiating with individual senators to lock down their support. Obama has maintained an active, if behind-the-scenes, role in coaxing the committee across the finish line. White House officials said he called
Sen. Olympia J. Snowe (Maine), the only Republican who may support the plan, on Tuesday, and phoned half a dozen committee Democrats on Thursday to ask about last-minute concerns.

The panel is expected to reconvene for a final vote Tuesday or Wednesday, giving congressional budget analysts time to determine whether the bill meets Obama's twin goals of significantly expanding coverage to the uninsured and not increasing the federal budget deficit. Reid then plans to merge the package with a measure approved by the Senate health committee and begin debate before the full Senate shortly after Columbus Day. The House also expects to begin action in mid-October.

Schumer, a strong advocate of a public option, said he was working to build support for the idea among moderate Democrats, who have been skeptical of any plan to expand the federal government's role in the health-care system. One idea that appeared to be gaining traction is a proposal by
Sen. Thomas R. Carper (D-Del.) to let states decide how to encourage competition in their insurance markets, including through a public plan.

Beginning in 2013, the finance panel's package would require people to buy insurance or face penalties ranging up to $1,900, to be assessed on their income tax returns. It also would make it harder for taxpayers younger than 65 to deduct catastrophic medical expenses. Both provisions would fall heavily on the very taxpayers that Obama has vowed to protect, according to congressional tax analysts.

White House press secretary
Robert Gibbs dismissed Republican claims that the middle class would suffer, noting that the fines would hit only people who do not buy coverage and called the GOP charge "a silly argument that we can easily dispense with."

GOP proposals to exempt middle-class taxpayers from fees and taxes in the bill were defeated on narrow 12 to 11 votes, but the proposals attracted the backing of two moderates on the committee -- Snowe and
Sen. Blanche Lincoln (D-Ark.) -- suggesting that the issue could resurface as the debate advances.

Heading into the committee room mid-afternoon Thursday, Snowe said she was undecided about whether to support the bill and remained concerned that people could be forced to break their family budgets to buy insurance. She said she told Obama that any penalties should be deferred until "you're sure it's working on the affordability question."

Later, during committee debate, Snowe made the point more forcefully. "The obligation should be first and foremost on the United States government to ensure that these policies will be affordable in the marketplace. And right now we don't know that."


((This is nice - apparently, anyone who opposes the existing plans for health care reform wants people to "die quickly." And those same people have perpetrated "a holocaust in America." Of course, little old ladies carrying signs that tell Congress to keep its hands of their health care are right wing extremists....))
Grayson likens health crisis, holocaust

Republicans got an apology of sorts from Democratic Rep. Alan Grayson Wednesday – it just wasn’t the one they wanted.

Instead of saying he was sorry about accusing Republicans of wanting people to “die quickly,” he gave an apology “to the dead.”

“I would like to apologize,” he said. “I apologize to the dead and their families that we haven't voted sooner to end this holocaust in America.”

His sarcasm, delivered on the House floor, drew a swift rebuke from the National Republican Congressional Committee, which hopes to see Grayson defeated in an Orlando-based swing district next year.

“This is an unstable man who has come unhinged,” NRCC spokesman Andy Sere said. “The depths to which Alan Grayson will sink to defend his indefensible comments know no bounds.”
Grayson told reporters he’s not worried at all about a backlash from voters and instead thinks his chances for re-election have been boosted.

“It improves them,” he said. “People like elected officials with guts who say what they mean.”

But in the same interview, he wavered between suggesting he meant what he said Tuesday night – “Republicans want you to die quickly” – and saying it had been a tongue-in-cheek satire. ((Isn't satire supposed to be amusing...?))

“I stand by what I said,” he said. “I didn’t violate any House rules. I didn’t do anything inappropriate. I’m not under any pressure at all.”

Grayson provided the contretemps of the day on Capitol Hill, and even one of his party’s leaders, Democratic Caucus Chairman John B. Larson of Connecticut, at one point publicly called on him to apologize for Tuesday night’s speech.

“I wouldn’t have used the words that Mr. Grayson has,” Larson said. “I would encourage Alan to apologize.”

Later, Grayson contested whether Larson really meant what he said.

“I spoke to him and he did not ask me to apologize,” Grayson offered.

He also claimed he hadn’t said “Republicans want you to die quickly” – until a reporter read his words back to him.

Republican Study Committee Chairman Tom Price of Georgia drafted, but did not offer, a resolution that would have expressed the House’s disapproval of Grayson’s remarks.

Republicans hoped to equate Grayson’s behavior with that of Rep. Joe Wilson, R-S.C., who was disciplined by the House for yelling “You lie!” at the president during a joint session of Congress earlier in September.

Wilson declined to discuss Grayson’s comments, saying he hadn’t heard them.

Other Republicans weren’t so charitable.

“The people of central Florida sent Alan Grayson to Washington to work for them. Instead, he has become the laughing stock of the House of Representatives and a complete embarrassment to his constituents,” said Jim Greer, chairman of Florida’s Republican Party. “What we have seen over the course of the last 24 hour[s] is a Congressman who is completely consumed with his own spotlight and has absolutely no respect for the citizens who elected him.”

One thing is clear: The otherwise obscure first-term lawmaker has raised his profile. ((Which may have been his goal all along....))

Read more:


National Call Congress Day Tuesday October 6.

Dear Patients First supporter,

This is a critical time in the health care debate. The Senate Finance Committee is debating what will likely be the final health care bill. As details of the Baucus proposal seep out of Washington, opposition grows.

Congressional leaders learned their lesson this summer when Americans read the House bill (HR 3200) and rejected it outright. Now they are trying to rush this bill through, denying us the right to know how much this legislation will cost, how it will affect our quality and access to care and most importantly, whether it will place a bureaucrat between you and your doctor.

Unfortunately, transparency and thoughtful consideration of legislation are playing second fiddle to Congressional leaders' hopes of imposing Washington-run health care on all Americans. Just last week, the Finance Committee voted down an amendment that would have forced them to make the bill available to the public at least 72 hours before the committee voted.

Even the Congressional Budget Office doesn't have enough information to answer fundamental questions like whether premiums will go up under the Baucus proposal or how many billions of dollars would go toward health benefits for illegal immigrants. Congress is intent on ramming through this legislation before Americans have a chance to read it. In fact, rushing has become such a priority that Congressional leaders may try all kinds of procedural gimmicks to avoid the 60-vote requirement in the Senate.

This is not the change we were promised and not the way to reform our health care system. Americans deserve to know what is in the health care bill, and those details should come out in the Senate debate. But some Senators want to vote for cloture -- which means ending debate and rushing to a vote -- before the Congressional Budget Office has determined the cost of the bill and the American people have heard what's in it.

Download our Facebook application to participate in our National Call Congress Day next Tuesday October 6.

Your Senator needs to hear from you. Tell Congress any vote to move a bill without knowing the cost, and letting their constituents know what they're voting for, is an irresponsible vote.

Sincerely, Patients First Team

P.S. The coalition of unions, pharmaceutical companies and other special interest groups supporting pushing government-run health care are about to unleash massive campaigns to counter our efforts. We need your help today.

Patients First, A Project of Americans for Prosperity
TM, focused on real health care reform that will lead to more choices for patients and affordable healthcare options for all.
Patients First is not affiliated in any way with Patient First healthcare clinics.

Arlen Specter - Washington, D.C. Office:
711 Hart Senate Office Building,District of Columbia 20510-3802Phone: (202) 224-4254Fax: (202) 228-1229

Bob Casey Jr. - Washington, D.C. Office:
393 Russell Senate Office Building,District of Columbia 20510-3804Phone: (202) 224-6324Fax: (202) 228-0604


from Congressional Quarterly

CQ TODAY MIDDAY UPDATE Oct. 1, 2009 – 1:36 p.m.
Overhaul Won’t Fix Medicare Physician Payment System

The current health care overhaul effort was supposed to prompt Congress to fix one of its most troublesome recurring problems — a formula that each year demands deep cuts in Medicare payments to physicians, forcing lawmakers to scrounge for money to temporarily stop the cuts.

But once again, Congress is most likely to settle for another one-year patch to block a scheduled 22 percent reduction in the payments to doctors in 2010. ((This is one of the main reasons the AMA supported HR 3200 - because the flawed SGR formula threatens the very fabric of Medicare with cuts that will make it impossible for America's doctors to afford to take care of seniors....))

That would set up even deeper required cuts in 2011, and force lawmakers to step in again next year — just as it has almost every year since 2002.

At best, lawmakers might scratch up enough money to patch over both years.

“We have a broken doctor payment system in Medicare that we have to fix every year,” said Sen.
Orrin G. Hatch , R-Utah, a member of the Finance Committee, which has responsibility for the policy in the Senate. “It’s a disgrace.”

Finance Chairman
Max Baucus , D-Mont., included only a one-year patch in the health care overhaul his panel is working on this week. Why? Keeping the rest of the scheduled cuts on the books reduces the deficit on paper by tens of billions of dollars over the next decade, and even more in future years. Baucus is struggling to hold down the officially scored costs of his health bill.
“Sen. Baucus has been a leader in addressing the problems with this formula, and it is an issue that continues to be important to him,” said an aide to Finance Committee Democrats. “The physician payment formula is a problem that Congress should address as quickly as possible to bring predictability and stability to doctors and other health care providers.” ((Uh-huh....then why not address it now, HONESTLY....?))

But the costs of eventually fixing the mess will be enormous.

According to a 2008 analysis by the Congressional Budget Office, just freezing physician payment rates at 2009 levels would cost $318 billion over the next decade. Letting them grow at current medical inflation rates would cost up to $556 billion, more than half of the cost of the entire health care proposal.


((Before folks decide that the health insurance tax provisions in the Baucus bill don't apply to them....perhaps they should think about what the government considers a "cadillac" plan...))

What Makes a Health Plan a 'Cadillac'?
By Keith B. Richburg
Washington Post Staff Writer Thursday, October 1, 2009

NEW YORK -- In the scramble to find money to overhaul the health-care system, Senate Democrats have been eyeing the most generous insurance packages -- what some call the "Cadillac" plans -- as a lucrative target to tax.

But as the competing proposals are debated on Capitol Hill, a fundamental challenge has emerged: Few people agree on exactly what constitutes a Cadillac plan.

Many proponents of taxing high-end employer-based coverage have singled out the titans of Wall Street finance and industry, whose insurance might pay for regular EKGs, CAT scans and weekend health retreats at tony spas. The California Health and Longevity Institute, for example, offers "comprehensive physicals" over several days that include personalized counseling on wellness, fitness and nutrition.

But insurance plans that cover those types of things are rare. More common are the generous health benefits that many union workers receive -- plans with high employer-paid premiums, low deductibles, prescription drug coverage, vision and dental care, and low or no co-payments.

Over the past decade or so, unions in contract negotiations typically chose to forgo large wage increases in exchange for more generous medical benefits, mainly because costs were rising faster than inflation. Now, as the Senate Finance Committee works on health-care legislation, union members say they feel unfairly targeted. ((So...maybe this wasn't the hope and change they supported?))

"It's the old Washington, D.C., law of unintended consequences," said Robert Laszewski, president of Health Policy and Strategy Associates, a consulting firm. "They went after the Goldman Sachs partner and they ended up with the fireman in Brooklyn."

Laszewski and other health policy experts said union plans are likely to be the hardest hit by any new tax because their premiums tend to be higher for several reasons: Union workers are often older and concentrated in urban manufacturing areas, where medical costs are higher.

"State workforces and nursing home workforces -- they are older and their plans are more expensive," said Celia Wcislo, an executive board officer of District 1199 of the Service Employees International Union. "They were talking about lawyers with their Cadillac plans, but in fact, the way it's written applies to everyone."

With the Finance Committee marking up a bill that would then be melded with another Senate plan, details of a tax on high-end policies are still uncertain -- including whether it would survive. Such a tax probably would be met with fierce resistance by the full Senate and in the House, where more members favor funding reform with a tax on wealthier Americans.

Unions are adamantly against the tax on medical benefits, even though in its current form insurance companies would be taxed. "They will pass it on back to the individual in terms of higher premiums," Wcislo said. "There are a lot fairer ways."

Currently, employer-paid premiums are not taxed.

The idea of eliminating that tax exclusion was raised during last year's presidential campaign by Sen. John McCain (Ariz.), the Republican nominee, who urged targeting "those people who have the gold-plated Cadillac insurance policies that have to do with cosmetic surgery and transplants and all those kinds of things." In fact, experts said very few plans cover plastic surgery, laser eye operations or even chiropractors.

President Obama, during the campaign, sharply criticized his opponent's proposal. "John McCain calls these Cadillac plans," he said in October. "In some cases, it may be that a corporate CEO is getting too good a deal. But what if you're an American line worker . . . who's given up wage increases in exchange for better health care? Well, Senator McCain believes you should pay higher taxes, too."

Some analysts of health-care policy and taxation have long argued that the current tax exclusion for employer-paid premiums unfairly benefits those with higher incomes, while not helping those whose jobs do not provide coverage.

Also, critics of the exclusion say it adds to health-care inflation -- meaning that people with expensive plans and employer-paid premiums have no incentive to shop around for better deals. "If you could deduct the cost of your car, you might buy a Cadillac instead of a Chevy," said Len Burman, a professor of tax policy at Syracuse University.

Burman has long been a critic of the current system, including the tax break for expensive medical plans and companies giving union workers better health benefits instead of increasing wages.

"I think providing a large share of compensation in the form of health benefits is pretty inefficient," he said. "My preference would be to get rid of the tax exclusion altogether." ((Or give it to EVERYONE....))

Finance Committee Chairman Max Baucus (D-Mont.) initially proposed an excise tax of 35 percent on insurance companies for plans that amounted to $8,000 for an individual and $21,000 for a family. Those amounts were initially set to increase with inflation.

But several of Baucus's fellow Democrats immediately objected. "I want people to know -- particularly the coal miners in my state -- that I will work to protect plans for high-risk workers from an excise tax," Sen. John D. Rockefeller IV (W.Va.) said at the Sept. 22 opening of the committee's markup session. "Taxing these higher-priced insurance plans is simply unacceptable."

To lessen the impact of the tax and mollify Democratic critics, Baucus revised his bill to exempt people with high-risk professions, such as firefighters and coal miners, who may have more costly plans because they need more frequent doctor's visits. In addition, he agreed to a request from Rockefeller and five other senators to increase the threshold defining a "high cost" plan by $750 for such individuals and $2,000 for families.

Baucus also agreed that those amounts should be indexed to inflation plus 1 percent, because of objections that health-care costs have been rising at three times the level of inflation. To cover the added cost, he proposed increasing the tax to 40 percent.

Fred J. Myers, an 81-year-old retired coal miner in Morgantown, W.Va., knows he has a Cadillac plan, with a low co-pay and no deductible.

"A lot of my people died, in explosions or whatever, in order to get what we got," he said. "I think, seriously, if they try to tax the miners' health plan, Congress is going to hear from us. We might need to go up there and enlighten 'em."

The Tax on High-End Care

Under a proposal by the Senate Finance Committee, insurers would, starting in 2013, be charged a 40 percent excise tax on portions of employer-sponsored health plans that exceed a certain value. The tax would be imposed only on the amount above the threshold, not the entire value of the plan.

The Tax Would Affect You If ...-- You have individual coverage and the aggregate value of your plan exceeds: $8,000

-- You have family coverage and the aggregate value of your plan exceeds: $21,000

(Note: These threshold values would be indexed to the consumer price index for urban consumers.)
Determining 'Aggregate Value'
The aggregate value of the insurance plan includes reimbursements under a flexible spending account for medical expenses or reimbursement arrangements, employer contributions to a health-care savings account and coverage for dental, vision and other supplementary coverage.

An Increased Threshold for Some
Threshold amounts would be increased for retired people age 55 and older and for employees engaged in high-risk professions, by $750 for individual coverage and $2,000 for family coverage.
SOURCE: Kaiser Family Foundation


((I've always believed that you're far more effective lobbying your OWN legislators, but extra phone calls certainly can't HURT....))

From the Coordinator of the National TEA Party Patriots - "Kill the Bill"

Greetings Fellow Patriots,

The past couple of weeks, we have put the pressure on the Senate Finance committee to let them know that we do not want the government to takeover health care. The time has come where the legislation will be voted on within the next 2 to 3 weeks and we need to turn up the heat!

One of our messages over the next week needs to be No Vote for Cloture. This means that if we can get one Senator of 60 not to vote for cloture, we can kill the bill!

We have learned from one health care expert, there are 13 Senators that we have the possibility of turning and voting NO! Of these 13 Senators, two are up for reelection in 2010. The time has come for us to target and pressure these 13 Senators! Will you do your part to help convince them that this government takeover of health care is not good for the American people? Y

ou can do your part and stand shoulder to shoulder with other Patriots this week by applying pressure to these 13 Senators.

We have made this easy for you. We have broken the country into five regions and the 13 Senators into five groups. Each day, you call and email the group of Senators that is assigned to your region of the country. This way, all 13 Senators will have a constant barrage of calls and emails all week.

We need to make sure they feel the pressure daily.

All of the contact information is listed below the chart. It has been highly recommended that we target the Senators' local district offices when calling, as the local offices are not used to getting pressure like the DC offices. When making your calls and sending your emails, please be sure to make four simple points:

No Government Takeover of Health Care
No Public Option
No Mandates
No Vote for Cloture

Also, please email the Chief of Staff for each Senator!
North East
Group 1 (Bayh, Bennett, Lieberman)
Group 2 (Nelson, Lincoln, Landrieu)
Group 3 (Pryor, Warner, Begich)
Group 4 (Byrd, Carper)
Group 5 (Webb, Tester)
South East
Group 2 (Nelson, Lincoln, Landrieu)
Group 3 (Pryor, Warner, Begich)
Group 4 (Byrd, Carper)
Group 5 (Webb, Tester)
Group 1 (Bayh, Bennett, Lieberman)
Mid West
Group 3 (Pryor, Warner, Begich)
Group 4 (Byrd, Carper)
Group 5 (Webb, Tester)
Group 1 (Bayh, Bennett, Lieberman)
Group 2 (Nelson, Lincoln, Landrieu)
North West
Group 4 (Byrd, Carper)
Group 5 (Webb, Tester)
Group 1 (Bayh, Bennett, Lieberman)
Group 2 (Nelson, Lincoln, Landrieu)
Group 3 (Pryor, Warner, Begich)
South West
Group 5 (Webb, Tester)
Group 1 (Bayh, Bennett, Lieberman)
Group 2 (Nelson, Lincoln, Landrieu)
Group 3 (Pryor, Warner, Begich)
Group 4 (Byrd, Carper)

Group #1 (Bayh, Bennet, Lieberman)
Group #2 (Nelson, Lincoln, Landrieu)
Group #3 (Pryor, Warner, Begich)
Group #4 (Byrd, Carper)
Group #5 (Webb, Tester)

REGIONS & Groups to Call by Day of Week
North East (Mon/1, Tues/2, Wed/3, Thur/4, Fri/5)
South East (Mon/2, Tues/3, Wed/4, Thur/5, Fri/1)
Mid West (Mon/3, Tues/4, Wed/5, Thur/1, Fri/2)
North West (Mon/4, Tues/5, Wed/1, Thur/2, Fri/3)
South West (Mon/5, Tues/1, Wed/2, Thur/3, Fri/4)

Of course, you can always do more and call more than just the one group assigned to your region that day! If you want to call more, I would suggest calling and emailing the Senators in group number one because these are the ones that are up for reelection in 2010.

If you want to do even more, please focus on the Senate Finance Committee. You can get all of their contact information

One last point, when calling a Senator' office from another state, you can tell them that their vote will affect all Americans. You can also let them know you will be happy to contribute to the campaign of their opponent the next time they are up for reelection!

Thanks for all you are doing to save our great capitalist society! Together we can Kill This Bill!

Group #1
Senator Evan Bayh (IN) Chief of Staff: Thomas Sugar (, DC (202) 224-5623 / (202) 228-1377 faxIndianapolis (317) 554-0750 / (317) 554-0760 faxEvansville (812) 465-6500 / (812) 465-6503 faxFort Wayne (260) 426-3151 / (260) 420-0060 faxHammond (219) 852-2763 / (219) 852-2787 faxJeffersonville (812) 218-2317 / (812) 218-2370 faxSouth Bend (574) 236-8302 / (574) 236-8319 fax

Senator Michael Bennet (CO)Chief of Staff: Jeff Lane (, DC (202) 224-5852 / (202) 228-5036 Denver (303) 455-7600 / (303) 455-8851 faxDurango (970) 259-1710 / (970) 259-9789 faxColorado Springs (719) 328-1100 / (719) 328-1129 faxFort Collins (970) 224-2200 / (970) 224-2205 faxFort Morgan (970) 542-9446 / (970) 542-3088 faxGrand Junction (970) 241-6631 / (970) 241-8313 faxPueblo (719) 542-7550 / (719) 542-7555 faxAlamosa (719) 587-0096 / (719) 587-0098 fax

Senator Joe Lieberman (CT)Chief of Staff: Clarine Riddle (, DC (202) 224-4041 / (202) 224-9750 faxHartford (860) 549-8463 / (866) 317-2242 fax

Group #2
Senator Bill Nelson (NE)Chief of Staff: Tim Becker (, DC (202) 224-6551 / (202) 228-0012 faxLincoln (402) 441-4600 / (402) 476-8753 faxOmaha (402) 391-3411 / (402) 391-4725 fax

Senator Blanche Lincoln (AR)Chief of Staff: Elizabeth Burks (, DC (202) 224-4843 / (202) 228-1371 faxLittle Rock (800) 352-9364 / (501) 375-7064 fax

Senator Mary Landrieu (LA)Chief of Staff: Jane Campbell (, DC (202) 224-5824 / (202) 224-9735 faxNew Orleans (504) 589-2427 / (504) 589-4023 faxBaton Rouge (225) 389-0395 / (225) 389-0660 faxShreveport (318) 676-3085 / (318) 676-3100 faxLake Charles (337) 436-6650 / (337) 439-3762 fax

Group #3
Senator Mark Pryor (AR)Chief of Staff: Bob Russell (, DC (202) 224-2353 / (202) 228-0908 faxLittle Rock (501) 324-6336 / (501) 324-5320 fax

Senator Mark Warner (VA)Chief of Staff: Luke Albee (, DC (202) 224-2023 / (202) 224-6295 faxAbingdon (276) 628-8158 / (276) 628-1036 faxNorfolk (757) 441-3079 / (757) 441-6250 faxRoanoke (540) 857-2676 / (540) 857-2800 faxMidlothian (804) 739-0247 / (804) 739-3478 fax

Senator Mark Begich (AK)Chief of Staff: David Ramseur (, DC (202) 224-3004 / (202) 224-2354 faxAnchorage (907) 271-5915 / (907) 258-9305 faxFairbanks (907) 456-0261 / (907) 451-7290 faxJuneau (907) 586-7700 / (907) 586-7702 faxKetchikan (907) 225-3000 / (907) 247-3000 fax

Group #4
Senator Robert Byrd (WV)Chief of Staff: Barbara Videnieks (, DC (202) 224-3954 / (202) 228-0002 faxCharleston (304) 342-5855 / (304) 343-7144 faxMartinsburg (304) 264-4626 / (304) 262-3039 fax

Senator Thomas Carper (DE)Chief of Staff: Jim Reilly (, DC (202) 224-2441 / (202) 228-2190 faxWilmington (302) 573-6291 / (302) 573-6434 faxDover (302) 674-3308 / (302) 674-5464 faxGeorgetown (302) 856-7690 / (302) 856-3001 fax

Group #5
Senator Jim Webb (VA)Chief of Staff: Paul Reagan (, DC (202) 224-4024 / 202-228-6363 faxDanville (434) 792-0976 / (434) 972-0960 faxVirginia Beach (757) 518-1674 / (757) 518-1679 faxFalls Church (703) 573-7090 / (703) 573-7098 faxNorton (276) 679-4925 / (276) 679-4929 faxRichmond (804) 771-2221 / (804) 771-8313 faxRoanoke (540) 772-4236 / (540) 772-6870 fax

Senator Jon Tester (MT)Chief of Staff (Deputy): Mary Walsh (, DC (202) 224-2644 / (202) 224-8594 faxBillings (406) 252-0550 / (406) 252-7768 faxBozeman (406) 586-4450 / (406) 586-7647 faxButte (406) 723-3277 / (406) 782c8-4717 faxGlendive (406) 365-2391 / (406) 365-8836 faxGreat Falls (406) 452-9585 / (406) 452-9586 faxHelena (406) 449-5401 / (406) 449-5462 faxKalispell (406) 257-3360 / (406) 257-3974 faxMissoula (406) 728-3003 / (406) 728-2193 fax

If you need any additional information, please let me know. Have a great week!

Thanks,Amy Kremer
Tea Party Patriots, Founder & National Coordinator
Atlanta Tea Party, Co-Chairman (
Tea Party Patriots Social Network, (


Obama’s Tort Reform: A Tale of Two States
by Bob Dorigo Jones

President Obama’s promise to conduct “demonstration projects” to determine whether medical liability and tort reform will work is a day late and many billions of dollars short. Key states already tell the tale about what works.

Employers pay up to twice the cost for health insurance and health-related services in states that have expansive medical liability laws than they do in states where medical liability reform has been enacted. There is a clear linkage between the cost of health care in a state and the nature of the state’s medical liability laws.

Consider Pennsylvania, where liberal medical liability laws have enabled more than 10,000 lawsuits to be filed against doctors since 2002, although the Pennsylvania Medical Board reports that only 73 lawsuits were found to have merit. According to the American Medical Association (AMA), the state is suffering from an “extreme-level” medical crisis. Pennsylvania’s medical liability insurance rates are among the highest in the nation.

As a result, there are “extreme” shortages in many essential specialties because nearly 4,000 doctors have left the state due to lawsuit abuse. Facilities are closing, most notably nearly 20 maternity units in the Philadelphia area, which leaves the region without ob/gyn delivery and crisis services. According to the National Federation of Independent Business (NFIB), small business owners have experienced a 50 percent increase in the cost of employer-provided health insurance premiums during the past three years.

In stark contrast to Pennsylvania, Texas is enjoying a health care renaissance. A decade ago, Texas had one of the nation’s worst legal environments. Entire counties languished without access to specialized medical services.

In 2003, Texas enacted comprehensive legal reform, including limits on damage awards. As a result, nearly 8,000 doctors have moved to Texas, insurance premiums have leveled off or are declining, and patient access to medical services is expanding. Lawsuits in one county alone dropped from 550 in 2002 -- before reforms were enacted -- to 204 in 2004, the year after reforms were enacted.

Taxpayers are also hit by the medical lawsuit system because the federal government pays health care for members of the armed forces, veterans and others. The direct cost of medical liability coverage and the indirect but very real cost of defensive medicine increases the amount the federal government must pay to cover its own by an estimated $28.6 billion to $47.5 billion per year. Reasonable limits placed on non-economic damages to reduce defensive medicine would reduce cost by an estimated $25.3 billion to $44.3 billion annually -- and that’s according to studies conducted by the U.S. Department of Health and Human Services.

State-level legal reforms, which cover the vast majority of the nation’s medical liability and medical services lawsuits, are the most direct way to address the health care access and cost crisis in America. Rampant lawsuit abuse, runaway verdicts, and a civil justice system that favors personal injury lawyers translates directly into lack of health care access, higher costs for insurance and even higher fatalities.

The facts are as clear as can be found anywhere in the health care reform debate -- states that enact reasonable reforms experience better health care at lower cost, and states that linger as lawsuit abuse havens jeopardize public health, lose doctors, and experience spiraling costs. No new studies needed. Let’s get on with the reform.

Dorigo Jones, creator of The Wacky Warning Label Contest and bestselling author, is Senior Fellow for FFCJ, a coalition of 65 national and state organizations empowering Americans to support legal reform to protect free enterprise.


((Here's the REAL story about medical malpractice and health care reform.....))

SEPTEMBER 29, 2009
Why Medical Malpractice Is Off Limits
A few thousand trial lawyers have a lock on Democrats, who refuse to consider any legal reform.

Eliminating defensive medicine could save upwards of $200 billion in health-care costs annually, according to estimates by the American Medical Association and others. The cure is a reliable medical malpractice system that patients, doctors and the general public can trust.
But this is the one reform Washington will not seriously consider. That's because the trial lawyers, among the largest contributors to the Democratic Party, thrive on the unreliable justice system we have now.

Almost all the other groups with a stake in health reform—including patient safety experts, physicians, the AARP, the Chamber of Commerce, schools of public health—support pilot projects such as special health courts that would move beyond today's hyper-adversarial malpractice lawsuit system to a court that would quickly and reliably distinguish between good and bad care.

The support for some kind of reform reflects a growing awareness among these groups that managing health care sensibly, including containing costs, is almost impossible when doctors go through the day thinking about how to protect themselves from lawsuits.

The American public also favors legal overhaul. A recent Common Good/Committee for Economic Development poll found that 83% of Americans believe that "as part of any health care reform plan, Congress needs to change the medical malpractice system."

Congress now realizes it can't completely stonewall legal reform. But what has unfolded so far is a series of vague pronouncements and token proposals—all of which assiduously avoid any specific ideas that might offend the trial bar. Here are some examples:

• On July 31, Rep. Bart Gordon (D., Tenn.), a Blue Dog Democrat, introduced an amendment to the House health-care reform bill (H.R. 3200) to fund pilot projects for liability reform, including pilots for "voluntary alternative dispute resolution."

What happened? According to the online newsletter Inside Health Policy, "While Gordon's amendment originally had seven policies that states could implement in order to receive federal funding, the other five suggestions were crossed out . . . due to the agreement with the trial lawyers."

• On Aug. 25, at a town-hall meeting in Reston, Va., Howard Dean, former chair of the Democratic National Committee, was asked why there is nothing in the health-care proposals about liability reform. Mr. Dean replied: "The reason that tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers. . . . And that is the plain and simple truth." ((Whoops! I suppose in his zeal to be loved, Dr. Dean forgot that he wasn't supposed to ADMIT that....))

• On Sept. 9, President Obama made a commitment in a speech before Congress to fix the problem of defensive medicine. On Sept. 17, his secretary of Health and Human Services, Kathleen Sebelius, announced an initiative that will allow states to test a variety of programs to "put patient safety first and let doctors focus on practicing medicine."

But in the initiative's statement of goals made no mention of defensive medicine, or of pilot projects such as special health courts. The funding for the initiative is a tiny $25 million. According to Katharine Seelye on the New York Times's Prescriptions blog, "the comparatively small budget seems commensurate with the administration's level of interest in the subject."

The upshot is simple: A few thousand trial lawyers are blocking reform that would benefit 300 million Americans. This is not just your normal special-interest politics. It's a scandal—it is as if international-trade policy was being crafted in order to get fees for customs agents.

Trial lawyers are agents, and their claims are only as valid as those they represent. They argue, of course, that they are champions of malpractice victims. As Anthony Tarricone, president of the trial lawyers association (called the American Association of Justice) put it: "Trial attorneys see first-hand the effects medical errors have on patients and their families. We should keep those injured people in mind as the debate moves forward."

But under the current system, 54 cents of the malpractice dollar goes to lawyers and administrative costs, according to a 2006 study in the New England Journal of Medicine. And because the legal process is so expensive, most injured patients without large claims can't even get a lawyer. "It would be hard to design a more inefficient compensation system," says Michelle Mello, a professor of law and public health at Harvard, "or one which skewed incentives more away from candor and good practices."

Trial lawyers also suggest they alone are the bulwark against ineffective care, citing a 1999 study by the Institute of Medicine that "over 98,000 people are killed every year by preventable medical errors." But the same study found that distrust of the justice system contributes to these errors by chilling interaction between doctors and patients. Trials lawyers haven't reduced the errors. They've caused the fear. ((And do we have to mention AGAIN that the study, based on decades-old statistics from two hospitals has been debunked as an over-ambitious extrapolation of a small data set by the very people who did the research?))

An effective justice system must reliably distinguish between good care and bad care. But trial lawyers trade on the unreliability of justice. It doesn't matter much whether the doctor did anything wrong—a lawyer can always come up with a theory of what might have been done differently. What matters most is the extent of the tragedy and that a case holds potential for pulling on a jury's heartstrings.

Former Sen. John Edwards, for example, made a fortune bringing 16 cases against hospitals for babies born with cerebral palsy. Each of those tragic cases was worth millions in settlement. But according to a 2006 study at the National Institutes of Health, in nine out of 10 cases of cerebral palsy nothing done by a doctor could have caused the condition. ((And the resulting increase in c-section deliveries, from 5% to 25%, hasn't resulted in a SINGLE PERCENTAGE POINT DECREASE in the occurrence of cerebral palsy...))

Unreliable justice is like pouring acid over the culture of health care. One in 10 obstetricians have stopped delivering babies, unable to pay malpractice premiums on the order of $1,000 per baby, according to the American College of Obstetricians and Gynecologists (ACOG). Some hospitals, including Methodist Hospital and Chestnut Hill Hospital in Philadelphia, have stopped delivering babies altogether; and the number of unnecessary caesarian sections have increased to the detriment of the health of mothers, according to the ACOG.

Trial lawyers scoff at the idea of special health courts. "First you have a court for doctors," a spokesperson for the trial lawyers, Linda Lipsen, recently said, "and then what? A court for plumbers?" But America has a long tradition of special courts for situations where expertise and consistency are important—bankruptcy courts, tax courts, workers compensation tribunals, vaccine liability tribunals, Social Security tribunals, and many more.

Trial lawyers often claim that any alternative to the current medical malpractice justice system, such as specialized health courts, will only make it more difficult for injured patients to seek justice. But that's why you start with a pilot project. If these courts are unfair they will be rejected. But if they succeed—that is, are fairer to patients and doctors—they could provide a solid foundation for rebuilding an effective, less costly health-care system than we have today.

Mr. Howard, a lawyer and author, is chairman of Common Good (
Printed in The Wall Street Journal, page A25


Senators bristle over Reid's deal
MANU RAJU 10/1/09 5:29 AM EDT

Senate Majority Leader Harry Reid moved swiftly to ensure that his home state of Nevada wouldn’t be hurt by Medicaid changes included in the health care reform bill moving through the Senate Finance Committee.

Now some of his Democratic colleagues are demanding the same treatment for their states.
“We have to make sure Colorado is treated fairly,” Democratic Colorado Sen. Mark Udall said Wednesday. ((I'm sorry....but don't ALL the states deserve to be treated fairly? Why only the favorites of the people in power?))

“We’re going to take a look at the details, but if Colorado has a fair claim on being treated the same way Nevada has been, of course we’re going to ask to have that kind of treatment.”

Indiana Sen. Evan Bayh, a moderate and a critical swing vote, said he’s “sensitive to the impact that this could have on state budgets and, indirectly, education funding, property taxes and things like that.”

Asked whether states like Indiana should get special protections that were afforded to Nevada, Bayh said: “If they want our votes ultimately, I suspect that they should take our concerns into account.”

“We’re watching it,” added Arkansas Sen. Mark Pryor.

The sweeping health care bill drafted by Finance Committee Chairman Max Baucus of Montana would expand Medicaid to cover families of four with an income of roughly $29,000 per year and people with an income less than 133 percent of the poverty level.

When Baucus first floated the bill in mid-September, Reid strongly criticized it because the federal government would pick up just 87 percent of the new costs, leaving the rest to the states. But Baucus later modified the language to ensure that the federal government paid 100 percent of the costs in Nevada. Reid’s state — along with Michigan, Oregon and Rhode Island — has been given the added protections because it has been hit especially hard by the recession.

A Sept. 16 Congressional Budget Office study estimated that state spending on Medicaid and children’s health insurance would increase by some $37 billion between 2010 and 2019, and Democratic aides expect that in the end, state spending could increase by $22 billion. But those numbers will almost certainly change once the Finance Committee finishes its markup, the CBO conducts a revised analysis and a modified version is prepared for debate on the Senate floor.

At that point, it will be up to Reid, key members on the Finance Committee; the Health, Education, Labor and Pensions Committee; and the White House to forge a compromise that would satisfy 60 senators. And to do that, Senate Majority Whip Dick Durbin of Illinois said, leaders will have to be sensitive to how the bill’s Medicaid language would affect states from coast to coast.

“At some point, whether it’s with the initial merged bill or in final passage, each of us has to sit down and be satisfied that our state has been handled fairly,” Durbin said.

In the meantime, Republicans are seeking to create a wedge between the Democratic leader and his caucus over how states are affected by the Medicaid spending.

“It means they’ve got a special deal for four states, one of them being the state of Nevada,” said an indignant Sen. John McCain (R-Ariz.). “Who pays? Who pays? The other states.”

Added Lamar Alexander of Tennessee, the No. 3 Republican in the Senate: “I wonder how citizens in Wyoming, in California and Florida and other states will feel if they pay more taxes so that Nevadans can pay less taxes.”

Reid, who faces a tough reelection next year, responded sharply Wednesday, taking to the floor to defend the deal and saying the GOP’s criticism was “false.”

“Republicans are upset that we’re helping the hardest-hit states in this country,” Reid said. “Were these four states selected at random? No. Were they just picked out of a hat at the Finance Committee? No. Were they chosen to intentionally exclude the 46 other states? Of course not. These states — Michigan, Oregon, Rhode Island and Nevada — are suffering more than most, and that’s an understatement.”

Reid said critics should be “embarrassed” to complain about the special protections for the states, citing the unusually tough economic times, including the foreclosure crisis in Nevada and its 12.7 percent unemployment rate — 3 points higher than the national average.

“The people of Nevada are hurting, and I make absolutely no apologies, none, for helping people in my state and our nation who are hurting the most,” Reid said.

Sen. Debbie Stabenow (D-Mich.), who sits on the Finance Committee, defended Reid and predicted that the leadership would work out its differences in the end.

“He’s going to fight for his people of his state, just like I’m going to fight for people in my state,” Stabenow said of Reid. “What we’re trying to do is make sure that we are recognizing what’s happening to people across the country who have lost their jobs.”

Sen. Jeff Bingaman (D-N.M.), a member of the Finance Committee, said states would shoulder a “relatively small portion of the costs” and that the federal government would initially take on most of them. In later years, he said, states would be in a better position from an economic recovery and could handle the additional costs.

“Frankly, considering the number of additional people that would get coverage under Medicaid, I think it’s a very good deal for virtually every state,” Bingaman said.
But other Democrats remain wary and expect the issue to get renewed scrutiny once the Finance Committee finishes its work.

“I don’t want to push an unfunded mandate onto the states,” said Sen. Jon Tester, the junior Democrat from Baucus’s home state of Montana, who added that the original versions of the bill appear to hold their state “almost harmless” on Medicaid spending.

But Tester added: “I ain’t going to break the states, you know what I mean?”


What's behind rising health costs? Lots
By Stacey Burling
Inquirer Staff Writer

Lots of us think we know why American health-care costs are rising faster than a speeding bullet, or at least faster than our GDP, incomes, and inflation.

It's because we're such profligate users of medical care. We run to the doctor at the first sign of a sniffle and demand heroic treatment until our final days.

We may cringe at the bills, but we're all after pain-free immortality. Plus, we've built the best health-care system in the world.

Industry experts see a much more complicated picture. Americans actually see doctors and stay in the hospital less than residents of other industrialized countries, they say. Our costs are high for a constellation of reasons involving relatively uncontrolled prices, insurance that masks real costs from consumers, heavy use of technology ((I'll bet our phone, TV and computer use are higher as well)), wide variations in care, and excessive administrative costs.

Making a dent in this problem, as Washington is discovering, is a tough, disruptive job that not only would change the way people get care, but also threaten the livelihood of powerful vested interests.

"Your cost is my income," Tom Getzen, a health economist at Temple University, pointed out. "Real cuts, the kind of cuts that count, are also the kind that hurt."

Health-care experts are divided on the best approach, with some saying a more rational use of resources could curtail spending and others saying the only effective solution is price control.

Reining in expenses Uwe Reinhardt, a health economist at Princeton University who falls into the latter group, sees little in the health-care packages under discussion that would rein in expenses.

"For bending the cost curve, there's really nothing in there but a few little hopes and a few little prayers," Reinhardt said.

Our cost curve is a thing to behold. While health spending has grown faster than GDP by half a percentage point a year in other rich democracies, it has averaged an extra 2 percent in the United States, said Jacob Hacker, an expert on the politics of health policy at Yale University.

Getzen said health spending in the United States began ramping up in the mid 1950s, even before the advent of Medicare.

People saw medical care as "modern miracle," he said. "This was the promise of the future, and it was great."

Health spending - now $2.2 trillion - accounts for 16.2 percent of GDP. We spend an average of $7,421 per person, even with millions uninsured. Other countries average far less and cover almost everybody. Generally, experts said, care here is not markedly more effective.

Economists say that health-care spending tends to rise with income everywhere. Even taking that into account, though, the United States spends about $2,000 per person per year more than expected based on income, Reinhardt said. ((Our crappy eating habits and other lifestyle boo-boos might have something to do with all that...))

End of life

Much as we might like to blame some of that on excessive spending in the last year of life, economists say that's not a major cost driver. Joseph White, an expert on international health care at Case Western Reserve University, said the proportion of Medicare spending in the last year of life has been consistent for decades.

"Do we spend a lot of money at the end of life? Yes," he said. "Do we spend a lot of money on people who are really sick? Yes. That's the whole point. That's why you have insurance."

Insurance itself has driven spending, some experts said, not only by making it possible for customers to get more care while insulating them from the cost, but by making it safer for companies to risk developing expensive new machines and for hospitals to buy them. But, other countries have more insurance than we do.

Our administrative costs, though, are through the roof, the result of having so many insurers with different rules and forms. The McKinsey Global Institute estimates that we spend six times more on administration than other developed countries.

"We have without any question the most complex, bureaucratic health system in the world," Reinhardt said.

Overuse of technology

That leaves the big culprits, resource use and prices.

We do use more technology, which researchers define broadly to include medicine, devices, and techniques. Over the years, new technology has improved care. But, American doctors and patients too often assume that "more is always better," said Elliott Fisher, director of the Center for Health Policy Research at Dartmouth.

We are far more likely than people in other countries to get MRIs and CT scans, Cesarean sections and knee replacements, Mark Pearson, head of the health division of the Organization for Economic Cooperation and Development, told the Senate Special Committee on Aging last week. (( that necessarily a BAD thing? And how would we reduce that? By having a government entity decide who gets what care? Or perhaps an Office for Comparative Research?))

We also have big regional variations in resource use without corresponding variations in quality, Fisher said. "Most of the differences across regions are about how much time people spend in the hospital for similar illnesses and how many physicians are involved in their care," he said.

Making everybody's care like that in the most cost-effective regions would cut overall costs 20 percent to 30 percent, he said. But, you cannot just cut spending 20 percent in high-cost areas - like Philadelphia - without causing "chaos," he added.


He thinks the key is making hospitals and doctors more accountable for spending.

Other experts said the main reason we pay so much for health care is that we have done a lousy job of controlling expenses compared with other countries.

"Our prices are higher for everything," said Jonathan Oberlander, a University of North Carolina expert on social medicine and health policy.

Oberlander and White argued in the New England Journal of Medicine last month for a system where all public and private insurers pay the same rates to doctors and hospitals.

"What I would say is that if countries want to control health-care spending, then they should have spending controls," Oberlander said.

In other countries, someone pays attention to overall cost, White said. Either there's a single payer, or payers band together to set rates. Here, everything is fragmented.

"There's no overall budget constraints so the system's just out there blowing up on its own," White said.

HMOs slowed spending between 1993 and 1997, White said, largely by negotiating lower prices with providers, not by managing care. After that, hospitals and doctors consolidated to form bigger, more powerful negotiating blocs that have effectively fought insurers, he said. Employers, who pay for most private health care, have even less clout, so they have had to accept rising premium bills.

Given all the hoopla about the more minor changes proposed so far, the policy experts think there is little chance that Americans will jump on the rate-setting bandwagon soon.

"It will happen, but not right away," Reinhardt said. "You have to get the American people a whole lot more desperate. The American people have to suffer."

((Um.....sounds like Mr. Reinhardt WANTS that? Odd, though, that he didn't mention defensive medicine and how many tests, etc., are ordered to protect doctors and hospitals from liability....which ISN'T as big an issue in other countries as it is here...))

Contact staff writer Stacey Burling at 215-854-4944 or


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