Thursday, April 29, 2010

4/29/2010 - ARE you your brother's health care provider?

4/29/2010 - Liability and Health News Update
ARE you your brother's health care provider?

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

This LIABILITY AND HEALTH NEWS UPDATE "newsletter" is a free service which I provide, as a volunteer, to help supply medical liability reform and health care reform 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 (I am....biased, I mean), 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 (("my opinion")), 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.
Join our Google Group: or Facebook Page to ensure you get all issues ASAP:

It also appears on the following BLOG (when I remember to post it):
If you'd prefer not to receive these periodic updates about health care issues in America, please hit "Reply" and put "Unsub health group" in the subject line and I'll remove your email address immediately.




It's what they're trying to do in Massachusetts. Here's the language from the actual bill that would require EVERY DOCTOR in the state to accept the state-run health care plans AS A CONDITION OF LICENSURE, even if the reimbursements don't cover the cost of the services.

"Every health care provider licensed in the commonwealth which provides covered services to a person covered under "Affordable Health Plans" must provide such service to any such person, as a condition of their licensure, and must accept payment at the lowest of the statutory reimbursement rate....and may not balance bill such person for any amount in excess of the amount paid by the carrier pursuant to this section, other than applicable co-payments, co-insurance and deductibles. (c) Providers shall not attempt to recoup such excess amounts by increasing charges to other health benefit plans or other payers. The Division of Health Care Finance and Policy shall monitor provider charges to ensure compliance with this section and report any non-compliance to the Attorney General. The Division of Health Care Finance and Policy shall promulgate regulations enforcing this subsection, which shall include penalties for noncompliance."

Here's the whole bill:

There are "penalties for noncompliance" if a doctor tries to make up the difference between providing health care services and what he or she will get paid for providing those services.

And here's another good one - doctors "must provide such service to any such person, as a condition of their licensure, and must accept payment at the lowest of the statutory reimbursement rate."

If this law passes, it will be ILLEGAL in Massachusetts for a doctor to refuse to work for less than his or her services are worth. And there will be "penalties for noncompliance."

Watch for something like this at the federal level, if more and more doctors refuse to participate in Medicare and Medicaid as those federal health care plans continue to pay them less and less.

Keep in mind that Medicare reimbursements are scheduled to drop 21% on June 1 - and that the new health care bill calls for $500 billion in Medicare CUTS over a 10 year period. And when Medicare wants to save money, we KNOW they reduce provider reimbursements first.


Exciting PAST event Update - On April 19, I had the honor of serving as Master of Ceremonies for the Pennsylvania Liberty March, an event held in support of Pennsylvania legislation to take advantage of the provisions of the 10th Amendment (which delineates the powers of the federal government and the states and the people) to exempt PA from provisions of the recently passed federal health care bill.

We had an exciting lineup of speakers, including several members of the PA General Assembly who sponsored the PA House and Senate Bills and amendments (Curt Schroder, Matt Baker and Mike Folmer); Harrisburg physician Dr. Bret DeLone; the head of the AARP-alternative seniors' group 60 PLUS Jim Martin (who is a FAR better informed dead ringer for Ted Turner); UNITE PA director Sharon Cherubin and Kitchen Table Patriots activist Ana Puig; as well as the Commonwealth Foundation's Matt Brouilette; and independent businessman and former morning DJ for Allentown's B104, Ken (Matthews) Walchinsky (who was AWESOME, BTW. If your group would like to have Ken come and talk about life, liberty and the pursuit of happiness, email me and I'll connect you to him.)

Here is a link to the rally video. Sorry I don't have it in manageable pieces, but you can fast forward if you like. Please feel free to SKIP the part where I sing the National Anthem - to quote Randy Jackson, "Yo, dog, for me it was a little pitchy." Oh, well. The rest was pretty good, though....

Exciting FUTURE event Update - These days, Ayn Rand's political and social philosophies have enjoyed a resurgence of interest, and Dr. Yaron Brook, executive director of the Ayn Rand Center, is quite the hot commentator.

We have been VERY fortunate, due to the efforts of Philadelphia radiologist Dr. Evan Madianos, to entice Dr. Brook (whom you've likely seen on MANY major networks) to come and share his fascinating take on whether or not YOU are your brother's health care provider with us on Tuesday, May 11.

We're looking to fill a big auditorium, so please pass information about this event along to your medical or non-medical colleagues, members of health-related groups, TEA Party groups, hospital medical staffs and more. I've attached a flyer which you're welcome to print off and pass out - in fact, PLEASE do so..

Details of the event, which will be held at the University of Pennsylvania Hospital and Medical Center, follow after several pieces which reinforce Dr. Brook's concerns about the virtual "enslavement" of America's physicians.

But, hey,doctors took an oath, so they ought to be willing to work for free, right? Plus, they're all rich, so they don't need to make any profit on Medicare or Medicaid or other government-run health insurance programs, right? I mean, really, who wants to go to a doctor who's just in it for the money? (As if there are any LEFT.....they all got into something more profitable, like being hospital CEO's or plaintiff's attorneys LONG ago....)

Oh, and they're going to make sure doctors can't let gifts from drug reps influence their prescription-writing habits, too, because everyone KNOWS doctors are more gullible than other business people and will use one product over another JUST because someone gave him or her a pen or a mug or something....

Is anyone other than me deeply offended by the level of CONDESCENTION directed toward doctors these days?



From the Ayn Rand Center
Massachusetts law would turn doctors into serfs
April 27, 2010 by Don Watkins

Throughout the health care debate, we have been arguing that the push for government control of health care is driven by a certain moral view: the view that need is a claim. That view is typically taken to be noble and benevolent, and one of Ayn Rand’s most controversial conclusions is that it is in fact vicious and unjust. Well, the latest proposal out of Massachusetts seems designed to prove Rand’s point.

Massachusetts, you probably know, passed a bill very similar to ObamaCare a few years back. Well, shocking news: the state is now hemorrhaging money. To stop the bleeding, it is clamping down on doctor reimbursements for Medicare and Medicaid, which has meant fewer and fewer doctors willing to accept Medicare/Medicaid patients. The state’s solution? Force them.

Every health care provider licensed in the commonwealth which provides covered services to a person covered under “Affordable Health Plans” must provide such service to any such person, as a condition of their licensure, and must accept payment at the lowest of the statutory reimbursement rate…

As one doctor noted:

So what this means is that in order for doctors to become licensed in Massachusetts, they will have to agree to accepting the payment rates imposed by the government, even though those payments may not cover their actual expenses for the care rendered.


But it isn’t unbelievable–not if you view need as an entitlement. If a Medicare patient’s need of health care entitles him to it, then why should a doctor have the right to refuse service just because the doctor won’t make money? Wouldn’t that be selfish and greedy? ((What's really frightening is that there are LOTS of patients out there who believe JUST that. Who stand at the reception desk and claim they don't have ANY money with them for their co-pay, which they shouldn't have to pay for ANYWAY, because they have insurance, while talking on their iPhone....))

There is nothing noble or benevolent about political thugs forcing doctors–the men and women without whom all of our health care needs would go unfulfilled–to sacrifice their time, their energy, and their wealth to anyone’s need.

Remember: the morality of need means serfdom for doctors

Here's the bill:

SENATE DOCKET, NO. 2188 FILED ON: 7/23/2009
SENATE . . . . . . . . . . . . . . No. 2170
The Commonwealth of Massachusetts
Richard T. Moore
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General Court assembled:
The undersigned legislators and/or citizens respectfully petition for the passage of the accompanying bill:
An Act Relative to an Affordable Health Plan.
Richard T. Moore
Worcester and Norfolk
Michael O. Moore
Second Worcester
Stephen M. Brewer
Worcester, Hampden, Hampshire and Franklin
Susan C. Tucker
Second Essex and Middlesex
The Commonwealth of Massachusetts
In the Year Two Thousand and Nine
An Act Relative to an Affordable Health Plan.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. "Statutory Reimbursement rate" means, with respect to payment to a health care

1 provider for services rendered to any person covered under an "Affordable Health Plan", one hundred and

2 ten percent of the Medicare reimbursement rate for those services as if there were rendered to a Medicare

3 beneficiary not taking into consideration any beneficiary cost sharing. For services or supplies for which

4 there is no Medicare reimbursement amount, the amount as determined by the Division of Health Care

5 Finance and Policy to be consistent with Medicare payment polices at a one hundred and ten percent level

6 and approved by the Commissioner of Insurance.

7 (a) As a condition of doing business in the commonwealth, a carrier that offers health benefit plans to

8 eligible small businesses and eligible individuals, as defined by chapter one hundred and seventy-six J,

9 shall offer an "Affordable Health Plan" to all eligible individuals and small businesses, both within the

10 Connector, for such carriers participating in the Connector, and for all such carriers outside the

11 Connector. This "Affordable Health Plan" shall contain benefits that are actuarially equivalent to the

12 lowest level benefit plan available to the general public within the Connector, other than the young adult

13 plan. Payment for all services, other than outpatient pharmacy benefits, for all providers under

14 "Affordable Health Plans" shall be consistent with the requirements as included in paragraph (b).

15 (b) Claims for services shall be adjudicated at the in-network benefit level or, if applicable under the

16 terms of the plan, the out-of-network benefit level based on the participation status of the provider in the

17 carrier’s network. Every health care provider licensed in the commonwealth which provides covered

18 services to a person covered under "Affordable Health Plans" must provide such service to any such

19 person, as a condition of their licensure, and must accept payment at the lowest of the statutory

20 reimbursement rate, an amount equal to the actuarial equivalent of the statutory reimbursement rate, or

21 the applicable contract rate with the carrier for the carrier’s product offering with the lowest level benefit

22 plan available to the general public within the Connector, other than the young adult plan, and may not

23 balance bill such person for any amount in excess of the amount paid by the carrier pursuant to this

24 section, other than applicable co-payments, co-insurance and deductibles.

25 (c)Providers shall not attempt to recoup such excess amounts by increasing charges to other health benefit

26 plans or other payers. The Division of Health Care Finance and Policy shall monitor provider charges to

27 ensure compliance with this section and report any non-compliance to the Attorney General. The

28 Division of Health Care Finance and Policy shall promulgate regulations enforcing this subsection, which

29 shall include penalties for noncompliance.

30 (d)Existing contracts between providers and carriers shall comply with the requirements of this Section as

31 to the reimbursement rate and providers must provide services to individuals under "Affordable Health

32 Plans" under such existing contracts with carriers. A provider that participates in a carrier’s network or

33 any health benefit plan may not refuse to participate in the carrier’s network with respect to the

34 “Affordable Health Plan”.

35 SECTION 2. Section 1 of this act shall be repealed upon such date determined by the

36 Commissioner that a common payment methodology has been implemented across all public and private

37 payers across the commonwealth.


From the Ayn Rand Center
“The Forgotten Man of Socialized Medicine”–and us
July 20, 2009 by Debi Ghate

During a meeting today, my colleagues and I were discussing the frightening prospect that socialized medicine is right around the corner. Obama-care is not being opposed on any principled grounds – the only real dispute appears to be over the details, such as its projected cost. So if you are counting on somebody, like the Republicans, stepping in to rescue us from this impending disaster, think again. ((Well, they DID try....didn't matter, though, since the people who are running the country decided it was going to pass NO MATTER WHAT....))

I emigrated from Canada some time ago and at that point, one of the significant differences between the two countries was their respective approaches to health care. A relatively free market in health insurance and health care rather than a monolithic government-managed system? Terrific! You mean I’m not stuck on a long waiting list in order to see whichever doctors the government allows people in my geographic area to see? Wonderful!

Should President Obama succeed in implementing “health care reforms,” those last remaining advantages of the American health care system will disappear. That would be disastrous for all of us, but it would be especially devastating for the medical profession.

In Ayn Rand’s Atlas Shrugged, there’s a minor character, a brain surgeon named Dr. Hendricks, who refused to practice under a socialized medicine. This excerpt (reprinted in “For the New Intellectual”) explains why Dr. Hendricks decided to shrug:

“I quit when medicine was placed under State control some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I could not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything—except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but ‘to serve.’ That a man’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards—never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind—yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t.”

Instead of bickering about the price tag of Obama-care, it’s time to fight the battle against socialized medicine on moral grounds. It’s time for doctors to defend their moral right to practice medicine free from government interference. And it’s time for their patients to defend their moral right to purchase health-care on a free market.


You are not your brother’s health care provider
March 17, 2010 by Don Watkins

Americans are understandably disgusted by all the shenanigans going on in the halls of Congress, as Pelosi races to pass ObamaCare by any means possible. But if you want to know why ObamaCare supporters hardly blush at employing heavy-handed tactics, it’s because they regard the bill’s aim as morally noble–and believe this sanitizes the sordid means by which they hope to achieve it.

As the President put it in a recent health care speech, “we are all in this together.” In America, he said, when “fortunes turn against one of us, others are there to lend a helping hand,” but “sometimes government has to step in to help deliver on that promise.” Obama was echoing the ethical premise he has uttered many times before: you are your brother’s keeper, and his health care needs are your responsibility.

But as ARC’s Yaron Brook and I argued in a recent op-ed, you are not your brother’s health care provider:

According to the American ideal, men are not their brother’s keeper–we are independent individuals with inalienable rights to support our own lives and happiness by our own efforts. That means taking responsibility for your own medical needs, just as you take responsibility for your grocery shopping and car payments. It means no one can claim that his need entitles him to your time, effort, or wealth. Where is the willingness to defend this ideal by saying, “Your health care is your responsibility–and if you truly cannot afford the care you need, then you must ask for private charity–not pick your neighbor’s pocket to pay for it”?

The Founders said you have a right to pursue your own happiness. Obama says you have a moral duty to serve mine. This week we’ll find out whether Obama’s vision will triumph. ((Of course, we all know what happened....details about Dr. Brook's presentation at the University of Pennsylvania Hospital follow.))



You Are Cordially Invited to Attend the Below Lecture Which has been sponsored by the Ayn Rand Center for Individual Rights

You Are Not Your Brother's Health Care Provider

by Dr. Yaron Brook, Executive Director, Ayn Rand Institute

TUESDAY, MAY 11, 2010
Time: 7: 00 - 10: 00 PM

3400 Spruce St.
Medical Alumni Hall; First Floor Maloney Building (HUP 1)
Philadelphia, 19104

Map: # 14 on this map <>

RSVP: here <>

Note to attendees: Photo ID required for hospital security

Despite overwhelming evidence that government intervention wrecks health care , government control over American medicine keeps growing.

Because, Dr. Brook argues, virtually everyone today believes that a person's need morally entitles him to have it fulfilled at others' expense. This morality of need is at the root of every government health care entitlement, from Medicaid to ObamaCare .

In this provocative talk, Dr. Brook attacks the morality of need , and proposes a revolutionary alternative: the moral right of each individual to live for his own sake, taking responsibility for his own life and needs--including his health care needs--on a free market .

Dr. Yaron Brook is president and executive director of the Ayn Rand Institute and is a contributing editor to The Objective Standard. A former finance professor, he has published in academic as well as popular publications.

He is frequently interviewed in the media and appears weekly on the new Fox Business Network to debate and discuss current economic and business news.

His columns and opinion-editorials are published on and in major newspapers.
Dr. Brook lectures on Objectivism, business ethics and foreign policy at college campuses, community groups and corporations across America and throughout the world.

For more information on lecture:

Visitor Information: Driving directions <>

HUP Floor Pan <>

Parking: Penn Tower Garage <>

Note: Entrance off Convention Ave on the Right , but one-way traffic pattern requires left onto East Service Drive off Civic Center Blvd, full loop behind Perelman Center. Covered walkway connects to Hospital.

Patients: Please feel free to forward this invitation to doctors, friends, family, and acquaintances.

Doctors: Please also feel free to forward this invitation to colleagues of all specialties, other medical professionals, residents or medical students.

Both: Please feel free to copy and paste to online bulletin boards or event listings in toto, or to print out and post in libraries or other suitable public areas.


If you are interested in attending a fund-raising brunch/ luncheon with Dr. Brook on Wednesday May 13th, contact:


Related Materials:

Yaron Brook discusses the newly passed ObamaCare legislation. (Pajamas TV interview; 20 min.)The Era of ObamaCare <>
March 26, 2010 with Yaron Brook <>
The sordid path to Obamacare <>
Who cares about the doctors? <>

For more information about these ideas, you can contact these organizations which support free market health care solutions:

Docs 4 Patient Care -
Sermo - The physicians' online community -
The Galen Institute -
Physicians for Reform, Advocates for Patient Centered Health Care -
MedPolitics -
The Benjamin Rush Society -
PATIENT POWER, Independence Institute -
John Goodman's Health Policy Blog -
Citizens' Council on Health Care -
Defend Your Healthcare -
Pacific Research Institute -


Note to Doctors: Now I'm "Entitled" To Your Services
by Austin Hill

Vice President Joe Biden did it again.

He reiterated what was once a central theme of Barack Obama’s presidential campaign, and what has been a central tenet of our government since Mr. Obama became President. And the idea is, simply, this: when government takes wealth away from certain individuals and groups, and gives it to certain other individuals and groups, such actions are NOT to be called “economic re-distribution.” Such actions are to be described as “fairness.”

Biden, of course, has been a government employee for nearly forty years, earning a six-figure salary paid for with our tax dollars. He has also earned a reputation of embarrassing public gaffes. And crude as his behavior is at times, it is nonetheless difficult to dispute the entertainment value generated when the Vice President utters the “f-word” into an open microphone (as he did during the recent White House “healthcare bill” signing ceremony), or when he proclaims somebody’s mother to be dead when she’s actually still alive (as he did with the Prime Minister of Ireland during a White House visit last month).

But during his recent sit-down interview with the journalists at Yahoo! Finance, Biden behaved like a Vice President should, and expressed ideas that are supportive of, and consistent with, the President that he serves. The problem, however, is that the economic irrationality of the entire Obama Administration is an endangerment to American freedom. Thus Biden’s remarks served to further advance a very destructive agenda.

Responding to claims that President Obama’s “healthcare” agenda is a matter of economic re-distribution, Biden stated "it's a simple proposition to us: Everyone is entitled to adequate medical health care. If you call that a 'redistribution of income' -- well, so be it. I don't call it that. I call it just being fair -- giving the middle class taxpayers an even break that the wealthy have been getting."
The broader implications of this “fairness” theme are the crux of the matter. But let’s look carefully for a moment at these specific remarks.

It sounds compassionate for a politician to say “everyone is entitled to adequate medical health care,” but stop and consider the implications of this statement. Vice President Biden – along with President Obama and the majority of the members of the U.S. Congress – have confirmed in the minds of at least some portion of the American public that they are “entitled” to the services of another human being.

Those “other” human beings are, of course, Medical Doctors, people who invest huge chunks of their time and energy and often delay gratification of their personal lives for a decade or more and frequently incur enormous personal debt just earning the right to practice their craft. And now the U.S. federal government says that “the rest of us” are entitled to a piece of these individuals. In previous generations, the idea of being entitled to the services of another person was called “slavery.” Can we really call this “fairness” today?

And notice how easily Vice President Biden, all within two sentences, seeks to sell the idea of Obamacare, with the implication that is balanced on the backs of “the rich.” By implying that somehow “rich people” have been getting an “unfair” advantage, he suggests that Obamacare gives “tax breaks” to the “middle class.”

Of course, this is also a bunch of falsehoods. The richest of Americans already pay the majority of our nation’s taxes. And Obamacare is loaded with new taxes that will impact all Americans, not just "rich" folks– new taxes on personal income, new taxes on medication and medical device purchases, even new taxes on wheelchair purchases (apparently the wheelchair-bound population is small enough that it is politically “safe” to punish them).

But thinking about this situation more broadly, one has to ask “what is fair?” Is it “fair” that wheel-chair bound Americans – some of whom presumably are living on fixed incomes – are now being forced to help pay for other people’s “entitlement?” Is it “fair” that Barack Obama and Joe Biden and Nancy Pelosi and Harry Reid and every elected member of Congress and their respective staff members and members of the United Auto Worker’s union are all exempt from the heavy handed mandates of Obamacare, while the mandates are imposed on the millions of the rest of us? Is this the “change” we were “hoping” for?

And what politician is so “moral,” so pure, so just, so good, that they, alone, can determine what is “fair” for everybody? Would it be Joe Biden himself? Or Barack Obama? Or does that elusive arbiter of fairness exist elsewhere in the world today – maybe Hugo Chavez, the dictator of Venezuela , or Mahmoud Ahmadinejad of Iran ?

The founders of our great nation recognized that, after a few thousand years of civilization and multiple, painful attempts by governmental leaders to create “fair” societies, the best hope for humankind was to construct a society of freedom, where individuals can freely chose to do business with one-another (or choose not to). This characterization of freedom and “fairness” runs counter to the type of governmental constructs that Barack Obama grew-up with in Indonesia , and bares little resemblance to the world he knew in Chicago , but it is, nonetheless, distinctly American.

I suspect that President Obama has no interest in this type of freedom and “fairness.” And I’m beginning to believe that Vice President Biden has never contemplated such things. They are both, however, peddling a type of “fairness” that America simply cannot afford.


Why Physicians Oppose The Health Care Reform Bill
Daniel Palestrant, 04.28.10, 10:10 AM EDT

Health care without active physician participation is no health care at all.After the debate has ended and the lobbyists have moved on to their next clients, health care will be left the way it started, a physician and a patient sitting in a room trying as best as they can to prolong health and forestall sickness. Fortunately the many victories and losses claimed by both ends of the political spectrum will not change this shared pursuit.

So then why has reform that promises to get millions more in a discourse with their doctors been so polarizing? Making sure more Americans have health insurance can only be a major victory, right? Too bad the medical establishment is not celebrating. In fact, the mood in those exams rooms is downright morose.

In tens of thousands of exam rooms all over the country physicians are struggling to make sense of the 2,000-plus pages of the reform bill. A recently released poll of more than 2,000 physicians, conducted by Athena Health and Sermo, is alarming. The poll, part of a broader Physician Sentiment Index, indicates that 79% of physicians are less optimistic about medicine since the passage of health care reform. Fifty-three percent indicate they will consider opting out of insurance plans with passage of the bill. Worst of all, 66% indicate that they will consider opting out of all government-run programs.

The same reform bill that will provide "care for all" may drive away more physician caregivers than attract previously uninsured patients. What a predicament that would be.

Many may find the data from the poll puzzling. How could physicians be so pessimistic about a bill that clearly has so many positives? For one, the bill addresses none of the issues most consistently ranked by physicians as the most critical for lowering costs and improving access. Tort reform, streamlining billing and payment, and fixing the flawed government formula for calculating physician reimbursement are given little, if any, serious attention.

What physicians knew then and certainly know now is that instead of fixing these issues, the government will be forced to take the path of least resistance to save money (that is to say the path with the least special interest resistance). That means reducing physician reimbursement, just as the country is counting on even more physicians to be available.

Physicians knew the health care bill had a "gotcha" buried deep inside. The only way it could be called "budget-neutral" was to implement significant reductions in physician payments. So just as we are hoping more physicians become available to treat the influx of 31 million more patients, the government is implementing a massive reduction in physician reimbursement (a 21% reduction in physician reimbursement went into effect April 1 after several years of no adjustments for inflation, meaning physician reimbursement has been declining for several years already). ((Those cuts were deferred to JUNE 1, presumably after this piece was already submitted and unable to be edited.))

In a moment of complete legislative hypocrisy, the proponents were touting one health care bill that included cost estimates that assumed a massive reduction in payments while another bill moved its way through Congress that would reverse those cuts (the bill reversing the cuts was ultimately defeated, meaning the cuts did go into effect). At some point, basic supply and demand will kick in, and there will be insufficient physician resources for treating patients.

But what of the much-touted American Medical Association's support for the bill? The AMA, which counts less than 10% of its $300 million dollars in revenue from physician membership dues (the rest comes from a government sanctioned monopoly whereby the AMA sells the billing codes upon which the entire health care system relies) had little choice but to endorse the bill, lest the government retract its exclusive license on billing codes. Again physicians know what the public does not: Less than 15% of practicing physicians are AMA members, so any AMA support is more a reflection of the AMA's financial interests than what physicians in this country truly want. This is a situation that proved opportunistic to proponents of the bill but could prove painful for America's health care system.

Indeed this might be a pyrrhic victory. Health care without active physician participation is no health care at all. Many physicians are investing in electronic health records and billing technologies that alleviate some of the huge administrative brunt that threatens the independent medical office and enables them to fare better in the uneven fight with insurers. These technologies do hold great promise in ensuring these projections remain just that, projections, and not reality.

But still, as the Athena Health-Sermo poll shows, many physicians are ultimately faced with the choice of opting out of government insurance programs or going out of business. A significant number of physicians are realizing they cannot stay in business--let alone remain independent--if they continue to accept artificially low government reimbursement rates.

Many states are recognizing this impending crisis, and rather than addressing the causes of medical inflation are resorting to an "easy," short-sighted fix: Make participation in state and federal insurance programs a condition of medical licensure. Far from a theoretical proposition, Massachusetts' health care system is so over budget that the state legislature is considering a bill that would mandate physician participation, in effect making physicians state employees.

Can anyone say socialized medicine? ((Or indentured servitude?))

Daniel Palestrant, MD, is founder and chief executive officer of Cambridge, Mass.-based Sermo, the largest online physician community, where more than 112,000 physicians collaborate to improve patient care.


((Here's what another American doctor thinks....))

From: An American doctor Sent: 4/4/2010
Subj: The domino effect

In the past decade our reimbursement rates have basically been flat. According to the below website, the calculated rate of inflation for the dates between Jan. 2000 to Feb 2010 has been 28.4%.

This means, everything else being equal, that something I had to pay 100 dollars for in Jan. 2000 I now have to pay $128.40. and some costs, such as the health insurance I must buy, have gone up by much more.

As a business person, under normal circumstances, I would be able to increase my charges for the goods and services I provide in order to keep up. But as a physician I am prohibited from doing so for the government, and I am powerless to do so for managed care, which is tied to government rates.

In order to make up the difference, I must work 28.4% harder just to keep even. It may even be more, since working harder also costs me more resources in supplies, staffing, risk exposure, etc. Working harder as a physician means earning more money by providing more services, not increasing the return per service.

If I can do more work by spending more hours working, it is more costly to me than if I can make up the difference by doing more work in the same period of time. But by doing the latter I also must to some extent trade time for quality, since better quality adds more time.

Further, less quality reduces good outcomes. Poorer outcomes means more care episodes for patients to restore a good outcome.

I can also make up the difference by reducing costs. I can stop paying for things I used to. I can attend fewer educational meetings, hire fewer staff, reduce or fail to upgrade staff benefits, bonuses, or raises, put off upgrading, modernizing, or repairing equipment, etc. These measures also reduce quality.

I can also temporize by taking on more debt. However in the long run this will further reduce my earnings as I will have to use some earnings to pay debt service.

I can also voluntarily reduce my standard of living by taking home less pay. This means that I am taking home less pay although inflation has risen. The net effect on me personally will be greater than the 28.4%.

Another way I can cope is to drop lower paying insurances. I can try to fill my book with the better paying insurances only. In this case, access to care for patients with lower paying services is reduced.

The effect of me either reducing my personal lifestyle or reducing my office costs is to reduce what I spend. The economy in general will suffer if I am spending less and if I am either hiring or paying staff less the net result will be that staff will spend less, magnifying the effect. If I buy less, the merchants who depend on me will suffer by receiving less, which will further reduce their spending. The effects of this on hundreds of thousands of physicians will reverberate through the economy.

The savings that the government receives by not funding proper reimbursement to me will therefore be offset by the braking of the economic engine of the country. The reduced income of my practice, myself, staff, merchants I support and my staff support, and other merchants these merchants support and so on and so on, mean a severe and significant reduction in tax revenues. Indeed, there might be more lost from tax revenues when all is said and done than gained by reducing my reimbursement. This is also due to the leveraging effect of my revenue being also reduced by the health care plans. It is also due to an increase in the number of care episodes that must be paid for to help restore good outcomes lost to the reduced quality from lack of reimbursement.


((But there's still opposition, and it's getting organized....))

Attacks on Healthcare Law Gain Steam
Ronald Kessler - Newsmax
Now that Congress has passed the healthcare bill, it’s under attack from all sides. Twenty-one states have filed lawsuits challenging the constitutionality of the law, and legislation has been introduced or is about to be introduced in 41 states banning key aspects of the measure. States’ efforts to prohibit the bill from taking effect go back to 2006, when Dr. Eric Novack, an orthopedic surgeon based in Phoenix, realized that some form of national healthcare legislation was a possibility. Novack worked with conservative groups to craft what is now called the Healthcare Freedom Act.


Health Alert Obama Administration Report is a Devastating Critique of ObamaCare
Apr 26, 2010
by John Goodman

Rick Foster is my hero. Over the past year, he has proved over and over that he cannot be bullied, intimidated, threatened, cajoled, browbeaten, buffaloed, hornswaggled, seduced, tricked, duped, bamboozled, bribed, blackmailed, coerced or bought off. In a place like Washington, D.C., this means that most days he probably eats lunch alone. It’s amazing that he still has his job.

Rick Foster is the Chief Actuary of Medicare, and his office has just released a devastating critique of the Administration’s health reform law.

Before getting to details, let me say there is nothing in the report that is surprising to independent health economists. The conclusions are consistent with everything The Lewin Group and other private estimates have been saying for months. What is surprising is that one of the most respected agencies of the U.S. government is completely undermining the Alice-in-Wonderland fables being spun by the White House, on Capitol Hill and in the mainstream media. To wit:

You cannot take close to one trillion dollars away from one group of people and spend it on another group of people and somehow leave those footing the bill better off.

You cannot give millions of people large increases in medical care without creating any new doctors, new nurses or other paramedical personnel.

You cannot arbitrarily reduce what you are paying providers by billions of dollars and still expect to get the same quantity and quality of care.

You cannot give millions of patients and thousands of doctors new incentives to waste medical resources and then expect health care spending to go down.

In other words, the Chief Actuary is simply saying reality is reality. Economics is economics. A is A.
Convenient summaries of the Actuary’s report have been produced by the Republican staff of the House Ways and Means Committee and by the Senate Republican Policy Committee. Although these are partisan groups, the summaries appear to be quite faithful to the source. Here are the salient findings (with page numbers in the Actuary’s report):

Health care costs will go up, not down. National health expenditures will increase from 17 percent of GDP now to 21 percent under the new law and will be higher than without the legislation. [Page 4] Net federal spending on health care will also increase.

Health care shortages are “plausible and even probable.” Because of the increased demand for health care, “supply constraints might initially interfere with providing the services desired by the additional 34 million insured persons.” [Page 20]

14 million employees will lose their employer coverage. Employees of small firms are especially at risk (despite small employer tax credit subsidies). [Page 7]

2 million employees who lose coverage will have to enroll in Medicaid. [Page 3]

A Medicaid insurance card is not a guarantee of care. An estimated 18 million people will be added to Medicaid. [Page 3] However, because there is no corresponding increase in the supply of caregivers, “it is reasonable to expect that a significant portion of the increased demand for Medicaid would be difficult to meet, particularly over the first few years.” [Page 20]

One in ten insured workers will see their health benefits taxed. By 2019, more than 10% of insured workers will “be in employer plans with benefit values in excess of the thresholds (before changes to reduce benefits) and this percentage would increase rapidly thereafter.” [Page 13]

Higher taxes will lead to higher premiums. The new taxes on medical devices, prescription drugs, and insurance plans “would generally be passed on through to health consumers in the form of higher drug and device prices and higher insurance premiums.” [Page 17]

There are more than one-half trillion in Medicare cuts. The new health law cuts “$575 billion” from Medicare. [Page 4]

Medicare cuts would threaten almost one in every seven hospitals. About “15 percent of Part A providers would become unprofitable within the 10-year projection period.” [Page 10]

Overall access to care for seniors would go down. Because of the law’s payment reductions, “providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and, absent legislative intervention, might end their participation in the program. [Page 10]

7.4 million people will lose access to Medicare Advantage plans. Enrollment in MA plans will be cut in half (from its projected level of 14.8 million under the current law to 7.4 million under the new law). [Page 11]

False advertising: The new “Medicare Tax” doesn’t go to Medicare. “Despite the title of this tax, this provision is unrelated to Medicare; in particular, the revenues generated by the tax on unearned income are not allocated to the Medicare trust funds.” [Page 9]

False advertising: Budgetary double-counting does not improve Medicare’s solvency. Medicare cuts “cannot be simultaneously used to finance other federal outlays (such as the coverage expansions) and to extend the [life of the Medicare] trust fund, despite the appearance of this result from the respective accounting conventions.” [Page 9]

The new long-term care insurance plan (CLASS Act) is unsound. The program faces “a significant risk of failure” because the high costs will attract sicker people and lead to low participation. [Page 15]

The promise to those with pre-existing conditions is unfunded. “By 2011 and 2012 the initial $5 billion in Federal funding for [high risk pools] would be exhausted, resulting in substantial premium increases to sustain the program.” [Page 16]

The law does almost nothing to limit actual fraud and abuse. The fraud provisions in the law will save only about two percent of $47 billion in suspect claims.


APRIL 26, 2010
ObamaCare Mulligan
About those lower insurance costs we promised . . . .

When President Obama signed his health-care reform last month, he declared it will "lower costs for families and for businesses and for the federal government." So why, barely a month later, are Democrats scrambling to pass a new bill that would impose price controls on insurance?

In now-they-tell-us hearings on Tuesday, the Senate health committee debated a bill that would give states the power to reject premium increases that state regulators determine are "unreasonable." The White House proposed this just before the final Obama- Care scramble, but it couldn't be included because it violated the procedural rules that Democrats abused to pass the bill.

Some 27 states currently have some form of rate review in the individual and small-business markets, but they generally don't leverage it in a political way because insolvent insurers are expensive for states and bankruptcies limit consumer choices. One exception is Massachusetts: Governor Deval Patrick is now using this regulatory power to create de facto price controls and assail the state's insurers as cover for the explosive costs resulting from the ObamaCare prototype the Bay State passed in 2006.

National Democrats now want the power to do the same across the country, because they know how unrealistic their cost-control claims really are. Democrats are petrified they'll get the blame they deserve when insurance costs inevitably spike. So the purpose of this latest Senate bill is to have a pre-emptive political response on hand.

ObamaCare includes several new cost-driving mandates that take effect immediately, including expanding family coverage for children as old as 26 and banning consumer co-payments for preventive care. Democrats are bragging about these "benefits," but they aren't free and their cost will be built into premiums. And those are merely teasers for the many Washington-created dysfunctions that will soon distort insurance markets.

In Massachusetts, Mr. Patrick says his price-control sally will be followed by reviewing what doctors and hospitals charge—or in other words for price controls on the medical services that make up most health spending. ObamaCare will gradually move in the same direction.

Or maybe not so gradually, judging by the study released last last week by Richard Foster, the Obama Administration's Medicare actuary. Mr. Foster predicts net national health spending will increase by about 1% annually above the status quo that is already estimated to be $4.7 trillion in 2019. This is one more rebuke to the White House fantasy that a new entitlement will lower health costs.

"Although several provisions would help to reduce health care cost growth, their impact would be more than offset through 2019 by the higher health expenditures resulting from the coverage expansions," Mr. Foster writes—and that's assuming everything goes according to plan. He considers it "plausible and even probable" that prices in the private market will rise as greater demand due to subsidized coverage runs into the relatively fixed supply of doctors and hospitals.
Most of ObamaCare's unrealistic "savings" come from cranking down the way Medicare calculates its price controls, and Mr. Foster writes that they'll grow "more slowly than, and in a way that was unrelated to, the providers' costs of furnishing services to beneficiaries." He expects that 15% of hospital budgets may be driven into deficits, thus "possibly jeopardizing access to care for beneficiaries." Isn't reform grand?

The official who will preside over this fiscal trainwreck is Donald Berwick, the Harvard professor and chief of the Institute for Healthcare Improvement who the White House has nominated to run Medicare. Dr. Berwick explained in an interview last year that the British National Health Service has "developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn." He added that "The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

In fact, the real choice with medical care, as with any good or service, is between rationing via politics and bureaucratic lines or via a competitive market and prices. As Democrats are showing by trying to pass a new insurance bill, they want all U.S. health care to function like price-controlled Medicare. Dr. Berwick's job as the country's largest purchaser of health care will be to find ways to offset the higher insurance and medical costs that ObamaCare's subsidies and mandates will cause, which will inevitably mean political rationing of care.

In a 17-minute, 2,600-word answer to a question about tax increases in Charlotte, North Carolina earlier this month, Mr. Obama mentioned that "what we've done is we've embedded in how Medicare reimburses, how Medicaid reimburses, all these ideas to actually reduce the costs of care." The embedding via price controls is already underway.


ObamaCare Dominoes Falling
American Thinker Blog: ObamaCare Dominoes Falling
C. MacLeod Fuller

The predictable consequences of forcing companies to sell healthcare insurance to people with pre-exisiting conditions are unfolding. On Tuesday, American Thinker reported that a mere two weeks after President Obama signed ObamaCare into law, one result was that Massachusetts Democrat Governor, Deval Patrick, "rejected 235 of 274 insurer requests for premium increases for individuals and small businesses over the coming year" -- requests made by that state's three largest nonprofit insurers, Blue Cross Blue Shield, Harvard Pilgrim, and Tufts Heath Plan. Later in the week, the insurers simply stopped selling policies. According to the Wall Street Journal, three of the four largest suffered net operating losses in 2009 and the Democrats' "arbitrary rate cap will result in another $100 million in collective losses this year [...making...] it impossible to pay the anticipated costs of claims, and threatening the near-term solvency of some companies."

The Journal noted,
...state officials have demanded that the insurers-under the threat of fines and other regulatory punishments-resume offering quotes by today and to revert to year-old base premiums. Let that one sink in: Mr. Patrick has made the health insurance business so painful the government actually has to order private companies to sell their products (albeit at sub-market costs).

The article also reveals a number of interesting facts, including: - Massachusetts' "insurance regulators have concluded the reason [that state's] premiums are the highest in the nation is the underlying cost of health care, not the supposed industry abuses" imagined by President Obama and Governor Patrick. - The unsurprising fact that because Massachusetts' universal healthcare mandate prohibits exclusion for pre-existing conditions, people simply "wait until they're about to incur major medical expenses before buying insurance and transfer the costs to everyone else." - Once the medical emergency has passed, short-term enrollees drop their coverage - because they know they can demand "insurance" the next time they want it. - Blue Cross Blue Shield reported "short-term customers ... ran up costs more than four times the average" and dropped coverage "within three months."

Harvard Pilgrim's experience with such hit-and-run enrollees is that they remained with the plan "fewer than five months and on average incurred costs about 600% higher." Of course, when their next medical stubbed toe happens, such short-term "purchasers" will return. Under ObamaCare, Massachusetts foreshadows the future of all 50 states - with a socialist-inspired financial vengeance.


Cost? What Cost?
The Fredericksburg (Va.) Free Lance-Star Mr. Obama mocked foes of the health care law in campaign-style speeches after he signed the bill, saying they acted as if it were the end of the world. It's not, of course, but, so far, opponents' forecasts have been much more accurate than Mr. Obama's otherworldly promises (4/29).


How the Health Care Law is Financed
The Tax Foundation has a useful chart showing how the health care law is financed over the next 10 years (keep in mind most of the taxes don't kick in until 2014, and the tax on "cadillac" coverage until 2018).


From the AMA
April 27, 2010

The Patient Protection and Affordable Care Act—health system reform legislation signed into law by President Obama on March 23—contains a number of key provisions for you and your patients. Some provisions may have an immediate impact on your practice and patients, while others will not take effect for some time.

Given the new direction for the nation's health system, the AMA has developed Health System Reform Insight to help you understand the new law and how it will affect you, when certain provisions are scheduled to take effect, how you can be ready when the regulations go into effect and what your patients need to know.

Past editions have explained how health system reform will affect physician practices, your patients and average Medicare payment rates, and provided descriptions of Medicare savings and tax credits and changes. Today we'll present an overview of some of the major provisions in the Patient Protection and Affordable Care Act relating to health insurance coverage and market reforms.

The Patient Protection and Affordable Care Act: Overview of major provisions relating to coverage

Health insurance market reforms

Immediate reforms to be implemented within six months, include:
Creating temporary high-risk pool with subsidized premiums for certain people with pre-existing conditions
Ending health insurance rescission abuse
Banning coverage exclusions of pre-existing health conditions for children
Requiring public disclosure of overhead/benefit spending by health insurance issuers
Providing coverage of certain preventive health services without cost-sharing
Eliminating lifetime limits on benefits and restrictions on annual limits on benefits
Requiring insurers that offer dependent coverage to allow children to be covered on their parents' insurance policy up to age 26
Developing uniform explanation of coverage documents for enrollees

Bans coverage exclusions of pre-existing health conditions or rating or coverage restrictions based on health status for adults
Provides standards for medical loss ratios to ensure premiums pay for benefits
Requires guaranteed issue and guaranteed renewability of coverage
Allows states to form compacts for the interstate sale of insurance
Increases transparency by requiring health insurers to provide a summary of coverage to applicants and enrollees
Allows enrollees to select their primary care provider (pediatrician for a child); no prior authorization or increased cost-sharing for emergency services; direct access to obstetrical and gynecological care

Insurance exchanges

Creates by 2014 state-based and state-administered health insurance exchanges (marketplaces) for the individual and small group market; states may be granted a waiver to opt out of this requirement if they provide coverage at least as comprehensive as that required under the Patient Protection and Affordable Care Act; only qualified health benefit plans meeting specific criteria can be sold in the exchange; insurers may sell policies outside the exchange; large employers would be phased into the exchanges in 2017
Prohibits health plans from discriminating against any health care provider acting within their state scope of practice law that wants to participate in the plan, but plans are not required to contract with any willing provider
Requires health plans to implement a process for appealing coverage determinations and claims
Allows qualified health plans to provide coverage through a qualified direct primary care medical home that meets requirements established by the secretary of the U.S. Department of Health and Human Services
Requires health plans to publicly disclose information on claims payment policies, enrollment, denials, rating practices, out-of-network cost-sharing and enrollee rights
Requires health plans to implement activities to reduce health disparities, including the use of language services, community outreach and cultural competency trainings

CO-OP and multi-state health plans

Creates the Consumer Operated and Oriented Plan (CO-OP) program to foster the creation of non-profit, member-run health insurance companies in all states
Specifies that a CO-OP organization may not be an existing organization; substantially all of its activities must consist of the issuance of qualified health benefit plans in each state in which it is licensed; governance of the organization must be subject to a majority vote of its members; any profits must be used to lower premiums, improve benefits or improve the quality of care delivered to its members
Provides initial grants to enable CO-OP organizations to meet state solvency requirements; precludes insurer or insurance industry involvement; organizations cannot operate until state has implemented the individual and small group insurance market reforms required under the Patient Protection and Affordable Care Act
Authorizes the Office of Personnel Management to contract with private health insurers to offer at least two multi-state qualified health plans (at least one non-profit) to provide individual or small group coverage through state-based exchanges

Long-term care

Creates a national, voluntary long-term care insurance program to help purchase services and supports for people who have functional limitations, in order to help them maintain personal and financial independence (CLASS program); financed through voluntary payroll deductions

Medicaid and CHIP

Expands Medicaid to all individuals under age 65 with incomes up to 133 percent of the federal poverty level
Provides 100 percent federal funding to states for costs of newly eligible individuals for 2014-2016
Increases payments for primary care services provided by primary care physicians (family medicine, general internal medicine or pediatric medicine) to 100 percent of the Medicare payment rates for 2013 and 2014; states will receive 100 percent federal funding for increased payment rates
Maintains current structure of the Children's Health Insurance Program (CHIP), with a 23 percent increase in the match rate in 2015 through 2019

Individual mandate

Requires most individuals to have minimum acceptable coverage or pay a tax penalty beginning in 2014; exemptions allowed for those who cannot afford coverage, religious objectors or if the individual has income below the tax filing threshold

Employer requirements

Requires employers with more than 50 full-time employees to provide health care coverage or pay a penalty
Requires employers that offer coverage and make a contribution to provide free choice vouchers to qualified employees for the purchase of qualified health plans through exchanges

Premium subsidies to individuals

Provides refundable, advanceable, and sliding-scale premium credits for individuals and families with modified gross incomes up to 400 percent of the federal poverty level

Small employer tax credits

Provides tax credits to small employers with 25 or fewer full-time employees and average annual wages of no more than $50,000 that purchase health insurance for their employees


((3 million, 4 million, what's the difference, right?))

3 million in middle class to pay health law penalty
Sean Lengell - Washington Times

Some 3 million middle-class Americans will be required to pay a penalty for not getting health insurance under the Obama administration's new health care law, raising questions about the president's willingness to break a campaign promise by increasing taxes on some families earning less than $250,000. A Congressional Budget Office analysis released Thursday said the average cost of the penalty will be slightly more than $1,000 apiece in 2016. Republicans chided the Obama administration for hurting middle-class Americans.

CBO: 4 Million To Face Fines For Not Having Health Insurance In 2016

About four million people "could be fined for failing to buy health insurance when the health overhaul law is fully in force in 2016, the Congressional Budget Office forecast on Thursday," Reuters reports, adding: "Most individuals must buy health insurance under the landmark legislation passed by Congress last month, or face fines that will be phased in."
The penalty would raise about $4 billion a year from 2017-2019, the CBO said. Starting in 2016, people without coverage could be fined $695 or up to 2.5 percent of their income for not having health insurance, but many of the 21 million likely to remain uninsured in that year will avoid the penalties. "Democrats called the numbers unsurprising and said that those paying penalties amounted to 1.5 percent of the population" (Dixon, 4/22).


Health Care Law
60% Believe Health Care Law Will Increase Deficit, 58% Favor Repeal
April 26, 2010

Support for repeal of the recently-passed national health care plan remains strong as most voters believe the law will increase the cost of care, hurt quality and push the federal budget deficit even higher.

The latest Rasmussen Reports national telephone survey finds that 58% of likely voters nationwide favor repeal, while 38% are opposed. Those figures are little changed from a week ago and include 47% who Strongly Favor repeal. Twenty-nine percent (29%) Strongly Oppose the repeal effort.

Support for repeal is proving to be just as consistent as opposition to the plan before it was passed into law. Over the past five weeks since Congress passed the measure, support for repeal has remained in a very narrow range from a low of 54% to a high of 58%.

Sixty percent (60%) of voters nationwide believe the new law will increase the federal budget deficit, while just 19% say it will reduce the deficit.

Fifty-seven percent (57%) think the law will increase the cost of health care, while 18% believe it will reduce costs.

Fifty-one percent (51%) expect the quality of care to decline, while 24% predict it will get better.
(Want a free daily e-mail update? If it's in the news, it's in our polls). Rasmussen Reports updates are also available on Twitter or Facebook.

Overall, 39% of voters nationwide believe the health care law will be good for the country, while 52% believe it will be bad.

There is a huge gap between the Political Class and Mainstream Americans on the new health care law, however. Eighty-two percent (82%) of Political Class voters oppose repeal. Seventy-one percent (71%) of Mainstream American voters take the opposite view and favor repeal (see more on the Political Class/Mainstream divide).

Attitudes about the new laws impact on deficits, the cost of care and the quality of care have been unchanged for many months. Prior to passage of the law, Scott Rasmussen wrote a Wall Street Journal column explaining “Why Obama Can’t Move the Health Care Numbers.”

As always, there are sharp partisan difference on all aspects of the new law.

Eighty-nine percent (89%) of Republicans, for example, believe the new law will increase the federal budget deficit, a view shared by 68% of voters not affiliated with either of the major parties. On the other hand, a modest plurality of Democrats (37%) believe the new law will reduce the deficit.

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.

See survey questions and toplines. Crosstabs are available to Premium Members only ShareThis
Rasmussen Reports is an electronic publishing firm specializing in the collection, publication, and distribution of public opinion polling information.

The Rasmussen Reports Election Edge™ Premium Service offers the most comprehensive public opinion coverage available anywhere.

Scott Rasmussen, president of Rasmussen Reports, has been an independent pollster for more than a decade.


((It isn't "reform" if there aren't enough doctors to take care of the patients....and there aren't....))
Solving Primary Care Shortage Requires More Than New Healthcare Reform Law

Robert Lowes - Medscape

Imagine, for a moment, the sound of ringing telephones in physician offices in 2014, the first year most Americans are required to carry health insurance under historic healthcare reform legislation enacted last month. Millions of previously uninsured and undertreated individuals have just purchased policies, many with the help of tax credits, and now they are trying to make appointments with internists and family physicians to treat their migraine headaches, high blood pressure, and constipation. However, receptionists and schedulers who answer their calls do not have encouraging words. "The first appointment we can give you is 2 months out," they say over and over. "We’re just swamped." Does this sound like reform?

The New York Times: "A new study detailing the uncompensated work burden on family doctors points to the need to change how they are paid, medical experts say -- particularly as the new health care law promises to add millions more patients to the system. ... Family doctors make up the embattled front line of the nation's health care system. They earn about half the money of specialists who focus on treating particular ailments or parts of the body. That is a reason less than 10 percent of medical school graduates choose so-called primary care, which includes general internists and pediatricians. Worsening shortages of family doctors were being predicted even before the recent health care legislation, which opened the door to an estimated 30 million newly insured people who will begin making appointments for checkups and other care. ... Comparatively modest salaries and rising patient numbers are part of the challenge, medical experts say. But so is the breadth of the unpaid work performed by family doctors. A study published on Wednesday in the New England Journal of Medicine measured that problem precisely, using computerized patient records and reporting systems to track all the tasks done in a five-physician practice over a year" (Lohr, 4/28). The study is called "What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice" (Baron, 4/29).

Stateline: The problem faced by most states is the same one that Massachusetts already faced after their health overhaul. Due to the increase in insured patients and the doctor shortage in the state, wait times for primary care appointments increased greatly after the law went into effect. Similar problems are expected nationally as the federal law is enacted. "Even before President Obama signed the health bill, there already was a shortage of primary care physicians, who usually are the first person a patient goes to for treatment. ... A surge of as many as 32 million new patients -- many of whom are poor and haven't seen a doctor in a long time -- could make the scarcity even worse."Since the federal law was based largely in part on the Massachusetts legislation, similar problems are expected. In addition to long wait times, an increased doctor shortage and budget problems when it comes to Medicare and Medicaid reimbursement increases are expected. "Massachusetts offers a cautionary tale about the pay hikes, as well. The state initially included Medicaid payment hikes in its health care overhaul, but those increases stopped after two years because of the state's budget problems" (Vock, 4/27).

HHS report on healthcare reform: Up to 15% of providers could fall into the red
McKnight's Medicare cuts under the new healthcare reform law could add 12 years of solvency to the program—but they may also be unrealistic and need to be scaled back, according to results of a new study from the Department of Health and Human Services. The HHS report suggests that up to 15% of Medicare hospitals and other providers could slip into the red due to the cuts. New fees on manufacturers of prescription drugs, reduced Medicare Part A costs and an increase to the Hospital Insurance payroll tax will extend solvency of the Part A trust fund until 2029, HHS' Office of the Actuary reported Thursday.


ObamaCare: Now What?
Insurance expansion will do nothing to fix higher prices and lengthy waiting times.

Marc Siegel, 04.26.10, 01:51 PM EDT

Every one of my patients has asked me what they can expect now that ObamaCare has passed. Many have said they are hoping for amiraculous change for the better.

I hate to disappoint them, but I am compelled to tell my patients that there are no miracles coming and in fact nothing will change right away or for the better. They will still spend a long time in my waiting room and in the waiting room of the hospital ER. They will still find that many of the tests I order are not approved by their insurance, neither public nor private. My patients will continue to discover that they are often compelled by their insurance to take a different medication than the one I initially prescribe for them.

As the months drag on, and my office expenses continue to increase, my patients will find that I am barely able to continue to keep my office open. Many will grow more disappointed as my carpeting grows worn and my wallpaper begins to peel. But they will soon discoverthat doctors' offices everywhere are falling into disrepair.

Even before the health reform bill and its proposed Medicare cuts take hold, my Medicare patients will grow more and more frustrated as reimbursements continue to be cut, doctors opt out and services grow scarcer. HMOs are following Medicare's lead and cutting fees too even before the federal government flexes its new oversight muscles and tries to tighten its belt. But down here in the trenches, as my reimbursements continue to diminish, I will have less and less time to spend with the increasing problems that accompany aging.

When many of the real ObamaCare changes finally do take hold beginning in 2013, my patients will find that the world of their medical care will get even worse, not better. Hospital ERs will be even more crowded with the newly insured. Doctors' offices will be swamped.

Beginning in 2013 16 million more people will be eligible for Medicaid, but where will they go for care? I don't accept Medicaid now, because it doesn't pay my office expenses, and I won't accept it then, even if the reimbursements increase slightly for two years. Without a network of specialists to refer Medicaid patients to (specialists fees will not be increased), I won't be able to work with it any more in 2013 than I am now.

In 2014 patients with pre-existing conditions will be able to obtain insurance no matter whether they are working, healthy, or sick. Many will qualify for federal subsidies. But where will this group go for care? My office practice is already full. And I must admit that once the health reform bill takes hold in a few years, if I do have an opening in my overburdened schedule I will be more inclined to see a patient with a single problem rather than a complex patient. Insurance may cover those with multiple pre-existing conditions but this doesn't mean I will be able to take care of them.

Somewhere out there is a patient without insurance who in a few years will have coverage that will help him or her get needed care or even stave off bankruptcy. But I am not likely to ever meet this patient, because I and others like me are already overwhelmed with the numbers of patients we do have.

I can barely afford to pay my rent and my staff and take care of the patients I have now. Insurance expansion will do nothing to cure this bitter reality.

Marc Siegel, M.D., is a practicing internist and a Fox News Medical Contributor.


Obamacare: Impact on Businesses
Published on April 27, 2010 by John Ligon

While President Obama continues traveling the U.S. heralding the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, businesses across the U.S. are growing more and more discontent—and for good reason.

The new health care law will impose new compliance regulations, employer mandate taxes, taxes on business “flow-through” and investment income, and numerous indirect costs on small- and medium-size companies. Altogether, these constraints will dramatically affect companies’ per-employee costs, firm-level allocation of labor, desire to take on health coverage, and motivation to grow both in terms of income and employment.

Congress should repeal this massive statute, start over, and get health care reform right.

Medium-Size Business Under Fire

Obamacare will dramatically impact the behavior of medium-size firms in the U.S.—specifically, those companies with 50–199 workers.[1] Beginning in 2014, Obamacare will begin imposing taxes—to help offset the cost of individual employees receiving premium subsidies through the to-be-established state health insurance exchanges—on companies with 50 “full-time equivalents” that do not offer an “acceptable” level of health insurance coverage.[2] These mandates will force companies—including companies below the 50-employee threshold—to react to eventual overall cost increases.

These changes will likely produce upward pressure on health insurance premiums in the “fully insured market”—and this will disproportionately affect these medium-size companies as well as smaller companies.[3] Employees will likely bear most of the burden since these costs will likely be passed on to them in the form of reduced wages, discontinued hiring, or loss of employment. Instead of adding more regular full-time employees, some businesses will simply increase hours for current employees, hire low-skilled and low-income labor, or opt for more temporary or seasonal workers.

Health Reform Penalizing Small Business

President Obama and congressional leadership repeatedly claim that Obamacare is good health reform policy for small businesses (companies with 50 or fewer workers), but this claim is not supported by the facts.[4] Instead, Obamacare will likely exacerbate many of the concerns of small businesses—particularly small business owners—in at least four ways.

1. Higher Health Care Costs. Obamacare does nothing to “bend down the cost curve” that small businesses face relating to providing health insurance coverage. In fact, it is likely that the endless regulations, mandates, fees, and taxes will put upward pressure on premium prices—particularly in the “fully insured” market, where 88 percent of workers and dependents at small businesses purchase health insurance.[5] Heritage analysis estimates that roughly 54.5 percent of the total “premium tax” on health insurers will be paid by workers and dependents covered by these employer group policies.[6]

Additionally, the increased costs of health insurance will cause many firms with 50 or fewer employees—perhaps most—to either not offer coverage or drop coverage if they currently offer it. There is nothing currently in Obamacare that will stop them from doing so.

2. Ineffective Small Business Tax Credit. Even accounting for the “cost-reducing” tax credits—which the Congressional Budget Office estimates will impact at most 12 percent of businesses with 25 or fewer workers and expire after two years beginning in 2014—Obamacare will not address the many uncertainties small businesses face in deciding whether to offer health insurance coverage to its workers.

Essentially, after all exclusions the only eligible firms for the heralded “small business tax credit” are those with 10 or fewer workers and those with low-income workers—and most of these workers will qualify for premium subsidies in the state exchanges. These small firms are the least likely to offer coverage even with a significant price reduction.

3. Higher Regulation Compliance Costs. Small businesses do not have the capacity to easily take on additional administrative complexities. Many small companies will have to hire additional workers—and incur higher external accounting expenses—to handle not only the enhanced compliance regulations on health insurance plans but also stricter tax compliance regulations relating to business-to-business transactions.[7]

4. Medicare Taxes on “Flow-Through” and Investment Income. Obamacare will increase the Medicare payroll tax and establish a new Medicare non-payroll (“investment”) tax. This tax will apply perversely on “flow-through income”—thus reaching a significant share of small businesses.[8] Moreover, the wage thresholds on this tax increase are not indexed to inflation and, consequently, will push more small business owners into this higher tax group.[9] The Medicare “investment” tax will also lead to greater deterrence on investment—and passive income—which will suppress economic growth.

Penalizing Business Growth and Success

Businesses will not take much comfort from the passage of this “historic” health care bill. The President and many lawmakers in Washington are consistently proposing and passing legislation that hurts these businesses, and Obamacare is one more example.

Obamacare fails to appropriately address the concerns of small- and medium-size businesses relating to health care reform, and it will force many companies to react to new cost burdens. The intended consequences of this poorly constructed bill are harmful enough, but the many unintended consequences are even worse.

John L. Ligon is Policy Analyst in the Center for Data Analysis at The Heritage Foundation.


((And since those greedy doctors can't be trusted not to perform unnecessary surgery in their own hospitals in order to pad their bottom lines....presto, no more doctor-owned facilities. Because accountants and lawyers are SO much more qualified to be making decisions about how health care facilities should be run....))

Forbes Magazine
ObamaCare's First Victim: Physician-Owned Specialty Hospitals
April 5, 2010 - 4:46 pm
David Whelan is a staff writer at Forbes

Big community hospitals supported the president's health overhaul. In exchange they are getting something they have desperately wanted for years: a ban on new competition.

The health overhaul was of course supposed to be about expanding coverage to the uninsured and slowing down the inexorable rise in health care costs, though the second goal was more talk than reality.

Buried in the hundreds of pages of legalese and footnotes are handouts unrelated to these two goals. The recipients are favored groups that went along with ObamaCare from the get go. Some of these groups got surprisingly little--doctors got neither tort reform nor a Medicare pay increase--but others got huge handouts. The AARP got the donut hole of Medicare drug plans filled.

Some of these handouts are harder to see and haven't gotten much attention but are extremely generous. One is to the hospital industry, for which the bill actually bans a potent form of competition. Section 6001 of the bill contains a measure that prevents groups of doctors from investing in new hospitals. A group of lawyers can own a hospital. A group of hedge fund managers can own one. But doctors, who would presumably know the most about starting a hospital, won't be able to after this year when the bill kicks in.

The back story here is long and interesting. (Check out Forbes' cover story on physician-owned hospitals from 2008: "Stop That Patient.") Big hospitals, represented by the nonprofit American Hospital Association and the for-profit Federation of American Hospitals, have long sought to limit competition from the doctors they employ. When a doctor sees a patient he generates two streams of revenue, a professional fee that he collects and technical fees related to the facility. The latter could be for an operating room during surgery or a hospital bed overnight for a patient who's admitted. Big hospitals would like to monopolize this second revenue stream, which is much larger than the professional fee.

Physicians, facing cuts to their professional fees, feel that by owning hospitals they can get a larger share of the revenue associated with their work. Physician groups have started heart hospitals, spine hospitals and orthopedic hospitals to get out from under the shoe of whatever the big medical system is in town. Some have even started acute care--general--hospitals.

There's a lot of money at stake. A new report by the search firm Merritt Hawkins that just came out last week, shows just how much. This table shows how much hospital revenue is associated with different kinds of doctors and compares it to their salaries. The vast majority of the economic value created by physicians is not captured by them but by the hospitals where they work. This unheralded part of ObamaCare, which prevents any new physician-owned hospitals from being built, institutionalizes that set-up regardless of patient or physician preferences. No wonder the big hospitals are running ads congratulating those legislators who voted for it.

((And, of course, doctors can't be trusted to use their best medical judgement to order prescriptions, because they're so weak-minded and downright sleazy that they'll order the wrong medication JUST BECAUSE a drug rep gave them a pen or bought them dinner....))

New Health Law Will Require Industry To Disclose Payments To Physicians
Writing for Kaiser Health News, Arlene Weintraub reports: "Doctors who accept speaking fees, five-star meals and other compensation from pharmaceutical or medical device companies will soon see their names -- and the value of the gifts they accept -- revealed on the Web, under a new federal law that follows several states in drawing attention to such financial benefits" (Weintraub, 4/26). Read entire article.


What Will Health Care Reform Look Like in 2019?

Derek Thompson - The Atlantic Health care costs will raise projected spending by about 1 percent over 10 years and Medicare cuts could put 15 percent of hospitals into the red, according to a new report from the Center for Medicaid and Medicare Services. The full estimates are here (warning: PDF). The report is generating quite a bit of heat from bloggers, but it's not exactly new news. The effect of the law is that American health care will cover more (35 million more) and cost more ($311 billion more) over the decade. We knew that.


Individual Mandate Would Impose High Implicit Taxes on Low-Wage Workers
Michael F. Cannon is director of health policy studies at the Cato Institute and author of "ObamaCare's Prescription for Low-Wage Workers: High Implicit Taxes, Higher Premiums," released today by the Cato Institute.
Added to on January 13, 2010
This article appeared on on January 13, 2010.

((This was written BEFORE the bill passed, but it's an outstanding analysis of how the mandate will work...))

by Michael F. Cannon

In their attempt to expand health insurance coverage, House and Senate Democrats are poised to make the American dream less accessible to low-income Americans by hitting them with higher implicit tax rates than even multi-millionaires face.

In a new study, I found those implicit marginal tax rates would hover near 70-80 percent over broad ranges of income. In many cases, they would exceed 100 percent, financially penalizing those who try to climb the economic ladder.

The legislation would cause taxes and health insurance premiums to climb higher still, by creating huge financial incentives for healthy people to drop out of the market.

President Obama's economic advisors and other Democratic economists acknowledge that the individual mandate is essentially a tax.

Two features of each bill would combine to impose punitive implicit tax rates on low-income Americans.

The first is an "individual mandate," which would force Americans to purchase health insurance whether they want it or not, under penalty of fines and/or imprisonment. President Obama's economic advisors and other Democratic economists acknowledge that the individual mandate is essentially a tax.

Each bill would require low- and middle-income Americans to pay an increasing percentage of their income toward health insurance. In so doing, the bills dispense with the heretofore universally accepted principle that marginal tax rates should only apply to income at the margin. As a result, the "mandate tax" creates marginal rates as high as 53 percent — and that's for people making just $15,000 per year.

The second feature is the health insurance subsidies tied to the individual mandate. Those subsidies would disappear as income rises. Under the House bill, families of four with an annual income around $43,000 can lose a $1,000 subsidy just by earning $1 over the eligibility cutoff.
The non-partisan Congressional Budget Office writes, "That effect, known as an 'implicit tax,' can lead people to work fewer hours than they otherwise would, in the same way that income and payroll tax rates do." It may also discourage them from "working harder in the hope of winning raises; accepting new positions or responsibilities with higher compensation; or investing in their future earning capacity through education, training, or other means."

The disincentives to climb the economic ladder would be severe:

Under the Senate bill, a single adult who scrapes her way from $12,000 to $17,000 in annual earnings would only get to keep one out of every three of those additional $5,000 dollars — an implicit tax rate of 66 percent.

Under the House bill, a family of four that struggles to climb from $30,000 to $45,000 would only get to keep $3,000 of that additional $15,000 — an implicit tax rate of more than 80 percent.

In many cases, implicit marginal tax rates would exceed 100 percent:

Under the Senate bill, adults with annual earnings of $14,560 who earn an additional $560 would see their total income fall by $200, due to higher taxes and reduced subsidies.

Under the House bill, a family of four starting at $43,670 that earns an additional $1,100 would see its total income fall by $870.

Multi-millionaires would face tax rates no higher than 47.9 percent under these bills. In contrast, the Senate bill would create at least three "cliffs" where families of four would face implicit marginal tax rates greater than 100 percent. The House bill would create at least four.

Many low- and middle-income families will decide the American dream is no longer worth it. If work no longer pays, who could blame them?

These high implicit tax rates are not a minor problem that can be fixed with a quick amendment. They are an inherent part of the Democrats' strategy of expanding coverage by shifting costs, rather than reducing costs.

The perverse incentives don't stop there.

Americans would have to pay a penalty if they lack insurance, but the penalties are so small that healthy individuals could save as much as $3,000 per year by going uninsured, while families of four could save $8,000. Those savings would grow over time. Each bill would effectively eliminate any penalty for "going bare" by forcing insurers to sell to the uninsured at standard premiums whenever they fall ill.

When healthy people respond to those incentives by abandoning insurance pools, premiums will rise for those who remain. That will create pressure for even more government spending and higher taxes.

Congress should apply the brakes to this locomotive. Americans deserve time to figure out what's going on inside these 2,000-page bills.


Overhaul May Cost Drugmakers More Than Expected
Bloomberg BusinessWeek: The health overhaul legislation will likely cost drugmakers $25 billion more than the $80 billion the industry anticipated when it agreed to back the Democratic-led effort, according to Wall Street analysts. "The extra costs will come from expanding drug rebates through Medicaid, the U.S. insurance program for the poor, [Leerink Swann & Co executive] John L. Sullivan said today at a Bloomberg conference in Chicago." He added that the "[i]ndustry is being asked to shoulder a significant amount and it feels like that which industry will be shouldering is at risk of rising" (Nussbaum, 4/27).

The Philadelphia Inquirer: Employers are looking for answers to a host of health reform questions, and some health consultants are offering guidance. "What seems inescapable, they say, is that the American health-care marketplace likely will look vastly different when and if the plan is put into effect. ... Some health-care benefits managers have been telling (Brian) Pinheiro (a lawyer and partner at Ballard Spahr LLP in Philadelphia) that they see a future in which employers no longer provide coverage because the cost of dropping health insurance for employees, about $2,000 per person in federal penalties to employers, is far less than the current cost of providing family coverage, about $12,000 per employee" (Mondics, 4/27).

Politico: States are worried about the establishment of high-risk pools, mandated by the new health reform law. "On Friday, states must decide whether to help the Department of Health and Human Services set up or expand high-risk insurance pools by the June 21 deadline set in the law, or, in the alternative, leave HHS to do it all by itself. The pools, modeled after similar programs that already exist in more than 30 states, are designed to quickly provide coverage to adults with pre-existing medical conditions. People will qualify to join the pools, which will offer catastrophic coverage but still have high premium costs, if they've been without insurance coverage for six months." HHS has $5 billion to start up the pools, but states like Louisiana and Georgia have already opted out of assisting HHS (Haberkorn, 4/27).

Democrats Say ‘Oops’ on Obamacare Write-Downs
Daniel Foster - NRO's The Corner
Remember when companies started reporting the write-downs they'd take as a result of the passage of Obamacare? You know, the write-downs they were required by law to report? And remember when the Democrats who shepherded the bill through Congress reacted with outrage at the announcements, and scheduled hearings to demand answers and accounting methods from AT&T, Caterpillar, Deere, and Verizon? Well, the hearings were canceled, but the congressional inquiry, which pored over hundreds of pages of e-mails and financial documents, has yielded . . . absolutely nothing untoward.

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


No comments:

Post a Comment