Thursday, November 11, 2010

11/8/2010 - Medical Professionals win BIG; Now the work begins

11/8/2010 - Liability and Health News Update
Medical Professionals win BIG in Election; NOW the work begins

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

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I can't begin to thank the doctors and other health care professionals who supported candidates who support them for all the work you did. Words are simply inadequate.

The margins were close enough in many of Tuesday's elections that we know doctors, patients and other advocates for quality health care made a HUGE difference.

Without your help, the results of Tuesday's election might have been very different.

Now, the real work begins, and no matter how much we would like to see the so-called Patient Protection and Affordable Care Act (which will do none of what its name implies) repealed the day after the 112th session of Congress opens, we all know it's a lot more complicated than that. I'll try to keep you updated and to let you all know when noise is required.

Question of the Week:

What do two opthalmologists, one optometrist, two orthopedic surgeons, five obestetrician/gynecologists, two dentists, four family practice/general practitioners, one cardiothoracic surgeon, one gastroenterologist, one cardiovascular surgeon, one anesthesiologist, one general surgeon, two nurses, one emergency room doctor, one psychologist and one psychiatrist have in common?

Answer: No, they're not members of a medical surgical mission to a third world country - although they'd probably make a terrific team.

They are ALL members of an extremely exclusive club, whose members never exceed 535 Americans - the U.S. Congress, as of last Tuesday's election.

The vast majority of these, 24 of 26 to be exact, are also Republicans, and one of the primary things they ran against was the Patient Protection and Affordable Care Act.

Previously, there were two doctors in the US Senate - Tom Coburn and John Barrasso. Now there are four, with the addition of Rand Paul and John Boozeman.

Previously, there were 18 medical professionals in the House, including four Democrats who supported the PPACA. Now there are 22, including two Democrats who support the PPACA.

One Republican doctor - Parker Griffith, (who changed parties from Democrat after passage of the health care bill, which he opposed) lost his primary. One Republican doctor, Rep. John Linder, retired, but his seat was won by his non-physician Chief of Staff. One, John Boozeman, left the House to run for the Senate, and won. One Democrat doctor who supported PPACA, Steve Kagan, lost his seat, while another, Vic Snyder, retired. Two Democratic doctors who supported the PPACA were re-elected - Donna Christensen, from the Virgin Islands, and Jim McDermott.

Both doctors who ran as Democrats in support of the PPACA - Manan Trivedi and Ami Bear - lost their races.

A complete list of the medical professionals who ran and the results of each election follows.

This group of health care professionals overwhelmingly supports defunding, repealing and replacing the PPACA with reforms doctors and other health care providers can support.

Within the next week, I plan to contact each of them to offer support, and to find ways to connect them with various medical and patient organizations and tea party groups who will be happy to help them do what they were elected to do - preserve America's health and the doctor-patient relationship by repealing and replacing the PPACA.

Lists of those organizations will follow, as will strategies to assist in the effort. Please stay tuned!

And, again, THANK YOU for your efforts. You DID make a difference.

Sincerely and gratefully,

Donna Baver Rovito



Boehner: "Trust me. I'm Going To Make Sure This H'care Bill Is Never, Ever, Ever Implemented"!



((Kudos to this insightful and forward-thinking group of women doctors! I've been in contact with Dr. Alieta Eck from New Jersey for several years on liability issues, and she is a champion for physician and patient rights.))



Election 2010: Medical Professional Results

US Senate

(Unless otherwise noted, candidates are Republican)

Arkansas *WON SEAT* Rep. John Boozman - Optometrist (Currently representing AR-06 in the House) Campaign site:

Kentucky *WON SEAT* Rand Paul, MD - Opthalmologist Campaign site:

Maryland *LOST* Eric Wargotz, MD - Pathologist Campaign site:

Ohio *LOST* Michael Pryce, MD (Running as an Independent) - Orthopedic Surgeon Campaign site:

Oklahoma *Incumbent - HELD SEAT Sen. Tom Coburn, MD - Ob/Gyn Campaign site:

Wyoming *Incumbent- not up for re-election until 2012 Sen. John Barrasso, MD - Orthopedic Surgeon Official site:

US House
(Unless otherwise noted, candidates are Republican)

AZ-01 *WON SEAT* Paul Gosar, DDS - Dentist Campaign site:

CA-03 *LOST* Dr. Ami Bera (Democrat), medical school associate dean Campaign site:

CO-01 *LOST* Mike Fallon, MD - Emergency Medicine Campaign site:

GA-06 *Incumbent - HELD SEAT Rep. Tom Price, MD - Orthopedic Surgeon Campaign site: Official site: Visit Rep. Tom Price's Website

GA-07 Rep. John Linder (Retiring - chief of staff won seat) Official site: Visit Rep. John Linder's Website

GA-10 *Incumbent - HELD SEAT Rep. Paul Broun, MD - Family Medicine Campaign site:

GA-11 *Incumbent - HELD SEAT Rep. Phil Gingrey, MD Ob/Gyn Campaign site: Official site: Visit Rep. Phil Gingrey's Website

IA-02 *LOST* Mariannette Miller-Meeks, MD - Ophthalmologist Campaign site:

ID-02 *Incumbent - HELD SEAT Rep. Mike Simpson - Dentist Campaign site: Official site: Visit Rep. Mike Simpson's Website

IL-07 *LOST* Mark Weiman, DMD - Dentist Campaign site:

IN-08 *WON SEAT* Larry Bucshon, MD - Cardiothoracic Surgeon Campaign site:

LA-04 *Incumbent - HELD SEAT Rep. John Fleming, MD - Family Practice Campaign site: site: Visit Rep. John Fleming's Website

LA-06 *Incumbent - HELD SEAT Rep. Bill Cassidy, MD - Gastroenterology/Internal Medicine Campaign site: site: Visit Rep. Bill Cassidy's Website

LA-07 *Incumbent - HELD SEAT Rep. Charles Boustany, MD - Cardiovascular Surgeon Campaign site: Official site: Visit Rep. Charles Boustany's Website

MA-07 *LOST* Gerry Dembrowski - Chiropractic Primary Care Campaign site:

MD-01 *WON SEAT* Andy Harris, MD - Anesthesiologist Campaign site:

MD-02 *LOST* Marcelo Cardarelli, MD - Cardiothoracic Surgeon Campaign site:

MI-01 *WON SEAT* Dan Benishek, MD - General Surgeon Campaign site:

MI-15 *LOST* Robert Steele, MD - Cardiologist Campaign site:

NC-02 *WON SEAT* Renee Ellmers - Nurse Campaign site:

NC-04 *LOST* BJ Lawson, MD - Neurosurgeon Campaign site:

NV-03 *WON SEAT* Joe Heck, DO - Emergency Medicine Campaign site:

NY-28 *LOST* Jill Rowland, DDS - Dentist Campaign site:

NY-19 *WON SEAT* Nan Hayworth, MD - Ophthalmologist Campaign site:

PA-6 *LOST* Dr. Manan Trivedi (D), Internal Medicine, Obama campaign advisor Campaign site:

PA-18 *Incumbent - HELD SEAT Rep. Tim Murphy - Psychologist Campaign site: Official site: Visit Rep. Tim Murphy s Website

TN-01 *Incumbent - HELD SEAT Rep. Phil Roe - Ob/Gyn Campaign site: Official site: Visit Rep. Phil Roe's Website

TN-06 *WON SEAT* Diane Black - Nurse Campaign site:

TN-04 *WON SEAT* Scott DesJarlais, MD - General Practice Campaign site:

TX-14 *Incumbent - HELD SEAT Rep. Ron Paul, MD - Ob/Gyn Campaign site: Official site: Visit Rep. Ron Paul's Website

TX-16 *LOST* Tim Besco, RN - Nurse Campaign site:

TX-25 *LOST* Donna Campbell, MD - Emergency Medicine Campaign site:

TX-26 *Incumbent - HELD SEAT Rep. Michael Burgess, MD - Ob/Gyn Campaign site: Official site: Visit Rep. Michael Burgess's Website

WA-07 *Incumbent - HELD SEAT Rep. Jim McDermott, MD (Democrat) - Psychiatrist Official site: Campaign site: (YES on PPACA)

WI-08 *Incumbent - LOST SEAT Rep. Steve Kagen, MD (Democrat) - Allergist/Immunologist Official site: Campaign site: (YES on PPACA)

Virgin Islands *Incumbent* Rep. Donna Christensen, MD (Democrat) - Family Practice Official site:


New wave of House Republicans includes several health care professionals who ran against ObamaCare
By Caroline May - The Daily Caller Published: 2:06 PM 11/04/2010 Updated: 5:20 PM 11/04/2010

The Republicans gave the Democrats a historic spanking election night in the House of Representatives — netting over 60 seats, taking the majority, and leaving House Speaker Nancy Pelosi to contemplate a variation on Charlton Heston’s “from my cold dead hands” declaration.
Notably, out of those 60 plus Republican seats, nine of the newly elected Republicans are or were health care professionals. Many of the health care professionals elected to
Congress Tuesday ran on a platform in opposition to President Barack Obama’s new health care law — giving those anti-Obamacare adherents even more to smile about this week.

The nine House newbies include: Larry Bucshon, an Indiana thoracic surgeon; Joe Heck, a Nevada physician; Dan Benishek, a surgeon from Michigan; Renee Ellmers, a North Carolina nurse; Scott DesJarlais, a Tennessee general practitioner; Diane Black, a Tennessee nurse; Paul Gosar, a dentist in Arizona; Andy Harris, an anesthesiologist in Maryland; and Nan Hayworth, a New York ophthalmologist.

These newly elected congressmen vocally stood in opposition to the president’s new health care law. Bucshon, for example,
told Byron York in March that Obama’s plan would bring down the entire health care system.

“[Obamacare] will basically decimate the health care system in America,” he told York. “The number of doctors who are going to retire, and the number of young people who are no longer going to go into medicine, will be massive.”

Ellmers also
voiced support for repealing Obamacare. “One of my main objectives when going to Washington is to work on the repeal of the health care bill,” she told The Daily Caller in September.
Robert Moffit, senior fellow at the Heritage Foundation, contends that the increase of medical practitioners in the House was a huge development, not just for repeal of Obama’s health care law, but also for the makeup of Congress generally.

“I think it is tremendous, I think it is a great development, largely because Congress has been dominated for so long by members of the legal profession,” he told TheDC. “It also is an indication of how the American Medical Association and professional medical organizations have failed to represent their own constituents. What is happening here is that members of the medical community are beginning to these issues into their own hands. They do not trust their lobbyist in Washington.”

Paul Lindsay, National Republican
Congressional Committee spokesman, said that he is pleased not only with the overall outcome, but also the experience the new members will be bringing with them.

“These are dedicated professionals who will bring a depth of experience to Congress, as well first-hand knowledge of America’s healthcare needs,” he said. “Their input will be critical as Republicans consider how to repeal and replace ObamaCare with a system that works.”

Georgia Republican Rep. Phil Gingrey, co-chair of the GOP Doctors Caucus, told The Daily Caller that the new congressmen will be a net gain.

“The issues facing our health care system are complex and solutions to these problems require an intimate understanding of how the system works. Medical professionals – like the members of the GOP doctors – are uniquely qualified to offer solutions for what ails our health care system,” he wrote in an email to TheDC. ”They have spent their professional lives caring for patients both in their practices and here in Washington. As we look forward to the coming Congress and our efforts to repeal ObamaCare, physician members of Congress are uniquely qualified to put forth solutions.”

((Hopefully, the GOP leadership will assign these new members of Congress to committees which will best utilize their medical expertise. Of course, they should all work with the GOP Doctors' Caucus - which should perhaps be renamed the GOP Medical Professionals' Caucus - and we need to work with ALL of them!))


There's No Avoiding 'Repeal and Replace' It’s essential for limited government. James C. Capretta Posted: Wednesday, October 20, 2010

Scores of House and Senate candidates are campaigning on a platform of reestablishing limited government. There could hardly be a more encouraging development for our republic. After decades of legislators' piling countless new programs on top of old ones, and two years of the most intense tax-and-spend binge ever conducted by an administration, government finances have reached the breaking point. Something is going to give, and probably sooner rather than later. Voters know this, which is why they are ready to take matters into their own hands and send a brigade of genuine change agents to the House and Senate on November 2. And these new members will come with clear marching orders: Cut government spending, hold the line on taxes, and shake up Washington in ways not seen in many years.

The crusade will no doubt start where it should, by reining in the obvious excesses of the sprawling and bureaucratic federal enterprise. Wasteful stimulus projects should be terminated immediately. Earmarking and pork projects should be banned from future appropriations measures. The federal workforce should be downsized, and government pay held in check until commensurate with wages in the private economy. Whole departments should be targeted for restructuring and elimination, and others scaled back dramatically. Obama's massive increases to appropriations should be reversed, and funding restored to its pre-2009 level. All of this, and much more, should be pursued with vigor, and without delay, come January.

But Washington's newcomers must not lose sight of the big enchilada on the government-reform menu: the repeal and replacement of Obamacare.

Because the hard truth is that the proponents of a supersized welfare state believe they have already won the fight. Their vision is now the law, with the government on course to control the flow of resources in the entire health sector. Even if every other idea to downsize the government is enacted, Obamacare as passed has us on the road to unlimited government -- with America's middle class increasingly dependent on the benefits they receive from elected political leaders.
The Congressional Budget Office (CBO)
estimates that Obamacare will add 35 million new people to the federal health-entitlement rolls by 2019, at a cost of $214 billion in that year alone. And that's almost certainly a vast underestimate of the true costs. Douglas Holtz-Eakin -- a former director of CBO and now president of the American Action Forum -- and Cameron Smith have estimated that Obamacare will lead to much more migration out of employer-sponsored plans than assumed by CBO: Tens of millions of workers -- and the firms that employ them -- will figure out that all involved will be far better off with the workers getting the massive subsidies provided by the federal government in the so-called "insurance exchanges," rather than with the much smaller tax break they receive for getting job-based insurance. According to Holtz-Eakin and Smith, an additional 35 million people are therefore likely to end up in the government's new subsidized insurance system, on top of the 35 million already assumed by CBO in its cost estimate, putting the total entitlement expansion at 70 million, or more than Medicare's total enrollment today. The additional enrollees will drive up the costs of Obamacare's new premium subsidy program to $1.4 trillion over the first decade, or about $1 trillion more than CBO estimated.

And that would be just the beginning of it. Both CBO and the chief actuary of the Medicare program expect that once Obamacare is in place, the cost of providing benefits to tens of millions of new enrollees will grow just as rapidly in future years as Medicare and Medicaid have in the past.
CBO forecasts that total federal health-entitlement spending will increase from 5.5 percent of GDP today to 10.9 percent of GDP in just 25 years. (This estimate uses different, but more realistic, estimates of future Medicare payment rates than Obamacare prescribes.)

What's needed to head off fiscal calamity is a market-based health reform that puts cost-conscious consumers, not the government, in charge. It's the opposite of the Obamacare prescription, and it starts with converting today's existing federal support for health-insurance coverage -- Medicare, Medicaid, and the tax preference for employer-paid insurance premiums -- into fixed-dollar contributions for the cost of coverage instead of open-ended programs that encourage and underwrite rising costs and inefficiency.

It's the kind of reform that Congressman Paul Ryan has proposed in his
Roadmap. Indeed, it's the essential centerpiece of any serious conservative effort to reform the nation's entitlement programs and bring federal commitments over the long run in line with a rate of taxation that promotes strong economic growth.

Fortunately, and to their everlasting credit, most of today's fiscally conservative candidates are campaigning hard on repealing Obamacare, and many have also taken the courageous step of endorsing, in broad terms, the need for fundamental reform of both Social Security and the health-entitlement programs. They aren't shying away from the challenge, at least not yet.

But the climb will get much steeper once they get to Washington. For starters, the president wields a veto pen, which means repeal and replacement is likely to be a multi-year endeavor, not a short-term fix. Moreover, the entire Washington establishment, including the national media, will be lined up against them. When things look hopeless, it will be tempting to turn full attention and energy to lower hanging fruit.

But that would be a mistake. Yes, it's crucial to rein in government excesses wherever they exist.

But if Obamacare is allowed to stand, the fight over the size and reach of the federal government will have been lost. Repeal and replacement is a must, no matter how hard or long the journey. The new troops coming to Washington must see it that way, and see themselves as laying the crucial foundation for a final victory when the time is ripe.

James C. Capretta is a fellow at the Ethics and Public Policy Center. He was an associate director of the Office of Management and Budget from 2001 to 2004.


ObamaCare's Day of Reckoning
James C. Capretta Posted: Monday, November 1, 2010

All signs point to an electoral rebuke of epic proportions tomorrow for those who sponsored and pushed ObamaCare through Congress in 2009 and early 2010. That would certainly be just.

Because, months ago, ObamaCare's advocates decided it was more important to them to jam the health care bill of their ideological dreams through Congress than it was to secure the consent of the governed for a more balanced, consensus plan. Now voters are set to do what they should under the circumstances: turn out of office those responsible for such a brazen act of political arrogance.

It was clear as early as August 2009 that the government-heavy health plan the president was pushing did not enjoy consensus support from voters, to put it mildly. Thousands of Americans took it upon themselves to attend last summer's congressional town hall meetings and express -- in clear and unmistakable terms -- that the president and Congress should cease and desist from pushing their ideologically driven health care agenda through the legislative process. These concerned Americans were not an isolated minority. Polling data has consistently shown since mid-2009 that a majority of Americans opposed the president's health care plan, and still do today.
And so what did those in power do when confronted with this deep and widespread opposition to their health care agenda? They ignored it. The president delivered an address to a joint session of Congress in September 2009 that dismissed the voices of opposition as an ill-informed minority who were easily swayed by demagogic excess. His allies then proceeded throughout the fall to march in lockstep as they pushed the legislation through its various stages of consideration, with no backtracking whatsoever from their plan to pass a full government takeover of American health care.

The voters, however, also did not give up. They flooded their elected representatives' offices with calls and letters pleading with them to change course, work with Republicans, and pursue sensible reforms that would enjoy wide support. These efforts bore some fruit, as a bipartisan coalition of rank and file House and Senate members began to express grave concerns with the emerging legislation, and pushed their leaders to seek a broader consensus by dropping their liberal ambitions and compromising with their adversaries.

But ObamaCare's proponents responded again by stepping on the accelerator rather than the brakes. To get around growing congressional opposition, their leaders stooped to the lowest forms of threats, bribes, and political brinksmanship to get their way. They bought votes, bullied opponents, and broke arms on their way to narrow passage of the original versions of the legislation in the House and Senate.

Of course, all of the back-room deals and taxpayer giveaways only infuriated the public even more. As it happened, there was a special election in Massachusetts in January to pick a successor to Senator Ted Kennedy, who had died the previous summer. No one had paid much attention to the race in 2009, under the assumption that Massachusetts' voters were almost certain to pick an ideological soul mate to Kennedy as his replacement. But Massachusetts's voters turned out to be just as irate as the rest of the country that the House and Senate had rammed through such an unpopular measure on a matter of such import. Republican state senator Scott Brown ran in the special election on the explicit promise to become the 41st vote in favor of a filibuster of the final version of the legislation -- and won in a rout.

But, once again, ObamaCare's proponents showed an unusual capacity to ignore the will of those who sent them to Washington. Within days of Brown's election, the administration and congressional leaders decided to press ahead with their plans for government-run health care by effectively bypassing the new senator from Massachusetts. After promising not to do so in 2009, House and Senate leaders chose to pass the final version of their health care plan under special, expedited procedures that required only a majority vote in the Senate, and thus avoid a filibuster.
By the end of the health care debate, ObamaCare's advocates had dropped all pretense of public persuasion. They knew they had lost the debate. There was no convincing the American people that the federal government had the capacity to manage the entire health sector well. Or that piling a massive new entitlement on top of the unaffordable ones already on the books was a good idea. Or that $1 trillion in new spending, $700 billion in new taxes, and $500 billion in Medicare cuts were sensible steps to take when the federal government was already running a $10 trillion deficit over the coming decade. In the end, it became an exercise in raw political power. ObamaCare's sponsors saw a once in a generation chance to bring the American middle class into full dependence on government-run health care, and they weren't going to pass it up.

But the electorate can only be ignored for so long. ObamaCare doesn't really become operational until 2014. Between now and then, the voters will have two opportunities (tomorrow, and again in November 2012) to render judgment on those who sponsored and rammed it through Congress. And after those votes are counted, ObamaCare's advocates may rue the day they embarked on their ideological health care crusade. Because not only will many of them lose their jobs, but ObamaCare itself could be well on its way to reversal before ever taking effect.

James C. Capretta is a fellow at the
Ethics and Public Policy Center and project director of


The Morning After
by John Goodman

Wow — what an election! What does it mean for health care? Almost every Republican and quite a few Democrats ran against ObamaCare in yesterday’s elections. Can it be repealed?
Outright repeal and nothing else will probably be stopped in the Senate; and, barring that, will undoubtedly face President Obama’s veto pen. But that’s not what the public is ultimately asking for anyway. Polls show that voters want health reform. They just don’t like the reform they got last spring.

As I explained at Kaiser Health News the other day, in thinking about what can be done, it’s helpful to review who won and lost under the Affordable Care Act (ACA). The big winners under the bill passed last spring are most (but certainly not all) of the 32 million newly insured plus some people with high health care costs. Let’s generously peg that at 50 million. The other 250 million are going to lose more than they gain. That’s right. For every winner, there are five losers.

If Republicans and moderate Democrats assert their will, the former group will almost certainly get less and the latter will get more. A numbers game will not be enough, however. To be successful, the second round of reform will have to solve some of the most important problems of ordinary citizens. Problems that ObamaCare does not solve. I believe that means making health insurance portable, affordable and fair.

Portable Insurance. If you took a poll, I believe you would find that the single biggest problem most nonelderly Americans have is lack of portability. If they get laid off, if they quit their job or just retire, they lose their health insurance. If you believe that problem is solved with a health insurance exchange coupled with government subsidies and community-rated premiums, take a look at Massachusetts. If you lose your BlueCross group plan and buy subsidized insurance in the Massachusetts health insurance exchange, you will get insurance that pays doctors little better than Medicaid rates. You’ll move from the head of the waiting lines to the rear. And in the not-too-distant future, you will probably be forced into a very restrictive HMO (called an Accountable Care Organization).

Not what you had in mind? Here’s a better solution.

In most states it is currently
illegal for employers to buy individually-owned insurance for their employees with untaxed dollars. They can buy BlueCross group insurance, but not BlueCross individual insurance — even though the insurance may be just as good and has the added advantage of being portable.

To solve this problem, we need to amend the federal law (ERISA/HIPAA) to allow portability nationwide. (See my own suggestion for
four steps to portability at the state level.) Note: This proposal would not require employers to buy portable insurance for their employees; it would only allow them to do so.

Affordable Health Insurance. Did you notice the other day that
McDonald’s is thinking about ending its insurance for about 30,000 low-wage employees? I suspect Burger King, KFC, Wendy’s and every other fast food restaurant chain will quickly follow suit.

The problem here is best summarized in Barack Obama’s own words. During the Democratic presidential primary, he said to Hillary Clinton, “You want to force people to buy something they cannot afford and then fine them when they don’t buy it.” Ten-dollar-an-hour employees and their employers cannot afford insurance that costs more than $5,000 for individuals and more than $12,000 for families. ObamaCare really is an eat-your-spinach reform for these employees and their families. It offers only mandates and fines. There are no new subsidies!

A similar observation applies to the
millions of baby boomers who will retire before they become eligible for Medicare. ObamaCare’s minimum-benefit mandates will make their insurance more expensive than it would have been. Further, above-average-income retirees will get very little help from government if they buy the required insurance in a health insurance exchange and they will face a hefty fine if they don’t buy it.

Even employees who think they have postretirement benefits from an employer may face an unpleasant surprise. The
3M corporation just announced it will be ending its coverage for its retirees and sending them instead to the health insurance exchange.

The answer to these problems is to completely drop the idea of individual and employer mandates and offer reasonable tax relief to people to buy reasonable coverage. But for this approach to work, we must (a) live within our means and (b) deal with everyone fairly.

Fair Health Insurance. We will never get sensible health reform without a leader who levels with the public about the economics of health care. For starters, the public needs to be told that the federal government cannot afford to buy every family (not on Medicare or Medicaid) an insurance plan whose annual premium is $12,000 or more.

What we have to do is take the tax subsidies already in the system and add to them whatever taxpayers are willing to pay and call it a day. Let’s put that number at $3,000 for an adult and $7,500 for a family. Conceivably, one could give more to lower-income families and less to higher-income ones. But in health care, legislators are so quick to abandon any defensible allocation principle, I think the best policy is to provide the same subsidy for everyone.

Instead of the arbitrary, unfair and regressive tax subsidies that pervade the current system as well as ObamaCare, every single adult should get a refundable health insurance tax credit of $3,000. Every family should get $7,500. And that’s that. (On how to do this, see my original
Health Affairs article with Mark Pauly and my summary of the Coburn/McCain approach.) Individual choice and market competition are going to have to find ways to make do with those limited subsidies.
What about pre-existing conditions? President Obama and the Democratic leadership in Congress have blurred the distinction between people who are uninsured through no fault of their own and people who are willfully uninsured. We can have a workable system in which people who are continuously insured do not lose access to the system merely because they retire or lose their jobs. (I have previously summarized one approach to
workable insurance reform.) However, we cannot allow people to game the system by opting not to be insured while healthy (and thus consuming all their income) and then insuring at the rates everyone else pays after they get sick. Such gaming is already threatening the Massachusetts health plan.

Here is what is most interesting about all of this. In solving the problems of ordinary Americans we can go a long way toward cleaning up and fixing the Rube Goldberg contraption commonly called ObamaCare. In helping middle-class voters we can, at the same time, also help everybody else.


Anger over health reform swamped Dems
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Published: Thursday, Nov. 4, 2010 - 5:06 am

ALEXANDRIA, Va. -- The evidence is clear:
Health reform was a serious liability on the campaign trail for Democrats who supported passage of the massive overhaul law.

President Obama had promised Democrats who were nervous about voting for the unpopular bill last March that he had their backs: If they voted for his signature legislation, he said he would work relentlessly to overcome public opposition and convince the American people the $1 trillion law was good for them and for the country.

It didn't work. Despite the sweeteners added to the bill to provide early appeal - such as coverage for pre-existing conditions, allowing 26-year-old "children" to stay on their parents' health insurance and free preventive care - the American people weren't convinced.

They know that the law's $500 billion in new taxes will be passed on to consumers in higher health costs and insurance premiums.

Business owners are aghast at the avalanche of mandates and new costs, stifling job creation. Seniors know you can't cut $500 billion out of Medicare and make their coverage more secure. And states know that the mandatory expansion of Medicaid will explode their budgets.
Anger was up close and personal with incumbent Democrats, especially those in the most competitive congressional districts.

Democratic congressmen who switched from voting "No" to "Yes" on the
health reform legislation faced the biggest trouble on the campaign trail.

Bill McInturff and Peter Hart found in a pre-election survey that health care was indeed a huge issue with voters. And they found that in nearly 100 of the most competitive House districts, opposition was most intense: 55 percent of voters oppose the law and only 38 percent support it.
And those who strongly oppose the health care legislation outnumber those who strongly favor it by two to one. Important, only 15 percent said they want the law to go into effect unchanged.
A second poll found that the issue mentioned most in motivating votes against Democrats was health care, mentioned more often than
President Obama, Nancy Pelosi or liberal. Independents opposed the law by a two-to-one margin, tipping the scale against Democrats in many competitive districts.

West Virginia's Democratic Gov. Joe Manchin withdrew his endorsement of the legislation in his attempt to rescue his Senate campaign, saying, "Reaching as far as they did in the - in the weeds of the bill that we didn't know about, no one else knew about until it came out - knowing that, I would not have supported that or voted for that at that time."

The few Democrats who talked about
health reform on the campaign trail were defensively asking voters to give them another chance so they can fix it and get it right this time. It would be something of an understatement to say that most voters were disinclined to do that.

Nearly half of the nearly 25 new governors sworn in next January campaigned against the legislation, and most have no intention of implementing a law that they and a majority of their constituents oppose.

Opposition will only grow as the real impact of the law on our health sector becomes more and more apparent. And if it's a problem for candidates in 2010, when most people still don't know everything that is in the law, it will become even more of a liability in 2012 when the mandates, costs and regulations will become even more apparent.

Grace-Marie Turner is president and founder of the
Galen Institute, which is funded in part by the pharmaceutical and medical industries. Readers may write to her at Galen Institute, P.O. Box 320010, Alexandria, Va. 22320; Web site:; e-mail: For information about Galen's funding, please go to
This essay is available to McClatchy-Tribune News Service subscribers. McClatchy-Tribune did not subsidize the writing of this column; the opinions are those of the writer and do not necessarily represent the views of McClatchy-Tribune or its editors.


Obamacare Takes a Shellacking
By Grace-Marie Turner

President Obama clearly doesn’t get it. His post-election news conference shows that he believes his health-policy agenda was correct and may only need a bit of “tweaking.”

Despite his acknowledgement that Democratic incumbents took a “shellacking,” he did not back down from the policies that caused dozens of them to lose their seats.The president clearly is in denial. Health-care reform was very much a key part of Tuesday’s elections: New poll results out Wednesday from Bill McInturff and Public Opinion Strategies (POS) show that a vote for the president’s signature health-care law was a death knell for candidates.
McInturff found that 52 percent of independents said their vote was a message opposing President Obama’s health-care plan; only 18 percent said their vote was a message of support. Those numbers were crucial in bringing down Democratic candidates in dozens of swing House districts.
All five of the House Democrats who flipped to support final passage of the law in March lost. Two others retired, and Republicans took their seats. Sen. Russ Feingold (D., Wis.) and Rep. Earl Pomeroy (D., N.D.) were two rare Democrats who actively defended their votes for Obamacare. Both lost.Voters who were basically told to shut up after last year’s tumultuous town-hall meetings about Obamacare patiently held their fire and flocked to the polls yesterday. Seniors in particular said they were opposed to the health overhaul by almost two to one, and they voted in greater numbers on Tuesday than they did in 2008.
POS found that nearly seven in ten voters (69 percent) had seen ads about “the changes to the health care system that have been enacted by Congress and the Obama Administration.” This is up significantly from the 42 percent recall in the POS October pre-election survey. And 70 percent said the ads they’d seen were critical of the Obama plan, 8 percent said the ads were supportive, and 20 percent said they recalled advertising on both sides of the issue.
Many House Democrats in swing districts who voted against the law survived basically by saying they know the law has serious problems and needs to be fixed.
But the president is not backing down. While he said he is willing to work with Republicans to refine the law, he said it would be “misreading the election if we thought that the American people want to see us for the next two years relitigate arguments that we had over the last two years.”
So what does he plan to do? Based upon his news conference today, not much. He said that the outcome of the law was good, but that the process of passing it was messy, and the deals made to pass it turned people off.
While the president said he would be open to considering changes to the massively unpopular requirement that businesses file 1099 forms with the IRS for purchases over $600, he just doesn’t hear how deeply Americans despise this law.In his news conference, the president said while “we can tweak and make improvements on the progress that we’ve made,” he doesn’t think Americans want to repeal popular provisions like barring insurers from refusing to cover people with preexisting conditions or dropping people when they get sick. “I don’t think that you’d have a strong vote for people saying, you know, ‘
Those are provisions I want to eliminate,’” he said.This is the slicing and dicing that the administration has been doing all along in its health care messaging, focusing on a few small provisions of the law while the regulatory machinery is being built for a massive federal takeover of one-sixth of our economy.
The job of the next Congress will be to craft policies that will forestall the wreckage of Obamacare in hopes they can buy time for a repeal of the whole bill in 2013. The American people know it needs a lot more than “tweaking.” The law is fundamentally and structurally counter to the American values of freedom, limited government, and individual control over our lives and destiny.


The GOP Can Outsmart ObamaCare
How Republicans can create a national insurance charter, deregulate health insurance and save ObamaCare from itself.

In a crude way, the economy demanded a massive government intervention in late 2008 because of the problems of the banking sector.
In a crude way, yesterday's election was about calling off that rush of government activism, which threatened to become a political end in itself.

We underline the modifier "crude" because crudely is how the political system deals with policy challenges. Crude was the system's response to the crisis, when we got a lot more intervention than we needed or bargained for, including a new health-care system.
Crude will be the antidote authorized by voters yesterday, putting the GOP in position to stonewall further encroachment.Nicely summing up matters was a conversation in an elevator Thursday. A fund manager acquaintance mentioned that he was optimistic for the first time, and offered two reasons: a widely forecast GOP House takeover and his conviction that the Supreme Court would scuttle ObamaCare.
What was striking here was that his optimism depended partly on a deus ex machina—the Supreme Court intervening to do what the Republicans likely can't. Gridlock may be good, but gridlock is not enough.
He's right. We woke up this morning with unemployment no lower than it was yesterday, and the Krugmanites are already laying out an argument that the economy's failure to mend itself is because of the GOP resurgence in Washington.
On the Bush tax cuts, Republicans have a strategy beyond gridlock and might well find enough Democratic support to stop the tax hikes. President Obama might well sign such a bill unless, as market economist Don Luskin predicts, he wants to provoke a second recession.
But even if the Supremes act to spare us the ObamaCare train wreck, our health-care system is still a train wreck. This is the toughest wicket for Republicans.
Happily, a path back to the future exists that just might be politically actionable in a divided Washington. It involves not repealing ObamaCare but adding something to it—an optional federal charter for health insurers.

Under this charter, let's permit insurers to design their policies free of ObamaCare's mandated benefit levels and free of state regulation. Let's let these policies be purchasable with pre-tax dollars and allow them to satisfy ObamaCare's mandate requiring individuals to have insurance and employers to provide it.
Yes, we know the ObamaCare mandate is objectionable on philosophical and constitutional grounds, but since we're seemingly bent on taxing ourselves to make medical care available to those who can't or won't pay for it themselves, an individual mandate perhaps is the only way to short-circuit a collapse toward government-run, single-payer health care under the burden of free-riding.
What's the first thing the new nationally-chartered insurers would do? Rush out cheap, high-deductible policies, allaying some of the resentment that the mandate provokes among the young, healthy and footloose affluent. At the same time, these policies would quickly re-revolutionize ObamaCare from within. Here's why:
First, these folks could buy the minimalist coverage that (for various reasons) actually makes sense for them. They wouldn't be forced to buy gold-plated coverage they don't need so the money can subsidize the old and sick (the hidden tax logic of ObamaCare).
Secondly, this relatively healthy cohort would be covered for a rare major injury or illness. The rest of us wouldn't have to pick up the tab.

Thirdly, and when paired with a health savings account—as would happen as employers large and small rush to take advantage of a better option than ObamaCare now affords them—it would provide a much-needed kick of consumer discipline to the medical complex's pants, which has always been the conservative alternative to a creeping government takeover of medicine.
There's already a base of sensible Democrats who've championed exactly such reforms. And because it can be sold as expanding the options under ObamaCare and lessening the burden of an unpopular mandate, a lot of other Democrats (who can read the election returns) might vote for it too. Even more so when they realize it would allow backing off the unaffordable subsidies required to make ObamaCare's individual mandate go down with the public.
And the president? The truth is that Mr. Obama is a go-along-to-get-along guy. He did not (like Sarah Palin) rise by bucking his party's establishment. His one attempt at doing so—his run for Chicago Rep. Bobby Rush's House seat in 2000—ended in the only personal electoral defeat he's ever experienced.
In a Congress controlled by Harry Reid and Nancy Pelosi, Mr. Obama's path of least resistance was the path of Pelosi and Reid. A lot of things become possible now that a different path of least resistance faces the president.


Dear D4PC Member and Friend:

The Executive Board of D4PC is pleased to announce the successful election of the following D4PC endorsed candidates in the 2010 mid-term elections:
US House of Representatives
Alabama 5: Mo BrooksGeorgia 8: Austin Scott
Illinois 8: Joe Walsh
Michigan 1: Dan Benishek, MD

US Senate
Pennsylvania: Pat Toomey
Wisconsin: Ron Johnson

We also share in the disappointment of our candidates who sought election in those districts with long-term, well-financed incumbents. All of our candidates were selected for their solid understanding of health care issues and recognition that the passage of the Patient Protection and Affordable Care Act(PPACA) will work to the detriment of patients and the American healthcare system.
The second round of the healthcare debate is just beginning and Docs4PatientCare will work closely with the new congress to DEFUND and REPEAL the PPACA and REPLACE with the common-sense alternatives that we have proposed since our beginning. These measures will be consumer-driven, patient-centric reforms that will protect the physician-patient relationship, preserve patients' independent decision making with their doctors, while preventing the bureaucratic destruction of the best healthcare system in the world.
Over the next several months, D4PC will concentrate our efforts to grow the organization and draft our policy positions, which we will present to congress as options for responsible health insurance reform. As elected officials debate this matter, we continue to need your help in bringing new physician members to D4PC and concerned patients/citizens to the D4PC Alliance.
Please direct your doctors and friends/family to our website,, where they can sign up for emails and become members.The mid-term election results have given us a second chance to get health insurance reform done right, but it will require the participation of the nation's physicians and patients working together to influence congress. We will continue to send legislative updates and action alerts and we encourage you to follow us on Facebook and Twitter. Thank you in advance for all of your help and support.Respectfully,The Executive Board, D4PC

Specialty Doctors Welcome New Members of Congress
Alliance of Specialty Medicine Encourages Lawmakers to Help Ensure Access to High-Quality Specialty Care

BUSINESS WIRE)--The Alliance of Specialty Medicine (Alliance) today welcomed newly-elected lawmakers to Congress and encouraged them to help improve patient access to high-quality specialty care in the United States by implementing sound health care policy on Capitol Hill.

“We would like to congratulate everyone who was elected to Congress from both sides of the aisle”
“We would like to congratulate everyone who was elected to Congress from both sides of the aisle,” said Alex B. Valadka, MD, FACS, spokesperson for the Alliance of Specialty Medicine and member of the American Association of Neurological Surgeons and Congress of Neurological Surgeons. “We look forward to working with the new Congress to help ensure that patients have access to the highest quality specialty care. We hope that Congress’s newly elected members will bring a fresh outlook on how to approach health care issues facing this country. First on their lists should be providing a permanent fix to the outdated Medicare reimbursement formula, repealing the Independent Payment Advisory Board, and bringing real reform to the medical liability system. These changes are vital to helping doctors do their jobs better and, ultimately, improving their patients’ health.”
Dr. Valadka also showed special support for doctors who were elected to Congress yesterday. “Doctors have a unique understanding of what has to be done to improve patient care and the Alliance of Specialty Medicine hopes that these physicians will make their voices heard and impact the overall health care policy debate.”
The Alliance of Specialty Medicine was actively engaged in policy discussions during the health care reform debate and continues to work with Members of Congress to develop sound public policies that strengthen our nation’s health care delivery system.
Most recently, the Alliance has focused on urging lawmakers to permanently fix the outdated Medicare physician payment formula, which reimburses doctors at rates that don’t cover physicians practice expenses, causing many to stop serving Medicare patients altogether.
The Alliance is also working towards a fix to the nation’s medical liability system which encourages defensive medicine and results in billions of dollars in unnecessary spending, and encouraging Congress to repeal the Independent Payment Advisory Board (IPAB), which came as part of the health care reform law. IPAB is a 15-member board of non-elected officials charged with recommending vast Medicare spending reductions in years when spending exceeds a targeted growth rate. These unprecedented cuts would further endanger access to doctors across the country for the 46 million patients currently covered by Medicare.
For more information on the Alliance, visit
The Alliance of Specialty Medicine is an organization of national medical societies, based in Washington, DC, which represents specialty physicians in the United States. This non-partisan group is dedicated to the development of sound federal health care policy that fosters patient access to the highest quality specialty care. For more information, please visit
Alliance of Specialty Medicine202-441-3515


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.

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