Tuesday, April 19, 2011

4/19/11 - Liability&HealthNews ALERT - Fair Share Act in Judiciary Committee - Need help NOW

4/19/11 - Liability&Health News ALERT
Fair Share Act in Senate Judiciary Committee:
Need help NOW!

by Donna Baver Rovito

Editor, Liability and Health News Update

((Donna's in-article comments in double parentheses and blue italics. Please scroll to the end for more information, disclaimer, etc.))


((This alert courtesy of a fellow supporter of medical liability reform in the Lehigh Valley, Mary Barket. Thanks for the heads-up, Mary!))


Senate Bill 2 (the Fair Share Act) is now going through the PA Senate Judiciary Committee after passing in the House. This is important tort reform (see below).

We need to let Sen. Lisa Boscola, a member of the Judiciary Committee, know that we need her vote! Call her today at 717-787-4236 or 610-868-8667 and let her know that we need this bill to come to the PA Senate floor!

((If you live in Lisa Boscola's district, please contact her - if not, see the Commentary below to see if your Senator is a member of the Judiciary Committee....DBR))

Nothing would provide a greater “stimulus” to Pennsylvania’s lagging economy than a fair, predictable and even-handed legal system. Current Pennsylvania law allows a defendant who is just marginally responsible for injury or harm to be made to pay 100 percent of the damages.

We need meaningful reform – the Fair Share Act – to limit awards against defendants who are judged to have been only partially liable in a lawsuit. The Fair Share Act would create a proportional liability system in which defendants found to be less than 60 percent responsible for an injury or damage to pay only their proportionate share of the award.



In fact, we need physicians, members of medical families, and other supporters of liability reform and quality health care throughout PA to make calls to their Senators who sit on the Judiciary Committee.

It might seem that the Republican majority will support this measure, which was passed twice by the PA legislature, but given the strong ties of some members of the Judiciary committee with the trial bar, it's something we DEFINITELY shouldn't take for granted.

If you live in the district of ANY of the following members of the Judiciary Committee, please contact their offices ASAP and tell them YOU support the Fair Share Act and that you'd appreciate his or her vote to move it out of Committee so the full Senate can vote on it and express the will of the people in PA on this issue.

At this point, with the vote taking place shortly, unless you KNOW your Senator well enough that he or she would open your email right away rather than waiting for it to be processed through his or her office, it would be best to CALL. We've included phone numbers for your convenience.

Your message should be short and sweet - "Please ask Sen. ___________ to vote YES on moving the Fair Share Act out of the Judiciary Committee for a full Senate vote."

If you don't know who your state senator is, go here to find out: http://www.pasen.gov/cfdocs/legis/home/findyourlegislator/#zip

Doctors - please write letters to your local newspapers about the importance of this bill to Pennsylvania medicine! If you'd like help with that, please email me!

Thank you!



Members of the PA Senate JUDICIARY Committee


Greenleaf, Stewart J. , Chair
(717) 787-6599

White, Mary Jo, Vice Chair
(717) 787-9684

Leach, Daylin , Minority Chair
(717) 787-5544

Scarnati, Joseph B., III, ex-officio
(717) 787-7084


Alloway, Richard L., II
(717) 787-4651

Earll, Jane M.
(717) 787-8927

Gordner, John R.
(717) 787-8928

Orie, Jane Clare
(717) 787-6538

Piccola, Jeffrey E.
(717) 787-6801

Rafferty, John C., Jr.
(717) 787-1398


Boscola, Lisa M.
(717) 787-4236

Farnese, Jr., Lawrence M.
(717) 787-5662

Hughes, Vincent J.
(717) 787-7112

Stack, Michael J.
(717) 787-9608


From the PA Medical Society Website
PAMED Supports Repeal of Complete Joint and Several Liability

House Bill 1 and Senate Bill 2 would modify Pennsylvania’s joint and several liability law. By a vote of 112-88, the House passed HB 1 on April 11, 2011, sending the bill to the Senate for consideration.

A hearing was also held in the Senate Judiciary Committee on April 11 on SB 2, a similar bill sponsored by Sen. Jake Corman (R-Centre).

Pennsylvania is one of only a handful of states that has complete joint and several liability. Under the current law, if one defendant is without assets or has insufficient funds to pay their share, the other defendant(s) can be held responsible for 100 percent of the jury’s award.

If either HB 1 or SB 2 is passed, each responsible defendant would only have to pay their share as long as the jury finds them less than 60 percent at fault. If a defendant is found more than 60 percent at fault, they can be made to pay 100 percent of the damages, if the other defendant(s) are without sufficient funds.

If either HB 1 or SB 2 is passed, each responsible defendant would only have to pay their share as long as the jury finds them less than 60 percent at fault. If a defendant is found more than 60 percent at fault, they can be made to pay 100 percent of the damages, if the other defendant(s) are without sufficient funds.

Under HB 1, some exceptions for full joint and several liability would still exist, including:

Intentional misrepresentation
Hazardous tort(s)
Hazardous substances released or threatened to be released
Liquor code violations

This is not the first time around for this legislation. In 2002, a very similar bill was signed into law, but was thrown out by the state Supreme Court on a procedural technicality. In 2006, Gov. Ed Rendell vetoed yet another bill after previously indicating he would sign it if it passed.

PAMED has been a long-time advocate for medical liability reforms, and has been successful in getting a number of reforms passed in Pennsylvania, including Act 13 of 2002. Currently, PAMED also supports a bill to allow physician apologies (HB 495) and a bill to strengthen the certificate of merit requirements.


From the Philadelphia Inquirer
Posted on Tue, Apr. 19, 2011
Pennsylvania trial lawyers, business groups square off over lawsuit reform
By Chris Mondics Inquirer Staff Writer

Trial lawyer Gerald McHugh Jr. likes to explain the battle over lawsuit reform now playing out in Harrisburg by using the story of a childhood rock-throwing incident that ended with his neighbor's smashed window.
The woman who owned the house knew McHugh's parents and called to complain. At dinner that evening in the McHugh family's West Philadelphia home, his parents read him the riot act: He would pay for the window, even though he had not thrown the rock that broke it. He and his friends could sort out who actually was responsible and how costs might be shared.

"My parents resolved that case quickly and surely," McHugh said. "I had participated, it was wrong, and therefore I was paying for a new window."

((Right....we should base all legal precedent on little boys breaking windows and one incident of parental responsibility. Does Atty. McHugh think the state of PA should be everyone's daddy?))

McHugh, a lawyer with the Philadelphia trial and appellate firm of Raynes McCarty, said the anecdote showed in the simplest of terms why the Pennsylvania Senate should vote down a proposal that would end the long-standing practice of requiring some defendants to pay full civil-damages awards, even though they might have minimal responsibility.

McHugh has become a leading spokesman for Pennsylvania trial lawyers, who believe the changes would serve businesses, physicians, hospitals, and other institutions at the expense of aggrieved customers.

This so-called doctrine of "joint-and-several liability" traditionally has undergirded civil litigation in state courts throughout the country. It has been defended by trial lawyers and other proponents who say it improves the odds for accident victims to gain fair compensation.

((It has also been repealed in all but a handful of states, including PA. As usual, PA is lagging behind....))

If one defendant does not have enough money or is judgment proof, it stands to reason that an accident victim should seek compensation from another defendant, even though that defendant may have only minimal responsibility, trial lawyers contend. ((Plus, they want to make sure their 40% contingent fees are based on the HIGHEST possible amount of money....ooops, did I say that out loud?))

McHugh's personal story of the childhood rock-throwing incident sounds folksy, but it rings hollow to businesses, physicians, and many health-care institutions that say the current legal doctrine is a green light for trial lawyers and plaintiffs to seek out the deepest pockets.

The businesses have been pushing legislation, passed by the state House of Representatives on April 11, that would end the practice for any defendant found to have less than 60 percent responsibility. The bill, which has been praised by Gov. Corbett, a Republican, now is in the Senate, which is expected to deal with the issue before lawmakers leave for summer recess.

"The long-standing legal rule of 'joint and several' has been grossly distorted by greed and, in many cases, has become nothing more than a search by personal-injury lawyers for defendants whose only real reason for being named in a lawsuit is their ability to pay," said Gene Barr, vice president of the Pennsylvania Chamber of Business and Industry." ((Mr. Barr is absolutely correct - this is why every doctor in the hospital the day an incident occurs is likely to be named in a lawsuit whether they had anything to do with it or not.))

Under the bill passed by the House, sponsored by State Rep. Curt Schroder (R., Chester), a defendant who is less than 60 percent responsible would have to pay only a proportional share of a damage award. Exceptions include cases in which the defendant intended to cause harm, engaged in intentional misrepresentation, or engaged in activity that resulted in the release of hazardous substances.

While Corbett earlier this week praised the House for passing the bill, called the Fair Share Act, it faces stiff opposition from the state's politically powerful trial lawyers and many Democrats who see the measure as a favor to big businesses, physicians, and hospitals at the expense of accident victims. ((And not all of that opposition will be from Democrats. In the case of trial lawyers, it often seems that profession trumps political party.))

"The effect, if it becomes law, is that injured victims will not be able to recover the full damages awarded to them in a court of law if they are victims of sexual assault, rogue judges, greedy gas drillers who damage the environment, and other wrongdoers," said Bill Patton, spokesman for Rep. Frank Dermody (D., Allegheny), the House Democratic leader.

But with both chambers of the legislature and the governor's office controlled by Republicans, who traditionally favor lawsuit restrictions, opponents of the bill face difficult odds. According to legislative sources, one approach they are considering is suggesting some modified version of "joint-and-several" liability, where defendants with the greatest ability to pay would still face paying a disproportionate amount, but not so much as before.

The battle playing out in Harrisburg is a mirror image of legislative confrontations and judicial elections that have been fought over lawsuit reform nationwide. Business groups have been aggressive in supporting judicial candidates who take a more restrictive approach to litigation, and have pushed bills in state capitals making it harder to sue. Dozens of states have eliminated joint-and-several liability and instituted other curbs on lawsuits.

In Pennsylvania, and nationally, business groups say excessive litigation costs are a drag on the economy, diverting precious resources from business development and job creation.

The Pennsylvania Chamber of Business and Industry points to a 2008 study by consultant Towers Perrin that concludes the U.S. tort system cost $252 billion in 2007, or $835 per person.

The study's authors qualified their work, noting they had made no effort to quantify potential benefits from lawsuits, such as the added incentive for manufacturers to make safer products rather than confront litigation.

Business and their lawyers do not see it that way, of course. Mitch Goldman, a lawyer at Duane Morris L.L.P. who specializes in health care, said a hospital client of his faces potential ruin because of the joint-and-several rule.

The hospital, which he declined to identify, is embroiled in litigation over a medical-malpractice case - in which, he said, it had only minimal involvement. But, he said, if the hospital went to trial and lost, it would be stuck with a huge bill. As a result, it probably will settle.

"The hospital in almost every one of these cases will be the deepest pocket," he said.


This LIABILITY & 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.

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Donna Baver Rovito, Editor, Liability and Health News Update




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Friday, April 1, 2011

4/1/11 - Liability&HealthNewsUpdate - Tort reform in PA, "Happy" belated birthday, PPACA?

4/1/11 - Liability&Health News Update Tort Reform in PA, "Happy" belated birthday, PPACA? ((Donna's in-article comments in blue italics. Please scroll to the end for more information, disclaimer, etc.)) Commentary: OK, I've recently changed my mind on a lot of important things: We don't need liability reform in PA. Or anywhere else, for that matter. The lawyers have been right all along - if there weren't mistakes, there wouldn't BE any malpractice lawsuits. There's no such thing as defensive medicine. The government, not doctors, is far more qualified to dictate America's health care. Everyone should be forced to pay for everyone else's health care (or car, or house, or iPhone). Legislators shouldn't have to READ those pesky laws they pass. We should give the PPACA a CHANCE instead of trying to repeal it. Hey, it might work. What's the fuss about border security? EVERYONE should be allowed to enjoy America's largesse. The Constitution is old and outdated and we should ignore it. Our taxes are too low - they pay lots more in Europe and look how great everything is there. People should just stop whining about their rights and do what the government tells them to do. The people who run our government are SO much smarter than the average citizen. Gasoline is too cheap - I'd love to pay $10 a gallon. (scroll down......) ((APRIL FOOL!)) ~~~~~~~~~~~~~ ((Dr. Marilyn Heine is a dynamo and will be an outstanding president of the PA Medical Society.....here are her comments from Monday's Capitol press conference on medical liability reform in PA.)) Pennsylvania State Capitol News Conference, Media Center Remarks of Marilyn Heine, MD President-Elect, Pennsylvania Medical Society On March 28, 2011 Good Morning. Thank you for the opportunity to share with you a few reasons it is imperative to reform our legal system to ensure continued access to high quality medical care for all Pennsylvanians. We’ve all seen the barrage of personal injury lawyers’ ads on billboards, television, and telephone book covers asking, “Have you been injured?” and “Did you have a ‘less than perfect’ outcome?” They offer to make someone rich simply by suing. Through constant repetition of these types of advertisements, personal injury lawyers have skillfully changed the way Americans view personal responsibility. They have convinced many that when something doesn’t go the way they’d like, that “they’ve been injured” and someone else is to blame. Everyone in this room has examples of how lawsuit abuse negatively impacts each of our types of work. For physicians, personal injury lawyers are strangling patient care. The motive of a personal injury lawyer is the “contingency fee,” and it is taking its toll on physicians and our patients. Young physicians who graduate from Pennsylvania’s medical training programs often leave to practice elsewhere. Physicians in private practice in Pennsylvania find it nearly impossible to recruit new associates. The cost of medical liability insurance is higher here than in much of the country. Furthermore, despite what our opponents say about Pennsylvania’s medical liability climate, lawsuit abuse continues to erode the clinical practice of medicine. As I stand here this morning, physicians across Pennsylvania are ordering medically unnecessary MRIs, CAT scans, PET scans, biopsies, and other tests for one simple reason…the fear of litigation. This drives up the cost of health care for all of us. The overwhelming majority of claims brought against physicians are dropped, dismissed, withdrawn, or found in favor of the physician. Yet, these claims are costly to defend. And time spent on defense is time that a physician could have been caring for other patients. Personal injury lawyers have a huge error rate. Their error rate is crippling patient care by increasing costs and decreasing access. Broad based liability reform in Pennsylvania is good for all Pennsylvanians from patients, physicians and hospitals, to employers and civic organizations, to the girl scouts and our little league teams. The benefit of broad legal reforms will be felt by all of us because each of us has been the victim of Pennsylvania’s out-of-control legal system. Everything we buy has a higher price tag due to lawsuit abuse. Some call this a “tort tax.” The only ones who won’t benefit from fixing a broken legal system are those who created the need for reform in the first place…personal injury lawyers. I respectfully ask our legislature to do the right thing. For the better health of all Pennsylvanians, restore common sense to our legal system. Thank you. The patient-doctor relationship has been the priority of the Pennsylvania Medical Society since its founding in 1848. Today, the physician members continue to focus on better health for all Pennsylvanians. To learn more about the Pennsylvania Medical Society, visit its web site at www.pamedsoc.org or its patient website at www.myfamilywellness.org. The Institute for Good Medicine at the Pennsylvania Medical Society can be found www.goodmedicine.org. The Pennsylvania Medical Society is a proud sponsor of the PAMED Better Health Network, www.BetterHealthPA.org. The PAMED Better Health Network™. Where innovators meet innovators. Find out more at www.BetterHealthPa.org ~~~~~~~~~~~~~ From the Pittsburgh Post-Gazette Sorry is OK: Doctors and nurses should be allowed to say so Tuesday, March 29, 2011 ((For more information about this concept, visit our good friend Doug Wojesiak's site Sorry Works! at www.sorryworks.net)) Those who deliver superior health care recognize that patients are not a number on a chart but human beings with feelings. And in a human enterprise in which not all treatments work and mistakes are sometimes made, doctors and nurses should not be discouraged from being empathetic even in adverse situations. Unfortunately, in a litigious culture, people have to watch what they say -- and that's especially true in a health care setting, where costs have been driven up by the threat of lawsuits. In short, if kindly health care providers express sorrow after a treatment that didn't work, they could be sorrier still if sued. Fortunately, state legislation aims to rectify that affront to common sense. House Bill 495 says that any benevolent gesture or statement by a health care provider "that conveys a sense of apology, condolence, explanation, compassion or commiseration emanating from humane impulses" shall be inadmissible in a liability action. Is this a real problem? There's no question, according to Scot Chadwick, vice president of governmental affairs for the Pennsylvania Medical Association, which supports the bill. He says the doctors and others are eager to talk to family members if a procedure doesn't work out but are inhibited from doing so in a toxic legal environment. HB 495, which passed the House 171-27 this month and is now in the Senate Judiciary Committee, is part of several tort reform measures being pushed by a coalition of more than 50 business, health care, local government and insurance groups. On Monday in Harrisburg the coalition released the results of a poll that showed broad public support for various components of tort reform. On the so-called apology legislation, 84 percent of the 800 registered voters surveyed were in favor. This is hardly surprising. Families and friends of patients don't want an unresponsive health care provider. They want answers and they want doctors and nurses to share in their pain if the news is not good. Long before modern lawsuits, an ancient wisdom observed that a "soft answer turns away wrath." This bill allows for that kindly, humane answer. First published on March 29, 2011 at 12:00 am ~~~~~~~~~~~~~ ((From one of our liability reform allies - this group is looking for doctors who are willing to speak at events, write letters to editors and legislators, etc - basically, they're looking for health care professionals to help them make NOISE on PA medicine's behalf - please contact either me or Lindsey Shaw if you can help in this effort.)) Good morning! My name is Lindsey Shaw, and I am helping Citizens to Protect PA Jobs, a Pennsylvania based pro-business advocacy group organize grassroots support for broad based liability reform. We are pushing for true legal reform here in PA, but we really need your help to do it! We are in need of people that would be willing to write letters to the editor, make calls/send e-mails/send letters to their legislators and show up at different events such as town hall meetings. You can find out more about the issue at hand at the following website under "Lawsuit Abuse Reform:" http://www.protectpajobs.com/issues/. If you or someone else you know is interested in participating in our cause, please e-mail me back with your/their name, phone number and e-mail address. We are looking for the doctors to write letters to the editor, make calls / send emails / send letters to their legislators and show up at different events. Thank you, and I look forward to hearing back from you soon! Sincerely,Lindsey N. Shaw(717)-433-0379Lindsey@coldsparkmedia.com ~~~~~~~~~~~~~ From the Pittsburgh Post-Gazette: Corbett opposes Medicaid expansion under health care law Wednesday, March 23, 2011 By Laura Olson http://www.post-gazette.com/pg/11082/1134106-100.stm HARRISBURG -- Gov. Tom Corbett says the Medicaid expansion under the year-old federal health care law is unaffordable to Pennsylvania, and he is repeating a request for speedy consideration of lawsuits challenging the constitutionality of that law. ((It's unaffordable to EVERY state - please stand strong on this, Gov. Corbett.)) Mr. Corbett testified this morning at a U.S. House committee field hearing here, along with his insurance and welfare department secretaries, on the state's fiscal and administrative challenges in beginning to implement the health care law's provisions. In his previous role as state attorney general, Mr. Corbett joined in a multistate lawsuit challenging the federal law. That suit and several other similar cases are working their way through the court system, while states are left to begin enacting portions of the law. Enacting the required changes will add another 750,000 Pennsylvanians to the state Medicaid rolls, Mr. Corbett said. That would mean one in four state residents would be receiving Medicaid benefits, at a cost he described as unsustainable. The state already spends 30 percent of its operating budget on Medicaid, he said. "That means that before we spend one penny on schools, on roads, police, firemen, infrastructure, we will only have 70 cents of our state dollar left," Mr. Corbett said. "With the commonwealth facing a tremendous budget shortfall in the billions this year, we simply cannot afford the expansion of Medicaid." Outside the hearing room, several Pittsburgh-area residents joined in a rally supporting the health care law. They said they're counting on the insurance exchanges that will start under that law in 2014 to help them gain coverage. Cal Schuchman, a Reserve resident who until recently worked as a security guard, said he was on the state's adultBasic program for more than three years. That coverage ended this month, and he's unable to afford the more expensive Fair Care insurance that the state made available to adultBasic recipients. Without health insurance, the 61-year-old said he'll continue exercising and eating a balanced diet, which he sees as his only options to stay healthy until the insurance exchanges are created. "There shouldn't be any juggling act here finding funding -- this is a necessity," said Mr. Schuchman. Laura Olson: 717-787-4254 or lolson@post-gazette.com First published on March 23, 2011 at 12:50 pm ~~~~~~~~~~~~~ ((Few people "get" the whole "health care is a right" issue better than Dr. Paul Hsieh.)) From The Objective Standard Health Care and the Separation of Charity and Statehttp://www.theobjectivestandard.com/issues/2011-spring/health-care-charity-state.asp This article is from TOS Vol. 6, No. 1. The full contents of the issue are listed here. Paul Hsieh If someone in America needs medical care but cannot afford it, should he rely on charity or should others be forced to pay for it? President Obama and his political allies say that Americans should be forced to pay for it. Forcing some Americans to pay medical bills for other Americans, says Obama, is a “moral imperative”1 and “the right thing to do.”2 Throughout the health-care debate of 2010–11, Obama repeatedly referred to government-run health care as “a core ethical and moral obligation,” arguing that, “No one should die because they cannot afford health care, and no one should go broke because they get sick.”3 In speeches, he repeatedly cited the story of Natoma Canfield, an Ohio cancer patient without health insurance, as a justification for his health-care legislation.4 Many of Obama’s supporters on the political left made similar moral claims. Vanderbilt University professor Bruce Barry wrote in the New York Times that, “Health insurance in a civilized society is a collective moral obligation.”5 T. R. Reid, former foreign correspondent for the Washington Post, called universal health care a “moral imperative.”6 Ezra Klein, another writer for the Washington Post, agreed that it is an “ethical obligation.”7 But all such claims are wrong—morally wrong. There is no “right” to health care. Rights are not entitlements to goods or services produced by others; rather, they are prerogatives to freedom of action, such as the right to free speech, the right to contract, or the right to use one’s property. Any attempt to enforce a so-called “right” to health care necessarily violates the actual rights of those who are forced to provide or pay for that care. If a patient needs a $50,000 operation but cannot afford it, he has the right to ask his friends, family, neighbors, or strangers for monetary assistance—and they have the right to offer it (or not). But the patient has no right to take people’s money without their permission; to do so would be to violate their rights. His hardship, genuine as it may be, does not justify theft. Nor would the immoral nature of the act be changed by his taking $100 each from five hundred neighbors; that would merely spread the crime to a larger number of victims. Nor would the essence of the act change by his using the government as his agent to commit such theft on an even wider scale. The only moral way for this patient to receive the assistance he needs is for others to offer it voluntarily. Morally, he must rely on charity. Fortunately for him, there is no shortage of people willing to offer charity, nor is there a shortage of reasons why one might self-interestedly wish to do so. . . . To read the rest of this article, select one of the following options:Subscriber Login Subscribe Renew Purchase a PDF of this articl ~~~~~~~~~~~~~ BRIEFS ((These are quick summaries and links to articles which might interest you. Many of these come from the "Today's Daily Dose" newsletter which is now administered by the Independent Women's Forum - The Daily Dose is a joint project with the Independent Women's Forum (501(c)(3)) and the Independent Women's Voice (501(c)(4)). This is part of the SavingOurHealthCare.org http://www.savingourhealthcare.org initiative which is sponsored by several physician advocacy organizations as well, including the American Association of Physicians and Surgeons - AAPS - and Docs4PatientCare. You can sign up free to get the whole version of Today's Daily Dose in your email box. Really, it's all you need to read to keep up with all the news and information about health care reform.)) WHY OBAMACARE IS WRONG FOR AMERICA And second, you’ve probably already heard about Why Obamacare Is Wrong for America, the new book by Grace-Marie Turner, Jim Capretta, Tom Miller, and Bob Moffit, with an introduction by Rep. Paul Ryan. I encourage you to watch the webcast of the book launch at their site, and refer interested friends to the book as a substitute for having to wade through a sea of PDFs and background. It distills in an excellent way the chief arguments against this law, and provides a strong overall view on the nature of America’s health care crisis. Check it out! SOURCE: Why ObamaCare Is Wrong for America Latest Polling Rasmussen Reports March 28, 2011 58 percent of voters favor repealing ObamaCare ObamaCare Is Billion-Dollar Cash Cow for AARP, GOP Report Says, Pressing for Probe Henry J. Reske - Newsmax The powerful seniors lobby AARP stands to make more than a billion dollars over the next 10 years from the sale of supplemental Medicare policies under ObamaCare, a House GOP report reveals. The report from Reps. Wally Herger, R-Calif., and Dave Reichert, R-Wash., alleges the Affordable Care Act will result in great demand for the Medigap policies that have the AARP stamp of approval, The Washington Post reported. Uncovered: New $2 Billion Bailout in ObamaCare Washington Examiner Investigators for the House Energy and Commerce Committee have discovered that a little-known provision in the national health care law has allowed the federal government to pay nearly $2 billion to unions, state public employee systems, and big corporations to subsidize health coverage costs for early retirees. At the current rate of payment, the $5 billion appropriated for the program could be exhausted well before it is set to expire. Lawmakers Unveil Legislation Which Removes Automatic Funding for Health Care Legislation Pat Summers - Fox News Georgia Republican Congressman Jack Kingston and Texas Republican Congressman Louie Gohmert held a press conference to introduce new legislation designed to remove up to the $105.5 billion in automatic funding that they insist was buried in President Obama's health care legislation. ObamaCare Implementation: What Rivkin Said, and Why Michael F. Cannon - Cato @ Liberty A couple of people have asked me about a comment David Rivkin made at Cato's recent conference on the first anniversary of ObamaCare. Rivkin is representing the 26 states suing to overturn ObamaCare in Florida v. HHS, the case in which a federal judge declared ObamaCare unconstitutional and void. In his most recent ruling in that case, Judge Roger Vinson allowed the Obama administration to keep implementing and enforcing the law, in part because the fact that most of the plaintiff states are also implementing the law "undercut" their request that he stop the Obama administration from doing so. ObamaCare Cost in One Chart Joseph Lawler - The American Spectator The Congressional Budget Office produced this clear graph on the budgetary effects of ObamaCare. The left-hand scale is billions of dollars. "Net Changes in Other Revenues" means, generally, tax increases. "Net Changes in Other Spending" is mostly cuts to Medicare. This chart represents the absolute best-case scenario that Democrats could present to the CBO for scoring. In all likelihood, the Medicare cuts (the medium-blue lines) will not materialize. Where’s My Waiver? Caroline May - The Daily Caller Conservative groups are encouraging individual Americans to request health care reform waivers from the Obama administration. Wednesday, Let Freedom Ring, a conservative public policy organization, in coordination with groups such as Americans for Tax Reform, Heritage Action, and others launched the website WheresMYWaiver.com to allow individuals to easily submit waiver requests to the Department of Health and Human Services. “With union workers comprising over 45% of waiver beneficiaries, it is quite ironic that the very same folks that fought for ObamaCare are now seeking to be exempt from it. National Restaurant Association Member Tells Congress of Real Impact of New Health Care Law on Business Restaurant News A Michigan restaurateur and National Restaurant Association member today gave the Subcommittee on Health of the House Energy & Commerce Committee a look at what it takes to run a restaurant business in the United States—and a daunting prognosis for what the new health care law could mean for businesses like his. On behalf of the National Restaurant Association, Larry Schuler described for Congress how the law will significantly impact his employees and how he runs his business, and urged early action to make fundamental changes to the Patient Protection and Affordable Care Act (PPACA) of 2010. In Campaign Against Health-Care Law, Republicans Take on AARP Dan Eggen - Washington Post House Republicans, who are continuing their efforts to chip away at President Obama’s health-care law, have now set their sights on a powerful group that strongly supported the legislation: the AARP seniors lobby. Two GOP members of the House Ways and Means Committee released a report Wednesday alleging that the nation’s largest seniors group stands to gain financially from the Affordable Care Act, because the law could result in greater demand for supplemental Medicare policies that carry the AARP stamp of approval. Obama Administration Delaying Some Rules for Appealing Health Insurance Denials Susan Jaffe - Los Angeles Times The Obama administration is delaying until next January its enforcement of some new rules designed to protect patients who appeal insurers' decisions to deny or reduce health care benefits. In the meantime, the Labor Department said in a posting on its website that it will revise the requirements to deal with objections raised by insurers. These rules were mandated by the health care law, and federal officials had earlier said they would start enforcing them in July. Why States Are Shying Away From ObamaCare’s Health Insurance Exchanges Peter Suderman - Reason Should states refuse to implement the health care overhaul? As I pointed out last week, some of them already are, and now opposition to the law appears to be scoring wins in even more states. A story in Politico this afternoon notes that Tea Party activists opposing the law seem to be “finding surprising success...blocking the law’s implementation.” Those victories are occurring at the state level, where a number of governors are both politically sympathetic and justifiably worried about the burdens the law places on their states. At first glance, the law seems like a trap for those who both oppose the law and favor federalism: ObamaCare calls on states to set up exchanges; in any state that does not sufficiently comply by 2013, the federal government will simply swoop in and set up an exchange on its own. Pelosi: Health-Care Defunding Provision Will Not Be Signed into Law ((But....didn't she also say that Americans would LIKE the PPACA once they found out what was in it?)) Felicia Sonmez - Washington Post's 2 Chambers House Minority Leader Nancy Pelosi (D-Calif.) said Wednesday that any longer-term government funding bill that eventually gets signed into law by President Obama will not include any policy riders aimed at defunding the national health-care law. “Let’s put it this way: the health-care rider is not one that will be in any bill that will be sent to the president and that the president will sign. ... This bill will not be repealed,” Pelosi said at an event touting Democrats’ health-care and student loan laws. CQ Healthbeat: CMS Actuary: Medicare Cuts In Health Care Law Unrealistic ((No kidding.....we've been saying that all along....)) The cuts in Medicare spending growth that pay for the health care overhaul "may not be viable indefinitely," Rick Foster, the chief actuary of the Medicare and Medicaid programs, told House lawmakers on Wednesday. Republicans on the House Energy and Commerce Subcommittee on Health scheduled Wednesday's hearing as a way to contrast Foster's skepticism about whether the health care law (PL 111-148, PL 111-152) will ultimately reduce the federal deficit, after the Congressional Budget Office (CBO) projected in February that repealing the law would add $210 billion to the deficit from 2012-2021. The cuts in the law are so deep that medical providers "eventually would become unable or unwilling to provide services to Medicare beneficiaries," Foster testified (Adams, 3/30) Weekly Standard: Cash For Doctors Revisited http://www.weeklystandard.com/articles/cash-doctors-revisited_555536.html[ Dr. Brian Forrest's] practice, Access Healthcare outside Raleigh, doesn't accept insurance. Instead, Forrest takes payment from patients on the spot, and he lists prices in his waiting room in an effort to be transparent, "like a Jiffy Lube." At the time, he said he figured his approach would become more popular as people opted to circumvent the hassles and cost of regulations from government and insurance companies. Now, nearly a year later, Forrest says he's more sure than ever that his business model makes sense. He's planning to franchise his practice, with six similar doctors' offices scheduled to open in North and South Carolina this summer, and plans to open others as far north as Baltimore and as far west as Indiana (Tony Mecia, 4/4). The New England Journal of Medicine: Hospitals' Race to Employ Physicians -- The Logic Behind A Money-Losing Proposition http://healthpolicyandreform.nejm.org/?p=14045&query=TOC ((It's not about cost - it's about control.)) If the fee-for-service system persists, large physician networks will provide hospitals with greater pricing power when they are contracting with health plans. This scenario favors greater hiring of specialists. Conversely, if payment systems move toward population health management and risk-based reimbursement, then large outpatient networks will allow a system to shift patients away from higher-cost hospital-based care and recapture lost revenues as shared savings or capitation surpluses. This scenario favors greater hiring of PCPs. A major concern in either scenario is the potential for hospitals to convert greater market power into higher prices and less competition (Dr. Robert Kocher and Nikhil R. Sahni, 3/30). Louisiana is Ninth State to Seek Waiver from ObamaCare’s Medical Loss Rules David Hogberg – Investor’s Business Daily IBD has just gotten word that Louisiana will become the ninth state to request a waiver from ObamaCare’s medical-loss-ratio regulations. An MLR is the share of health premiums spent on medical costs. Under ObamaCare, insurers in the individual and small group market must have an 80% MLR, which means that 80% of premiums are spent on medical care, leaving 20% for things like salaries, advertising, fraud prevention and profits. The Rise of the Anti-ObamaCare Compacts David Weigel – Slate Back in December, I attended part of the American Legislative Exchange Council’s annual meeting and heard about a bold, new-ish idea that could let states slip out of the Affordable Care Act’s mandates. Several states — Arizona, Virginia, etc — have already passed Health Care Freedom laws that prohibit the states from complying in the health care mandate. According to Nick Dranias of the Goldwater Institute, that opens the door for states to form compacts that would supersede federal regulation. On Health Care, Stop, and Then Start Over! Carter Wood – National Association od Manufacturers’ Shop Floor Leaders of the Start Over! Coalition, including the National Association of Manufacturers, wrote Sen. Kay Bailey Hutchison (R-TX) to express support for her amendment (S.Amdt.197) to the pending small business bill, S. 493, that would suspend further implementation of the Patient Protection and Affordable Care Act. Rep. Larry Bucshon Supports Amicus Brief against ObamaCare ((Let's hear it for the physician members of the GOP Doctors' Caucus! They need the support of their physician and other health care professional colleagues all over the country - let them hear from you today!)) The State Column Congressman Larry Bucshon (IN-08) joined Congressman Paul Broun (GA-10) and fellow members of the 112th Congress in supporting an amicus brief filed by the American Center for Law and Justice in support of the Commonwealth of Virginia in the 4th Circuit of the U.S. Court of Appeals. The amicus brief focuses on why the individual mandate in the Affordable Care Act is unconstitutional and therefore the entire law must be completely invalidated. 1,000+ Pages of Health-Care Rules? David Nather and J. Lester Feder – Politico Health care lobbyists and advocates are bracing for six pages of the health care reform law to explode into more than 1,000 pages of federal regulations when the Department of Health and Human Services releases its long-delayed accountable care organization rules this week. “What, you expected less than a thousand pages for legislation that only took a page and half?” a staffer with one of the current proto-ACOs asked. ((Actually, they just released 429 pages of ACO stuff.....based on six pages in the 2,700 page bill....can anyone do the math here? How many pages of regulations should we expect? And where are the environmental activists screaming about all the trees they're going to kill?)) The Real Cost of Health Care Andrew Freeman and Dr. Paul Keckley – The Hill’s Congress Blog A year ago President Obama signed health care reform into law. Political debate continues, even as the business of implementing reform marches on. Both elements need reliable and complete information if the best choices are to be made for America. But official health care figures are incomplete. A number of important health-related costs are currently not captured by official statistics. Putting these into the picture not only offers a richer sense of the challenges facing US consumers, but also has important implications for the US economy. ((And if you add in the cost of the mandates on citizens, businesses and states, the REAL cost of the PPACA is somewhere in the neighborhood of SEVEN TRILLION DOLLARS. That's a pretty exclusive neighborhood.)) Evan Bayh Now Unsure If ObamaCare Reduces Health Costs Real Clear Politics “The real issue that was not addressed, Laura, that you’ve raised now, and I think appropriately, is the cost, the cost to both the government and to your listeners. We need to take steps now to get the costs of health care under control. That was not dealt with really in an aggressive way in this legislation. I think it now needs to be,” Sen. Evan Bayh (D-Indiana) told Laura Ingraham. ((Ummmm...wasn't cost control one of the POINTS, Senator?)) One Year of ObamaCare Nathan Deal – Savannah Morning News March 23 marked the one-year anniversary of the president signing ObamaCare into law. The majority of the major provisions aren’t set to go into effect until 2014, but the harmful effects are already starting to surface. If something is not done soon to stop ObamaCare from full implementation, its negative impact will be even more destructive across the board. No one is above the law, and we must follow federal law even when we disagree. As a constitutionalist and a conservative, I believe firmly in the rule of law. As such, Georgia will prepare for implementation of this federal law even as we continue to fight against ObamaCare all the way to the Supreme Court. Currently, our case is before the 11th Circuit Court of Appeals after our great victory in a federal district court in Florida. Canadian Medical Association Calls on Governments to Fix Ailing Health System Karen Kleiss – Edmonton Journal/ Vancouver Sun The Canadian Medical Association says governments need to stop playing “whack-a-mole” with problems in the health-care system and embark on a wholesale transformation to address the ongoing, national crisis. Association president Dr. Jeff Turnbull on Tuesday called on federal election candidates to share their visions for the future of health care, while Canadians contribute their ideas at CMA-sponsored town halls across the country, including one in Edmonton Tuesday night. A Primer on Health-Care ‘Exchanges’ Julie Appleby – Washington Post It seems like a simple idea: Create new marketplaces, called “exchanges,” where consumers can comparison shop for health insurance — sort of like shopping online for a hotel room or airline ticket. But, like almost everything else connected with the health-care overhaul law, state-based insurance exchanges are embroiled in politics. Some Republican governors are threatening to refuse to set up exchanges unless they get more flexibility over Medicaid, the state-federal health program for the poor. Others say they don’t want to implement any part of the federal health-care law. ObamaCare’s Campaign of Misinformation Merrill Matthews – Forbes ((And yet, in spite of ALL the taxpayer dollars spent on "selling" the PPACA to the masses, 58% of Americans want it repealed....my suggestion, Madame Secretary, would be for you to hire a new advertising agency....what, are you using the same agency that produces those creepy Burger King commercials or something?)) Health and Human Services Secretary Kathleen Sebelius appeared on National Public Radio’s Diane Rehm Show last week as part of a concerted effort to promote the one-year anniversary of President Obama’s health care legislation. She claimed that the opposition has been delivering “lots of misinformation” about the legislation. Below I provide some quotes from her appearance, along with a summary of the law. I’ll let you decide who is disseminating the misinformation. Media Matters and Reality on ObamaCare ((Actually, the terms "Media Matters" and "Reality" are mutually exclusive....)) Derek Hunter – Daily Caller Forget comedy clubs, if you really want a laugh these days you simply have to venture over to the Media Matters website. The extent to which the organization is willing to contort reality to keep fellow “progressives” in line is nothing short of an expert yoga class. Given their recent “declaration of war” against Fox News for perceived bias, and the questionable legality of it given the group’s “charity” tax status, this is as surprising as the sun rising in the east each morning. There is no length to which Media Matters’ employees will not go to defend anything Democrats do; it’s what they’re paid to do. So it came as little surprise that on the one-year anniversary of ObamaCare’s passage, Media Matters was there to defend the unpopular law. ObamaCare’s Birthday No Cause To Celebrate Rep. Tom Price – The Weekly ((Once again, let's hear it for the Doctors' Caucus! Visit them at http://doctorscaucus.gingrey.house.gov/)) Last Wednesday marked one year since President Obama signed ObamaCare into law. Contrary to what its supporters have said since the time of its passage, the law remains a profoundly destructive impediment to quality health care in America and its implementation – if allowed to proceed – will disrupt the patient-doctor relationship and limit choices for care. In the past year, two federal judges have ruled the individual mandate unconstitutional, the estimated cost of ObamaCare has risen, and the promise that Americans could keep the coverage they have has been proven false. The Ulterior Motive Behind Rising ObamaCare Premiums Sally Pipes – Forbes Last week, proponents of ObamaCare celebrated the one-year anniversary of the passage of the landmark health care law with several hundred events across the country. They have little reason to cheer, according to a sobering new study. In the report, former Congressional Budget Office Director Douglas Holtz-Eakin calculates that health reform’s tax on insurers, which takes effect in 2014, will raise family premiums by $5,000 over the decade–all by itself. ((Ummmmm....but wasn't the bill supposed to "bend the cost curve" DOWNWARD?)) Not-So-Happy Birthday for ObamaCare Ronald E. Bachman – The Gwinnett Gazette The Patient Protection and Affordable Care Act (PPACA) commonly referred to as ObamaCare was signed into law on March 23, 2010. One year later, the law remains unpopular with the public and a core fiscal concern for many voters, while many are learning just how intrusive are the government mandates. Supporters believed that once passed, the law would gain in popularity. It has not. This law of the land may not be for long. In January this year, Senior U.S. District Court Judge Roger Vinson ruled the individual mandate in the new law to be unconstitutional. NYC Hopes to Join Legions Freed from Health Care Rules Michelle Malkin – Dayton Daily News New York Democratic Rep. Anthony Weiner toasted the one-year anniversary of ObamaCare last week — and accidentally spilled his champagne glass all over the disastrous, one-size-fits-all mandate. Ostensibly one of the federal health care law’s staunchest defenders, Weiner exposed its ultimate folly by pushing for a special cost-saving regulatory exemption for New York City. If it’s good for the city Weiner wants to be mayor of, why not for each and every individual American and American business that wants to be free of ObamaCare’s shackles? On ObamaCare’s Anniversary, Voters Favor Repeal 58%-36% Avik Roy – Forbes Since the Patient Protection and Affordable Care Act was signed into law one year ago, Scott Rasmussen has been conducting a weekly tracking poll, asking likely voters whether or not they favor or oppose repealing the law. (Many other polls that are less reliable do not assess whether respondents are likely to vote, a key factor in the accuracy of any given survey.) Rasmussen’s latest survey shows that likely voters favor repeal by a wide margin: 58 percent to 36 percent. Even more telling, among those expressing a strong opinion, 46 percent strongly favor repeal, as compared to 27 percent who strongly oppose. Obamacare's First Anniversary. Let's Hope There Aren't Too Many More. Paul Howard, National Review Online, March 24, 2011 This week marks the first anniversary of the passage of the Patient Protection and Affordable Care Act, aka "Obamacare." The Obama administration and its allies will be hawking the law's achievements, while its critics (present company included) will be touting its myriad problems, unintended consequences, and budget-shattering costs. For policymakers who want to move the country in the direction of a more market-oriented health-care system, the key to "repealing and replacing" Obamacare will be to define a narrative that links health care to the nation's broader economic woes, and to avoid the trap of pigeonholing the Obamacare debate as a debate just about health care. It's really a debate about the future of the American economy, and that's a debate that should resonate with moderates, conservatives, and independents. . . Obamacare: One year later Dr. David Gratzer and Dr. Jason Fodeman, Washington Times, March 23, 2011 This week marks the one-year anniversary of Obamacare, and there has been no shortage of Washington rhetoric on the goals of the legislation for the occasion: Bending the cost curve. Reducing health insurance premiums. Expanding the number of insured Americans. But as we mark this anniversary, it's important to note the other agenda that has been missed in the debates of the past two years: reining in our doctors. Look carefully at the legislation signed into law by President Obama last March, and you'll discover a not-so-subtle campaign to dramatically reshape the doctor-patient relationship. From compensation to autonomy, Obamacare represents something of a war on doctors. . . Health Care’s Hidden Costs: $363 Billion Parija Kavilanz – CNN Money http://money.cnn.com/2011/03/23/news/economy/health_care_hidden_costs/A year after the passing of health reform, a new industry report revealed that consumers may be paying billions of dollars more in out-of-pocket health care expenses than was previously thought. These “hidden” costs of health care — like taking time off to care for elderly parents — add up to $363 billion, according to a report from the Deloitte Center for Health Solutions, a research group. That amounts to $1,355 per consumer, on top of the $8,000 the government says people spend on doctor fees and hospital care. ObamaCare Unlikely to Gain Popularity… During Tax Season Hadley Heath – Independent Women’s Forum http://www.iwf.org/inkwell/show/24554.htmlTime is ticking away… Only a few weeks left to file your taxes! I almost laughed when I read this headline from The Hill: Administration hopes tax time will boost support for healthcare reform. “Health care reform” meaning the one-year-old law that includes at least 20 different tax hikes? Oh yes, that’s bound to be popular around tax time. But the article from The Hill focuses specifically on small business taxes. The administration is hoping that small businesses (that is, fewer than 25 employees) will apply for the small business tax credit in ObamaCare. Boehner, McConnell Push Assault on Health Care Law Michael D. Shear – New York Times’ The Caucus http://thecaucus.blogs.nytimes.com/2011/03/23/boehner-mcconnell-push-assault-on-health-care-law/?partner=rss&emc=rss A year after President Obama signed his health care law into effect, the two leading Republicans in Congress are making it clear that they do not intend to let up in their assault on the historic measure. In a joint opinion article to be published in the Cincinnati Enquirer Wednesday morning, House Speaker John Boehner and Senator Mitch McConnell of Kentucky, the Republican leader, promise to continue pursuing “full repeal” of the law. “The fog of controversy has now cleared, but contrary to the confident predictions of some, the contents of this law are even worse than anyone expected,” the pair write. “And that’s saying something.” Public Wants ObamaCare Repealed, and I Can Do It Rep. Steve King – DesMoines Register http://www.desmoinesregister.com/article/20110323/OPINION01/103230342/0/MOMS/?odyssey=nav%7Chead On March 23, 2010, President Obama defied the wishes of the American people and signed ObamaCare into law. At the time, supporters of the unconstitutional law claimed that Americans would warm up to ObamaCare as they began to realize what was in it. This claim was unlikely then, and recent polling indicates that it is completely without merit now. A Glimpse of a Future with ObamaCare Sally C. Pipes - Washington Post The one-year anniversary of the Affordable Care Act this week brings new reason to consider a major health-care announcement by Massachusetts Gov. Deval Patrick. Almost five years into his state’s Romneycare plan, it turns out that spending is out of control, threatening public-sector budgets and private-sector wealth generation. The solution to this government-created mess, Patrick told the Greater Boston Chamber of Commerce last month, is more government control — or health-care reform Part II, as some are calling it. Americans in the other 49 states should pay attention. Massachusetts is the blueprint for ObamaCare, and Patrick is among those who want his state’s plan to serve as a national model. Senate Democrats Eye Health-Law Strategy David Nather - Politico It may be uphill for Democrats to hold the Senate in 2012, but they’re eyeing an opportunity on the health care law: They believe the Republican candidates might be forced to push so hard for repeal that they lose swing voters. That may be a surprising take, given that the law is still unpopular with much of the public. With 23 Democratic seats and only 10 Republican seats up for reelection, it could take a hard sell for those candidates to turn the public around. 11th Circuit Accelerates Timetable for ObamaCare Constitutional Appeal Avik Roy - Forbes I got busy with other things, and haven’t had a chance to comment on important developments with the ObamaCare constitutional challenges. So here’s my take. As readers will know, in January, Judge Roger Vinson of the U.S. District Court for the Northern District of Florida overturned PPACA in its entirety. The White House refused to abide by the ruling, instead asking Vinson to “clarify” it. Vinson responded vigorously, demanding that the White House seek an expedited appeal of his ruling by March 10. $5B Hollywood Handout Bankrupting ObamaCare Chris Gonsalves - Newsmax A $5 billion handout to states, big corporations, and Hollywood unions to subsidize health insurance for early retirees is threatening to bankrupt a major part of the year-old healthcare reform law, according to staffers of the House Energy and Commerce Committee. A small percentage of the organizations singed up for the plan has already drained more than $500 million from the program’s coffers. Breaking Health Care Research: Pursuing a Different Path in Health Reform Margot Crouch - The Foundry After one year, ObamaCare remains just as unpopular as ever. The fight for repeal has gained ground in both Congress and the states. But repeal is only the first step in setting a new agenda on health care. In her recently released paper, Heritage expert Nina Owcharenko explains the four steps necessary to creating lasting reform that is truly market-based and patient-centered: “Unlike ObamaCare, Congress should pursue an approach to health care reform that preserves the doctor–patient relationship and cutting-edge innovation while controlling costs and expanding access to private health coverage.” ~~~~~~~~~~~~~ From the NCPA's health care blog: Is Medicaid Real Insurance? ((Quick, easy answer - NO.)) http://healthblog.ncpa.org/is-medicaid-real-insurance/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-18618 Filed in Health Alerts on March 30, 2011 with 9 comments As governors across the land pepper the federal government with requests to scale back Medicaid — many people are losing sight of the fact that health care reform (what some call ObamaCare) requires a huge expansion of Medicaid. In fact, in just three years the nation is expected to start insuring about 32 million uninsured people. About half will enroll in Medicaid directly; and if the Massachusetts precedent is followed, most of the remainder will be in heavily subsidized private plans that pay little more than Medicaid rates. That raises an important question: How good is Medicaid? Will the people who enroll in it and in private plans that function like Medicaid get more care, or better care, than they would have gotten without health reform? The answer to that question is not obvious. In fact it’s probably fair to say that we are about to spend close to $1 trillion over the next 10 years insuring the uninsured and we really don’t know what we expect to accomplish by spending all that money. The 32 million newly insured may not get more health care. They may even get less care. And even if they do get more, odds are that low-income families as a group will get less care than if there had never been a health reform bill in the first place. The reason: the same bill that insures 32 million new people also will force middle- and upper-middle-income families to have more generous coverage than they now have. As these more generously insured people attempt to acquire more medical services they will almost certainly outbid people paying Medicaid rates for doctor services and hospital beds. To make matters worse, the health reform bill (following the Massachusetts precedent) did nothing to increase the supply side of the market to meet the increased demand. Both anecdotal and scholarly reports from Massachusetts are consistent with this prediction. The wait to see a family doctor in Boston is now longer than in any other US city. More people are going to emergency rooms for their care in the state than before Massachusetts enacted its health reform. A Boston cab driver went through a list of twenty doctors (a list Medicaid gave her!) before she found a doctor who would see her. A preliminary report on the state as a whole found that nearly a quarter of adults who were in fair or poor health reported being unable to see a doctor because of cost during the implementation of the reforms. Further, state residents earning less than $25,000 per year were much less likely than higher earners to receive screening for cardiovascular disease and cancer. That brings us back to the initial question: Is Medicaid real insurance? Or is there little practical difference between being on Medicaid and being uninsured? It would appear at the margin that there’s not much difference. Currently there are roughly 10 million people in the U.S. who are eligible for Medicaid and S-CHIP but have not bothered to enroll. That implies that for about one in every six eligibles, Medicaid insurance is not worth the effort it takes to fill out the enrollment papers! Consider the case of Dallas emergency rooms. At Parkland Memorial Hospital both uninsured and Medicaid patients enter the same emergency room door and see the same doctors. The hospital rooms are the same, the beds are the same and the care is the same. As a result, patients have no reason to fill out the lengthy forms and answer the intrusive questions that Medicaid enrollment so often requires. At Children’s Medical Center, next door to Parkland, a similar exercise takes place. Medicaid, S-CHIP and uninsured children all enter the same emergency room door; they all see the same doctors and receive the same care. Interestingly, at both institutions, paid staffers make a heroic effort to enroll people in public programs — (going patient by patient, family by family) right there in the emergency room. Yet they apparently fail more than half the time! After patients are admitted, staffers go from room to room, continuing with this bureaucratic exercise. But even among those in hospital beds, the failure-to-enroll rate is significant. Clearly, Medicaid enrollment is important to hospital administrators. It determines how they get paid. Enrollment may also be important to different sets of taxpayers. It means federal taxpayers pay more and Dallas County taxpayers pay less. But aside from the administrative, accounting and financial issues, is there any social reason we should care? Economics teaches that people reveal their preferences through their actions. If people act as though they are indifferent between being uninsured and being on Medicaid, we may infer they are equally well off in both states of the world from their own point of view. If someone drops a $20 bill on the floor in Parkland’s emergency room, how long do you think it would stay there? Probably not very long. If someone drops a Medicaid enrollment form on the floor, how long do you think it would stay there? Probably until the next janitor comes along with a broom. Health economists tend to think Medicaid insurance is really valuable – worth a lot more, say, than $20. Many patients, through their actions, communicate that they disagree. Against this conclusion, there are two counter arguments worth considering. First, some claim that transactions costs (administrative difficulties) are the real reason why so many eligibles don’t enroll. At Parkland and Children’s Hospital those costs are close to zero, however. Second, there is the argument from paternalism: that people will be better off if we push them into Medicaid, whether they prefer it or not. But even on that score, the evidence is weak. A very comprehensive RAND study, found that the type of insurance people have — or whether they are insured at all — does not affect the quality of care they receive. With respect to cancer care, it is unclear that Medicaid matters very much. Health blogger Avik Roy summarizes other studies that find that Medicaid patients do no better and sometimes worse than the uninsured. Additional evidence is supplied by Scott Gottlieb. If you’re trying to get a primary care appointment, it appears your chances are better if you say you are uninsured. Health economist Austin Frakt takes issue with these studies, claiming that Medicaid and non-Medicaid populations are fundamentally different, even after adjusting for race, income and other socio-economic factors. That claim seems improbable — at least at the margin — however, in light of the heavy ping-pong migration of people in and out of Medicaid eligibility. Frakt points to some studies finding that Medicaid makes a positive difference over being uninsured. But the results would probably have been just as good or better if we spent the money giving free care to vulnerable populations. Moreover, even with their Medicaid cards, enrollees turn to emergency rooms for their care twice as often as the privately insured and the uninsured. Austin and I have had a further volley (at his blog and mine) after a version of this Alert appeared at Kaiser Health News last Friday. Here’s my bottom line: after we get through spending our $1 trillion under ObamaCare, there is no convincing reason to believe that the bottom half of the income distribution will have more care, better care, or better access to care than they have today. ~~~~~~~~~~~~~ From the AMA March 23, 2011 AMA Report Finds Physicians Support nearly 170,000 jobs and $44.7 billion in Economic Activity in Pennsylvania Study provides state-level snapshot of the economic impact of office-based physicians studied (Harrisburg, Pa.) A new report released by the American Medical Association (AMA) and the Pennsylvania Medical Society (PAMED) shows that office-based physicians play a vital role in Pennsylvania’s economy by supporting jobs, purchasing goods and services and generating tax revenue. In 2009, office-based physicians in the Keystone state contributed $44.7 billion in economic activity and supported nearly 170,000 jobs. According to the Pennsylvania Medical Society (PAMED), the AMA report further proves the vital role of our state’s physicians in helping local communities with economic recovery. “Our focus is always the better health of Pennsylvania patients, and in the past, other studies like those by the Institute for Good Medicine at PAMED have shown the millions of dollars our members provide in charitable care,” said Ralph Schmeltz, MD, president of PAMED. “Now, this new AMA study provides yet another example of the benefits to communities of robust physician practices, specifically jobs and business opportunities for others.” AMA President Cecil B. Wilson, MD, agreed. “Although physicians are primarily focused on providing excellent patient care, physician offices and the jobs and revenue they produce are significant contributors to state economies,” said Dr. Wilson. “This study illustrates that office-based physicians contribute to both the health of their patients and also to the economic health of their local communities.” The study found that, in comparison to other industries, office-based physicians almost always contribute more to state economies than each of the following: education, legal, nursing home, and home health. The findings show the economic impact of office-based physicians as measured through sales revenue, jobs, wages and benefits and tax revenue. The report provides information on the economic impact of office-based physicians in all 50 states and the District of Columbia. In Pennsylvania, office based physicians supported $28.3 billion in wages and benefits. To view the Pennsylvania report, please visit www.pamedsoc.org/economicimpact. For the full national report, visit www.ama-assn.org/go/eis. The Pennsylvania Medical Society has been focused on the better health of patients since it was first founded in the 1800s. Today, the organization continues to stress the importance of the patient-doctor relationship. To learn more about PAMED visit www.pamedsoc.org or our patient website at www.myfamilywellness.org. The American Medical Association helps doctors help patients by uniting physicians nationwide to work on the most important professional, public health and health policy issues. The nation’s largest physician organization plays a leading role in shaping the future of medicine. For more information on the AMA, please visit www.ama-assn.org. ~~~~~~~~~~~~~ From the Heritage Foundation Doctors Give the Practice of Medicine under Obamacare a Grim Prognosis http://blog.heritage.org/2011/03/23/doctors-give-the-practice-of-medicine-under-obamacare-a-grim-prognosis/?utm_source=Newsletter&utm_medium=Email&utm_campaign=Morning%2BBell Posted March 23rd, 2011 at 6:00pm in Health Care with 2 comments Print This Post On Monday, The Heritage Foundation hosted a panel of current and future physicians to discuss the impact of Obamacare on their profession. Their remarks highlighted the importance of the doctor-patient relationship as the heart of the practice of medicine and detailed direct threats as a result of the new health law. Representative Michael Burgess, M.D., (R-TX) explained that part of being a physician is fighting for the best interests of each individual patient. Under Obamacare, this will be harder to do, as government inserts itself further into the provision of care. One example is the creation of accountable care organizations (ACOs) in Medicare. Representative Burgess pointed out that under ACOs, doctors would not be held accountable to patients, but rather to the hospital or health plan in charge. Based on his experience as an OB/GYN, Representative Burgess argued that it will be more difficult for doctors to stand up for patients’ needs to insurers or the government if they work directly for the latter. Dr. Martha Boone, a urologist from Atlanta, further argued that currently, if an insurer denies coverage for a certain treatment, she can call the medical director (a fellow physician) and explain her rationale. In the case of coverage provided by the government, such as Medicare and Medicaid, that’s not an option—the answer is always no. Greater government influence in medical decision-making will come at the expense of patients’ own desires. Physicians’ concerns go beyond the expansion of bureaucratic power into patient care. Jeet Guram, a first-year medical student at Harvard Medical School, pointed to the new law’s expansion of Medicaid, a flawed program, to cover an additional 18 million Americans. Since Medicaid pays physicians significantly lower rates than private insurance or Medicare, it is difficult for doctors to accept Medicaid patients without risking insolvency. As more Americans enter the system, barriers to access for Medicaid beneficiaries will become even more pronounced. Of further concern to Guram is Obamacare’s “misalignment of priorities” when it comes to medical innovation. The new law increases government control over cost and utilization of services, which could distort demand. Further discouraging innovators are the law’s new taxes on pharmaceutical and medical device manufacturers. As Representative Burgess said, investors “don’t hazard big things for small rewards.” Medicine is on the cusp of exciting new territory, but discouraging future innovation could change that. The sentiments expressed by the panel echo those of the medical profession at large. According to a recent survey sponsored by Pfizer, 59 percent of physicians cited the interference of non-medical entities in medical decisions as a negative development in the health care system. And 50 percent held an unfavorable view of Obamacare, compared to 24 percent who saw it as favorable. Threats to the doctor-patient relationship existed before the passage of Obamacare. However, rather than empowering doctors and patients, the new law will result in further erosion as a result of government intrusion in health care. ~~~~~~~~~~~~~ From John Goodman's Health Care Blog at the NCPA Does the GOP Have a Health Plan? by John Goodman ((Of course it does. Always did. Claims that the Republicans HAD no plan were lies.)) Filed in Health Alerts on March 28, 2011 with 32 comments ((Goodman has an amazing ability to make the complex comprehensible. Other than myself, he may well be the only person in America who really understood John McCain's health care plan - and HE was able to explain it so people would understand it, while, me, well, not so much....)) The Republicans have no plan to insure the uninsured. How do I know that? A New York Times editorial told me. So did Ezra Klein, writing in The Washington Post. Matt Miller, also writing in the Post, went further. “I’m willing to repeal ObamaCare,” he wrote, provided the Republicans can “cover the same number of uninsured” and “do it at a lower cost.” So why don’t the Republicans have a plan? That’s easy. “They’re against reform because it would cover the uninsured — and that’s something they just don’t want to do,” wrote Paul Krugman in The New York Times. The Times’ own editorial said the same thing. ((And I hear they want to dirty up our air and water, too - oh, and make Grandma eat dog food!)) All this has caused me to suffer a bout of severe depression. But, wait a minute. Wasn’t health care the biggest issue in the last presidential election? And…how memory fades…didn’t the Obama campaign spend millions of dollars…promoting his own plan?…no, that’s not right… Ah, now I remember. The Obama campaign spent tens of millions of dollars on TV commercials attacking the John McCain health plan! It spent more money than has ever been spent for or against any policy proposal in the history of American politics. The McCain plan, for all those suffering from collective amnesia, proposed to replace all existing health care tax and spending subsidies with a universal health grant, structured like a refundable tax credit. The Patients’ Choice Act version of the idea is sponsored by Tom Coburn (R-OK) and Paul Ryan (R-WI). It promises $2,300 (individual) or $5,700 (family) to everyone who isn’t enrolled in a government health plan. So what was candidate Obama’s problem with that? Did he object that the plan wasn’t generous enough? Too few regulations? No, none of that. The Obama TV ads focused like a laser on raw self-interest. McCain’s health plan, the ads said, will cause your withholding taxes to go up (without mentioning the offsetting credit that would cause them to go down). Think about that. The Obama campaign spent all that money attacking the most comprehensive and progressive proposal for universal care proposed by any serious presidential candidate in modern times on the grounds that somebody’s tax bill might — just might — go up! I’ll skip over the question of how you can spend that much money on TV ads and not come to the attention of The New York Times or any of the opinion writers mentioned above, to address a point that can easily get lost with all the demagoguery swirling around. Under the McCain/Coburn/Ryan approach, the first $5,700 a family spends on health insurance is courtesy of Uncle Sam. To have the kind of coverage a typical large corporation has, employees and employers would have to kick in about $6,300 more (with unsubsidized money). Not everyone may choose, or be able, to do that. Some might add $3,300 of their own money and buy a $9,000 plan. Some might settle for whatever catastrophic coverage $5,700 will buy. But everybody — and I mean everybody who doesn’t turn down a free lunch — would have protection against large medical bills. Let’s contrast that approach with what happens under the new health reform legislation. Recently, Health and Human Services Secretary Kathleen Sebelius gave 30,000 McDonald’s workers a temporary waiver from the new regulations so they can keep their limited-benefit, “mini-med” plans — which would otherwise be wiped out by ObamaCare regulations. If McDonald’s lowered these employees’ wages by $5,700 and bought them $5,700 worth of health insurance, the only subsidy available today is the one embedded in the tax law — the ability to pay premiums with dollars that escape the payroll tax. (These employees earn too little to pay income taxes.) That’s worth about $872 — less than one-sixth of what the Republicans were offering. The new health reform law will make things even worse. Because mini-med plans won’t be compliant in 2014 with ObamaCare’s mandated benefit package, McDonald’s will have to pay a $2,000 fine for each employee. In short, to get the kind of plan McCain/Coburn/Ryan would give them for free, McDonald’s workers would have to pay almost all of the cost out of their own pockets (remembering that employer payments are dollar-for-dollar substitutes for wages) and pay a net fine to the government to boot! To be fully compliant with the new law, McDonald’s and its employees will have to spend an estimated $12,500 on family health insurance in 2014. In this case the federal tax subsidy rises to $1,913. But that implies that $15-an-hour employees will have to give up more than one-third of their take home pay! This is what backers of ObamaCare call “insuring the uninsured.” Technically, employers and employees have another option. They could drop employer-provided insurance, pay a $2,000 per person fine and let low-income employees join Medicaid or enroll in heavily subsidized plans in newly created health insurance exchanges. But if every employer did this, the cost to the federal government would far exceed the revenues ObamaCare raises. This way of insuring the uninsured is not paid for under the new law. For all the hoopla, the health reform law enacted last year has no practical way to insure millions of uninsured and underinsured families. By contrast, the Republicans actually had a plan. It’s a better plan than ObamaCare. More universal. More progressive. More rational. And it was funded. But they would be foolish to trot this plan out again and start talking about it — subjecting themselves to more relentless and dishonest demagoguery — unless the Democrats are willing to renegotiate the entire health reform package. One party cannot reform major institutions on its own. Not Social Security. Not health care. Not Medicare. Invariably, the party that tries to go it alone loses seats in the next election. ~~~~~~~~~~~~~ From the Allentown Morning Call Dent, Toomey slam medical device tax Republican lawmakers meet with industry reps, who say levy would be devastating. By Colby Itkowitz, CALL WASHINGTON BUREAU March 23, 2011 A 90-year-old local manufacturer that fits war veterans with prosthetics could close if a new federal tax on medical device manufacturers is enforced. "Basically, if the tax goes through we will turn out the lights, lock the doors and go home and not be able to service patients anymore," said Chris Field, chief financial officer of BOAS Surgical, which manufactures pedorthic, orthotic and prosthetic devices and has a branch in Allentown. To help offset the cost of reforms, last year's health care law includes an excise tax of 2.3 percent on sales of most medical devices beginning in 2013. It is expected to raise $20 billion over 10 years. Advocates for the tax said businesses would benefit from millions of new government-insured customers and should help pay for the reforms. Field says his small business, which employs 45 people, would be crushed by the tax. Large corporations like B. Braun Medical Inc. in Bethlehem say the tax would stunt growth. Bruce Heugel, chief financial officer at B. Braun, said the tax would cost his business $24 million. He said an Ernst & Young survey shows the medical device industry makes a profit of 3.4 percent on sales. A tax of 2.3 percent would consume more than 65 percent of the industry's profits, Heugel said. Big device makers have lobbied forcefully against the new tax. B. Braun does not employ its own lobbyist, but is a member of the Medical Device Manufacturers Association, a trade organization representing device makers in Washington, D.C. The group spent $360,000 in 2010 on lobbying, mostly against the tax. Jan Wald, a medical device analyst at Morgan Keegan, said the tax will not devastate the industry but will crimp innovation. "It's not going to kill it, but it is going to potentially damage it and I think the issue there is, the device industry has maintained itself and been able to grow at a nice rate primarily because of the ability to innovate," Wald said in a phone interview. "To the extent that there is less research and development …I think that's the danger." Republican lawmakers U.S. Rep. Charlie Dent and U.S. Sen. Pat Toomey held a joint event at B. Braun on Wednesday, the one-year anniversary of the health care law, to decry the tax. Afterward Dent spent an hour speaking with industry representatives about the tax's impact. Other local companies that would be affected by the tax, OraSure Technologies and Olympus America, did not participate. "Only in Washington could people say we are going to lower health care costs by adding to the cost of all the things we have in hospitals and doctors' offices," Dent said. Dent received $12,850 in individual contributions from B. Braun in 2010, according to OpenSecrets.org. ((You know, it would be really NICE if the media checked up on this kind of information for EVERYONE....like, I'd like to know where Bob Casey's campaign contributions came from - which unions, or special interest groups in favor of government health care contributed to HIS campaign....or which trial lawyers, since he opposed liability reform. But most of the media never bother to check THAT information. Only for those greedy Republicans, because we all KNOW they can be "bought," right? NEVER the other side....)) Some lawmakers in Congress, including Dent, have offered legislation to repeal the tax. Toomey said he expects the Senate to vote, but likely not pass, a repeal attempt. It's unclear where U.S. Sen. Bob Casey, D-Pa. stands on the tax. Spokesman Larry Smar said his boss believes there "are a number of ways in which the law can be changed" and wants to continue examining and debating the issues. ((Nice way to dodge. SO I just did a little of my own checking on Sen. Casey's contributions - seems that almost $4 million of his career campaign contributions have come from lawyers and law firms - FIVE TIMES the amount he received from his second largest group of contributors, retired people who gave him $800,000, while 27% of his PAC contributions - about 9% of his total - were from unions. Guess that explains a little....assuming that politicians ONLY vote to favor their donors.)) The tax was championed by U.S. Sen. Max Baucus, D-Mont., who wrote the Senate version of the health care bill. He said hospitals, insurance companies, the pharmaceutical industry and medical device makers would benefit under it. ((Ummmm...paying a NEW tax benefits them....how?)) Toomey said start-ups in the state are too small to be profitable and will not survive the additional levy. "We've got a tax that on every level I can think of is going to harm an incredibly important industry in Pennsylvania," he said. Robert Loiterman, president and CEO of GrantAdler Corporation, a small start-up in Allentown that makes implants for vascular access, said the tax would make it difficult to keep his business going because he needs a positive cash flow to qualify for working capital. "This tax is not so much a tax on my profit; my company is just starting revenue … it's in addition to my losses while I ramp my sales to hopefully get to break even," Loiterman said. Most medical device companies are small. Brendan Benner, spokesman for the industry's trade association, said 80 percent have fewer than 50 employees. "These are by no means giant corporation entities that can easily absorb this tax," he said. colby.itkowitz@mcall.com 202-824-8216 Copyright © 2011, The Morning Call ~~~~~~~~~~~~~ ((GOOD FOR ST. LUKE's! If more doctors and hospitals countersued for meritless cases - note I didn't say "frivolous" which has an entirely different legal definition and is deliberately difficult to prove - then there would be fewer of them. When doctors and hospitals "win" 90% of court verdicts - costing countless hours that could otherwise be devoted to health care and well over $100,000 per case - that means lawyers are pursuing at least a COUPLE of cases that probably shouldn't have made it past the first steps. While no one who's been through the trauma of a court case WANTS to go back to court to countersue, this is a non-legislative way to provide negative reinforcement to the legions of personal injury lawyers who are willing to take the chance of a big payout. I know of two groups which assist doctors and hospitals in such endeavors - Doctors' Advocate, www.doctorsadvocate.org, based in PA, and Medical Justice, www.medicaljustice.com, based in Florida. There are probably others.)) St. Luke's countersues in Cullen cases Hospital claims plaintiffs filed abusive claims in the deaths of two patients. http://www.mcall.com/news/local/bethlehem/mc-bethlehem-stlukes-cullen-countersu20110328,0,6946756.story STORY ARCHIVES: Charles Cullen Case St. Luke's Hospital and Health Network has countersued prominent local personal injury lawyers and their clients, charging that the original plaintiffs filed abusive lawsuits when they alleged the hospital was responsible for two additional deaths at the hands of serial-killer nurse Charles Cullen.With the lawsuits, which name attorney Martin Cohen and his firm, Cohen & Feeley, attorney John R. Vivian of Easton and Dr. John Shane of Allentown, the hospital is seeking to recover attorney fees and costs and collect punitive damages over the filing of the earlier complaints, which were dismissed in Lehigh County Court. The dismissals were upheld on appeal. Also named as defendants are Harry H. Miller of Saylorsburg; Robert Hall Jr. of Northampton and Leslie Hall of Mount Bethel, who were executors of the estates of relatives who died at St. Luke's-Fountain Hill while Cullen worked there. Over the course of the two cases, both filed in 2004, St. Luke's amassed a total of $564,111 in legal fees and costs, the lawsuits say.In a statement, the hospital said it is seeking "a full public accounting" of the initial complaints against it. "At St. Luke's, we believe it is our responsibility to respond to frivolous lawsuits which represent an inappropriate and unconscionable attempt to divert precious health care resources for personal financial gain," said St. Luke's President and CEO Richard A. Anderson. "We believe the actions of these individuals and their attorneys are reprehensible and should not go unaddressed." Mark K. Altemose, a lawyer at Cohen & Feeley, which has offices in South Whitehall and Bethlehem townships, said no one there could comment since they had not seen the complaints. "Our firm at all times acted appropriately within the bounds of the law," he said. Shane denied allegations in the complaints, filed Friday, that he "blatantly ignored" a lack of evidence that Cullen was involved in the deaths of Regina C. Miller and Marilyn Hall. Shane, who also had not seen the lawsuits, said he offered "an honest opinion based on a thorough review of the case. "Harry Miller said he pursued the case because he had been told his late wife, Marilyn, was going to recover while she was at St. Luke's. That doctor, whose name Miller could not remember, gave Miller "a glowing description of how I was going to take my wife home in five days," he said, adding he believes Cullen killed his wife. Leslie Hall declined to comment. Robert Hall and Vivian could not be reached for comment.Cullen, who worked as a nurse in health care facilities in the Lehigh Valley and New Jersey, pleaded guilty to killing 29 patients — 22 in New Jersey and seven in Pennsylvania — and is serving a life sentence in a New Jersey prison. Formerly of Bethlehem, Cullen worked at Warren Hospital, Liberty Nursing and Rehabilitation Center and Sacred Heart Hospital in Allentown, Lehigh Valley Hospital-Cedar Crest, Easton Hospital and St. Luke's-Fountain Hill, among other places between 1993 and his arrest in 2003. According to the complaints, after Cullen had been arrested for killings in New Jersey, he told investigators of the patients at St. Luke's he had killed. Regina Miller and Marilyn Hall were not among them, they said. When they were admitted, both Marilyn Hall and Regina Miller suffered from "end-stage" heart complications, the lawsuits said.In the Hall case, the St. Luke's complaint says Cohen & Feeley investigated the case and determined it was "not viable," but took the case over from Vivian four years later anyway. While he had the cases, Vivian had Shane sign certificates of merit, documents that were required for the filing of the case against the hospital, the St. Luke's suits say.St. Luke's alleges in its complaints that Shane and Vivian "had an outstanding and pre-existing arrangement by which Dr. Shane would sign his name to any written statement provided by Vivian… regardless of the merits of the claims." Cohen & Feeley took over the cases from Vivian. The cases eventually were dismissed in county court. State Superior Court affirmed the decisions last June. The St. Luke's suits claim that the defendants wrongfully used the court system against the hospital, despite a lack of evidence Cullen was involved in the cases. They said St. Luke's spent $228,116 defending itself in the Miller case and $335,995 in the Hall case. St. Luke's also claims that Shane signed a certificate of merit fraudulently stating the evidence suggested Cullen was involved in the patients' deaths. The suits also claim Vivian had Shane sign certificates without regard to the facts of the case or by adopting language prepared by Vivian. tim.darragh@mcall.com ~~~~~~~~~~~~~ This LIABILITY & 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, who are biased by won't admit it. 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. 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