Obama cancels meeting of President's Council Bioethics

I wonder whether the new commission/committee/council will have even one pro-life member? Will Robert P. George (one of only 3 or 4 conservative bioethicist with tenure at a major university), for example, have a spot?

And remember the fuss and bother when some of the members of President Bush's Council were replaced in March, 2004? Bet there's none, now!

Obama Plans to Replace Bush’s Bioethics Panel
By NICHOLAS WADE

Members of the President’s Council on Bioethics were told by the White House last week that their services were no longer needed and were asked to cancel a planned meeting, a council staff member said Wednesday.

The council was disbanded because it was designed by the Bush administration to be “a philosophically leaning advisory group” that favored discussion over developing a shared consensus, said Reid Cherlin, a White House press officer.

President Obama will appoint a new bioethics commission, one with a new mandate and that “offers practical policy options,” Mr. Cherlin said.

$1 Trillion to cover 11 Million people

According to the Associated Press, 37 Million people would remain uninsured under the legislation discussed in Kennedy's Senate Health, Education, Labor and Pensions Committee. If there are 48 million uninsured, now (not, more below), then one trillion dollars to cover an additional 11 million people.

Can you imagine? There's no coverage at all for people who aren't eligible for Medicaid, but who make less than 150 percent of the Federal poverty level ($33,000 for a family of four.)

Of course, some of this cost comes from subsidizing families of four who make $110,000 a year. In fact, 60% of the cost will be in the subsidies for people who make 150% to 500% of the Federal poverty level.

(We won't mention the cost of regulating restaurant menues and forcing the placement of nutrition information on those menues and on notices next to each item on a buffet line. Or the as-yet uncounted costs to the chefs who must calculate and document their recipes in order to know those nutrition facts.)

Daschle/Dole/Baker! Health care on the fast track -along with the entire Nation's finance

Right after this Yellow Brick Award ceremony, I'm thinking that it may save my life for me to learn to use Twitter and Facebook. Now.

While President Obama is planning to take over the entire finance world ASAP, ABC is planning their all-day infomercial for Obama and his push - there is no "plan," yet - for health care "reform" by July 4. No opposing or alternate viewpoints will be allowed. They're even refusing to take a paid-for program in rebuttal, according to the Drudge Report.

ABC REFUSES PAID ADS OFFERING ALTERNATIVE VIEWPOINT FOR WHITE HOUSE HEALTH CARE PROGRAM
ABC is refusing paid ads for its health care program at the White House. Thus they're refusing even a paid-for alternative viewpoint.

Conservatives for Patients Rights requested the rates to buy a 60 second network spot immediately preceding the broadcast of the Town Hall meeting.

While looking for verification of this story, I came across several that report that former Senators Tom Daschle, Bob Dole and Howard Baker are working on a health care "compromise." (Come on! there's a reason they aren't Senators any more!)

See their report, "Crossing the Streams Lines" here.

So, we'll have a Secretary of the Treasury (who claims to be unable to do his own taxes using Turbo Tax) running Wall Street and all the banks. We'll have a known plagiarist and serial failed Presidential candidate (who also can't figure out that gifts and services are taxable) working with another serial failed presidential candidate (who took money for telling the world that he needs a little pharmaceutical help in the bed room) working to reign in the cost of doctors, hospitals, and those pharmaceutical companies. (The third player in the health care waters is Baker, another serial failed presidential candidate. It's just that no one's ever heard of him.)

But don't worry -- even if you are able to vote for a completely new House and a turnover of a good portion of the Senate in 2010, Obama will still run the Census out of his Committee to Reelect the President.

In the meantime, Obama is planning to cut Medicare fees to Hospice, hospitals and doctors while instituting a new tax on health care insurance benefits from employers, according to the Washington Post.

Why not? After all, Daschle had to pay taxes on his limo and driver and Geithner had to pay them on his kids' summer camp!


Addendum after skimming the report:
The "Crossing the Lines" report is full of calls for more regulation with a sprinkling of pablum.

First, they demand that everyone have health insurance. (Could be acceptable if we were allowed to chose between Major Medical and From-First-Dollar. And if it weren’t for the rest of the trash.)

They believe - or at least claim to believe - that it will pay for itself. (Who knew old white haired men could be so funny?)

How will the money be raised?

By a “trigger” to enforce cuts when costs reach a certain point and by not paying for those treatments that are considered less effective.

What are they going to do with all the men and women who insist on antibiotics, today, for their bronchitis? Will they protect the doc when the patient develops bacterial pneumonia?

How about my man in his mid-80’s with a 102 fever in the ER, a bladder infection, multiple falls that resulted in bruises and skin tears, and potassium at 2 (normal is 4)? Medicare would not allow me to actually admit him because he turned out not to be septic by their criteria. He ended up on “Observation” for 3 days while his wife and I tried to find some safe place for him to go after discharge and I tried to get a handle on his potassium. He left for the rehab hospital with a potassium of 2.6. On a heart monitor. Because Medicare rules threaten us with charges of “fraud and abuse.”

How about our local hospice? Obama has announced his intention to cut funding to hospice. I guess there’s not much efficacy in hospice. After all, the hospice patient is, by definition, expected to die within 6 months. However, hospice patients are less likely to present at the ER, with the costs of their care much less than hospitalization.

Force Medicare "reform" without proof that it will work?

The Washington Post reports on the latest findings of the "Medicare Payment Advisory Commission" (MedPAC) today. According to the WaPo, this is a "commission that advises Congress on the federal medical program for older Americans."

In other reports, there is mention that President Obama plans - at the same time - to cut Medicare and Medicaid funding by over $900 Billion dollars, to somehow expand the numbers of Americans who are given "guaranteed health care" under some government "public plan," and to pay for any expansion by taxing insurance benefits given by employers.

And it all has to be done in the next two weeks:

For months, Obama remained on the sidelines of the health-care debate because "he felt it was important to not be too proscriptive," Axelrod said in an interview. "Now we're into a different phase, where decisions are being made very quickly, so it's time to weigh in to a greater degree."

The Obama strategy, articulated in the speech here and in a series of private meetings, is to present each major stakeholder with an enticement in return for a bit of sacrifice.

Again, there's mention of "accountable care organizations," and how to force doctors into them. This time, we do learn that coercion will be necessary to form these organizations and that there's evidence that these sort of interventions don't save money or improve the health care of patients caught up in the schemes. In fact, some of these interventions are now considered wasteful and the first place to cut:

To illustrate what it might take to save Medicare, the commission describes how primary-care doctors, specialists and hospitals could be reorganized into "accountable care organizations" whose members would receive bonuses if the organizations met quality and cost targets. To ratchet up the incentives, health-care providers that fail to meet cost and quality targets could be penalized, the report says.

Even then, any projected savings would be highly uncertain, the report says. What is certain is that Medicare cannot maintain its current trajectory, it adds:

"If current spending and utilization trends continue, the Medicare program is fiscally unsustainable. . . . Part of the problem is that Medicare's fee-for-service payment systems reward more care -- and more complex care -- without regard to the quality or value of that care."

The report underscores the challenges facing President Obama and Congress as they seek to overhaul the health-care economy. The administration has put a spotlight on what it considers wasteful spending, but it has offered sparse details as to how it would change the incentives that produce the waste.

The report identifies some areas that are ripe for savings. MedPAC estimates that the government is paying private Medicare health plans -- which were supposed to save the government money -- much more than it should. In addition, the government could save money by adopting a more streamlined approval process for "follow-on biologics" -- products that imitate biotech treatments already on the market.

Getting doctors to join accountable care organizations may require pressure, MedPAC Executive Director Mark E. Miller told reporters: "If you want people to voluntarily organize, you may want to make sure that the current system isn't as pleasant a place to be."

The model for accountable care organizations resembles that of large, tightly managed physician groups, practices that have been the subject of demonstration projects, and Medicare's experience with those offers limited encouragement, according to the report. Measurable quality improved in the areas of care monitored, such as for diabetes and congestive heart failure. But "whether the demonstration has actually generated savings for the Medicare program is debatable," the report says.

Policymakers hope that money can be saved by better coordinating care. But, according to the MedPAC report, Medicare pilot programs intended to coordinate care for patients with chronic diseases -- programs that involved insurance companies and other private groups -- generally achieved modest quality improvements. Most of the programs cost Medicare more money than it would have spent without them, the report says.

Public Funding for Health Care in Real Life

I don't see how this will cut costs to the government for Medicare and Medicaid.

The group Physicians for a National Health Plan, published a link to an April, 2009 report from the Lewin group by Sheils and Haught outlines the expected effects on insured, employers, doctors and hospitals under various types of public plan financing. At Medicare rates, doctors would see their income go down if everyone is covered, and go down slightly if only the self-insured and small businesses were covered. In the long run, if the public option is offered to everyone, 119 million people would switch over from private insurance.

The numbers in the news say that the Kennedy-Dodd Bill before the Senate Finance Committee will offer Medicare plus 10% to doctors and hospitals - so those decreases are not quite accurate.



Here's a report on one example of just such an effect.

Real world experience comes from Hawaii's short attempt to cover all uninsured children. It also describes the increased Medicaid coverage in Hawaii in the last few years, and the Federally Qualified Health Clinics that give care to uninsured and underinsured.

Texas Medical Association Health Care Principles

Available for members on the TMA website, but looks okay to post here.

The TMA House of Delegates adopted the principles as official TMA policy in May. They include:

* Promote portable and continuous health care coverage for all Americans using an affordable mix of public and private payer systems.
* Promote patient safety as a top priority for reform, recognizing an effective mix of initiatives that combine evidence-based accountability standards, committed financial resources, and rewards for performance that incent and ensure patient safety.
* Adopt physician-developed, evidence-based tools for use in scientifically valid quality/patient safety initiatives that incentivize and reward the physician-led health care delivery team, and include comparative effectiveness research used only to help patient-physician relationships choose the best care for patients.
* Preserve patient and physician choice and the integrity of the patient-physician relationship.
* Incorporate physician-developed, evidence-based measures and preventive health and wellness initiatives into any new or expanded health benefit package to promote a healthier citizenry.
* Recognize and support the role of safety net and public health systems in delivering essential health care services within our communities to include essential prevention and health promotion public health services.
* Support the development of a well-funded, nationwide emergency and trauma care system that provides appropriate emergency and trauma care for all Americans.
* Support public policy that fosters ethical and effective end-of-life care decisions, to include requiring all Medicare patients to have an advance directive that a Medicare enrollee can discuss as part of a covered Medicare visit with a physician.
* Provide sustainable financing mechanisms that ensure the aforementioned affordable mix of services and create personal responsibility among all stakeholders for financing and appropriate utilization of the system.
* Invest needed resources to expand the physician-led workforce to meet the health care needs of a growing and increasingly diverse and aging population.
* Provide financial and technological support to implement physician-led, patient-centered medical homes for all Americans, including increased funding and compensation for services provided by primary care physicians and the services provided by non-primary care, specialist physicians as part of the patient-centered medical home.
* Through public policy enactments, require accountability and transparency among health insurers to disclose how their premium dollars are spent, eliminate preexisting condition exclusions, simplify administrative processes, and observe fair and competitive market practices.
* Reform the national tort system to prevent nonmeritorious lawsuits, keeping Texas reforms in place.
* Abolish the Medicare SGR annual update system and initiate a true cost-of-practice methodology that provides for annual updates in the Medicare Fee Schedule as determined by a credible, practice expense-based, medical economic index.
* Support the implementation of an interoperable National Electronic Medical Records System, financed and implemented through federal funding.
* Require payers to have a standard, transparent contract with providers that cannot be sold or leased for any other payer purposes without the express, written consent of the contracted physician. This principle, in effect, calls for a prohibition against so-called silent PPOs.
* Support efforts to make health care financing and delivery decision-making more of a professionally advised function, with appropriate standard setting, payment policy, and delivery system decisions fashioned by physician-led deliberative bodies as authorized legislatively.

AMA offers public plan compromise

One more post before I have to work, from the American Medical Association morning newsletter.

Unfortunately, I can't access most of the links:

AMA offers public plan compromise.

The AP (6/12, Tanner) reports that the American Medical Association "has long opposed government intrusion into healthcare and believes reform can be achieved by revamping private health insurance plans." Now, AMA President Dr. Nancy Nielsen "says the group wants details on Obama's proposal for a public health insurance plan to compete with private plans." She noted that the AMA "opposes any public plan that forces physicians to participate, expands the fiscally challenged Medicare program, or pays Medicare rates."

But, she explained that the group "remains open to the idea of a government-run health insurance plan, as long as doctors are not required to participate and the plan pays doctors more than Medicare does," CQ Today (6/12, Wayne) reports. Dr. Nielsen said that "doctors would accept a public plan that competes on a 'level playing field' with private insurers." She claimed that "at a minimum...the government should not require doctors to participate as a condition of retaining their Medicare billing privileges, and the plan must pay higher rates than Medicare does." Among "other variations of a public plan" that "the AMA 'is willing to consider,'" include Senate Budget Chairman Kent Conrad's (D-ND) proposal to "create a system of publicly owned insurance cooperatives in place of a government-run public plan."

AMA said to be open to considering Sen. Conrad's co-op proposal. CongressDaily (6/12) reports, "The American Medical Association wants to see details of Senate Budget Chairman Kent Conrad's (D-ND) compromise proposal for a public health insurance plan, the group told senators Thursday." The group's statement "could help an already promising compromise gain more traction." AMA Trustee Samantha Rosman told the Senate Health, Education, Labor and Pensions Committee at a roundtable meeting that "the AMA is open to consideration of a new health insurance option that is market based." She added that although "no legislative details have yet been put forth," the group is looking "forward to reviewing those ideas." Sen. Conrad's proposal includes that creation of "a nonprofit co-op that would serve as a public plan alternative to private insurance."

Chamber Of Commerce, insurance industry join AMA in push against public plan. In a follow-up to Wednesday's New York Times (6/10, Pear) article about the American Medical Association's (AMA) push to eliminate the public plan from the health reform legislation, Shirley S. Wang observed in the Wall Street Journal (6/11, Wang) Health Blog that the AMA is arguing that a public plan "threatens to restrict patient choice" by crowding out the private insurers. In this effort, they are joined by the US Chamber of Commerce, which "says it is concerned that the proposed mandate that employers help pay for insurance would add new costs to already struggling businesses." Finally, "private insurers also are pushing back against the idea of government-run exchanges where consumers could buy policies." In an update to the blog entry, Wang added, "The AMA later issued a statement saying it might be able to support some version of public plans being discussed."

Public plan debate sparks Democratic "civil war." The Politico (6/12, Brown) reports that President Obama's calls for a public health plan "has touched off an increasingly fierce Democratic civil war on Capitol Hill, as liberals fearful about squandering the chance to achieve that goal are taking aggressive steps to keep moderates in line." The Politico notes that Democratic strategist Joe Trippi "launched a campaign" accusing Nebraska Sen. Ben Nelson (D) of "being a 'sellout' for special interests" when he spoke out against the concept. Meanwhile, bloggers on the Daily Kos "went on the attack" after the centrist Democratic think tank Third Way "cautioned Democrats on overreaching on a public plan." Louisiana Sen. Mary Landrieu (D) "is the next target," the Politico reports.

In the Washington Post (6/12) 44 blog, Ben Pershing notes "the increasingly heated debate over healthcare reform...within the Democratic party," adding that the formation of a public plan option is a major point of contention.
From the AMA

Obama to address AMA House of Delegates. President Barack Obama will speak at the Annual Meeting of the AMA House of Delegates on June 15 in Chicago about the nation's need for health system reform. "President Obama has made health reform a top domestic priority, as has the AMA," AMA President Nancy H. Nielsen, MD, PhD, said. "[His] speech to AMA physicians shows that he values the input of those who dedicate their lives to caring for patients." The House of Delegates opens tomorrow, June 13, during which physicians and medical students from around the country will debate and set policy on health system reform and a variety of other matters that affect physicians and patients. The meeting runs through June 17.

HELP (the whole government prepaid health plan)

Appropriate (on several levels), the proposed plan for government mandated and government financed health care is called the "HELP" plan. The current draft (I think)in .pdf can be accessed, here.

The Kennedy "draft of a draft" was 167 pages long. This thing is over 600 pages and I've gotten through about 150 pages, so far.

You may hear about the Hawaii Prepaid Health Care Plan, or Hawaii's mandated employer-provided insurance plan instituted in 1974.

Here's an article that covers the problems with Hawaii PHCP, according to one author from that State. Please note that the uninsured in that State is still 10% and that many employers attempt to use employees for less than 20 hours a week, so that they don't come under the mandate.

Please see the part near the end that I've highlighted, concerning the mandated services (including in vitro fertilization, etc.) that increase the cost of health care and insurance in Hawaii.

Due to Hawaii's low uninsured rate of 9.6 percent, policymakers have been looking at our unique employer-mandated health insurance as a model to be followed at the state and even national level. Since 1974, Hawaii has implemented the Prepaid Health Care Act (PHCA), which contains two major directives: 1) That employers provide employees working 20 or more hours a week with health insurance; and 2) That any plan offered by insurers provide equal or better benefits offered by the plan with the most subscribers in the state.

For several reasons, expanding PHCA beyond Hawaii's borders would be a catastrophic mistake.

Fact: From a low of only 5 percent of uninsured residents in the 1980s, the number has nearly doubled to 10 percent today. According to the US Census Bureau, Hawaii's current uninsured rate is not statistically different from states like Minnesota, Wisconsin, Iowa, and Maine, none of which implement employer-mandated insurance.

Conclusion: A low uninsured rate cannot be solely attributed to employer-mandated insurance. Mandating that employers provide coverage does not tackle the underlying problem of skyrocketing health care costs.

Fact: Employers find ways to save on costs by manipulating employee work hours. Following PHCA, the number of employees in the state working between 20 and 35 hours per week decreased while utilization of both employees working less than 20 hours and employees working over 36 hours increased. Evidence supports the claim that employers also drop employees altogether to avoid providing coverage, thereby increasing the rate of unemployment as well.

Conclusion: Requiring employers to cover employees working 20 or more hours has not eliminated, but merely shifted, the burden of health insurance costs to businesses while contributing to the growing uninsured rate.

Fact: Hawaii Medical Service Association (HMSA) is by far the largest provider in the state with 68 percent of the private market and 701,527 members as of May 2008. Kaiser is the second largest with a 20 percent share — thus, HMSA and Kaiser control nearly 90 percent of the state's insurance marketplace.

Conclusion: By requiring insurers' health plans to provide equal or better benefits offered by the plan with the most subscribers, PHCA protects HMSA's and Kaiser's majority control of the market, leaving little room for other insurers to enter the market. Lifting this restriction would introduce badly needed competition, which would go a long way in driving down expenses.

Fact: The state government mandates a wide range of benefits, including expensive and questionably necessary services such as in vitro fertilization and drug and alcohol addiction treatment, which highly inflate the cost of coverage.

Conclusion: Granting consumers the freedom to customize their own plans free of costly state requirements would allow them to prioritize cheaper, preventive services such as cancer screening. This would lower the price of coverage, leading to a larger number of both covered and healthier residents.

PHCA has effectively eliminated health insurance competition in the state, beleaguering citizens with growing expenses and lack of freedom in choosing the health plan that best fits their needs. Opening up the market within and outside the state (much like how consumers can already shop for auto insurance across state lines), in addition to eliminating expensive mandated benefits, would go a long way in restoring the purchasing power and choices of Hawaii's residents regarding the most important aspect of their lives — their health.

Pearl Hahn is a policy analyst at the Grassroot Institute of Hawaii.

TriCommittee Health Care Bill Summarized

I'm still looking for the actual Bill(s), with the names of sponsors. Evidently the Kennedy Bill is going to be voted on next week.

In the meantime, the "Tri-Committee plan" is summarized, here.

Eliminates cost sharing, creates "accountable care organizations," allows employers to chose between offering coverage and "contributing funds on behalf of their uncovered workers," includes individual mandates (people must have one of the approved plans, except in "hardship"), Expands the National Health Service Corps, Expands Medicaid, and (according to the AMA) will force doctors who take Medicare to participate in the "Public Option."

UNITED STATES CONGRESS

Key Features of the Tri-Committee Health Reform Draft Proposal
in the U.S. House of Representatives
June 9, 2009


President Obama’s Commitment: The Tri-Committee bill fulfills the President’s commitment to health care reform via legislation that:

•
Reduces costs;
•
Protects current coverage and preserves choice of doctors, hospitals and health plans; and
•
Ensures affordable, quality health care for all.
Plan Overview:

•
Maintains the ability for people to keep what they have and minimizes disruption;
•
Invests in health care workforce to improve access to primary care;
•
Invests in prevention and public health programs;
•
Creates a new national health Exchange that permits States the option of developing a State or regional exchange in lieu of the national Exchange;
•
Establishes shared responsibility among individuals, employers, and government;
•
Offers sliding scale credits to ensure affordability for low and middle-income individuals and families;
•
Jump starts health care delivery system reforms to reduce costs, maintain fiscal sustainability, and improve quality; and
•
Expands authority to prevent waste, fraud and abuse.

Workforce Investments:

• Expands the National Health Service Corps;
• Boosts training of primary care doctors and expands pipeline of individuals going into health professions, including primary care, nursing and public health;
• Supports workforce diversity efforts; and
• Expands scholarships and loans for individuals in needed professions and shortage areas.

Prevention and Wellness:

• Expands Community Health Centers;
• Waives cost-sharing for preventive services in benefit packages;
• Creates community-based programs to deliver prevention and wellness services;
• Targets community-based programs and new data collection efforts to better identify and address racial, ethnic and other health disparities; and
• Strengthens state, local, tribal and territorial public health departments and programs.


Insurance Market Reforms:

• Ensures availability of coverage by prohibiting insurers from excluding pre-existing conditions or engaging in other discriminatory practices;
• Prohibits rating based on gender, health status, or occupation and strictly limits premium variation based on age;
• Establishes a new Health Insurance Exchange to create a transparent marketplace for individuals and small employers to comparison shop among private insurers and a new public health insurance option; and
• Introduces administrative simplification and standardization to reduce administrative costs across all plans and providers.
Ensuring Affordability and Access:

• Includes sliding scale affordability credits in the Exchange to support individuals and families with incomes between Medicaid eligibility levels and 400% of the federal poverty level (FPL); (NOTE: The average cost of family coverage today is 14% of a
family’s income at 400% of poverty.)
• Expands Medicaid for the most vulnerable, low-income populations and improves payment rates to enhance access to primary care under Medicaid; and
• Caps total out-of-pocket spending in all new policies to prevent bankruptcies from medical expenses.

Public Health Insurance Option:

• Enhances transparency and accountability by creating a new public health insurance option within the Exchange to offer choice and ensure competition;
• The public health insurance option is self-sustaining and competes on “level field” with private insurers in the Exchange; and
• When individuals “enter” the Exchange, whether on their own or as employees of a business that is purchasing in the Exchange, they are free to choose among available public and private options.
Benefits:

• Independent public/private advisory committee recommends benefit packages based on standards set in statute;
• Guarantees choice and fair, transparent competition by creating various levels of standardized benefits and cost-sharing arrangements, with additional benefits available in higher-cost plans; and
• Phases-in requirements relating to benefit and quality standards for employer plans.

Shared Responsibility:

• Once market reforms and affordability credits are in effect to ensure access and affordability, individuals are responsible for having health insurance with an exception in cases of hardship;
• Employers choose between providing coverage for their workers or contributing funds on behalf of their uncovered workers;
• Government is responsible for ensuring affordability of insurance through new affordability credits, insurance market and delivery system reforms and oversight of insurance companies; and
• Protects small businesses by exempting small low-wage firms and providing a new small business tax credit for firms providing health coverage.


Reforming the Health Care Delivery System and Ensuring Sustainability:

• Uses federal health programs (Medicare, Medicaid and the new public health insurance option) to reward high quality, efficient care, and reduce disparities;
• Adopts innovative payment approaches and promotes better coordinated care in Medicare and the new public option through programs such as accountable care organizations; and
• Attacks the high rate of cost growth to generate savings for reform and fiscal sustainability, including a program in Medicare to reduce preventable hospital readmissions.

Modernizing, Improving and Preserving Medicare:

• Replaces the currently flawed Sustainable Growth Rate (SGR) formula that determines physician pay rates in Medicare;
• Increases reimbursement for primary care providers, improves the Part D program, and implements many other MedPAC recommendations;
•
Extends solvency by eliminating overpayments to Medicare Advantage plans, and refining payment rates for certain services;
•
Creates new consumer protections for Medicare Advantage beneficiaries;
• Improves low-income subsidy programs to ensure Medicare is truly affordable and accessible for those with lower incomes; and
• Eliminates cost-sharing for all preventive services.

Downgrading American Medical Care

That image above is from a report in the American Spectator by Betsy McCaughey (the former Lieutenant Governor of New York State) on the true cost of medical care in the United States. It demonstrates that Americans still pay approximately the same for combined food and medical care expenses. As food costs less of the family budget, more is spent on medical care. The reason is that food is less expensive, not that people don't buy food because they have to pay for medical bills.

She also points out that our US survival rates for cancer are much better than those in countries that have longer waiting periods and that spend less on health care.

Obama to push public health plan, forced physician participation

The New York Times is covering the opposition to a public health plan (government pre-paid health care) by the American Medical Association.

Within that article is the news that the Democrat leadership intends to not only implement a government insurance plan that would compete with private insurance companies, but the legislation would force doctors who already accept Medicare to accept this new plan, also.

America’s Health Insurance Plans, a lobby for insurers, said Tuesday that the government plan proposed by some Senate Democrats could “dismantle employer-based coverage and significantly increase costs for those who remain in private coverage.”

Under a proposal favored by many Democrats, doctors who take Medicare patients would also have to participate in the new public plan. Democrats say that requirement is needed to make sure the public plan can go into business right away with a large network of doctors.

The medical association said it “cannot support any plan design that mandates physician participation.” For one thing, it said, “many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate.”

“In addition,” the A.M.A. said, “federal programs traditionally have never required physician or other provider participation, but rather such participation has been on a voluntary basis.”

Those who had Medicare supplements that paid for their drugs before the Medicare Part D plan was implemented will remember their surprise when they were forced out of their old plan and onto the new one. The big surprise came when they hit the "donut hole," or the level when they had to pay for all of their own prescriptions.

Imagine your boss has the choice between buying insurance, or (as in Massachusetts) paying a fine that is less and allowing you to be absorbed by the government plan.

Now, imagine that you can't find a doctor that is taking new patients. Or a doctor that can see those patients within a reasonable time frame.

Here in Texas, some Medicaid patients are assigned to clinics, not doctors. Their "primary care providers" are not doctors, but groups that hire nurse practitioners to see them, to take call, and to manage their care.

In fact, Rural Health Clinics are required by Federal law to hire Physician Assistants or Nurse Practitioners who *must* do a certain percentage of the visits and patient care - I believe it's 50%. In other words, the government forbids the doctor who owns the clinic from seeing all his own patients and keeping the patient load at a reasonable level. Just another example of unintended consequences of government interference.

Obama/Kennedy Health Care Reform in the works

(This is a cross post from the Comal County GOP blog. I believe the report is relevant to LifeEthics.org.)


(As you read this, remember that this is the same group who gave us No Child Left Behind and "accidentally" released a nearly-300 page report on the "site, location, facility, and activity" of all the civilian nuclear sites that the Obama Administration plans to report to the International oversite agency, with pretty little tables. That's the picture above.

And note that no one seemed to blink an eye at the claim that Germany has had government single payer health insurance "since the '20's. The President toured one of the medical facilities from the 30's just before D-day.)


Today, across the US, the Democratic National Committee sponsored small group meetings on Health Care Reform, called "Organizing for America." See this news report and this one, that shows the Daily Kos group is not happy.

Here in New Braunfels (at the public library, as announced in the News), our host and an "advocate planner" - see this definition here and this usage here - Dona Evans, told us that the purpose of the meeting was to support President Obama's "plan" - she passed out copies of this outline and showed us video from this press conference - or maybe it was the three principles of health care reform.

The meeting was very tightly planned. The paperwork and agenda were available to the hosts before the meeting, on line.

It also appears that our little meeting in New Braunfels, Comal County, Texas was worthy of one man who told us he met with Obama planners on the health care reform last November and December, and another man who said he was trained by Saul Alinski himself in Chicago in the '60's. I believe I identified a core of about 7 people who were DNC/OfA plants and who remained behind for over 30 minutes after the meeting broke up.


BTW, as I said at the beginning of the meeting, I'm not an opponent of "reform." As I said, I believe that every problem we mentioned today is a result of government interference. The President said that we've talked about the problem but haven't had reform for 60 years. I say that we had government interference that increased costs and hurt our chances of meeting the President's goals. Medicare in the 60's, HMO's in the '70's, HIPPA, DRG's, and now, the cover-from-first-penny drug benefit that caused many retirees to lose good private subsidies and leaves them responsible for the whole bill for much of the year.

Although no one at the meeting today seemed aware, Senator Edward Kennedy's staff released a "draft of a draft" of his Bill, a 177 page piece to be called "America Health Choices Act." The pdf is here.


Addendum (June 7, at 1:20 PM) - Actually, our agreement was that we do not believe that this is an emergency, that we do not want Congress to pass any bill before they go home for recess at the end of July, and we do not want to send our Health Care money to Washington or have our Health Care decisions made in Washington, at all. While some mentioned the fear of government (one young man quoted Jefferson), most spoke of experience and the history of Government interference.

Below, find the report that Ms. Evans sent out to all of us who attended the meeting, along with a few more - among them are the names of local docs who I assume is her daughter and son-in-law. (All of our email addresses were visible - I sometimes forget the "blind copy to" function, also, so I won't copy all the email addresses, here.)

26 people at our event plus an unknown number of protestors outside marching with signs.
0# of calls made at your event
3 service projects planned for Saturday, June 27th, again at 2:00 p.m. in the library: individual volunteers, blood drive and food drive

We had excellent support and publicity from the local newspaper.
An account of our event follows:


WOW! Democracy in action!

First let me express my appreciation to everyone who attended the Organizing for America kickoff meeting Saturday, June 6th, at the New Braunfels library. Also, thank you for the lively discussion and sometimes heated debate. We even appreciate those who showed up to march in protest of our meeting – that’s what free speech is all about.

When I volunteered to host the meeting, it is because I support what President Obama is attempting to do for our country, and because of my background and experience, I know firsthand that the current health care system is broken and needs to be fixed. I am not a Republican or a Democrat, I am an American who is a concerned citizen, mother of four, grandmother of two.

When I signed up to host the kickoff to organize support for President Obama’s plan, I naively thought everyone would want to improve the current system. What’s not to like about “improvement”?

Surprise! Surprise! Some folks are downright passionate about not supporting President Obama’s proposed health care reform. It’s a good thing that I truly believe, “The shining spark of truth cometh forth only after the clash of differing opinions.”

It is my job to talk to patients everyday about their medical bills, because I am a medical billing and coding clerk in a busy doctor’s office who services both newborns and seniors, and all those ages in between. And I know, many people who live in the Comal Area cannot afford health care insurance, doctor’s visits, hospital care, and prescription drugs; and those who do have insurance are being impacted by increased premiums, co-pays, coinsurance, and deductibles and reduced coverage and benefits. I know that what President Obama says about the current system is true – it needs to be fixed.

We had twenty-six concerned citizens show up to talk about health care reform at the meeting. I don’t how many protesters were outside the library. But, I am told that as we consulted, they marched carrying signs of protest.

About the only thing everyone at the meeting agreed on is that we – those who were present -- don’t want an inefficient government health care system that lacks prudent oversight and necessary regulations and ends up costing taxpayers more than it should and delivering substandard services. More than once, the TARP bailout and lack of oversight, lax regulations, and abuse were mentioned.

Despite the fact that not everyone agreed on what should be done, or how it should be done, everyone had constructive and thoughtful comments and most shared their story about how the present health care system has impacted their lives.

The big question is how can we structure change around the three basic principles put forth by President Obama and his Vice President Joe Biden: 1) reduce costs, 2) guarantee choice, and 3) make sure quality health care is affordable and available to all Americans.

But how? That is the big question. I am an optimist; I truly believe that there is a solution for every problem. And I firmly believe that the American people, if informed, can make good decisions. I know that when informed passionate Americans unite around a cause they can make miracles happen.

Interestingly, I discovered, that most of the attendees who oppose President’s Obama’s health care proposal, have never read it. Their opposition seems to be based on one of two things: 1) what they heard on talk radio or network tv; and 2) their general fear of a nationalized health system. (Because everyone has heard that Canada’s system doesn’t work right either.)

Most of those who attended and voiced their opposition were unwilling to actually sit through a reading of the proposed plan – which we offered to do. Based on their reactions, I would say, their mind is made up; don’t confuse them with the facts. It was my hope that they would at least listen/read to what the plan actually contains, rather than what a radical radio talk show host claims it contains. I have listened to some of the radio talk shows and realized that they are more motivated by ratings than telling the truth.

What I got from those who were the most negative about health care reform is their fear. Many attendees agreed they fear governmental bureaucracy. Many are afraid that big government programs would waste money on inefficient administration and would end up providing substandard services. One lady said, “I love my country, but I fear my government.” Another man said he feared a dictatorship. Others just expressed concern that centralized services tend to be inefficient and wasteful.

Some attendees expressed fear of electronic medical records, where ones medical history would be accessible over the internet. Everyone agreed, that safeguards should be built into any national EMR system to ensure privacy. Some noted that an efficient, properly operating EMR system could save the government and private companies millions by eliminating the need for duplicate services, such as MRI’s, X-rays, and labs, being performed each time someone moves to a new locality and sees a new doctor or changes doctors.

Many of those who attended praised the U.S. Military health care service. One lady who was born in Germany touted the many benefits of its program (including dental care), which has successfully operated since the 1920’s, and where co-pays were recently raised to $10. I mentioned my own positive experience with the universal health care system operated in Hawaii. There was a consensus that it would be good to look at the countries and states that successfully insure all their residents and use those as an example on which the U.S. could model a new health care system for Americans.

One gentleman, who is a private contractor with a minority-owned company that bids on government contracts, suggested that insurance contracts be awarded to those companies that can provide the best services for the least amount of money on a regional basis – similar to construction contracts.

Several people shared stories of how their lives and the lives of their family had been negatively impacted as the result of a catastrophic illness or major surgery. They came to the meeting to genuinely see how they can support President Obama so that health care wouldn’t bankrupt families and cause them to have to choose between paying exorbitant doctors and hospitals bills or pay for food and rent.

However, most of the attendees had either had good experiences with U. S Medicare or the U.S. Military or reported they had received excellent services from both.

Almost everyone agreed, that instituting a regional system based on contracts, similar to the present contracted administration of Medicare Jurisdiction 4 system by Trailblazer Health, of which Texas is part of along with Oklahoma, Colorado, New Mexico, Arkansas and Indian Health, might be a way to avoid an inefficient centralized system.

Many attendees expressed concern over what the future might hold for their children and grandchildren. From a personal standpoint, I am now concerned because my youngest daughter who is the mother of a five year old is going to enter the military, not only because she loves her country and feels passionately about its defense, but also because she will get health care for her daughter as one of the benefits. Despite working for twenty years, she is unable to afford health care insurance through her employer.

Many attendees advocated a “single payer system”. I have to admit, I didn’t know what a single payer system is, so I looked it up. “Single-payer health care is a term used in the United States to describe the payment of doctors, hospitals, and other health care providers from a single fund. It is often mentioned as one way to deliver universal health care. The administrator of the fund is usually the government, but may be privately subcontracted similar to Medicare, the existing US system that is nearly a single-payer. Australia's Medicare, Canada's Medicare, and healthcare in Taiwan are examples of single-payer universal health care systems.”

Given the overwhelming positive comments about U.S. Medicare and the Military, that might be something to explore further.

One concern that came up more than once was the Medicare donut hole, which I recently experienced first hand. Here’s what Wikipedia says about that subject, The term "donut hole" (or "doughnut hole") refers to a coverage gap within the defined standard benefit under the Medicare Part D prescription drug program. Under the defined standard benefit package, there is a gap in coverage between the initial coverage limit and the catastrophic coverage threshold. Within this gap, the beneficiary pays 100% of the cost of prescription drugs before catastrophic coverage kicks in. The term "coverage gap" is preferred by Centers for Medicare and Medicaid Services (CMS) and prescription drug plans, but "donut hole" has been more widely adopted in the popular media.[citation needed]

On a more personal note, one of medications costs over $500 a month. So, when combined with my other medications, I had reached the coverage gap – the donut hole -- by May of this year. What that means very simply is, that those who are the most needy medically receive the least amount of help with their medicine.

On another topic, volunteerism, it was suggested and agreed that among other things, American volunteers are what make our nation great.

Organizing for America, a project of the Democratic National Committee, urged today’s attenders to return for a National Day of Community Service. Everyone was asked to take part in at least one of the following activities: 1) volunteer at some kind of health-related center, such as a clinic, hospital, or nursing home; 2) organize a blood drive; and/or 3) take part in a food drive, in support of the health care reform initiative.

It was agreed that we will meet again: Saturday, June 27th, at the New Braunfels public library to report in individual acts of volunteering in health-related centers. One opponent of healthcare reform suggested, involvement in Options for Women, the Pregnancy Assistance Center, or participation in the Texas Alliance for Life Walk in Seguin, June 20th.

Organizing for America will hold both a blood drive and food drive to be held at the New Braunfels library on June 27th, the National Day of Community Service, at 2:00 pm. Folks are urged to donate blood at that time, and to bring nutritious foods such as canned fruits and vegetables, juices, rice, beans, powdered milk, baby food, and diapers as a way of showing the group’s interest in and concern for the health of the local community.

During the coming weeks, everyone who supports President Obama’s health care reform plan is urged to share their personal story with their friends, neighbors, and coworkers as a way of increasing awareness and garnering support for change. That is what got President Obama elected, the promise of change. The status quo is not acceptable. The group unanimously recommends careful well thought out

If you haven’t read the plan put forth by President Obama and Vice President Biden, then please go to: http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf download the entire nine page document, read it, and then decide for yourself. What do agree with? What do you disagree with? Would you like to hold an event that is expressly for debating the issues? We have well-informed advocates that are willing to do just that – advocate for President Obama’s proposed plan by going over the plan point by point to see where/if we can come to an agreement.

I have to confess, I am an Advocate Planner. I believe that the clash of differing opinions is not only healthy, it is imperative to generate the spark of truth. If you would like to attend the next meeting, or perhaps meet with members of OFA to discuss the merits of President Obama’s proposed plan for health care reform and support this initiative, please let me know: (email and phone at the link, above. BBN).