Volume 73, no. 8 August 2017
At one point in the Senate debate over ObamaCare, Sen. Ted Cruz (R-Tex.) introduced an amendment that would allow insurers to offer plans that were not compliant with the Affordable Care Act (ACA) so long as they offered at least one plan that was: an opening for a free market in true insurance. Astonishingly, this “freedom option” is controversial and caused “moderates” to threaten to vote against the whole bill.
It would mean insurers could offer “bare bones” policies under which people assume individual responsibility for routine medical costs and rarely make a claim. They might choose to do without some services (less revenue to providers); would pay lower premiums (less revenue and profits to insurers); might opt for less costly, lower quality, or “alternative” care (competition!); and allegedly might be less healthy (doubtful, according to RAND study). The New York Times dubs this “junk insurance.”
But then an updated Senate draft destroyed the Cruz amendment by imposing ACA “single risk pool” price controls, assuring that secure, long-term guaranteed-renewable policies would be taxed to death (http://tinyurl.com/yca6reag).
Note that these price controls also make it impossible to adequately insure the sick (http://tinyurl.com/y8pfqq3o), leading to the “race to the bottom” in coverage for serious illnesses.
If a free market would help most Americans, ACA defenders ask, “What about those who live paycheck to paycheck”? Or those who don’t have a paycheck? More and more Americans are in such situations. Yet we do not ask how they can afford to lose 15% of their earnings to the payroll tax—or any amount to health plan premiums, even if subsidized. These are like taxes, in that they are gone forever and might not provide any usable benefit: they might tout a $5 copay, but first there’s a $6,000 deductible.
Some Senators want to keep ACA’s 3.8% tax on investment income and 0.9% payroll tax on “high earners” as this could go to the “stability fund” to subsidize insurers (never mind the $20 trillion national debt). But there still might not be enough money “to go around” for cancer victims, drug-addiction victims, etc. And money must be found somewhere for things like an Alaska pipeline proposed to buy support from Sen. Lisa Murkowski.
Deal-making by politicians is inevitable when government is allocating other people’s money.
“Most corners of the health-care industry,” including the American Academy of Family Physicians, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association, are trying to get Congress to ditch Republican reforms to ACA (Wash Post 7/13/17). The American Medical Association strongly opposes any proposal that “would cause individuals who are currently covered to become uninsured” (http://tinyurl.com/y7dq5w75)—apparently even by choice. More than 70% of CBO’s “lost coverage” is based on repeal of the individual mandate and the unfounded belief in its magical powers (http://tinyurl.com/y8gmxele). AMA wants to ensure that low/moderate income patients can secure “affordable meaningful coverage”—and assumes that ACA does that.
The ACA Marketplace is anything but free. Cigna CEO David Cordani called it a basket of rules, standards, and approaches. “How that basket gets refreshed, changed or solidified [by central planners] is what’s most important” (Wash Post 7/21/17).
Defanging ObamaCare without Repeal
Daniel Horowitz writes: “When frontal assault fails, the only way forward is a flanking maneuver.” Conservatives should stop trying to save an industry that has a government-guaranteed monopoly and focus on the heart of the problem: the government-distorted price of medical care. Horowitz writes that one simple reform would set off a chain reaction of competition and put patients back in charge. He suggests requiring hospitals, doctors, clinics, labs, pharmacies, etc. to post their prices online and send the bill to the consumer, not the insurance company.
Since we need catastrophic coverage, and insurance companies won’t or can’t provide it, he suggests expanding cost-sharing associations to any group of individuals.
“Insurance is not the solution; it’s the problem. The current system is nothing but a racketeering scam between politicians, lobbyists, insurance companies, and the existing hospital establishment to block competition and protect incumbent politicians and incumbent health providers, all the while fleecing the consumer” (http://tinyurl.com/y96oyuxp).
After the Republican betrayal, the Trump Administration could still do a lot to reduce the damage of ObamaCare. Michael Cannon lists 13 ways (http://tinyurl.com/y8l66bgr). These include ending Congress’s illegal ACA exemption and the illegal cost-sharing subsidies to insurers (18% of the total subsidies to marketplace insurers). He could show Americans how to avoid the penalties; Secretary Tom Price stated in a Tweet that 6.5 million people paid $3 billion in penalties to stay out of ObamaCare.
While ObamaCare purports to help the poor, its basic structure expands and cements in place the cause of our medical financing problems: the third-party prepayment scheme—de facto socialism—that has developed in the U.S. over the past 70 years.
Props to the insurance-centric system date back to the 1930s, and now escape notice (http://tinyurl.com/ycelqr2p). Cash and membership-based services must be allowed to compete!
Some Little-Known Facts about 1984
During World War II, George Orwell worked for the British government as a propagandist at the BBC, where there was a conference room numbered 101. While writing the novel, he was himself under government surveillance. He borrowed the slogan “2 + 2 = 5” from Russia, and the Thought Police from the Japanese wartime police who literally arrested citizens for having “unpatriotic thoughts.” They officially named this pursuit the “Thought War.” Orwell’s novel, which is recently reappearing on best-seller lists, has also made the list of the world’s most frequently banned books (http://tinyurl.com/yab5yujj).
Why Do Elites Want You to Lie?
The purpose of torturing Winston in 1984 to make him say that “2 + 2 = 5” was not that the Party elites believed the mathematical fiction, writes William Briggs. “It was to subjugate and for no other reason.” What happens when the mighty and well-armed government demands that you lie? Most will.
“The majority now buys the lie that two men may marry each other. And we have already seen the rabble chase after the truth-tellers on this subject.” How many will lie to save themselves grief? Probably a lot. “So what?” ask the utilitarians.
Now the elites are pushing onto new territory, as with men pretending to be women. Why pick this, instead of making us swear, for example, that Bigfoot is real? That would be a trivial affront to reality, and nobody would care if it were true. But officially stating that a man is a woman is so far removed from reality that none can accept it unless they have lost their bearings or are suitably threatened. Any combination spells cultural suicide (http://wmbriggs.com/post/21802/).
Canada Launches “Carrot Rewards” App
Canada invested $5 million in a new social engineering project combining game design with behavioral science insights into how to manipulate people to behave in ways to produce government’s desired outcomes. Canadians can earn reward points to buy popular goods by responding to prompts such as to take the quiz about flu shots (http://tinyurl.com/y93eapu4).
Ralph Oscar Butz, Jr., M.D.: R.I.P.
Dr. Ralph Butz, a surgeon, was active in AAPS since the 1960s, then serving as chairman of our Muncie, Ind., chapter. Though wheelchair-bound for years because of amyotrophic lateral sclerosis, he continued to spread the message of freedom. He distributed hundreds of copies of our 1995 pamphlet “Repeal, Repeal, Repeal” by Hans Sennholz, and authored “Healthcare Is Not an Insurable Risk” in the winter 2013 issue of our Journal. His wife Joanne wants his friends to know that he went to be with his Heavenly Father in March 2017.
“The harsh fact of the matter is when you’re going to pass legislation that will cover 300 [million] American people in different ways it takes a long time to do the necessary administrative steps that have to be taken to put the legislation together to control the people.”
John Dingell (D-MI), on passage of ACA
The Medicaid Deniers
For years, studies have shown that patients on Medicaid do no better, and sometimes do worse, than the uninsured. But those citing such studies are accused of launching a “conservative assault on Medicaid.” Progressives need for us to believe that Medicaid makes people healthier, since half of ACA’s government-subsidized coverage is routed through Medicaid, writes Avik Roy.
The study of the Oregon Medicaid lottery (AAPS News, June 2013) was hailed as the “gold standard for health-policy research” by Austin Frakt of Boston University. “That insurance . . . improves health and reduces mortality risk is as close to an incontrovertible truth as one can find in social science,” Frakt had averred in 2010. When the mostly negative results were published in May 2013—after the election—Frakt insisted the study was “far too small.” Economist Paul Krugman—the “Medicaid denier-in-chief” wrote: “If health insurance is a good idea—and you are nuts if you let this study persuade you otherwise—Medicaid is cheaper than private insurance. So where is the downside?” Perhaps the expenditure of $7.4 trillion over the next 10 years?
Roy notes that only 60% of the 35,169 “winners” of the Oregon Medicaid lottery bothered to fill out the application, and only half of those actually enrolled (http://tinyurl.com/yanx3k9u).
Unlike in 1984, America has no paid Thought Police. No brown-shirted Nazi will knock on your door. Yet on college campuses, in media and entertainment synods, and in corporate offices, failure to adhere to a certain orthodoxy means loss of income, status, business, and career. Failure to accept an interpretation of the scientific data in line with the prescribed climate-change hysteria gets you labeled a “denier” and an enemy of the Environment. Passage of public-safety laws regarding restroom access got Indiana and North Carolina dubbed “states of hate” and unleashed economic and social forces that imposed the will of aggrieved LGTBQ activists on citizens and their elected representatives. “What we are witnessing is not state dictatorship but a new phenomenon—the rise of a totalitarian culture which seeks to control everything and everybody.” And judges and bureaucrats are cooperating in the destruction of freedom of speech (http://tinyurl.com/y98ojfkx).
If there is any doubt about the culture war, in which the Left is intent on destroying Western civilization, read two articles published in The Atlantic in July concerning President Trump’s speech in Warsaw, Poland, writes Dennis Prager (http://tinyurl.com/ya3lbtf6). To Peter Beinart and James Fallows, Trump’s ringing defense of Western civilization boils down to white racism.
Oct 5-7. 74th annual meeting, Tucson, AZ.
Oct. 3-6, 2018. 75th annual meeting, Indianapolis, IN.
Osteopaths Defeat Effort to Change Oath
The America Osteopathic Association’s Task Force on the Osteopathic Oath submitted a resolution for the 2017 House of Delegates meeting to change one critical word in the Oath:
I will be ever vigilant in aiding in the general welfare of the community, sustaining its laws and institutions, not engaging in those practices which will in any way bring shame or discredit upon myself or my profession. I will give no drugs for [deadly—substitute ILLEGAL] purposes to any person, though it be asked of me.
Advocates for the change said it “allows for the difficult balancing between life and suffering and draws a clear boundary between what is wrong, the provision of illegal drugs, and the practice by some colleagues in the difficult provision of end-of-life care.” It “provides the flexibility needed in modern medicine.” Several states now allow physician-assisted suicide, and nine osteopathic colleges already use a modified oath.
John M. Kauffman, Jr., D.O., and Anita Showalter, D.O., filed a minority report. They warned of the danger of assuming that everything that is legal must be OK. “Everything physicians participated in during the Nazi regime was legal. Many individuals who suffered and died during World War II would have survived if physicians had followed the Hippocratic Oath.” Contemporary examples, as in the Netherlands, show that “the slippery slope is real” (http://tinyurl.com/ya7r4kk7).
The House soundly defeated the proposed change.
AOA Delegates Stand against MOC
Craig Wax, D.O., reports that the AOA House of Delegates affirmed member opposition to use of Osteopathic Continuous Certification (OCC) Maintenance of Certification (MOC) as a condition of licensure, hospital privileges, employment, or insurance reimbursement. Delegates standing together to achieve this include: Leroy Young, D.O.; Mike Ritze, D.O.; Jeff Davis, D.O.; Sheila Page, D.O.; Kelli Ward, D.O.; and Sam Urick, D.O.
Who Rules over Children?
In a new attack on parental rights, at least five school boards in Ontario, Canada, direct schools not to tell parents when a child “transitions” to another gender at school, without the child’s permission. The policy applies from kindergarten to grade 12. The underlying motive for excluding parents, according to Jack Fonseca of Campaign for Life, is to “indoctrinate children with state ideology.” This includes inculcating gender ideology as fact. The Liberal sex education curriculum, rolled out in 2015, teaches children by grade 8 that there are six genders rather than two sexes (http://tinyurl.com/y8jkpc74).
Return Overpayments for Veterans
More than 7 million appointments have been made with private providers for veterans. Payment is at Medicare rates, and overpayments must be refunded, even if the VA made the mistake. In Florida, the VA found $17 million in overpayments for physician-administered drugs (median overpayment, $37.28, but one physician received $6.9 million) (MPCA, July 2017).
!Tip of the Month: Ban maintenance of certification (MOC) in your state! Texas banned MOC mandates from the fast-growing, second largest state in our country by generally prohibiting hospitals and health plans from requiring it. AAPS-supported Texas SB 1148 was signed into law by its governor on June 15, 2017, and is effective starting January 1, 2018. Now is the time to plan on getting this good law passed in every other state. Already several states prohibit the medical board from requiring MOC, but the real problem has been hospitals and insurance companies unjustifiably mandating it. A simple state law can stop them from imposing this ridiculous requirement, which is not correlated to the quality of care in any way. Contact your state legislator now! Read the Texas law and see whether legislation is already pending in your state at: https://goo.gl/fnS22T.
Upcoding Enforcement Alerts
Doctors who are still accepting money from Medicare should note that two medical centers in Massachusetts will pay $700,000 to settle claims of upcoding by calling established patients “new.” A patient who has seen any “provider” in the same specialty in the practice, even in another setting such as the ER, is “established.”
Also note that initial hospital visits will not survive prepayment review if the initial history is insufficient, or if it is more comprehensive than is supported by the complexity of the presenting problem (Medical Practice Compliance Alert, July 2017).
“When you see the fork in the road, take it,” said Dr. Lawrence Huntoon, quoting Yogi Berra, in his 2017 update on opting out of Medicare (http://tinyurl.com/ycb9kgah).
Flashback: What about the Poor?
James Madison, known as the “father of the Constitution,” opposed a 1792 bill that would have appropriated $15,000 for French refugees. Madison said, “I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence, the money of their constituents.” Some argued that the Constitution allows for benevolent spending under the general-welfare clause. Not so, said Madison: “With respect to the words ‘general welfare,’ I have always regarded them as qualified by the detail of powers (enumerated in the Constitution) connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators.”
President Franklin Pierce, in 1854, vetoed a bill meant to help the mentally ill, saying, “I cannot find any authority in the Constitution for public charity.” To approve such spending, he said, “would be contrary to the letter and the spirit of the Constitution and subversive to the whole theory upon which the Union of these States is founded.”
In 1887, President Grover Cleveland vetoed a bill to send money to drought-stricken counties, saying: “I feel obliged to withhold my approval of the plan to indulge in benevolent and charitable sentiment through the appropriation of public funds…. I find no warrant for such an appropriation in the Constitution.”
Before ObamaCare, 35 states had “high-risk pools” so that their residents with pre-existing illnesses could get non-group health insurance (http://tinyurl.com/y7zfjfz3).
Data for Sale. Liberals claim it is beneficial to have your personal data in an electronic health record (EHR) in case you forget to take your list of medications with you to the ER. But, like Kim Kardashian, who flaunted her expensive jewelry on the internet and had it stolen, large personal health information databases present an enticing wealth of information for identity thieves. In China, for about $100 anyone can obtain a list of hotel rooms a person has stayed in (and with whom), a complete list of airline flights taken and internet cafes visited, detailed bank transactions, an exact real-time location, and more (Wash Post 1/4/17). In New York, the Dept. of Motor Vehicles makes about $60 million per year selling personal data of driver’s license holders, and other state DMVs are doing the same thing.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
Are Your Medical Records Being Sent to the Government? A couple of years ago, North Carolina Republicans in the General Assembly established the N.C. Health Information Exchange Authority, a state government authority set up to receive the EHRs of N.C. citizens. Participation is mandatory for entities that see patients under Medicaid and the State Employees Health Plan. Facilities that are already connected are listed at http://tinyurl.com/ybambl4g. My advice to N.C. citizens is to ask, every single time they present to a medical facility for evaluation and treatment, whether it is connected to the state information exchange and whether their records are routinely turned over to this exchange. They should instruct the staff that their records must not, under any circumstances, be sent in to the state, and request to sign a form stating that they “opt out” of having their records turned over electronically.
Joseph Guarino, M.D., Reidsville, NC
Opt-out Needed for ObamaCare. The 6 million Americans who paid an ObamaCare penalty and the 20 million who were able to get a hardship exemption—and anyone else who wants out—should be able to get out of ObamaCare-priced premiums. We also need a repeal of the prohibition on catastrophic coverage [§1302(e)] if Congress does nothing else.
Republicans should hold a vote on full repeal, the one thing they committed to do. If the vote failed, it would provide political cover for later actions. If they never try, they cannot claim that repeal was impossible. They should ignore the “whip count.” Some member may say they’ll vote “no,” but anything’s possible when the time comes to push the button and be on the record.
Twila Brase, R.N., Citizens’ Council for Health Freedom
A New Financing Mechanism. The credit and bond industry should be encouraged to compete with traditional insurance to offer individualized catastrophic stop-gap insurance schemes combined with appropriate health cost credit. Using Health Savings Account strategies in combination with out-of-pocket credit customized to various levels of risk or costs would revolutionize the system. (http://tinyurl.com/y7uj3mnn ).
Raymond Kordonowy, M.D., Fort Myers, FL
Disruptive Government. At Cookeville Regional Medical Center, our payer mix is 1% ObamaCare policies and 5% uninsured. ACA helped only 1 in 6 uninsured individuals, and disrupted the care of the other 94% of our patients. To comply with MACRA, our 11-man group will spend $170,000 on an information technology upgrade. This is a government-mandated transfer of wealth from the medical profession to the technology sector. There will be ongoing costs for maintenance. We have shortages of normal saline intravenous solutions and now sodium bicarbonate as a result of mergers in the pharmaceutical industry and FDA closures of production facilities.
Thomas Little, M.D., Cookeville, TN
Capitalism Today. Karl Marx said that a capitalist is someone who will sell you the rope to hang him. Today, a capitalist will sell you the government party line instead of rope or any other product. Business has joined the propaganda ministry. Much of what the tech industry does is appallingly dishonest. For example, the services that Google and Facebook purport to offer are not their real business—which is selling advertising. That depends on going through customers’ digital effluent to determine their spending habits. Unlike the old Robber Barons, who stuck to decreasing the cost and increasing the availability of useful things like steel and oil, Silicon Valley billionaires have ventured into news and entertainment media, where they increasingly control what people read and watch. They should be called the Rubbish Barons, not only because they pick through our trash but because of the leftist rubbish they propagate (http://tinyurl.com/y7y8ncft).
Craig Cantoni, Tucson, AZ
Venezuillinois Bankruptcy. Illinois is on the verge of filing for Chapter 9 bankruptcy, which could shut down the whole state. It also has to take into account $130 billion in unfunded pension obligations. According to Illinois Policy, drivers for the pension crisis include the fact that the average career pensioner will get back his entire contribution within 2 years of retirement (http://tinyurl.com/y72w64dv).
Jim Vanne, Aurora, IL