Volume 70, no. 1
PolitiFact called the promise that “if you like your health plan, you can keep your health plan” the Lie of the Year. Is the Chief Executive the Liar in Chief—or should we consider other worthy candidates for a Time “Man of the Year” type award?
Not accepting the “Obama fooled us” message, Paul Gottfried writes that Obama never pandered to or betrayed his base, or lied when it came to showing his ideology. His Leftist ideas have been an open book.
“No one…voted for Obama who wasn’t a true believer or who wasn’t at least hoping to have the government provide him… with social programs at someone else’s expense,” he states.
In contrast, “I’ve no idea what wannabe centrists like Karl Rove and Chris Christie stand for, beyond looking moderate by identifying themselves with some floating or invented center.”
Collateral Lies
Somebody Else’s Fault: “The scope and intensity of state resistance to Obamacare is extraordinary,” write Jonathan Oberlander, Ph.D. and Krista Perreira, Ph.D. (NEJM 12/11/13). “Reformers must figure out how to make the ACA work in states [such as N. Carolina] whose governments are rooting for and working to ensure its failure.”
“ObamaCare’s Secret Success.” NY Times Columnist Paul Krugman credits the Affordable Care Act (ACA) with a reduction in the growth rate of real healthcare spending. In fact, the growth rate in 2010, 2011, and 2012 (3.9%) was exactly the same as in 2009 before ACA was passed, and the decline started in 2002.
The Website Can Be/Has Been Fixed. The site is written in 10-year-old code, ASP.net 2.0, a.k.a. the “Leak-o-Matic.” The code cannot be tweaked; it must be replaced, writes Stanley Feld, M.D.
On Dec 11, HHS Secretary Sebelius told the House Energy & Commerce Committee Health Subcommittee that “we believe…[the] system…now works smoothly for the vast majority of Americans seeking quality, affordable healthcare coverage.”
Signing Up = Coverage. “About half a million people [vs. tens of millions of previously and newly uninsured] are poised to gain health care coverage,” boasted Obama at a White House press event (Townhall.com 12/3/13)—without a way to pay the insurer. In “one of the most lawless acts yet committed by this administration…, [it] is retroactively attempting to force insurers to hand out free health care…to those whom the White House rendered uninsured,” writes Avik Roy. Is this the “government takeover” that PolitiFact called the “lie of the year” in 2010? (Forbes 12/14/13).
There Will Be No Doctor Shortage. Just look at Massachusetts, write Scott Gottlieb and Ezekiel Emanuel (NY Times 12/4/12). We just need sensors for remote monitoring of disease, and policy changes to enable more “team care.” We need more efficiency and more productivity, not more doctors. These authors “wildly mischaracterize” research in Massachusetts, writes Greg Scandlen.
“Stronger” Medicare. Repeal and replacement of the Sustainable Growth Rate (SGR) formula would “consolidate and restructure existing quality improvement programs.” AMA President Ardis Dee Hoven, M.D., writes: “Our shared commitment to work together toward reform has generated significant progress for a pathway to a more stable, higher performing Medicare program” (AMA Wire 12/11/13).
Proposed “doc-fix” legislation would give HHS broad discretion to establish an “appropriate use” program for Part B services—part of a broader shift toward increasing federal control of medicine, writes Scott Gottlieb (WSJ 12/11/13).
The Value-Based Performance (VBP) program is “sophistry to hide the miniscule bribe promised clinicians for rationing care,” writes Robert Geist, M.D. “The SGR reform is a move from price fixing to price fixing and bribes.”
There Are No Death Panels. This is actually a half truth; the truth is worse. As former Vermont governor Howard Dean pointed out, ACA’s Independent Payment Advisory Board (IPAB) is a rationing board. Unlike the appeals committees (“death panels”) in the British National Health Service (NHS) that review individual funding requests, IPAB will make decisions on whole categories of treatments. It could issue a “quality measure,” binding on all “healthcare providers,” that does not authorize the use of this treatment. From this, there is no appeal. The result, according to Carol Tobias of National Right to Life, would be that patients could not even spend their own money to buy treatments ruled to be “ineffective.”
“It’s a Good Deal.” Instead of calling the Ryan-Murray budget deal a politically expedient compromise, Speaker Boehner is pretending it is a matter of deficit-cutting principle and calling opponents “ridiculous.”
Leftism: “Instinctive, Practiced, Indispensable Dishonesty”
Radicals of the Sixties blurted out that they wanted revolution, states David Horowitz—and they didn’t get far. They learned to lie, to camouflage their agenda, as under the official, Stalin-inspired slogan of the Communist Party: “Peace, Jobs, and Democracy.” ObamaCare is the instrument chosen to begin the transformation.
Progressivism vs. the Past
In The Great Divorce, C.S. Lewis recounted a science fiction story in which a man was able to return to the past. He finds that even the blades of grass are stiff and unbending. The message is that “the past is so real that it cannot be changed,” writes Christopher Manion. “Perhaps that’s why the Left hates the past. Leftists hate reality.”
Progressives promise that the future will be better, “if we but do what they tell us.” But the ball bouncing progressively toward a better life is a wrecking ball. For the Phoenix to rise from the ashes, “the first order of business is to produce the ashes.”
“The hidden heart of the socialist believer beats with the pulse of Marx’s candid assurance that the current historical transition to Truly Socialist Man would be more violent than any prior stage of the class struggle” (http://tinyurl.com/pgagm4n).
“As the shards of Obamacare’s collapse continue to inflict their death of a thousand cuts far and wide,… any rational inquiry would indicate that the entire enterprise is a disaster.”
How do the progressives keep the masses on their side? The answer, Manion states, is in Obama’s campaign slogan: “Hope.”
Three Battles in Texas: a Simplified History
When Antonio López de Santa Anna, 11 times president of Mexico in the 19th century, overturned the Mexican constitution and established a dictatorial government, Texans rebelled. According to the history taught c. 1950 in Texas schools, Santa Anna had four armies to subdue Texas. One was engaged at the Alamo, where William Travis may have drawn the legendary line in the sand. All 200 defenders died fighting, but devastated one army, killing some 600 of 2,000 Mexicans. Then at Coleto, Gen. James Fannin negotiated an honorable surrender, but the Mexicans reneged on the agreement and killed them all in the Goliad Massacre. That left Sam Houston at San Jacinto, who attacked over-confident Mexicans at siesta time from the west, when the sun was in their eyes. Victorious Texans slaughtered about half and captured the others—including Santa Anna, who tried to flee in the guise of a common soldier. Other prisoners recognized him and shouted “El Presidente!” Mexico paid possibly the highest ransom in history: Texas for the life of Santa Anna. Sam Houston blacked the word “compromise” out of his dictionary.
“Secret” ObamaCare Handbook Online
A 217-page training manual for Navigators, which threatens prosecution for disclosure, is available online. “It reads like a primer for Amway or novice car salesmen, offering sales advice on how to disarm potential customers.” Officials took no immediate action when a concerned citizen called the website to their attention. The most ironic section heading appears to be: “Build Trust: Be True to Your Word” (Watchdog.org 12/13/13).
♦ ♦ ♦
“And that after this is accomplished and the brave new world begins,
When all men are paid for existing and no man must pay for his sins,
As surely as Water will wet us, as surely as Fire will burn,
The Gods of the Copybook Headings with terror and slaughter return!”
Rudyard Kipling, 1919
Health Sharing Groups Grow
One of nine exemptions from the ObamaCare mandate, health sharing ministries report record growth. In 2011, 8 of 10 Christians were unaware of them. In addition to the three open only to practicing Christians, there is a fourth, Liberty HealthShare, which is open to anyone who agrees with its shared beliefs. Sean Parnell provides information on these groups and other ideas for opting out of ObamaCare while responsibly providing for medical needs. Not all health sharing groups require you to enroll in Medicare Part B if eligible.
Few Enroll in ObamaCare
According to last month’s survey, only 22 of the 98 who tried were able to sign up for an ObamaCare compliant plan as of the Dec 23 deadline. Nine say the insurer has been paid, and five have received a welcome packet. Only two said coverage was better than before, and three said it cost less. Only 9% of more than 1,000 respondents had tried to enroll, although 16% had had their existing plan cancelled and another 9% were uninsured. Many more expect to lose their plan in 2014. One person spent 6 hours online, and received a 12-page document to determine eligibility that was covered with question marks. Constantly updated tallies are at http://tinyurl.com/kww7t6m, and general comments are at http://tinyurl.com/k9dqw79.
MMS Opposes Meaningful Use Requirement
Thomas La Cava, M.D., reports that not all physicians in Massachusetts believe the federal government is on the right track. On Dec 7, the Massachusetts Medical Society adopted a resolution calling for a statute that eliminates any ties between Stage II Meaningful Use of electronic health records and licensure.
70% of California Doctors Boycott Exchange
Independent insurance agents estimate that 70% of California’s doctors will not be participating in the ObamaCare exchange. One reason is that payment is pegged to Medi-Cal rates: a return office visit is $24 (cf. $76 for Medicare), a tonsillectomy, $160.
Covered California lists many doctors as participating when they have not agreed to do so; it has been called a “shell game.” Theodore Mazer, M.D., a past president of the San Diego County Medical Society, says that many physicians are thinking of early retirement (Washington Examiner 12/6/13).
AAPS Calendar
Jan 31-Feb 1, 2014 Workshop, board meeting, Louisville
May 9-10, 2014 Workshop, board meeting, Minneapolis/St. Paul.
Sept. 2-6, 2014 71st annual meeting, Charleston, SC.
ACTION OF THE MONTH
Are you willing to see patients outside an “insurance” plan?
If so, please be sure your practice is listed on our website.
Sign up at http://www.aapsonline.org/cashlist.
Cover Up
In a Dec 11 letter, Chairman of the House Oversight Committee Darrell Issa (R-CA) reminded HHS Secretary Sebelius that obstructing a congressional investigation is a crime. The Committee has not received documents pertaining to companies hired to implement Healthcare.gov. HHS instructed companies not to comply with requests, relying on contractual language that forbids sharing data with third parties. Apparently, HHS is using the threat of litigation to prevent companies from cooperating with Congress, the letter said (Townhall.com 12/12/13).
HHS told Issa it would not turn over documents related to security, even for inspection in camera, because it did not trust him to “keep secret information that could give hackers a roadmap to wreak havoc on the system.” HHS insists that the website is secure (Townhall.com 12/13/13).
Internet security pioneer John McAfee, however, told Fox News that security was nonexistent, and hackers could empty enrollees’ bank accounts (IJ Review 10/11/13).
Tip of the Month Draft conscience clause provision for possible insertion in any physician employment contract:
“Notwithstanding any other provision in this Agreement, Physician shall not be under any obligation or expectation to perform, assist, provide information about, supervise, authorize, approve, recommend, refer to, or participate in any act or service in connection with any drug, device, or treatment, including any contraceptive or abortifacient, which is contrary to the Physician’s conscience, ethical principles, or religious beliefs, as determined by Physician in his sole discretion. Under no circumstances may Employer disparage or terminate Physician for cause or take any other action that is adverse to him, disciplinary or otherwise, based on his exercise of his rights under this provision, regardless of whether the drug, device or treatment may be considered helpful to prevent the spread of disease or otherwise be recommended by any guideline, medical society, or regulatory body.”
Defunding ObamaCare
Congressional Republicans failed to support Sen. Ted Cruz (R-TX) and others who tried to pass a Continuing Resolution to fund the government, minus funding to implement ObamaCare, ostensibly out of fear of public backlash from the Democrat-imposed “government shutdown” [paid furlough to certain publicly visible federal employees]. Some analysts say that it is not possible to defund ACA because funding is cleverly assured through various means not dependent on new appropriations. [If this is so, why the concern over the Republicans’ effort?]
Other strategies to defund ACA are, however, underway, writes Michael Cannon of Cato:
Stop Medicaid Expansion: The Medicaid expansion accounts for about half of ACA’s $2 trillion of new entitlement spending over the first 10 years. Almost a quarter of the new spending is being denied by the 25 states that refuse to expand Medicaid. Some Republicans are trying to overcome this effort: Gov. John Kasich of Ohio is seeking to implement the expansion over the opposition of the legislature. Gov. Jan Brewer of Arizona rammed the expansion through the legislature, but is facing a court challenge in Biggs v. Brewer from legislators and citizens, who argue that the bill violated the constitutional requirement for a two-thirds majority to raise taxes. Brewer argues that the provider tax in the bill is not a tax.
Challenge Federal Exchange Subsidies: The 34 states that refused to set up an exchange would defund one-third of the $2 trillion—save for the IRS regulation that allows subsidies to flow through federal Exchanges in explicit violation of ACA. Those subsidies trigger penalties under both the employer and individual mandates. Cannon writes: “The IRS is literally trying to tax, borrow, and spend more than $700 billion without congressional authorization.” Four lawsuits have been filed to challenge these taxes, and a federal judge has rejected the Obama Administration’s attempt to dismiss the case filed by Oklahoma attorney general Scott Pruitt (WSJ 12/1/13).
Block Illegal Taxes: The states that have not set up Exchanges could suspend the licenses of insurers who accept subsidies. Legislators in Ohio and Missouri have introduced bills.
Subpoena Materials Related to IRS Illegal Taxes: The Treasury Department is refusing to supply documents requested by the House Oversight Committee related to its regulations.
AAPS Sues over Separation of Powers
Although the U.S. Constitution prohibits the executive branch from rewriting laws passed by Congress, the Obama Administration has done this repeatedly in implementing ACA. In a lawsuit filed in federal court in Wisconsin (AAPS v. Werfel), AAPS asks the Court to enjoin the Obama Administration from imposing its individual mandate while delaying the employer mandate.
The delay in the employer mandate means that many Americans who might have had employer-purchased insurance will either have to purchase costly individual insurance for themselves, or else pay a tax. This unlawful change will force many Americans, more than Congress intended, to purchase expensive, unwanted health insurance. They will then have less income to use for things they do want, such as medical services purchased directly from private physicians without bureaucratic interference.
AAPS Brief Supports Dr. Bhanusali
In an amicus brief filed together with the American Association of Physicians of Indian Origin (AAPI), AAPS argues that orthopedic surgeon Govindlal Bhanusali, M.D., has the right to obtain routine discovery to prove claims of antitrust violations and discrimination by a powerful hospital acting in concert with a wealthy medical group.
When Dr. Bhanusali, an independent surgeon, lost his privileges at Orange Regional Medical Center (ORMC) as a result of sham peer review, his orthopedic clinic, a direct competitor of defendants in the case, was forced to close permanently.
The accumulation of trivial complaints, such as a broken drill bit over which the surgeon had no control, constituted pretextual rather than legitimate concerns, AAPS states. Dr. Bhanusali had no opportunity to prove his allegations.
“The effect of the lower court ruling is to give a blank check to self-enrichment by a few executives, to the detriment of the public. No meaningful accountability, other than judicial review, exists to restrain [the alleged] wrongdoing.”
Correspondence
No, You Can’t Keep Your Insurance. It looks as though we are one of the millions of victims of ObamaCare. We will be losing our current high-deductible health plan associated with our health savings account. I feared this might be the case, so I wrote to my insurer. The insurer was not going to tell me until 90 days prior to the expiration of our contract next July. Thus, those who have not yet received letters notifying them of termination of their plan may still receive one during the coming year. The millions who will lose coverage due to ObamaCare will continue to accrue.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
Bookkeeping. Hospitals keep at least two sets of books: one set for the government to show how much the hospital is losing, and one to show the trustees how much the hospital is making.
Hospitals make more for out-patient services because they bill Part B separately for every procedure, visit, and drug. If a patient stays only two midnights, he is an out-patient. Hospitals admit the patient at one minute past midnight to stretch the out-patient stay to 3 days. Patients may discover that they are responsible for hundreds of thousands of dollars in co-pays only when they receive a bill. In addition, Medicare pays for skilled nursing and rehabilitation only if the patient is in-house more than 3 days.
Medicare may claim that its administrative costs are only 3%, but insurers skim at least 40% off the top of both private and public plans. ObamaCare has done nothing about this. It is totally dependent on the industry for administrative services.
Stanley Feld, M.D., Dallas, TX
Information Control. By mid-November, the Colorado exchange had barely signed up enough people to replace those who were losing their policies in the high risk pool and the federal uninsurable program (http://tinyurl.com/luqhf6y).
This is standard Soviet crowd management. As long as people believe that things are getting better and have no idea how much better off they could be, they tend to go along with the authorities. I expect to see lots of stories on how ObamaCare helps people. And huge efforts will be made to erase the fact that people were better off in the past with respect to the cost of medical care, access to medical care, and the quality of medical care.
Linda Gorman, Ph.D., Independence Institute, Golden, CO http://i2i.org
Success? At one point, Washington State was bragging that it had more signups than the rest of the country put together. About 90% were Medicaid. Then lots of non-Medicaid enrollees, thrilled to have such cheap private insurance with heavy subsidies, found out that the State entered monthly income when the federal government wanted annual income. Thus, people with an annual income of $120,000 ($10,000/mon) were considered impoverished. They are now facing a reality check. What they are calling a “success” apparently means the system will collapse faster.
Russell Faria, D.O., Auburn, WA
Third-World Healthcare. Visiting the U.S. Capitol today is a humiliating experience. First, to be allowed in you must be escorted by a congressional staff member. But the real degradation was to be there with a group of physicians pleading to be allowed to do their job. They were like paupers begging for scraps of food, not unlike Oliver Twist: “Please, sir, can I have some more?”
Physicians fear that patients will die because hospitalization and diagnostic testing will be denied. This is not hyperbole. State high-risk pools will be shut down Jan 1. Hundreds of thousands of people in the middle of treatment could be suddenly uninsured.
Henry Chou famously said he hoped the website would not be a “third-world experience.” What about the whole system?
Greg Scandlen, Consumers for Health Care Choices
A Market Approach. Many businesses are contracting with practices like ours and paying directly for elective procedures. This saves money by lowering the cost of [catastrophic-only] employee insurance coverage. They pay only when procedures are needed as opposed for paying for care that is never used.
Daniel Goldberg, http://RegencyHealthNYC.com
ICD-10 Disaster. I attended a CME class on coding and billing. Advice from some at CMS is to stash up to 6 months of practice revenue in anticipation of payment delays. It is thought that the AMA is pushing the ICD-10 initiative onto a fictitious software system that likely does not exist to handle the transition.
Michael Riesberg, M.D., Pensacola, FL
ObamaCare Simplified. This description, circulating on the internet, pretty much sums it up: To insure that the uninsured are insured, we must first make the insured uninsured, and then make them pay more to be insured again so that the original uninsured can be insured for free.
Brent Rooney, Vancouver, British Columbia
You May Not Be Able to Keep Your Drugs Either. Health plans are cheapening their formularies, just like they cheapened their physician networks, to pay for expensive mandates. Out-of-pocket caps on spending may apply only to formulary drugs.
Joseph Scherzer, M.D., Scottsdale, AZ
