Volume 65, No. 10 October 2009
PHYSICIANS STAND TOGETHER
On Sep 10, 2009, "Dr. Smith" went to Washington.
Nearly 1,000 physicians left their practices to travel, at
their own expense, to the Capitol. After meeting with their
congressmen, they came to a rally in the Upper Senate Park,
organized by AAPS and Tea Party Patriots, to tell Congress to
"stop meddling in medicine."
Speakers included physician/congressmen Phil Gingrey (R-GA),
Tom Price (R-GA), and Paul Broun (R-GA), and practicing
physicians representing AAPS, Docs4Patient Care, Physicians for
Reform, and the D.C. Medical Society.
The event was prompted by the AMA's support of bills that
would turn more control over to government.
"The AMA's endorsement of H.R. 3200 was bought and sold, at
the expense of patients," said Seattle neurosurgeon Michael
Schlitt, M.D., who spoke at the rally. "I couldn't stand by
without telling Congress and the public that the AMA doesn't
represent me, or most of the doctors I know. And it's time
Congress listens to real doctors from the frontlines."
Before the rally, two shifts of six physicians held signs in
front of the AMA's D.C. headquarters: "Honk if you support your
doctor," or "the AMA has sold out patients and physicians."
Numerous people stopped to talk, reports AAPS President Mark
Kellen, M.D. "They were genuinely interested in our point of
view, and 9 out of 10 agreed with us that socialism is bad for
America," he said.
It's Not Just the Diabolical Details
When the Pima County (AZ) Medical Society board of directors
was considering letters written by other societies objecting to
the AMA's position, AMA delegate and Noridian medical director
William Mangold, M.D., said that the endorsement was the price of
a seat at the table without which the AMA would have no say about
What details can matter if the key part of the bill com-
pulsory insurance spells the death of American medicine? Dr. Tom
Price urged an unequivocal "No."
"Getting people to quibble over the details instead of
rejecting the whole thing is an old communist ploy," warns AAPS
director Curtis Caine, M.D. Passage of any government
medical bill establishes that government interference in medicine
is acceptable, when it is in fact unconstitutional. Any
objectionable details removed now can be added back later.
The U.S. Constitution limits government involvement in
people's lives. Nothing in the Constitution empowers government
to make deals with some private citizens at the expense of
others. By contrast, under the method now being solidified by
Obama, decisions are made by "stakeholders" around the table
under the guidance of their czars with no limits on what they may
impose on their fellow citizens. Stakeholders, in effect, are the
only citizens. And they are not equal individuals, but rather
unequal collective entities, writes Angelo Codevilla
(American Spectator, September 2009).
By definition, non-stakeholders have no stake. And what is
at stake for the AMA? According to its 2007 form 990, membership
dues constitute only $45 million (17%) of its $266 million
revenue. Royalties brought in $54 million, and sales from
inventory, $40 million. One cannot tell how much comes from its
government-conferred CPT code monopoly.
"For stakeholders, the price of privilege is to lend
themselves, and their increasingly captive customers, to the
rulers' agenda," Codevilla explains. Examples of this type of
government include Mussolini's Italy and Peron's Argentina.
"Reform" would replace Hippocrates (physicians serving
patients), with Plato (physicians serving the state), said North
Carolina internist Clare Gray, M.D., at the rally.
It's about creating a permanent, majority class of "victims
of capitalism" and government dependents, writes Kenn Beeman,
M.D., of Tupelo, MS. Shall we call it "two tiers"?
Obama supporters posted a distorted video clip, and bloggers
followed the Leader's suggestion that surgeons cut off legs for
the money. "Surgeons...there's a death panel for ya."
Physicians Stand with Patients for Real Reform
Addressing the rally, Dr. Kellen said: "We do not need
health care reform. We need government reform. Every major
problem with cost and access...is due to government...." He
called Obama's Sep 9 address "45 minutes of Orwellian
doublespeak.... [Obama] spoke the words of freedom such as
choice, competition, and responsibility. Yet every proposal he
made spoke of rules, requirements, regulations, fees, taxes,
mandates. In other words slavery really is freedom." Dr. Kellen
warned of trading promised security for freedom.
The Sep 10 rally was a prelude to the "912" demonstrations,
which also got scant coverage by U.S. major media. The Associated
Press said "tens of thousands"; the British Daily Mail
estimated that 2 million people converged on the Capitol,
carrying signs such as "Pull the Plug on Obama Care: It Will Kill
You." "Wake Up America: Fight Socialism." "Obama, Can You Hear Us
Now?" He couldn't, as he was speaking to 15,000 people in
Minnesota, at an event funded by the multimillion dollar Campaign
for America, asking them to help him "overcome opponents to his
In 1994, Sen. Jay Rockefeller's (D-WV) said, "We are going
to pass health reform whether the American people like it or
not." Obama will support "whatever it takes" to ram a bill
through. This includes the "nuclear option," the parliamentary
maneuver of budget reconciliation to avoid a filibuster.
"It's doing what democracy calls for," said Rep. Steny Hoyer
(D-MD) yet only 37% of Americans now support pending bills. The
Tea Party Express is rolling.
AAPS Member Assaulted at Rally
Barred from entering what they thought was to be a townhall
meeting in California, more than 100 people held an impromptu
rally, and three physicians jumped up on a park bench to speak
and answer questions.
"The government wants to tell me when I can see you," said
orthopedic surgeon Glenn Cohen, M.D.
A man apparently lunged at the physicians and was wrestled
to the ground by plainclothes policemen (Ventura County
The Tea Party throngs, in contrast, were well behaved, and
no one was arrested in D.C.
From a review of H.R. 3200 by David McKalip, M.D.:
Moratorium on enrollment. The HHS secretary could
stop enrolling new providers in a program in which she determines
there may be fraud, e.g. dialysis centers (p 706).
Guilt by association. A provider enrolling in
Medicare must report any affiliation within the past 10 years of
anyone with a Medicare debt or exclusion, and could be denied
participation on the basis of such an association (pp 709-710).
Report referrals. A physician could be disenrolled
for one year for failure to supply requested records of all
referrals to programs at risk of fraud, such as home health (pp
The People on the Effects of "Reform"
An August Washington Post/ABC poll asked, "If the
health care system is changed, do you think ... will get better,
worse, or remain the same? Answers:
Cost: 19% better, 41% worse
Quality: 19% better, 33% worse
Access: 14% better, 40% worse
In other words, people think they will pay more and get
less. How much more? Michael Tanner predicts that Americans will
pay $820 billion in higher taxes over 10 years, and see insurance
premiums rise as much as 95%. If the new entitlement were
subjected to the same actuarial standards as Social Security and
Medicare, the 75-yr unfunded liabilities would exceed $9.2
trillion (Cato Policy Analysis 9/9/09).
Increasing the "Wedge"
The economic separation of effort from reward, of patients
from physicians, because of government policies the wedge has
grown steadily. In 1960, 50% of medical expenses were paid out of
pocket; now, only a bit more than 10%. This key factor in cost
escalation will be worsened by "reform" (www.lafferhealthcarereport.org, August 2009). That's why "Americans would pay even
more for less quality and less access" (Wall St J
8/5/09). Instead, we need to empower patients and doctors to
manage medical decisions, Laffer writes.
"One of the traditional methods of imposing statism or
socialism on a people has been by way of medicine. It's easy to
disguise a medical program as a humanitarian project. Most people
are a little reluctant to oppose anything that suggests medical
care for people who possibly can't afford it."
Everything in pending legislation takes a demand-side
approach, writes John Goodman. It seeks to use the purchasing
power of government to force doctors to change how they practice.
The House bill has the word "require" and its derivatives 427
times, "limit" 167 times, "penalty" 156 times, "regulation" 91
times. "Marketplace" and "competition" occur only 3 times each.
"If in ordinary life you encounter a real paranoid, there is
only one safe way to proceed. Do not enter into dialogue; do not
give hostages in the form of things that you want from him; do
not make any part of your life depend on his decisions or good
will...." (Roger Scruton's advice on "Dealing with Iran,"
American Spectator, September 2009, could apply here).
Your Money Is No Good Here
Except for tips, a high-end NY restaurant will no longer
accept cash. The logic: if you don't have a credit or debit card,
you probably don't have a checking account and shouldn't be
eating at Commerce anyway. No more armored cars, and the IRS
likes it too (Wall St J 9/9/09).
Health care czar Nancy DeParle, the third most powerful
person in American "healthcare," after President Obama and HHS
Secretary Sebelius, has ties to numerous stakeholders, including
Cerner, Boston Scientific, Accredo Healthgroup, and Triad
Hospitals. In 2006 and 2007 alone, she collected at least $3.5
million in fees and sales and awards of stocks in companies that
will be under her jurisdiction. Although she is supposed to
recuse herself on issues involving a possible conflict, it is
hard to imagine any issue that won't involve one of her vast
array of former clients, employers, or corporate boards, writes
Michelle Malkin (http://michellemalkin.com 8/6/09).
The "Road of Bones"
Describing a journey on the Kolyma Highway in Siberia,
Kevin Hughes writes: "This is what statism and socialism are all
about: anyone who does not toe the line is dealt with ruthlessly
and without appeal." The road was built to service Stalin's gold
and diamond mines, while killing as many innocent prisoners as
possible. About 95% of the prisoners died of cold, malnutrition,
and overwork; their bodies were dumped into the roadbed, on
average one every 10 meters. Many victims were turned in by
fellow citizens solely on hearsay.
Sep 30-Oct 3, 2009. 66th annual meeting, Nashville, TN.
Sep 15-18, 2010. 67th annual meeting, Salt Lake City,
AAPS Sues White House for "Snitch" Site
Together with the Coalition for Urban Renewal and Education
(CURE), AAPS has filed suit against the Obama Administration for
violating the Privacy Act and First Amendment rights by
establishing an email address to report "fishy" misinformation
about the Obama health reform.
On the eve of the first planned filing date, the "flag"
email address was shut down. Macon Phillips, Director of New
Media, who is named in the lawsuit, said that "to better
understand what new misinformation is bubbling up online or in
other venues" and to "consolidate the process," a new address for
feedback had been set up:
www.whitehouse.gov/realitycheck/contact (Sarah Foster, News with
In its complaint (Civil Action No. 09-1621-EGS), AAPS
writes: "In the public-policy debate, the Executive Branch of the
federal government enjoys an advantage in its ability to chill
speech...(i.e. to intimidate the public), particularly in
regulated professions such as medicine."
The Court is asked to order the White House to expunge
information already collected, discontinue the solicitation, and
to refrain from further information-collection activities
regarding exercise of free speech.
The complaint is posted at www.aapsonline.org. The American Health
Legal Foundation is helping with funding.
Mandatory Compliance Programs
Compliance efforts that are now voluntary may become a
condition for participation in Medicare or Medicaid under
proposed reforms. Failure to maintain "core elements" could lead
to mandatory disenrollment or civil monetary penalties. These
requirements include written policies, a designated compliance
officer and compliance committee, training, an anonymous
reporting mechanism, and disciplinary guidelines. All this would
involve a "significant enhancement of program requirements"
(BNA's HCFR 8/26/09).
Remember that "everything you should have read can be
used against you." In the past "you may have heard that
you're better off without a written compliance plan," so that an
investigator couldn't use it as evidence that you knew you were
violating the rules. Lack of a plan will not protect you against
investigation or prosecution. Investigators have seized CPT or
ICD-9 code books as evidence. And failure to check carrier
websites for updates shows you purposely ignored the rules
(Medical Practice Compliance Alert 9/7/09).
"Incident To" Services
Physicians who bill for services given by nonphysicians need
to assure that these caregivers meet CMS qualifications. Also
they need to be immediately available if a practitioner
needs help (ibid.). Of the services it reviewed, the Office of
Inspector General found 21% of them to have been provided by
"unqualified practitioners" (MPCA 8/24/09).
Tenth Amendment Lawsuits?
In 30 states, the ObamaCare provision that all
medical facilities provide translators would conflict with
English-only laws. The cost of "language-appropriate services"
would be astronomical, and would drain personnel already in short
supply for the military (Collins Report 8/17/09).
Crack in the Wall of Sham Peer Review
In Richard Chudacoff, M.D., v. University Medical Center
of Southern Nevada, a doctor won a partial summary judgment.
The Court held that "Prior to being deprived of a protected
property interest, Dr. Chudacoff was entitled to notice and an
opportunity to be heard."
Dr. Chudacoff, an obstetrician-gynecologist in charge of
supervising resident physicians, was a whistleblower who
complained about the quality of care rendered by residents and
made recommendations about improvements. His privileges were
suspended, his employment was terminated, and he was ordered to
undergo drug testing and physical and mental evaluations.
The Court noted that the medical staff bylaws offered a
Hobson's Choice at the "fair hearing": the "physician may
represent himself or be represented by any other individual of
his choice, including a licensed attorney. A licensed attorney,
however, is not allowed to call, examine, or cross-examine
witnesses or otherwise present the case." In other words, a
person trained in advocacy would have to remain silent!
Dr. Chudacoff was subjected to several tactics
characteristic of sham peer review, notes Dr. Lawrence Huntoon,
Chairman of the AAPS Committee to Combat Sham Peer Review: the
ambush (failure to advise the physician of the charges); the
secret investigation; the "disruptive" label; and failure to
allow timely access to documents needed to defend himself.
Unfortunately, his win applies only to hospitals that are
considered "state actors."
Too Few Doctors Purged, Public Citizen Says
Hospitals are failing to "discipline and report doctors who
endanger patients," says Public Citizen. The evidence: nearly
half have failed to file a single report with the National
Practitioner Data Bank (Modern Healthcare 6/2/09). The
"notches-on-belt-equals-quality" system does not distinguish sham
from honest peer review, Dr. Huntoon observes.
Pharmacists Forced to Dispense Plan B Drug
The Ninth Circuit Court of Appeals overturned a lower court
ruling that put a hold on a 2007 Washington State pharmacy board
rule requiring pharmacists to dispense all legal drugs, even if
they violated religious beliefs. A lawsuit had been filed by a
small family-owned grocery store and pharmacy and two individual
pharmacists. Of concern are Plan B "morning after" drugs, which
may cause abortion, and also lethal cocktails recently legalized
under a new assisted-suicide law.
ACLU, Planned Parenthood, and the pro-abortion Northwest
Women's Law Center objected to the "refuse and refer" system the
injunction set up. The new rules allow a pharmacist to opt out
only if another pharmacist is available on-site at the time the
customer wants the drug. Pharmacists can't get in the way of a
patient's "right" to a prescription.
The ruling "immediately endangers conscientious pharmacists
in Washington State and also strikes a blow at medical
professionals throughout the West Coast," said Brad Dacus of the
Pacific Justice Institute, which filed an amicus brief in support
of the pharmacists. "The Ninth Circuit's reinstatement of these
regulations, despite strong evidence that they targeted people of
faith, renders the Free Exercise Clause meaningless"
Automatic Fund Transfers. Sec. 163 of the "healthcare
reform" bill, called "Administrative Simplification," would allow
the federal government to arrange real-time access to individual
bank accounts in order to facilitate automatic electronic fund
transfers. The apparent goal is to dovetail a real-time
electronic payment/remittance advice system with electronic fund
transfer from individual accounts.
Given the economic incentives, it is likely that these
transfers will become the only method of paying for medical care
(with the exception of cash-based practices, if these still
exist). Since the last Government Accounting Office study found
that Medicare gave the wrong answers to questions posed 96% of
the time, this drive to automated fund transfers is downright
frightening. Most people do not want someone with a 96% error
rate to have anything to do with their money.
The Improving Medicare and Medicaid Policy for Reimbursement
through Oversight and Efficiency Act would require all Medicare
and Medicaid payments to be made via direct deposit in federally
insured banks. If this is set up in the same way as Medicare
direct deposit is now, it will allow transfer both into and out
of the account, so that whatever the government portrays as
"improper payment" may be removed quickly and efficiently.
Physicians who currently opt for electronic fund transfers have
to sign an agreement that allows the government to do this.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
Real-Time Adjudication. Sec. 163 would also "enable the
real-time...determination of an individual's financial
responsibility at the point of service and, to the extent
possible, prior to service, including whether an individual is
eligible for a specific service with a specific physician at a
specific facility, which may include utilization of a machine-
readable health plan beneficiary identification card."
You can't do real-time determination unless you have real-
time accounting for all health transactions. Otherwise you'd have
no idea where people are in their deductibles (to use just one
example). You can never get real-time accounting unless you
outlaw cash payment. A better solution is to put the whole system
on a cash basis, and let government take care of income
subsidies. No need to do real-time determination of anything. ERs
would be stuck, but they're stuck now.
Most upsetting to me is that software somewhere would be
determining my eligibility to see a specific physician for a
Note to Obama: my current insurance doesn't worry about
real-time determination or eligibility; I like it just fine.
Linda Gorman, Ph.D., Independence Institute, Golden,
Abortion Coverage. Supporters of pending bills claim
that we shouldn't worry about taxpayer-funded abortions, as
abortions are not mentioned in the bills. This is a cute
obfuscation. The way health insurance works is that if it isn't
specifically excluded, it is covered. That is why your policy
will list many pages of exclusions. It is impossible to list
everything that is covered. If abortion isn't mentioned, it's
Greg Scandlen, Heartland Institute
Medicare Approval Rating. Investors loved Bernie Madoff
for the 25 years he was scamming them. If you had polled them 10
years ago, I bet he would've had a 97% approval rating.
Alieta Eck, M.D., Somerset, NJ
Public Plans. What a ruse it is to say that the public
option won't be able to dip into other federal funds to make up
deficits or comply with mandates. Once the plan is in place it
can be changed by amendment or executive order. I've heard such
assurances about government plans for 40 years....
Robert Hamilton, M.D., Godfrey, IL
Mandates No Guarantee. Ask a Medicare beneficiary who
can't find a doctor willing to accept the program's low payment:
coverage does not mean access to care. Nor does it guarantee
payment or make people fiscally responsible. In 2001, doctors and
hospitals were stiffed for $14.9 billion in unpaid deductibles
and copayments 30% of uncompensated care!
William Snyder, Scottsbluff, NE
Crowd Out. I applied for a loan, thinking that with the
stimulus package, banks would be lending. They're only lending to
one entity. The only ways the Fed can get the trillions it is
spending are to tax, print, borrow from foreigners, or borrow
from banks. Only the last is currently viable. Soon, the Fed will
control all the money in the U.S.: the single borrower, the
single lender, the single payer.
Ralph Weber, C.L.U., Paso Robles, CA
Scapegoats. It is painful to see that the U.S. is
committing suicide as my home country Germany did many years ago.
Stupidity is the prevailing modus operandi. One small but
significant example: it took less than 24 hours to blame
physicians for the death of Michael Jackson. No one of any
credence is protesting or trying to explain how fallacious this
premise is. It looks as though someone has revived old German
anti-Semitic rants, with a change: Die Juden [rzte] sind
unser Ungluck (Jews [physicians] are our misfortune). The
order of collapse makes statistical sense: more people need to
bank, live in a house, and drive a car than get medical
Walter Borg, M.D.