As it was physically impossible for congressmen to have read the mammoth “stimulus bill” (American Recovery and Reinvestment Act of 2009) before voting on it, or for the President to have read it before signing it, our rulers themselves are probably only dimly aware of what they have done.
In a conference call on Feb 19, Congressman Michael Burgess, M.D., (R-TX), founder of the Congressional Health Care Reform Caucus, noted the following:
1. The stimulus bill was 100% written by Democrats. There was no Republican input.
2. As with SCHIP, the Medicaid and COBRA provisions of the Stimulus Bill have a funding cliff There is zero funding after a certain point (4 years for SCHIP, 18 months for Medicaid, and 12 months for COBRA). That decreased the CBO scoring of cost. This makes the $87 billion worth of “help” to the states for Medicaid like a subprime mortgage: there’s a huge balloon payment due after a few months or years.
3. The Democrats will try to move quickly to enact a unified plan. (Apparently that’s what Obama meant by a “down payment.”)
PROVISIONS
Greg Scandlen observed that the COBRA provisions load a huge burden onto employers. They are supposed to track down all workers with adjusted gross income less than $125,000, who were terminated after Sep 1, to let them know they are newly eligible for COBRA. Instead of paying the premium themselves, the workers get a direct federal subsidy for 65% of the cost. Grace-Marie Turner writes that the $25 billion for COBRA “imposes a back-door mandate on employers to continue providing health insurance coverage to workers long after they have left… [I]t just may crack the already fragile ability of employers to continue offering health coverage” (Health Policy Matters 2/13/09).
“Privacy” provisions are expansions of HIPAA. Fortunately, they do not do away with noncovered entities (the “country doctor” exemption). They extend requirements to “business associates” of “covered entities.” They require an audit trail for accessing electronic records; prescribe penalties for breaches; and require notification to public if protected information is breached. The “stimulus” creates new government jobs: regional office privacy advisors to educate entities about security and privacy. Apparently, these are technical requirements written by a company that can supply just what is needed to meet them. While there are restrictions on the sale of information, there is a gaping loophole for “TPO” (treatment, payment, and operations, which can mean nearly anything, as well as research and public health purposes).
Electronic records. The bill states: “The National Coordinator shall…update the Federal Health IT Strategic Plan…to include specific objectives, milestones, and metrics with respect to…the utilization of an electronic health record for each person in the United States by 2014.” Starting in 2011, Medicare and Medicaid will provide financial incentives over multiple years of up to $40,000 to $65,000 per eligible physician for “meaningful” use of HIT, as in reporting of clinical quality measures. Starting in 2015, physicians and hospitals who do not use HIT in a “meaningful way” will be penalized (N Engl J Med 10.1056/NEJMp0900665).
“Comparative effectiveness research” receives $1.1 billion, including $400,000,000 to be used at the discretion of the Secretary of HHS (a slush fund). This is to compare the “clinical outcomes, effectiveness, and appropriateness” of medical services.
These two provisions set up the infrastructure for a health rationing bureaucracy, as explained by former New York Lieutenant Governor Betsy McCaughey (www.bloombergnews.com 2/9/09).
WHAT PEOPLE SAY
The AMA: “The final HIT provisions are not exactly what we would have drafted,but they do represent real progress and a major improvement upon the status quo.” And: “Suggestions that a[n] Office of Health Information Technology…will monitor treatments to make sure your doctor is doing what the federal governent deems appropriate and cost effective are unfounded” (AMA eVoice 2/17/09).
Rep. Pete Stark (D-CA): “The new research will eventually save money and lives, although it may very well shorten the lifespan of some senior citizens who would not be allowed to receive some treatments even if they volunteer to pay for them themselves” (Robert Pear, New York Times 2/15/09) [emphasis added]. This version was taken down, and the quotation was truncated after “money and lives.”
Rep. David Obey (D-WI), Chairman of House Appropriations Committee: “By knowing what works best…those items, procedures, and interventions that are most effective..will be utilized, while those that are found to be less effective and in some cases, more expensive, will no longer be prescribed” [emphasis added].
Sen Tom Coburn, M.D. (R-OK): “It is ludicrous to ask a body that can’t track its own spending to determine which medical treatments are best for individual patients suffering from complex diseases. The only reason to fund this project now is to lay the groundwork for establishing a government board that will be empowered to make life and death decisions about health care treatments and cost.”
Former Congressman Ernest Istook: The pace of debate on the Stimulus Bill was $4 billion/minute.
Robert Pear, reporter, New York Times: “The bill creates a council of up to 15 federal emloyees to coordinate the research and to advise President Obama and Congress on how to implement an oversight bureau that would require physicians to submit their patient diagnoses to this bureau for approved treatment and how much money it will cost to fund.” He also notes that Britain, France, and other countries “have taken the treatment decision away from the physician and given it to a government body to determine the tradeoff between cost and treatment.”
Barack Obama, on signing the stimulus bill: “We have done more in 30 days to advance the cause of health care reform than this country has done in an entire decade” (Health Policy Matters 2/20/09).
Additional information:
Mom Blogs – Blogs for Moms…
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From the 2/23/2009 Washington Examiner:
“America Doesn’t Need a Health Czar”
http://www.dcexaminer.com/opinion/40076027.html
WE ration at all levels in our lives and take the risks that result.we could make an airplane super safe but we cannot afford a 1 million dollar/seat fare.so in health care we cannot preserve life at any public cost.there has to be some contribution from the individual to participate significantly in the cost and decision making with the family and personal Doctor/health team as supporting and concerned team members.Maybe a 50% deductible applied to the last year of a mathematical determined life that we all accept to preserve the system. there must be some way to control the spending in health care.yes,those that have more resource/money will be able to access more care but that is always true.we must preserve a system that provides some care for many rather than all things for those few at the front of the check-out counter.
Read “Health Care Crisis, or More Misinformation?”, my book review of TWO DAYS THAT RUINED YOUR HEALTH CARE, by William C. Waters III, MD, at http://www.lpsacramento.com/tiki-page.php?pageName=Newsletters
This dictatorial approach to EHR is going to force lots of doctors in their 50s and 60s to retire early or find salaried parttime and employed positions where they don’t have to foot the hassle and cost of setting up these systems. AAPS should push for small practice older physicians to be grandfathered out of these mandates. Otherwise we will lose some of the most talented, skilled and dedicated physicians, especially in rural America where none of the younger newly trained physicians want to come.
It also has been proven thst most M. D. s that use an EHR are much less productive and see much fewer pts. day. The inefficiencis and slow record keeping are very difficult for the older physician who is not as adept and skilled with data entry. I hope we can still allow the older physicians to continue to do what they do best, and not force them out of the work place.
I strongly encourage the younger physicians to adapt to this approach since it is obvious to be the way of the future. My son who is a third yr. medical student willl be much more efficient with data entry than I ever could be.
I hope the AAPS can can help mitigate any harm that physicians will experience from Obama’s healthcare plan.
Michael A. Witt, M. D. Chatsworth, Georgia
1. Voting to pass this monster, without having read it, is”legislative malpractice.”
2. Didn’t I hear some democratic party leaders talk about “bipartisanship”? Maybe it was the some one who said “We won!” Oh, that’s right, “We won” means “you lost, big time.”
As a candidate for naturopathy and latter for PhD in Cancer prevention, I shudder to think about the future of health and wellness under this Obama administration.
The extreme stranglehold of Big Pharma over medical (allopathic and naturopathic) practice has disabled true medicine to be practiced and I am afraid it will get worse by nationalizing health care.
Traditional MDs will be saddled with unwilling bureaucrats’ dictates. Alternative practitioners will be all but eliminated from the radar screen.
Can someone please tell me if there will be doctors who will opt out of doing business this way? Will there be a sort of “underground” network of doctors who will not accept the gov’t incentive and will not utilize the electronic records system?
I will be the first in line if there is! I don’t want anyone but my doctor to see my medical records and I sure as hell don’t want some bureaucrat telling me that my elderly mother is not worth saving.
I believe, with the state of the economy, that the government is ill-equipped to tackle a “do-over” of the medical system. I also hope, that what with the American medical system being amongst the top in the world, that the medical community will withstand such attempts to take their power away. Physicians in the United Kingdom often leave because it does not pay to become a doctor. Why on earth would the United States government want to take the value away from the fine scientific work being done only in the name of improving public health?
[...] “What Does the Stimulus Bill Mean for Medicine?” AAPS News of the Day 2/24/09. [...]