By: Jane M. Orient, M.D.

Politicians love to boast of the benefits they shower on favored   constituents with their right hand. But as with the amazing feats performed by magicians, the unwary audience is watching the wrong hand.

It may seem   that in government the right hand often doesn’t know what the left is doing.   However, it is surely obvious that the goodies in the right hand did not materialize out of thin air. They had to be taken from   somewhere.

Usually that somewhere is taxes. Even doctors know that. For  example, while bemoaning the coming cuts in their pay from Medicaid, some  ventured to say out loud, at a medical society meeting, that there is an  answer to the problem: we just need to raise taxes.

The very same  left-leaning doctors had just finished agreeing that many Medicaid patients   come to the doctor only because they are lonely or bored. They add that this   is all right with them because they get paid even though the visit was   unnecessary.

With healthcare reform (“ObamaCare”) there are some frank  tax increases. But even the Democrats in the 2008 Congress probably wouldn’t  have passed a recognizable tax increase large enough to fund the enormously   expensive bill. Instead, they gave us an insurance mandate. They insisted this   wasn’t a tax, although the Obama Administration insists that it is a tax after   all—if that’s what it takes to get a court to find it   constitutional.

In 2014, assuming this law survives, we’ll have a clever sleight of hand that casts the redistributionist,   now-you-see-it-now-you-don’t tax/nontax, as a subsidy. If you, by their   criteria, can’t afford the high premiums on the comprehensive policy that is   required, you get a subsidy to buy it—a negative tax. Otherwise, you have to   pay the full cost yourself. So, is the absence of a subsidy a tax, or the   functional equivalent of a tax? Aren’t subsidies and taxes mirror images, like left and right hands?

Say that the court finds that it isn’t a tax, for purposes of invoking the taxing powers of Congress, but is instead a way of   regulating interstate commerce, the alternate constitutional justification.   Wouldn’t it be unprecedented for Congress to penalize inaction under the  Commerce Clause?

One advocate for ObamaCare wrote to the Wall   Street Journal that “countless” types of personal inaction violate the law.   Most of these, however, are “if…then” situations, contingent on a previous   action. “Failure to put out your campfire” assumes that you lit a fire.   “Failure to wear clothes when out in public” assumes that you decided to go   out; you are not required to wear clothes in the bath. “Failure to file a tax  return” assumes that you have taxable income—and that one took a  Constitutional amendment. The only thing close to “If you are alive, then you   must buy a certain specified type of health insurance” is “If you are a male   who has reached the age of 18, then you must register for the draft.” Is the   insurance mandate a form of conscription? It forces us all to pay for care   that we might not want to buy, or be willing to provide, without third-party payment.

The left-handed logic used by the Administration in court is:   “If you are alive, you will get sick or have accidents, and use medical care, and the rest of us might get stuck paying for it.”

Why not an individual responsibility mandate? Rather like a mandate that if you have   children, you must feed them. And if you take food from the grocery store, you   must pay for it. Why do people get to stick “the rest of us” with their   medical bills?

With medical care, we have seemingly accepted the  concept of collective responsibility—and entitlement. Under this concept, any   person who is sick or injured is entitled to be taken care of. If others do not provide the care voluntarily—that’s called charity—then the government   must force someone to pay.

The method might be a straight tax. Or it   might be a mandate to force everyone to prepay into a collective pot called insurance. Both require force.

We see the benefits that the politicians   and magicians want us to see. What their left hand does is invisible and   deceptive. How much it takes, how much it wastes, how much it corrupts, how   much it restricts freedom, and how much harm it does—all this has been hidden  in smoke and mirrors.

Americans must demand a look behind the curtain.

Jane M. Orient, M.D., On Air contributor speaking on Healthcare Reform. Dr. Orient has appeared on some of the largest TV and Radio Networks in the country and her op-eds have been printed in hundreds of local and national newspapers, magazines, internet, followed on major blogs and covered in the Wall Street Journal and The New York Times.

Doctor Orient is the Executive Director of Association of American Physicians and Surgeons and has been in solo practice of general internal medicine since 1981. She is a clinical lecturer in medicine at the University Of Arizona College Of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.

AAPS California Chapter Coordinator, Wayne Iverson, MD

Last year President Obama signed the Patient Protection and Affordable Care Act (PPACA), also known as ObamaCare, amongst a flurry of protests and concerns about the burdensome costs and impossibilities of complying with the regulations. Within months, large corporations demanded waivers while small business are left scrambling to meeting compliance under the new federal healthcare reform law. Individuals have seen their insurance premiums automatically increase 15-20% in 2010. The insurance companies claim they have to start charging more now because in years to come they will have more costs under the new law. So onerous and disruptive to the American way of life, over half of the states in America filed lawsuits challenging PPACA. Judge Vinson issued his final ruling on the lawsuit in Florida, agreeing with the attorneys representing 26 states and declared ObamaCare to be unconstitutional.

Accountable Care Organizations (ACO) are new entities spawned under ObamaCare that provide for any hospital inpatient service to be paid as a single lump sum to an administrative body. This entity will then in turn pass a portion of the money on to the hospital, doctors and ancillary healthcare providers rendering services during an individual’s hospitalization. Dr. Wayne Iverson, who has hospital attending staff privileges, holds an MBA and is an expert in healthplan development, says, “The new law establishes an expensive new administrative body that has all the functions and operating costs of an HMO without the safeguards HMOs have under state and federal law. With payments to hospitals and doctors already at very low insolvency levels, this additional drain will precipitate a financial crisis in the medical community.”

In San Diego County every major hospital system, except for the University of California San Diego (UCSD) Medical Center, is in the process setting up an ACO for their medical centers. One such multi-hospital system tried to establish an analogous administrative body over 10 years ago just to meet competition in the market place. In doing so, they spent millions of dollars in development which were completely wasted when the project closed down and the chief executive officer (CEO) was fired from his position. Dr. Iverson recently attended a medical staff meeting where plans for setting up an ACO were detailed. Dr Iverson said, “It was like having deja vu. The ACO promoters have a lucrative new project they can bring to the medical center, but it is not financially sustainable, and it ignores the fact that the ObamaCare has been declared unconstitutional.”

During the past two years the country has suffered from the poor US economy and measures passed by the last US Congress and signed by the President. With ACO development well underway the medical community is wasting millions of dollars on regulations that will be squashed. Whether it is a major medical center gearing up to have an ACO or individuals paying higher insurance premiums, it is hard to believe that our legal system allows an unconstitutional healthcare reform law to continue to drain the money from people in the United States.

The US Congress is currently struggling with reducing the historic budget deficit. Dr. Iverson concluded, “Our nation’s leaders and particularly our nation’s legal system should focus on saving the medical community and the community at large from wasting any more money chasing regulations promulgated under the decidedly unconstitutional ObamaCare.”

By Jane M. Orient, M.D.

The earth moved in Japan, and thousands of people were buried in rubble or washed out to sea. Hundreds of thousands are homeless, and suffering from thirst, hunger, and cold. Lacking reliable electricity, much of industry is shut down even if undamaged.

We don’t know the total death toll as yet, but so far the score is earthquake and tsunami around 10,000; nuclear energy, 0. But the damaged nuclear reactors are nonetheless at the top of the news.

The tsunami affected the other side of the Pacific too; some Americans lost their lives, or had to be rescued by the Coast Guard. The biggest fear, however, is not the tidal wave, but the prospect that demon radiation will cross the Pacific and rain down death. Potassium iodide tablets are selling out. Anti-nuclear activists call for shutting down nuclear energy.

I wouldn’t criticize people for buying potassium iodide; I already have some. If you ever really need it, you probably won’t be able to get it. Don’t assume that our government has stockpiled KI or other essentials.

There are a lot of other things that the Japanese need more right now, such as bottled water and food. You do have some of that stored away, don’t you?

Postage-Stamp Sized RadSticker

Another need is for radiation monitoring instruments. More than 1,000 RadStickers, postage-stamp sized detectors that instantly measure dangerous levels of radiation, have been sent to Japan as a gift by an American scientist. RadStickers are now available again after the entire U.S. supply was commandeered for use in Japan.]

One of my personal projects is to help distribute RadStickers to American firefighters and police officers so they will have them in the event of a real nuclear disaster, such as detonation of a terrorist (or North Korean) nuclear bomb. I have a RadSticker on my credit card, and also carry a credit-card sized SIRAD (self-indicating instant radiation alert dosimeter, see www.jplabs.com). In addition, I have a NukAlert, which is a dose-rate meter that chirps like a bird if it detects dose rates greater than 0.1 rad/hr (www.nukalert.com).

My SIRAD is showing a dose of between 2 and 5 rads because I usually forget to take it out of my carry-on luggage before it goes through the x-ray machine. It has made about 20 trips through there by now. It makes me wonder how much the TSA agent gets from standing by the machine all day. It is shielded, of course, but how effectively? I don’t see any of those lead aprons that x-ray technicians wear. If I worked for TSA, I’d have a SIRAD in my pocket. Agents used to be issued dosimeters.

The main purpose of RadStickers is to prevent panic. They are not very sensitive, so they are not going to pick up background radiation, or the excess radiation from a load of bananas or pottery. The lowest reading is 25 rads. An acute dose of less than 100 rads probably wouldn’t make you sick. A dose between 300 and 400 rads causes acute radiation sickness and a 50% chance of death. There’s a widespread belief that the teeniest dose might increase your risk of getting cancer in 20 years, say adding 1% to the 25% risk you have anyway, but there is also much evidence that low doses are actually protective.

For perspective, here are some numbers. At the gate of one Japanese plant during a fire, the dose-rate was temporarily as high as 11,000 microsieverts/hr, quickly dropping back to 600 microsieverts/hr. The level at the edge of the evacuation zone was 300 microsieverts/hr. In the older radiation-protection units, that’s from 1.1 rem/hr down to 0.03 rem/hr. The dose from one chest x-ray is about 0.01 rem and from a full-body spiral CT scan up to 10 rem. (In this context 1 rem is about the same as 1 rad.) If you stood at the gate of the plant for 10 hours at the highest dose-rate, you’d get as much radiation as from the total-body CT scan.

Irresponsible terror-mongers have been distributing material on the internet predicting an instantly lethal dose of 750 rads hitting western and intermountain North America within 10 days. This is preposterous.

Senator Lieberman is calling for a moratorium on U.S. nuclear power plants. Actually, we have had the near equivalent ever since Three Mile Island killed nobody, with a loss of some $10 trillion to our economy. China and India are not considering any such nonsense.

From the horror in Japan we should at least try to learn something. There are radiation threats in the world-the ones significant to the general population are from nuclear weapons. (Nuclear power plants absolutely cannot produce a nuclear explosion, though there have been explosions of hydrogen gas.) Americans have very little knowledge and less preparedness, and are thus highly vulnerable to merchants of fear.

You don’t need to believe anything I or anyone else says about your radiation exposure. You can measure it for yourself with an instrument you can make from materials you probably have around the house. There were rudimentary instructions in Parade magazine in the 1950s. Good, field-tested instructions can be downloaded free from the internet (http://www.oism.org/nwss/s73p938.htm). Thousands of schoolchildren have successfully made a Kearny fallout meter. So can you.

Let us do what we can to help people in Japan. Let us also improve our own knowledge of radiation and ability to survive catastrophes that are much more likely than a tsunami hitting the nuclear generating station near Phoenix.

By: Alieta Eck, M.D.,

The 50 governors of the United States are beginning to demonstrate some backbone. They now must remind the federal government that with ObamaCare it has overstepped its bounds.

Andrew Cuomo, Democrat governor of New York, divulged the fact that 1 in 4 New York residents is on Medicaid. Medicaid is the social safety net set up in 1965 with the elusive dream of making everyone equal. President Lyndon Johnson actually stated that this program would help eliminate poverty within seven years. Instead, it has served to spread the pain of poverty far beyond what anyone could have imagined. Instead of encouraging the drive and ingenuity of the American spirit, it tells one in four New York residents that he cannot care for himself or his family and is a victim of others.

Government has turned its people into pawns of the state, easily manipulated by those seeking to enrich themselves at the expense of the prosperity and independence of those it has purported to “help.” And at a cost of $50 billion per year in New York alone, the productive private sector workers who must fund such excess, are forced to cut back on things that would enrich their own lives. How many homes cannot be improved because there is simply no money left to do it after taxes? How many idle contractors thus have nothing to do and finally wind up on welfare themselves? The downward spiral is cruel. The people are burdened by a government that has gotten too big.

Cuomo has proposed Medicaid reforms, battling his own legislature to reduce the generous benefits offered by the system. And now he is looking to his own President to stop the inevitable growth of this mammoth system that is bankrupting everyone. He is horrified by the proposed expansion of Medicaid that is a major feature of ObamaCare.

Governor Cuomo may be on to something. The Medicaid system has morphed into something that was never intended– a highly bureaucratic system that pays and gives generous benefits to many people that fill in forms and shuffle papers. But when it comes to delivering health care to the poor, Medicaid only meddles, restricts, coerces, and grossly underpays those who actually see and touch the patients. As in England, it is a national system that grows in bureaucracy while delivering less and less care.

So what is the solution? A proposal is circulating the State of New Jersey to phase out the Medicaid for acute care services, saving $2 billion.

Since women and children in poverty need care, not “insurance,” we ought to encourage the private sector set up a network of free charity clinics.

Physicians would be asked to donate 4 hours per week, submitting no claim forms to the state for reimbursement. As their only reward, we would ask that the state provide the same medical malpractice coverage as it provides to attendings, residents and students of the state medical schools, to the entire practice of those physicians who volunteer.

It would cost the taxpayers nothing unless a lawsuit were brought, and these would be reduced. Lawyers are less likely to sue the state than a private physician.

Physicians would benefit from the lowered office overhead in their private practices and the freedom to work without having to defensively order so many extra tests.

Poor patients would benefit by having a place, right in their community, to go when they find themselves ill with no money to pay for care. Baby boomers would step up to staff the volunteer clinics, realizing that they would be improving the prosperity of their children and grandchildren.

The huge state Medicaid bureaucracy would melt away, freeing those workers to find private sector jobs fueled by the remarkable reduction in taxes. Since NJ spends $5 billion of its $30 billion budget on non-elderly Medicaid, it is not hard to envision the prosperity that would ensue if such an expense were greatly reduced. Though the federal government pays half, this is money that has lured us into the sense that we are really being helped. The strings attached to that “help” are strangling us.

The Governors need to stand up and just say “no” to the federal government. Tell the feds to keep those Medicaid dollars and put its own house in order. Let each state develop a common sense way to care for its poor and let there be 50 crucibles of innovation, ready to be emulated by others. May the best state win!

By: Jane M. Orient, M.D.

If you’d like a preview of what your medical care might look like after 2014, when the Patient Protection and Affordable Care Act (PPACA) is fully implemented, take a look at schools in Wisconsin: they’re closed.

The teachers, members of a public employees union, are not exactly on strike, as that would be illegal. Instead they are at the state capitol, obstructing government as well as education. They might still be getting paid because they are taking sick false leave. True, they are able to stand outside in the cold for hours, holding signs, but they do have a doctor’s excuse. They are “stressed,” or “sick of Governor Walker,” or “anxious” about their future taxpayer-funded benefits, or “depressed” about pending legislation. This has been coded and documented in appropriate medical terminology by a credentialed provider, on a properly executed form.

Under PPACA, doctors and other medical workers (now all lumped together as “providers”) are likely to be unionized too. They’ll have to follow work rules, or the equivalent, in any case. These rules are designed to prevent too much work. If doctors join the new type of collective practice, called an accountable care organization, they’ll be punished if too much money is spent providing too much care. Or if there are “disparities” because patients belonging to a “majority” (non-disadvantaged) ethnic or racial group got more than their fair share of the resources.

In addition to studying complex rules and performing administrative busywork, providers will spend a lot of their time writing work excuses, a high-priority function in a socialized economy. In England, for example, absenteeism nearly doubled in the first year of the National Health Service.

Union benefits will be protected by government, as the government is protected by unions. Waivers from onerous provisions of PPACA are generously granted to unions, which generously contribute to friendly politicians from the dues extracted from workers. If the majority (“We won”) party should lose that status in an election, because of taxpayer concerns about the impending bankruptcy of the state, it can still win by hiding out in a luxury hotel in another state. By making it impossible to obtain a quorum, they can keep the legislature from voting to diminish taxpayer-funded union benefits. This maneuver is not a boycott or a strike—when used by the union’s friends.

Once the PPACA passed, it seemingly became immune to repeal, like unsustainable union pensions—as long as its chief advocate (for whom PPACA is often called “ObamaCare”) rules over the executive branch and has the power to veto repeal.

Administrative agencies can redistribute the benefits to friends, and the burdens to enemies—a great way to increase the number of supporters and neutralize opponents. The executive branch is also in charge of the police, the prosecutors, and the prisons.

They enforce the very punitive laws against violating ambiguous and enormously complex rules. Phony work excuses for union members get a wink and a nod and a pass—and a paycheck. A wrong code or an extra service to an ineligible patient gets the doctor an “F” for “fail”—and possibly a fine and a prison term for “fraud.”

The courts are a weak barrier against overreaching by the executive. Judge Vinson, in a case brought by a majority of the states, ruled PPACA unconstitutional. The Obama Administration is forging ahead unhindered. On the other hand, if the legislature passes a law it doesn’t like, the Administration can decide on its own, without benefit of a court, that the law is unconstitutional and refuse to enforce it. (That kind of law seems to involve restrictions on gay marriage or abortion.) PPACA will go to the Supreme Court. But one wonders whether the question once asked about the Pope will be asked in another context: How many divisions does the Supreme Court have?

The “community organizers” who support unions and “reform” can mobilize thousands. Organizing for America, which uses the Obama “O” as its logo, is bussing protestors to Wisconsin. It is also raising money to fight the repeal of PPACA.
“The people are speaking” in the street here, though not as violently as in Egypt. Governor Walker is being portrayed as a Hitler or a Stalin. Signs say “Don’t Retreat, Reload; Repeal Walker,” and show Walker’s face in the crosshairs. Such a graphic on a map of congressional districts got Sarah Palin accused of instigating the shooting of Congresswoman Giffords. But venomous, hate-filled rhetoric is apparently okay when used by unions and their friends.

Education and medicine are key targets in the progressive agenda to “fundamentally transform” America. Government schools are already in its grip. By their actions in Wisconsin, unionized teachers are setting an example of cheating and lying. Is that what their students are learning? The union defines right and wrong, sickness and health, truth and falsehood—to suit its purposes. Some doctors are already collaborating with this agenda. In Wisconsin’s government schools, more than half of the students don’t learn to read well. What will happen to patients in medical facilities run on the same principles? Many may get nothing more than a work excuse.

Wisconsin is showing us the face of progressive reform. We need to study it, and learn.
 

Jane M. Orient, M.D.,  On Air contributor speaking on Healthcare Reform.  Dr. Orient has appeared on some of the largest TV and Radio Networks in the country and her op-eds have been printed in hundreds of local and national newspapers, magazines, internet, followed on major blogs and covered in the Wall Street Journal and The New York Times.
Doctor Orient is the Executive Director of Association of American Physicians and Surgeons and has been in solo practice of general internal medicine since 1981. She is a clinical lecturer in medicine at the University of Arizona College of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.