Archive for June, 2009

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Pelosi rams through $0.8 trillion tax increase, calls it a “jobs bill”

Tuesday, June 30th, 2009

On June 26, a narrow margin of 219 to 212, the U.S House of Representatives passed a “cap and trade” bill, H.R. 2454, the American Clean Energy and Security Act of 2009, or Waxman-Markey bill.

The 1,200-page bill is said to “literally save the planet,” while creating “millions of green jobs.”

In closing debate, Speaker Nancy Pelosi (D-CA) said, “Just remember these four words: Jobs, jobs, jobs, and jobs.”

The goal is overall reduction of U.S. greenhouse gas emissions by 17% from 2005 levels by 2020, and 83% by mid-century (Wall St J 6/27/09).

It was not possible for Congress to know the true impact of the bill, if enacted and implemented, especially as it was reportedly not possible to find the 1,200-page version of the bill, including the 3 a.m., 300-page amendment, by the time of passage.

The Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimated that federal revenues would increase by about $846 billion over the 2010-2019 period, starting slowly at $0.9 billion in 2010 and growing to $132 billion in 2019 (CBO Cost Estimate 6/5/09). There would, however, also be direct expenditures of $821 billion over the same period, so that the bill could only reduce the budget deficit by $24 billion.

This would fall far short of the $646 billion windfall hoped for by 2019 to cover the “down payment” on health care reform (AAPS News of the Day 3/2/09).

The bill would affect every aspect of American life, and impose massive reporting requirements on energy generators and users—including clinics and hospitals. “Every aspect of our lives must be subjected to an inventory in order to battle global warming and reduce our carbon footprints,” said Pelosi in May (Marc Morano, Climate Depot 6/26/09).

The lowest cost estimate is Obama’s—the cost of a postage stamp per day. “It’s paid for by polluters who currently emit dangerous carbon emissions” (AP 6/27/09). The CBO estimate is $175/yr for the average household, after tax credits and rebates, but not counting effects on employment or gross domestic product. Taking the Obama Administration’s estimate of $650 billion from auctioning carbon permits, and “knowledgeable” estimates of $2,000 billion for impact on consumers, and dividing by the number of households and 10 years, the Science and Environmental Policy Project (SEPP) calculates $650 to $2,000 per year per household. (The Week That Was 6/27/09).

The net reduction in jobs, according to Charles River Associates International, would be between 2.3 million and 2.7 million per year, as manufacturing is outsourced to China and India.

In the House Energy Committee, three Republican amendments were defeated during the few days in which debate was allowed: to suspend the program if gasoline prices hit $5/gal, or electricity prices increased 10%, or unemployment rates hit 15% (Wall St J 6/26/09).

If the emissions reductions goal were met—reducing carbon dioxide emissions to 1907 levels, when the primary mode of transportation was horses—the largest possible effect on temperature by the end of the century would be 0.2 degrees Fahrenheit, according to a climate modeling study by Chip Knappenberger (ibid.) Obama called the initial targets set by the House bill “modest” (NY Times 6/28/09).

As the House was voting on the biggest tax increase in history on 100% of Americans, the Obama Administration attempted to suppress a report by EPA scientists that “completely blows apart the scientific underpinnings of the endangerment finding that the EPA administrator made on CO2” (NY Times 6/26/09).

Alan Carlin and John Davidson were ordered, in emails obtained by the Competitive Enterprise Institute (CEI), not to communicate to the public their conclusion that the global warming theory is bunk, because the Administration had decided to go ahead with “the endangerment finding.” CEI has posted the report.

Obama pulled back an address on the urgency of health care reform, substituting a message focusing on the House “climate victory.” He is already turning up the pressure on the Senate, where the “cap and tax” energy-rationing proposal faces stiff opposition (NY Times 6/28/09).

Voting against the bill were 44 Democrats, and voting for it were eight Republicans: Mary Bono Mack (R-CA), Mike Castle (R-DW), Mark Steven Kirk (R-IL), Leonard Lance (R-NJ), Frank LoBiondo (R-NJ), John McHugh (R-NY), Dave Reichert (R-WA), and Chris Smith (R-NJ).

Additional information:

Posted in Uncategorized | 2 Comments »

Myth 2: A public plan could save enough on administrative costs to provide coverage to all.

Monday, June 29th, 2009

It is frequently asserted, especially by groups such as Physicians for a National Health Program (PNHP), that a “single payer” (government) system could “save” enough money on administration to buy coverage for all the uninsured. (more…)

Posted in health care reform, mythbusters | 9 Comments »

Myth 1: An electronic medical record could save your life in an emergency

Monday, June 29th, 2009

Information technology does not stop bleeding, start IVs, defibrillate the heart, or put in a breathing tube. In an emergency, those are the things that save your life. If you need them, the doctor does not have time to look at your EMR. (more…)

Posted in information technology, mythbusters | 13 Comments »

Where is the money for “health care reform”?

Sunday, June 28th, 2009

At a Tucson “tea party” on June 22, Steven Knope, M.D., opened the discussion with the remark that the U.S. just doesn’t have the money for the proposed “change” in American medicine—or anything else.

This is becoming increasingly clear to foreigners, if not to Americans. The U.S. was told “no” when it requested to attend the June 15/16 meeting in Yekaterinburg, Russia, as an observer. The six-nation Shanghai Co-operation Organisation was discussing ways to challenge American economic hegemony.

Member nations are Russia, China, Kazakhstan, Tajikistan, Kyrgyzstan, and Uzbekistan. Iran, India, Pakistan, and Mongolia have observer status.

“If China, Russian and their allies have their way,” writes Michael Hudson, the “world’s largest debtor” will no longer be able to “live off the savings of others” (Financial Times 6/15/09).

Some believe that the U.S.—or “Wall Street”—has been propping up the dollar by temporarily smashing the prices of commodities such as gold and crude oil. Having been thwarted in its efforts to buy an important stake in Western commodity firms such as Unocal or Rio Tinto, China has been directing its dollar reserves toward hedge funds, writes Jim Willie. He views this as part of an encirclement strategy, which will deprive the U.S. of a key method of supporting the dollar.

“China commands the Great Wall of Money that will eventually cascade onto world markets. That cascade could be more important as a factor in generating U.S. price inflation than the buildup and spillover of the USFed balance sheet” (Goldseek.com 6/18/09).

Chinese students recently laughed at U.S. Treasury Secretary Timothy Geithner when he told them that Chinese dollar assets were safe. Former Chinese central bank advisor Yu Yongding referred to the Federal Reserve as the “world’s biggest junk investor.”

If one counts private debt, official government debt, off-budget obligations, and internal commitments, America owes 100 times as much as Weimar Germany. And it just keeps borrowing more. In 2009 alone it will borrow $1.3 trillion, “just shy of the debt that sank the Weimar Republic,” writes Bill Bonner (LewRockwell.com 6/22/09).

The Federal Reserve is adding bank reserves at a rate that allows the money supply to expand geometrically, at a rate of 4,500%. Any normal bank that did that would be closed down immediately, Bonner states.

In 1923, Karl Helferich, Chairman, Central Bank of Germany, wrote: “To follow the good counsel of stopping [the inflation machine] would mean…that in a very short time the entire public, factories, mines, railways and post office, national and local government, in short, all national and economic life would be stopped.”

Some argue that hyperinflation will not occur—because the inflation machine simply will not work any more. Deflation is inevitable, they say, because of continuing debt collapse. Open market paper, instead of growing as it had in almost every prior quarter in history, is collapsing at an annual rate of $662.5 billion. The only major player borrowing money in big amounts is the U.S. Treasury, sopping up $1,442.8 billion of the credit available, leaving less than nothing for the private sector, writes Mish Shedlock (Mish’s Global Economic Trend Analysis 6/24/09).

Would more regulation work? Richard Maybury writes that instead of being restrained by a free market (contracts, courts with informed juries, and competition), all financial entities, no matter how incompetent or dishonest, are now under the same massive regulatory umbrella, so it is impossible to distinguish good guys and bad guys. Regulations are providing camouflage for crooks. Massive malinvestments in the U.S. economy are not being corrected. Huge injections of money are simply not being circulated. (Daily Bell 6/7/09).

The current version of “regulatory reform,” in any event, amounts to handing dictatorial control of the entire U.S. economy over to the Federal Reserve, said Congressman Ron Paul, M.D. (R-TX).

Paul concludes, in his June 22 weekly address, that the apparent goal of the Administration and Congress, with the continuing round of “stimulus” packages, is to bring about the total economic collapse of the United States.

“Bank robbers rob banks because that’s where the money is. Similarly, governments tax producers because that’s where the money is,” observes Robert L. Hale (Reactionary Utopian 5/20/09). Compared with the other five-sixths of the economy, how well off is medicine? Is it likely to be the sink for redistributed money—or the source?

Additional information:

Posted in Uncategorized, health care reform | 7 Comments »

Kennedy bill breaks Obama’s promises

Monday, June 22nd, 2009

In his campaign speeches and recent talk to the AMA, Obama promised that all Americans would “be able to get the same kind of coverage that members of Congress give themselves.”

The proposed Kennedy bill, the Affordable Health Choices Act, however, specifically exempts members of Congress and other employees from being pushed into stingy plans with HMO-type controls (section 3116), notes Betsy McCaughey (Wall Street Journal 6/16/09).

Contrary to what many seem to believe, the Federal Employee Health Benefits Program (FEHBP) is not a public plan. Rather, it offers a wide range of private plans, paid for by the employer—the federal government. Those plans include low-cost, high-deductible plans coupled with health savings accounts.

Ordinary Americans would have to enroll in a “qualified” plan—or else be tracked down and fined (sections 3101 and 6055). We won’t know all the requirements until after the bill gets passed and the Secretary of HHS writes the rules. The language suggests that the plan will require a “medical home” (sections 3101 and 2707). That is likely to be this decade’s version of the HMO gatekeeper, writes McCaughey.

The “payment structure” will be based on “incentives” to “provide the best care, rather than more care.” In other words, an incentive to get paid more by doing less.

Both Obama and Kennedy promise that if you like your plan you can keep it. The question is, how big a fine will you have to pay? The bill sets no limit, but says it will be enough to “accomplish the goal of enhancing participation in qualifying coverage” (section 161).

Obama also promises people that they can keep their doctor. Assuming, of course, that he’s still available on the patient’s plan. Or still in practice at all, after automatic, across-the-board Medicare spending cuts are triggered by failure to meet cost-cutting targets, as proposed by Senator Baucus.

Additional information:

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Alert: for physicians not opted out of Medicare

Saturday, June 20th, 2009

CMS asks that you share this important information with all of your association members and State and local chapters. 

Scam Alert

CMS has become aware of a scam where perpetrators are sending faxes to physician offices posing as the Medicare carrier or Medicare Administrative Contractor (MAC).  The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments.  The fax may have  the CMS logo and/or the contractor logo to enhance the appearance of authenticity.

Medicare FFS providers, including physicians, non-physician practitioners, should be wary of this type of request.  If you receive a request for information in the manner described above, please check with your contractor before submitting any information.  Medicare providers should only send information to a Medicare contractor using the address found in the download section of the  CMS.gov website found at

http://www.cms.hhs.gov/MLNGenInfo/ or

http://www.cms.hhs.gov/MedicareProviderSupEnroll .

Mary Case for Valerie A. Haugen, Director
Division of Provider Information Planning & Development
Provider Communications Group, CMS
(410) 786-6690
Valerie.Haugen@cms.hhs.gov

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Digital panacea is fiscally disastrous, clinically dangerous

Friday, June 19th, 2009

While advances in technology—eagerly adopted by doctors and hospitals—are often blamed for high medical costs, there is one type of technology that will supposedly save billions once we “invest” billions in it and force it on supposedly recalcitrant, technophobic doctors and hospitals: health information technology (HIT), including the electronic medical record (EMR) and computerized physician order entry (CPOE).

“Faith-based cost control” is the term used by Dr. Jon Oberlander in a “Perspective Roundtable: Health Care and the Recession,” offered by The New England Journal of Medicine in January, 2009.

The “stimulus” package provides between $44,000 and $64,000 for physicians who acquire an EMR and demonstrate “meaningful use.” However, “the price is dwarfed by the problems [an EMR] causes the office,” stated Evan Steele, CEO of SRS Soft, which provides a less complex alternative. If a specialist who bills $750,000 a year loses 5% of her productivity dealing with the computer system, she loses $162,000 over 5 years (Physicians Practice, April 2009).

Even the vaunted Veterans Administration system has major problems. An 8-year, $167 million project was not able to develop acceptable scheduling software. The military’s AHLTA system is so slow, unreliable, and cumbersome that clinicians spend 40% of their time inputting data, causing a “near mutiny” (CPR #172, 4/3/09).

For ₤12.7 billion the UK still does not have a national health information technology system, but rather an HIT quagmire, some of it caused by U.S. HIT vendors, writes Dr. Scot Silverstein to the Wall Street Journal.

The province of Ontario just created a new agency, eHealth Ontario, to replace Smart Systems for Health Agency, which spent $647 million without showing any noticeable results. The new agency is supposed to provide EMRs for all citizens by 2015. The province has just hired a consultant to examine whether eHealth Ontario is spending too much money on consultants (Canada Free Press 6/9/09).

In the U.S. also, “most big health IT projects have been clear disasters,” says Dr. David Kibbe, senior technology advisor to the American Academy of Family Physicians. And it’s not just the money.

One U.S. pharmaceutical data base found 43,372 medication mistakes, or about 25% of the total reported in 2006, that involved computer technology: flaws in data entry, inadequate software, and confusing screens. In 2006, Children’s National Medical Center in Washington, D.C., found an eightfold increase in dosage errors for high-risk medications (Terhune C, et al., Business Week 4/23/09).

A 2005 study by University of Pennsylvania sociologist Ross Koppel found 22 circumstances in which the software boosted the probability of error. Doctors also suffered from “alert fatigue” from endless false alarms about minor drug interactions.

“If drug companies sold products with this quality level,” states Dr. Scot Silverstein, “it would be a scandal” (Forbes 5/11/09).

HIT vendors shift liability to users and insert contract language that keeps them from learning of serious faults (Koppel R, Kreda D, JAMA 3/25/09).

“There is a dearth of data on the incidence of adverse events directly caused by HIT overall” (Joint Commission. Sentinel Events Alert, Issue 42, 12/11/08). Among many potential problems are “dangerous workarounds” necessitated by counterproductive technology.

Potential benefits have been greatly exaggerated. Large randomized controlled studies in both the U.S. and Britain have found that EMRs with computerized decision support “did not result in a single improvement in any measure of quality of care for patients with chronic conditions including heart disease and asthma” (Washington Post 3/17/09).

As a direct consequence of the EMR and pay for performance (P4P), the veracity of the clinical record is compromised, write David J. Gibson, M.D., and Jennifer Shaw Gibson (“The Case Against the Electronic Medical Record,” MedicalTuesday.net). Reported data may be “dry-labbed,” and, once entered, data are rarely checked for accuracy.

There are good reasons why only 1.5% of U.S. acute-care hospitals have a comprehensive EMR (Jha AK, et al. N Engl J Med 4/16/09).

Obama’s estimate of savings is an $80 billion exaggeration,” write Jerome Groopman and Pamela Hartzband (Wall Street Journal 5/12/09).

Additional information:

Posted in information technology | 14 Comments »

Kennedy plan estimated to cost $4 trillion, four times CBO estimate; legislation pushed at frantic pace

Wednesday, June 17th, 2009

The Congressional Budget Office (CBO) released a cost estimate of $1 trillion over 10 years for the Democrats’ Senate bill, scheduled to be marked up in the Health, Education, Labor and Pensions (HELP) Committee on July 18. This draft did not include provisions to increase Medicaid eligibility to 150% of poverty, or subsidies to persons earning up to 500% of poverty. It would leave 30 million uninsured (American Spectator, AmSpecBlog 6/16/09).

Adding in these provisions, which would lower the uninsured to less than 1% of the population, would raise costs to $4 trillion, according to calculations by Health Systems Innovations Network (HSI). About 79 million Americans would shift from private to government insurance. There is no mention of removing the tax exclusion for health insurance (worth some $300 billion per year) or of changes to Medicare or Medicaid, except for the need to reduce fraud.

The CBO’s estimate of crowd-out (loss of private coverage) was 23 million. The CBO noted that if enacted the bill would break a key Obama promise that those with private insurance would not be harmed.

Leading Democrats such as Christopher Dodd (D-CT) complained that CBO did not take into account receipts or savings from increased tax revenues as people moved from employment-based to other coverage, payments of penalties by uninsured persons, and reductions in outlays for Medicaid and SCHIP—including reduced payments to physicians. Also the CBO refused to take Congress at its word on savings assumptions, as from prevention.

Dodd told reporters that “reform” would affect 100% of the population. He could not, however, answer questions about the cost. “Contentious issues like a public plan” had been intentionally omitted from the draft submitted to CBO (CNS News 6/17/09).

The New England Journal of Medicine continues to weigh in with frequent articles.

“Some of the most prominent shortcomings of the U.S. health insurance market are rooted in the fact that the system is a voluntary one,” write Linda J. Blumberg and John Holohan in the issue slated for publication on July 2. They favor an individual mandate as the most politically feasible route to universal coverage.

In an update on congressional action dated June 18, John Iglehart notes the accelerated timetable for passing a bill through the House of Representatives by July 31. Neither Republicans nor the 50 Democrats in the House Blue Dog Coalition have participated in the secretive process.

A major issue is whether to eliminate the tax exclusion for employer-sponsored insurance—“the government’s third-largest health insurance expenditure (after Medicare and Medicaid).”

Iglehart also writes that the committees have yet to grapple seriously with the issue of what to do about the 21% reduction in physician Medicare fees scheduled for next January.

After the table-setting, the congressional posturing, and the Long Tease (the current stage) comes the scrum, writes New York Times columnist David Brooks. “You want the scrum to be quick before some of the interest groups realize they’ve been decapitated.”

Additional information:

Posted in health care reform | 8 Comments »

Obama disses doctors; gets standing O at AMA

Tuesday, June 16th, 2009

At the annual meeting of the AMA House of Delegates in Chicago, President Obama made an appearance to court physician support for his ideas for a comprehensive, government-directed “overhaul” of American medicine. Reportedly, he got a standing ovation from polite delegates, though there was a smattering of “boos” when he expressed opposition to limits on malpractice awards.

“Now, just hold on to your horses here, guys,” he told doctors when they applauded him for sympathizing with their worries about lawsuits. “I want to be honest with you. I’m not advocating caps on malpractice awards—which I personally believe can be unfair to people who’ve been wrongfully harmed.”

Obama called opponents of his plan “naysayers,” “fear-mongers,” and “peddlers of ‘Trojan horse’ falsehoods.” One such opponent is Representative Tom Price, M.D., of Georgia, an orthopedic surgeon, who calls the Obama proposal a “government takeover” that will set up a rationing board.

Obama stated publicly, for the first time, that his proposed “reshaping” would cost “about $1 trillion over 10 years.” That would include covering almost 50 million Americans who don’t have insurance. But not to worry: he ticked off $950 billion in hypothetical savings. These include cutting payments to hospitals for care of the uninsured, cuts in overpayments to Medicare Advantage plans, “adjusting” Medicare payments to reflect new advances, introducing generic biologic drugs, and reducing preventable hospital readmissions. This doesn’t count savings from computerization, prevention, and other things that the Congressional Budget Office can’t score.

There would also be revenue increases, as by “modestly limiting” the tax deductions of the “wealthiest Americans.” That should bring in $300 billion over 10 years for the $635 billion Health Reserve Fund.

Obama is for the “public option” and individual and employer mandates (“bearing a responsibility to own health insurance”). Not mentioned in the speech is his new “openness” to the idea of taxing some people’s health insurance benefits for the express purpose of subsidizing insurance for others. John Goodman notes that the Obama campaign spent hundreds of millions of dollars attacking John McCain for proposing to tax insurance benefits. Goodman explains the differences in proposed changes to the tax treatment of health insurance.

The huge cost of workers’ health care was “a big part of what led General Motors and Chrysler into trouble,” Obama said. Thus, the cost of not enacting his plan is higher than the cost of passing it, he asserts.

Obama promises to help doctors by seeing to it that “doctors can pull up on a computer all the medical information and latest research they’ll ever need to know to meet patients’ needs.” (No need for patients to tell every doctor they see their medical history.) Instead of “piecework” payments, and yearly negotiations over the Sustained Growth Rate, he proposes to pay for patients’ overall health status. He’ll get rid of cost disparities, like those in McAllen, Texas, detailed by Atul Gawande in a much quoted article in The New Yorker.

In return, he needs the doctors’ help. “The fact is, Americans—and I include myself, Michelle, and our kids in this—we just do what you tell us to do.”

Obama promised that “if you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” Same for “your doctor.”

He did not promise, however, that the price would not become unaffordable because of new regulations, such as guaranteed issue or community rating, or that the plan would still be available. Or that the doctor would still be in practice.

Congressmen, including Charles Rangel (D-NY), say the “overhaul” will definitely cost more than $1 trillion. Sen Orrin Hatch (R-UT), estimates that costs will exceed $1.5 trillion. Legislation being drafted by House Democrats will include $600 billion in tax increases and $400 billion in cuts to Medicare and Medicaid.(Bloomberg.com 6/12/09).

Additional information:

Posted in health care reform | 12 Comments »

Responding to President Obama’s doomsday predictions

Friday, June 12th, 2009

The President has kicked off the health care reform charge in the past week. Last Saturday, he used his weekly radio address to call for
a quick solution to the crisis, while his Town Meetings swung into high care, with him speaking today.

One of the best and most influential policy analysts and patient advocates, Betsy McCaughey, PhD, sent us a note that is one of the clearest rebuttals to most of the doomsday claims made by the President in his radio address, and again today at the town meeting. It also includes a link to her new article in American Spectator that blows the roof on many more of the claims – -titled “Downgrading American Medical Care.”

After you finish the articles, we recommend that you watch the video of Dr. McCaughey from our AAPS Congressional briefing held on April 16. Some of the data she is sharing cannot be found anywhere else.

READ “Downgrading American Medical Care”

WATCH THE VIDEO & COMMENT

FROM BETSY MCCAUGHEY:

New York, NY – June 9, 2009. In his Saturday weekly radio address, President Obama referred to the dangers of “skyrocketing costs” of healthcare. This doomsday scenario is untrue.

The truth is that healthcare spending is increasing at more moderate rates than in previous decades. Spending increased by 10% in 1970 and 13% in 1980. But over the last five years, spending increased less than 7% each year and reached a low of 6% in 2007. For more of the truth, backed up by government data, see “Downgrading American Medical Care,” at http://spectator.org/archives/2009/06/08/downgrading-american-medical-c

The evidence shows that Americans can afford their current standard of healthcare. They do not have to settle for the skimpier standards of care imposed by most Europeans governments. What Americans cannot afford is a healthcare overhaul based on misinformation.

“The President and his advisors owe the American people the truth, not misleading economics to back up their political agenda,” states Betsy McCaughey, Ph.D., a patient advocate and author of “Downgrading American Medical Care.”

“Slowing the flow of dollars into healthcare, as the President requests, will mean cuts in hospital budgets, nurses spread even thinner, fewer diagnostic machines, and waits for treatment,” McCaughey warns. “It’s an outrage that Americans coping with serious illnesses will have to make do with less.”

Posted in Uncategorized, health care reform | 3 Comments »

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