Random Thoughts » The DJP Update

DJP Update 3-19-2010: More breaking news & it is encouraging! Today 240,000 doctors in surgical coalition come out against health bill.

Mar 19

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP Update 3-19-2010: More breaking news & it is encouraging! Today 240,000 doctors in surgical coalition come out against health bill.

Hmm… More members than AMA? AMA represents all doctors via the various organizations yet large numbers of organizations that sit in the House of Delegates are coming out against the bill. They also know AMA policy and helped develop it. When Congress or the AMA Board doesn’t listen, then one must participate in elections and change the folks in those positions. That is the American way unless you have moved on and consider that a waste of time as far as AMA is concerned.

Here is the letter I just received. It also is posted at American Society of Anesthesiologists (ASA) Website: http://www.asahq.org/Washington/SS_HR3590FINAL.pdf

March 19, 2010

The Honorable Nancy Pelosi

Speaker, U.S. House of Representatives

H-232 The Capitol Building

Washington, DC 20515

Dear Madam Speaker:

On behalf of the more than 240,000 surgeons and anesthesiologists we represent and the millions of surgical patients we treat each year, the undersigned organizations are committed to meaningful health reform that will make affordable, quality health care more accessible to all Americans. Our organizations have consistently stated that the health care reform package must be built on a solid foundation and in the best interest of our patients. Unfortunately, the Senate-passed Patient Protection and Affordable Care Act of 2009 (PPACA, H.R. 3590) fails to build such a foundation, and it falls short when considering the needs of our patients. As a result, we are opposed to H.R. 3590.

Over the past year and a half, we have regularly communicated with Congress regarding our concerns such as the creation of the unelected, unaccountable Independent Payment Advisory Board (IPAB), the failure to repeal the sustainable growth rate (SGR) and implement a new Medicare payment system, and other provisions in H.R. 3590. Following the release of the Patient Protection and Affordable Care Act of 2009 last November, our organizations were left with no choice but to oppose H.R. 3590, and we clearly conveyed our disappointment to Senate Majority Leader Harry Reid in December. Our opposition was also shared with House leadership and the House Committees of jurisdiction. Likewise, our organizations sent a February 19 letter to the President expressing our continued concerns with H.R. 3590. Finally, this letter to the President was also followed by a March 12 letter to you outlining our concerns and the reasons for our opposition to H.R. 3590. In spite of our considerable effort to share our concerns, our fundamental concerns remain unaddressed.

The surgical coalition remains committed to the passage of meaningful and comprehensive health reform that preserves and improve Americans’ ability to access high quality surgical care and health care services. It is this commitment that requires the surgical coalition to oppose a bill that would undermine quality and threaten patient access to surgical care.

Sincerely,

American Academy of Facial Plastic and Reconstructive Surgery

American Academy of Ophthalmology

American Academy of Otolaryngology-Head and Neck Surgery

American Association of Neurological Surgeons

American Association of Orthopaedic Surgeons

American Congress of Obstetricians and Gynecologists

American College of Osteopathic Surgeons

American College of Surgeons

American Osteopathic Academy of Orthopedics

American Pediatric Surgical Association

American Urological Association

American Society of Breast Surgeons

American Society of Anesthesiologists

American Society of Cataract and Refractive Surgery

American Society of Colon and Rectal Surgeons

American Society for Metabolic & Bariatric Surgery

American Society of Plastic Surgeons

Congress of Neurological Surgeons

Eastern Association for the Surgery of Trauma

Society for Vascular Surgery

Society of American Gastrointestinal and Endoscopic Surgeons

Society of Gynecologic Oncologists

Society of Surgical Oncology

————————————–

————

A Politico article just sent to me.

http://www.politico.com/livepulse/0310/EXCLUSIVE__Democrats_plan_doc_fix_after_reform.html

EXCLUSIVE — Democrats plan doc fix after reform

But see followup posting at Politico: http://www.politico.com/livepulse/0310/EXCLUSIVE__Democrats_plan_doc_fix_after_reform.html

UPDATE: Democrats challenge authenticity of ‘doc fix’ memo———–

———

And this one from the Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2010/03/18/AR2010031803558.html?wpisrc=nl_pmopinions

On health reform’s price tag, score one for skepticism

————

And one last Weblink to an article at Galen Institute: http://www.galen.org/component,8/action,show_content/id,14/category_id,0/blog_id,1381/type,33/

Blindsided?

By Grace-Marie Turner

A discussion of procedure in Congress.

————

DJP Comment: The games adults play! What is true? What is rumor? Meanwhile doctors have to care for patients. Most will believe “Doc Fix” removed by Congress to prevent unfavorable “score” by CBO. But this doesn’t fool the Public. If the 21% fee cut happens, access to care will be at risk. Congress can’t allow that as the Seniors will revolt and then there will be a real problem! Too bad no one allows patients and doctors to privately contract without penalty like Australia does. The government pays what it can afford and the patients and doctors decide if a greater fee is needed. If the patient doesn’t agree with the doctor’s fee, the patient shops and the Free Enterprise system kicks in. The patient finds a doctor who is qualified and who agrees to what the patient believes is reasonable. That is the difference between government control and Liberty. Take the chains off of patients and doctors. Remember, a change to another price-fixing formula and stating the “SGR” is dead is not really a win. Others still in control of your destiny.

Stay well.

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us

This DJP Update goes to 2223 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

Comments (0)

TOP

DJP 3-19-2010 afternoon ALERT: AMA comes out in support of Senate bill now in House; AMA Phone conference summary; LAGNIAPPE: Time for a JAZZ Funeral for AMA so we can remember the good times in the past.

Mar 19

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP 3-19-2010 afternoon ALERT: AMA comes out in support of Senate bill now in House; AMA Phone conference summary; LAGNIAPPE: Time for a JAZZ Funeral for AMA so we can remember the good times in the past.

Wrong phone number for conference call send out by AMA as I stated in last email. Dr. Lazarus stated a correction email was sent out by AMA. I apparently am not on email list from AMA for HoD even though as a past-president I sit in the House of Delegates as a non-voter with microphone privileges. I had to call AMA to get correct phone number.

Speaker of AMA House of Delegates Dr. Lazarus stated at start of conference call that a press conference was being conducted by AMA President Rohack at same time of AMA House of Delegates conference call.

Dr. Lazarus said, in part:

————–

After carefully considering… H.R. 3590 should be passed.

Quotes 2.095 and 10.01

We don’t subscribe to end justifies the means…

Starting over is not the answer…

Pending bill moves Country forward…

The reconciliation process precluded changes….

AMA will be relentless…

IPAB remains in bill etc, etc,

DJP comment: IPAB is Independent Payment Advisory Board with significant authority.

————–

I was given the opportunity to ask a question and I asked that the comment that Dr. Lazarus stated about private contracting be repeated as I missed part of it. Dr. Lazarus read that sentence again and in summary stated that private contracting without penalty is neither better or worse in this proposed legislation but AMA will continue to talk with the Administration about this. I then summarized that the message is physicians and patients still cannot privately contract without penalty.

DJP comment to this email list: This means we did not get AMA policy implemented into this bill. The Liberty right of patients and physicians remains abridged.

While the phone conference still was going on, I went to the AMA Website and found this press release:

http://www.ama-assn.org/ama/pub/health-system-reform/ama-supports-reform-passage.shtml

AMA Supports House Passage of Health System Reform

Will work with Congress and the administration to make critical changes that cannot be addressed through the reconciliation process

For immediate release:

March 19, 2010

Washington, D.C. – After careful review and consideration, the American Medical Association (AMA) today announced its qualified support for the current health reform bill as a step toward providing coverage to all Americans and improving our nation’s health system.

“The pending bill is imperfect, but we cannot let the perfect be the enemy of the good when it comes to something as important as the health of Americans,” said J. James Rohack, M.D., AMA president. “By extending health coverage to the vast majority of the uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, this bill will help patients and their physicians.”

“While the final product is certainly not what we would have devised, we strongly support the parts of this bill that are desperately needed by millions of Americans who are struggling to get or keep health insurance coverage,” Dr. Rohack said. “We will continue to work with Congress and the administration to solve important issues that cannot be addressed through the reconciliation process.”

“This is not the last step, but the next step toward real health system reform,” Dr. Rohack said. “We will remain actively engaged with Congress and the administration to ensure that before Congress adjourns there are additional important changes to our health system. Congress must act to preserve access to care for seniors and military families by permanently repealing the Medicare physician payment formula that will cut Medicare payments by 21 percent next month. According to an AARP poll, nearly 90 percent of people age 50 and older are concerned that the Medicare physician payment cuts threaten their access to care.”

“Congress must also move immediately to correct problems with the Independent Payment Advisory Board,” Dr. Rohack said. “The current IPAB framework could result in misguided payment cuts that undermine access to care and destabilize health care delivery. The AMA will be relentless in our pursuit of permanent repeal of the Medicare physician payment formula, corrections to IPAB, and other important changes that we outlined in a letter today to House Speaker Nancy Pelosi.”

“Every day physicians see the devastating effect that being uninsured has on the health of our patients: They live sicker and die younger,” Dr. Rohack said. “Physicians dedicate their lives to helping patients live healthier and longer, and we have an historic opportunity to do just that.”

###

Media contact:

Katherine Hatwell

American Medical Association

202-789-7419

katherine.hatwell@ama-assn.org

———

AMA now joins American College of Physicians (ACP) in support of this bill.

LAGNAIPPE: Sad day for Medicine. Time to consider a New Orleans Jazz Funeral for our AMA and celebrate the good days.

I will say no more. If I did say more, I would repeat what I said in the earlier DJP Update of today quoting from my speeches in 1978 and in 1985.

Meanwhile, keep the calls going to the House and the Senate. Like the Marines or Special Forces, you don’t need large numbers on your team to win, just smart courageous folks who do their homework, have courage, and don’t give up.

The Q & A continues on conference call but I am going to hit the send button now.

Stay well.

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Comments (0)

TOP

DJP Update 3-19-2010 Anesthesiologists (ASA) say NO on health bill; AMA HoD conference call today at Noon; LAGNIAPPE: Thoughts from the past as you fight for patients and physicians

Mar 19

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP Update 3-19-2010 Anesthesiologists (ASA) say NO on health bill; AMA HoD conference call today at Noon; LAGNIAPPE: Thoughts from the past as you fight for patients and physicians

TIME SENSITIVE ESPECIALLY ITEM TWO

ITEM ONE: Anesthesiologists (ASA) say NO on health

Here is the tweet at: http://twitter.com/djpNEWS

DJPNEWS

More doctor organiz oppose current health bill #hcr #ASA Anes.http://tinyurl.com/yk6nvec & #TexMed http://tinyurl.com/ydssh6e

———-

ITEM TWO: AMA HOUSE OF DELEGATES CONFERENCE CALL TODAY AT NOON – call 800.794.6070 and enter the pass code 8278297#

From: AMA Delegates <ama.delegates@enews.ama-assn.org>

Sent: Fri, Mar 19, 2010 8:33 am

Subject: Health System Reform Legislation – Conference Call for the House of Delegates

To: Delegates and Alternate Delegates

From: Jeremy A. Lazarus, MD, Speaker, and Andrew W. Gurman, MD, Vice

Speaker

Our email of March 10 noted our intent to convene a conference call

after the final legislative language on health system reform was

reviewed and analyzed.

We will hold a call at 12 noon, Central time (1:00 pm Eastern, 11:00 am

Mountain, 10:00 am Pacific) TODAY (Friday, March 19). Your Speakers will

be on the call along with other members of the Board of Trustees to

discuss developments with health system reform legislation.

To participate, call 800.794.6070 and enter the pass code 8278297# (you

must include the # sign).

This call is meant for delegates and alternate delegates. We realize

this is short notice and will be setting up an additional call for the

Federation later today, which you may participate in as well. That

call-in information will be forthcoming as soon as it is available.

—————

CAUTION:

Be sure to read the health bill as it passed the Senate PLUS read the amendments that also will be voted by the House. Thus the complete and complex legislation that may become law will include both of those. They are available online. Read the readmissions policy. Read the payment control and price-fixing. Note the complexity. It would be very interesting to have a quiz given to those supporting this bill to see how many answers they get correct. That would include Congress as well as any doctors supporting it.

———–

ITEM THREE: LAGNIAPPE – Thoughts from the past as you fight for patients and physicians

Year 1978:

The Regulators

Guest Editorial

The Regulators:

The Danger of Blind Obedience

DONALD J. PALMISANO, MD New Orleans

In my opinion, we will receive more demands from regulatory bodies and voluntary accrediting agencies. We must be ever vigilant lest our freedoms be compromised or our patients harmed. We must protect the trusted doctor-patient relationship. I submit we have a covenant with our patients. We have a responsibility to them higher than the morals of the marketplace because of our position of trust; it is a fiduciary relationship. People in their moments of illness tell us their innermost secrets as they fight for their lives. The confidentiality of the patient must not be violated.

The person who advocates blind obedience to regulations is in reality no different than the cowards of Nazi Germany who herded innocents into gas chambers because the regulations told them a specific number had to die each day.

BEWARE OF A HOLOCAUST OF FREEDOMS AND INDIVIDUAL RIGHTS LIT BY PERFUMED POPINJAYS SPEWING REGULATIONS THAT WOULD CHAIN YOUR REASON AND CONSCIENCE.

Have you not heard the voices of those (administrators, doctors or others) who sell their intellectual birthrights of freedom and independence?

The payment varies; some get money: some get certainty: and some compromise regulatory lawsuits to avoid controversy and possible attention to their jobs. Because of their ever-changing chameleon-like characters and bankrupt philosophies with resulting low self-esteems, they fear that. the spotlight will cause loss of their jobs. Not a few even opt for power to control you. Their rationalization is the same: “Oh, you don’t understand. This is the law (or regulation); we have no choice. If we don’t do it or join, it will be done to us without our participation. At least by obeying or joining, we have some ‘input’. Our funds will be cut off.”

THREAT – COERCION – FEAR OF LOSS – SUBMISSION – THE PATTERN IS MONOTONOUS. What these cowardly individuals fail to understand is that victory falls to the regulators when you sanction their actions.

Do not forget that “The power to tax involves the power to destroy”(Chief Justice Marshall, United States Supreme Court: McCulloch vs. Maryland 17 U.s. (4 Wheat) 316 (1819).) The power to regulate is the power to enslave. Absolute power corrupts.

Let us briefly look to a specific US Supreme Court case and note the judge’s advice and see if you experience a deja vu:

In United States vs. Butler 297 US I (1936), a Congressional Act sought to raise farm prices by reducing surplus production. Farmers who agreed to contract with the Department of Agriculture were paid money extracted from all farms taxed on a particular commodity. A cotton processor challenged the tax stating the Act was beyond congressional constitutional authority. The US Supreme Court agreed with the farmer and ruled the scheme unconstitutional.

It is interesting to note the judge’s answer to the claim of the government that the plan was constitutional because it was voluntary:

The regulation is not in fact voluntary. The farmer of course may refuse to comply, but the price of such refusal is the loss of benefits. The amount suffered is intended to be sufficient to force pressure on him to agree to the proposed regulation. The power to confer or withhold unlimited benefits is the power to coerce or destroy.

If the cotton grower elects not to accept the benefits, he will receive less for his crops: those who receive payments will be able to undersell him. The result may well be financial ruin. The coercive purpose and intent of the statute are not obscured..

Before you accept the premise of a plan, keep in mind that the “power to tax lightly is the power to tax severely”. (New York vs. United States 326 US 572 (1946).) (You could equally well substitute the word regulate for tax.)

I advocate knowledge and rational lawful activism. Read the law or regulation. Use reason to analyze it. Is it just and in the best interest of those who have entrusted themselves to your care: or is it arbitrary, unreasonable or capricious. Does it preserve the right of confidentiality? Question the regulations.

Do not be intimidated and accept answers cloned from Humpty Dumpty:

In Through the Looking Glass by Lewis Carroll. Alice asks Humpty Dumpty “Why do you sit out here all alone?’

“Why because there’s nobody with me!,” cried Humpty Dumpty.

“Don’t you think I know the answer to that! Ask another?’

Ask the regulator to put his answer in writing and sign it. Ask him who will be responsible if irreparable harm is done to your patient as a result of his regulation.

Circulate copies of your question and his response to the appropriate authorities, legislators and the press.

The bright light of inquiry and careful documentation may cause the incompetent or unreasonable regulator to flee like the amoeba under the microscope when the viewing light is turned on.

Remember, if men of integrity and courage had not challenged regulations and taxes, there would have been no Declaration of Independence. Let us not forget our heritage and let us not by default desecrate the acts of Americans who died fighting throughout the world for the freedoms we enjoy today.

From the Outgoing Chief of Staff Methodist Hospital, New Orleans, l.a. The speech was given on October 9, 1978.

JANUARY. 1979- VOL 131, No. 1-The Journal of the Louisiana State Medical Society

——-

1985

From another article and speech in 1985: The Sine Qua Non of Quality Medical Care

BY DJP

EXCERPTS:

———-

1. The first inquiry, the sine qua non of the doctor-patient relationship in quality medicine, is simply stated:

Is this in the patient’s best interest? The patient’s welfare must be paramount.

2. Understand that the essence of the acronyms – PPOs, etc. – is contract medicine. An essential part of the contract is payment by third parties to you for services rendered. The responsibility for evaluation of the charge and the responsibility for payment is removed from the patient. Also cost containment, a prominent feature of these contracts, is a concept that may be bureaucratic in conception and flawed in execution. In fact, this may he the Achilles heel of the currently proposed forms of contract medicine because of the potential chameleon-like change into rationing of necessary medical care. Only a patient has the right to ration his or her individual medical care.

5. Never fail to use the concept of “Lateral Thinking” proposed by deBono in his book New Think. Define the problem, challenge assumptions and consider alternative solutions. As physicians, we are trained to use the scientific method and thus have the background to do a proper investigation.

6. Anticipate that a battle of philosophical principles is imminent. If you grant an erroneous premise, all the meetings and attention to detail will not make the conclusion correct. When one concludes that enslavement is wrong it serves no worthwhile purpose to go to meetings that will decide who will be the guards. Challenge assumptions! Remember that those who lust to control your destiny draw their power from your sanction.

7. Have the courage to come to a conclusion and act on your convictions. Do not let intimidation or fear or panic control your destiny. Let reason reign. Remember that one person in the right tips the scales of justice more than the majority in the wrong. In the quest for right, go for truth and not for the votes or market shares. Let Galileo be your hero and not the Opportunists in the Vestibule of Hell vividly portrayed in Dante’s Inferno. Imagine in your mind’s eye Galileo brought before the authorities. They ask him to recant. He looks them in the eye and says, “Though it may be heresy, the fact remains that the earth revolves around the sun” Cherish independence. Read for inspiration the life of Thomas Paine, author of Common Sense, and an intellectual father of the American struggle for independence. He too lived in times that tried men’s souls .“

Search out the Brian Hooker translation of Edmond Rostand’s Cyrano de Bergerac. Relax and delight in Cyrano’s bravery and wit, Listen for a moment as Cyrano answers his friend Le Bret.

Cyrano Very well, then I exaggerate!

Le Bret (Triumphantly) Oh, you do!

Cyrano: Yes; On principle. There are things in this world a man does well to carry to extremes.

Le Bret: Stop trying to be Three Musketeers in one! Fortune and glory-

Cyrano:

What would you have me do?

Seek for the patronage of some great man

Make my knees callous, and cultivate a supple spine, – Wear out my belly groveling in the dust?

No thank you! Scratch the back of any swine

That roots up gold for me? Tickle the horns

Of Mammon with my left hand, while my right

Too proud to know his partner’s business,

Takes in the fee? No thank you!

Calculate, scheme, be afraid,

Love more to make a visit than a poem,

Seek introductions, favors, influences? – No thank you! No, I thank you! And again

I thank you! – But, . . . To sing, to laugh, to dream, To walk in my own way and be alone, Free, with an eye to see things as they are, A voice that meal’s manhood – to cock my hat

Where I choose – At a word, A Yes, a No,

To fight – or write. To travel any road

Under the sun, under the stars, nor doubt

If fame or fortune lie beyond the bourne-

Never to make a line I have not heard

In my own heart; yet, with all modesty

To say; “My soul, be satisfied with flowers,

With fruit, with weeds even; but gather them

In the one garden you may call your own.”

So, when I win some triumph, by some chance,

Render no share to Caesar — in a word,

I am too proud to be a parasite,

And if my nature wants the germ that grows

Towering to heaven like the mountain pine,

Or like the oak, sheltering multitudes, – I stand, not high it ‘nay be – but alone!

From Cyrano de Bergerac by Edmond Ilostand – Brian Hooker translation, copyright 1923 by Holt, Rinehart, Winston; copyright 1951 by Doris C. Hooker -reprinted by permission of Hott, Rinehart. Winston, Publisher.

In contrast to the above brave souls, our actions should not he in the model of the social metaphysicians – those who derive their self-esteem from what others think of them. Remember our heritage. America is a land of immigrants born not of privilege but of opportunity. This is a land of giants – not in physical stature but in freedom of the soul. The soul of this nation is a heroic commitment to freedom, liberty and individual responsibility. Inherent in the definition of liberty is the absence of coercion. If you meet critics who state these values are storybook patriotism not consistent with the realities of the present world, have them tell that to the widows and children of Americans who died on battlefields around the world defending these ideals.

Also tell it to those who now stand ready to make the ultimate sacrifice try this nation. To challenge schemes that threaten quality medical care and encourage rationing not in the patient’s best interest should not be a difficult decision to make. The only time it creates anxiety is when the physician fears economic loss for failure to cooperate with what the promoters claim is the wave of the future. Is this a rational fear? Even if the non-joiner went bankrupt, is this a greater burden than the loss of life suffered by those who died for principles? One does not go to a debtor’s prison for bankruptcy. One can start anew and learn how to compete more efficiently the second time around and still not compromise principle. The likelihood of disaster because of failure to join present schemes is remote in my opinion. Also, a currently popular soothsayer, John Naisbitt, concludes that we are now in an information society and human resources are the competitive edge. Quality will be paramount. I believe in Competition, the Free Enterprise System and Freedom of Contract.

These are hallmarks of America. However, as physicians, we must balance competition and efficiency with our fiduciary responsibility to our patients. Compete as a professional and not as a hustler. The competent professional attracts patients with skills of healing, not with thinly disguised kickbacks or coercion.

……

In closing, I would remind you of the beautiful poem by Kipling entitled “If.”

It contains many “If” passages; ie,

If you can bear to hear the truth you’ve spoken twisted by knaves to make a trap for fools,

Then he speaks of risk and my modification follows:

If you can risk it all standing up for truth And the patient’s best interest

Yours is the Earth and everything that’s in it,

And – which is more – you will be a Doctor in the true sense of the word, my son

And lastly, to modify Henley’s Invictus:

My goal is to be the master of my fate:

My goal is to be the captain of my soul.

You have been patient while I exercised by First Amendment rights. Thank you for allowing me to serve you this year as President. As my physician friends in Hawaii say:

Aloha, Mahalo!

Reprinted from pages 15-17 of the May 1985,

Journal of the Louisiana State Medical Society

This speech was delivered to the Louisiana State Medical Society House of Delegates on March 8, 1985 by outgoing president Donald J. Palmisano, MD, JD.

————-

Stay well.

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Comments (0)

TOP

DJP 3-18-2010 Update: State Medical Associations speak out regarding health bill in Congress; Meanwhile AMA still studying; By the way, health bill train pulling out of station

Mar 18

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP 3-18-2010 Update: State Medical Associations speak out regarding health bill in Congress; Meanwhile AMA still studying; By the way, health bill train pulling out of station

Lots of states medical associations and specialty societies are speaking up about the health system reform debate. I previously sent you the list of the Coalition of State Medical and National Specialty Societies who have written Congress and also have written AMA requesting AMA oppose the bill before the House at present. Here are some new letters urging action and encouraging everyone to get involved.

Texas Medical Association (TMA) See full statement below and the Weblink to it.

EXCERPT:

Bad for Patients

TMA’s deep concerns with the bill haven’t changed since the Senate passed the original version on Christmas Eve. “This bill is still bad medicine for our patients, and TMA cannot support it,” TMA President William H. Fleming III, MD, said in December. The legislation…

———

Louisiana State Medical Society (LSMS)

http://www.lsms.org/cms/component/content/article/526

Health Care System Reform Hangs in the Balance

LSMS Call to Action – March 18, 2010

A message from LSMS President Dr. Patrick Breaux and LSMS AMA Delegation Chair Dr. Keith Desonier

The Democratic leadership in the US House of Representatives is pushing franticly to secure the necessary votes to bring a bill to the floor for a vote. It will be the Senate passed HSR bill or a reconciliation bill now being worked on by the House Budget committee (which may contain the embedded “deemed past” language regarding the Senate passed bill). To this point the AMA has remained silent on the impending vote preferring to wait and see the provisions of the reconciliation bill. This, however, is not the time for the AMA to be on the sidelines. It is the time to be in the fray, taking a stand and having the courage and leadership to speak out on behalf of the physicians it represents. If ever there is a time for the AMA to hear from every member it is now making your feelings on these two bills known to the AMA Board of Trustees. We urge you to contact the AMA and lend your voice to the critical debate that will decide the future of health care in America.

Contact the AMA

———

Texas Medical Association (TMA)

http://www.texmed.org/Template.aspx?id=8470

TMA Fights for Patients and Physicians as House Prepares to Vote

Keywords: Liability_Reform Medicare Quality_of_Care

First, do no harm. With the U.S. House of Representatives likely to take a historic vote on health system reform this weekend, your Texas Medical Association is engaged on multiple fronts to make sure the end result doesn’t violate the Hippocratic Oath. (See “Five Things You Can Do Right Now,” below.)

Our position on health reform remains steadfast: Keep what’s good in the health care system and fix only what’s broken.

House Speaker Nancy Pelosi this morning released the Congressional Budget Office evaluation of the $940 billion House package. It reduces annual growth in Medicare expenditures by 1.4 percentage points, and expands health insurance coverage to 32 million Americans.

The vote is expected to be extremely close, as the Obama Administration pressures all Democrats to vote for it. Already, though, Rep. Chet Edwards (D-Waco) has announced he cannot support it. Representative Edwards voted against it in the House Budget Committee earlier this week.

Bad for Patients

Does nothing to correct the flawed Medicare payment formula that Congress created in 1997. That formula is directly responsible for the slow erosion of access to care for seniors and the poor;

Would increase the cost of health insurance for our patients and deliver even less in return;

Would dramatically enhance federal government interference, bureaucracy, and red tape for patients and physicians;

Would create incentives for patients to pay a fine for not having insurance rather than pay an unrealistic amount for insurance coverage;

Would not protect Texas’ liability reforms and does even less to expand those protections to patients and physicians in other states; and

Would impose untested and arbitrary treatment standards that do not improve the quality of patient care.

In addition, it could be a budget buster for Texas and all state governments. According to the Texas Health and Human Services Commission, the current proposal could cost the State of Texas up to an additional $24 billion in increased Medicaid spending over the first 10 years of its implementation.

Fix Medicare First

TMA’s No. 1 priority is to win a permanent fix to the Medicare payment formula before Congress moves on to more extensive health system reform. Despite their professed support for a new Medicare payment system for physicians, senators and representatives from both parties have done nothing to fix the formula that threatens to bankrupt physicians and leave Medicare patients without a doctor. For 10 years, they’ve done nothing to fix the single largest government health program. How can they build a new system on a broken foundation?

“You and your colleagues have recognized this glaring problem — this gaping wound in our health care system — but have been willing to address it only with Band-Aids,” Dr. Fleming wrote in TMA’s open letter to Congress (PDF). “We need more than Band-Aids. We need more than sutures. We need a complete transplant. You created this disease, and only you can cure it.”

To educate patients on Medicare’s problems and to engage all Texans in the drive to fix them, TMA is embarking on a campaign to gather 1 million signatures to stop the Medicare Meltdown. We will deliver the open letter to Congress (PDF) to members of the Texas congressional delegation the first week of April at news conferences across the state. The petition drive includes online petitions posted on the TMA(PDF) and MeAndMyDoctor Web sites, another online petition for patients and the general public, social media petitions for Facebook and Twitter, and other tactics. We are using our communication vehicles and our county medical society partners to send campaign materials and the petitions to physicians and patients. We are working with community partners such as senior citizen groups, disability rights organizations, and others.

Voter Outreach

Given the highly partisan arm twisting that’s going on in Washington, TMA is teaming up with Gov. Rick Perry tonight to engage voters in four key South Texas congressional districts whose Democratic representatives are considered potential “no” votes. Dr. Fleming and TMA President-Elect Susan Rudd Bailey, MD, will join the governor in a telephone “town hall meeting” with constituents in those districts.

As part of the call, Governor Perry is expected to announce his support for TMA’s petition to stop the Medicare Meltdown and encourage his followers to sign it as well.

TMA leaders are planning tele-town hall meetings of their own with voters in those and several other swing districts.

Five Things You Can Do Right Now

Use the TMA Grassroots Action Center today to send a strong message to Sens. John Cornyn and Kay Bailey Hutchison and your U.S. representative. Tell them to oppose the health system reform bill in the House and begin work immediately on a permanent replacement of the Medicare payment formula.

Sign TMA’s online Stop the Medicare Meltdown petition and encourage your colleagues, friends, family, and neighbors to do the same.

Sign TMA’s open letter to Congress (PDF) and fax it to the TMA Public Affairs Division at (512) 370-1633.

Post the Stop the Medicare Meltdown petition (PDF) in your waiting areas and exam rooms for your patients to sign. Fax completed petitions to the TMA Public Affairs Division at (512) 370-1633.

Write a letter to the editor of your local paper.

——-

DJP Comment: Imagine if AMA entered the battlefield like Texas! In a war the timid lose!

——-

Meanwhile AMA still studies the latest amendments to the bill. The notice sent out today (see below) by AMA points out what AMA considers positive about the bill. WHAT ABOUT WHAT IS WRONG WITH THIS BILL!

The train is pulling out of the station. There is no SGR elimination in the bill. There is no right of private contracting without penalty. There is no medical liability reform. Medicaid is a disaster and yet this bill expands Medicaid. What about using AMA policy for vouchers! I won’t even go into the funny math and the financial disaster this bill will bring upon the USA.

And don’t forget that AMA wrote a letter to the Senate stating opposition to the IMAB. Is that out of the bill? If not, is AMA going to accept that?

EXCERPT from AMA letter December 1, 2009 at: http://www.ama-assn.org/ama1/pub/upload/mm/399/hsr-ama-reid-hr3590.pdf

Independent Medicare Advisory Board

AMA policy specifically opposes any provision that would empower an independent commission to mandate payment cuts for physicians, who are already subject to an expenditure target and other potential payment reductions under the Medicare physician payment system. Therefore, we oppose the Independent Medicare Advisory Board as currently designed in H.R. 3590, and we look forward to working with you on significant changes to the proposal.

—————-

Here is what AMA said today by email and you also can find it on AMA Website at: http://www.ama-assn.org/ama/pub/health-system-reform/language-reconciliation-bill.shtml

——–

hod.advocacy.update@enews.ama-assn.org

Subject: HSR Update

Date: March 18, 2010 4:39:40 PM CDT

This afternoon, the House released legislative language for the reconciliation bill that makes refinements to H.R. 3590, the health system reform bill to be considered soon on the floor. AMA staff are still in the process of analyzing the language, but key provisions for physicians that we have identified include:

Improved Medicaid payment rates for primary care physicians to equal 100 percent of Medicare payment rates, including payments for office visits and immunizations, in 2013 and 2014. Provides 100 percent federal funding for the increased costs to states. (Sec 1202)

Extended health insurance market reforms (dependent coverage up to age 26, prohibition of lifetime limits and rescissions, limitations on excessive waiting periods) to grandfathered plans six months after enactment. For group health plans, prohibits pre-existing condition exclusions in 2014, restricts annual limits six months after enactment, and prohibits them in 2014. (Sec 2301)

Closes the Medicare prescription drug donut hole through a process beginning in 2010 and completed by 2020. (Section 1101)

Increased federal medical assistance percentage (FMAP) paid to states for individuals newly enrolled in Medicaid as a result of the expansion of eligibility to 133% FPL (100 percent for 2014-2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent for 2020 and later years), repeal of the special FMAP for Nebraska, and changes in the formula used to calculate the amount of increased FMAP that will be paid to states that had expanded Medicaid eligibility to adults with incomes up to 100 percent FPL prior to enactment of the Act. (Sec 1201)

Sets a 75% assumed utilization rate for expensive diagnostic imaging equipment (priced at more than $1 million/MRI, CT). (Sec 1107)

House Majority Leader Steny Hoyer (D-MD) announced on the floor today that debate will not begin until after members have had 72 hours to review the new provisions, which sets the time for the first potential floor votes at Sunday afternoon.

We will post a detailed summary of the legislation on the AMA web site once it is completed.

(This ends AMA message of today)

————-

There should be a protest of all of America for such a large bill being presented with hundreds of pages of amendments written in such a way that the average citizen could not possibly read and research the wording in 72 hours. The Congress has demonstrated they are not to be trusted with what they try to slip into these bills. Here is some wording selected at random from the amendments. This excerpt is from page 53 of the reconciliation version released today:

Act, is amended—

6 (1) in clause (i)—

7 (A) by placing the subclause (II) (inserted

8 by section 10319(g)(3) of the Patient Protec9

tion and Affordable Care Act) immediately after

10 subclause (I) and, in such subclause (II), by

11 striking ‘‘and’’ at the end; and

12 (B) by striking subclause (III) and insert13

ing the following:

14 ‘‘(III) for 2014, 0.3 percentage

15 point;

16 ‘‘(IV) for each of 2015 and 2016,

17 0.2 percentage point; and

18 ‘‘(V) for each of 2017, 2018, and

19 2019, 0.75 percentage point.’’;

20 (2) by striking clause (ii); and…

——

Clock is ticking. AMA needs to oppose this bill without delay!

Stay well.

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Comments (0)

TOP

DJP Update 3-17-2010 President Obama exclusive interview today; DJP comments about this and AMA; Physician survey: 46% primary care out of Medicine or want to leave if health bill passes; LAGNIAPPE

Mar 17

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP Update 3-17-2010 President Obama exclusive interview today; DJP comments about this and AMA; Physician survey: 46% primary care out of Medicine or want to leave if health bill passes; LAGNIAPPE

President Obama in exclusive interview with Special Report host Bret Baier of Fox News March 17, 2010

http://www.foxnews.com/politics/2010/03/17/obama-tells-fox-news-procedural-spat-health-vote-doesnt-worry/

Video clips also available at that link.

All of the statements below are EXCERPTS from the article at the link above.

“I don’t spend a lot of time worrying about what the procedural rules are in the House or Senate,” Obama said. “What I can tell you is that the vote that’s taken in the House will be a vote for health care reform. And if people vote yes, whatever form that takes, that is going to be a vote for health care reform. And I don’t think we should pretend otherwise. And if they don’t, if they vote against it, then they’re going to be voting against health care reform and they’re going to be voting in favor of the status quo.

———–

Obama brushed off concerns about the special deals that helped get the Senate bill passed.

“By the time the vote has taken place, not only I will know what’s in it, you’ll know what’s in it because it’s going to be posted and everybody’s going to be able to evaluate it on the merits,” he said.

——–

“And yes, I have said that this is an ugly process,” he said. “It was ugly when Republicans were in charge. It was ugly when Democrats were in charge.”

————-

Questions by DJP:

If the process is bad (or “ugly”) when the Republicans do it and bad (or “ugly”) when the Democrats do it, does that justify doing it? Does the end justify the means? As for the “deeming” issue in the House which may be used instead of doing a recorded vote on the bill itself, does the argument that the Republicans did it in past (disregarding the issue of the magnitude of this legislation) justify the Democrats doing it now? Do two wrongs make a right? The answer should be NO to all of these questions if Congress wants to have the Public gain trust in them rather than the free fall Congress is in now.

I did not get the opportunity to ask these questions and a few others I have about the disaster in the details bill in the final stages of the attempt at resuscitation. I would hope the AMA, with a seat at the table, asks such questions PLUS why the liberty right of the “right to contract” is not allowed to physicians without penalty, why the bill has the enormous expansion of boards, why there is no true medical liability reform, and why could not a simple bill with these provisions and market enhancements such as true competition across state lines etc. be done. And why the funny math?

A simple word will end this bill and allow reason to start an appropriate bill. And those who block that, Republicans or Democrats, should be voted out of office. That is the American Way. Not this debacle.

And what is the “simple word”? It is NO! Clock is ticking, AMA. Please listen to your friends because you and I know, AMA has collected a few enemies over the years and you can’t look to them for help in the years ahead. Be strong. Be courageous. Be decisive.

————–

DJP: Didn’t need a survey to conclude these findings below. Price-fixing and more government micro-management always leads to this in the history of the world.

http://www.themedicusfirm.com/pages/medicus-media-survey-reveals-impact-health-reform

“In a physician survey conducted December 2009 by The Medicus Firm, a national physician search firm, 24.7% of physicians stated that they would “retire early” if a public option is implemented, and an additional 21.0% of respondents stated that they would quit practicing medicine, even though they are nowhere near retirement. This brings the amount of physicians who would leave medicine to a total of 45.7%.”

The Medicus Firm Physician Survey: Health Reforms Potential Impact on Physician Supply and Quality of Medical Care

Mar. – Apr. 2010

Key Findings from The Medicus Firm Survey

Physician Support of Health Reform in General

•

62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.

•

28.7% of physicians are in favor of a public option.

•

3.6% of physicians prefer the “status quo” and feel that the U.S. health care system is best “as is.

Health Reform and Primary Care Physicians

•

46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

Health Reform, Public Option, and Practice Revenue/Physician Income

•

41% of physicians feel that income and practice revenue will “decline or worsen dramatically” with a public option.

•

30% feel income will “decline or worsen somewhat” with a public option.

•

9% feel income will “improve somewhat” with a public option, and 0.8% feel income will “improve dramatically” with a public option.

Health Reform, Public Option, and Physician Supply

•

72% of physicians feel that a public option would have a negative impact on physician supply, with 45% feeling it will “decline or worsen dramatically” and 27% predicting it will “decline or worsen somewhat.

•

24% of physicians think they will try to retire early if a public option is implemented.

•

21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.

Health Reform and Recommending Medicine to Others as a Career

•

36% of physicians would not recommend medicine as a career, regardless of health reform.

•

27% would recommend medicine as a career but not if health reform passes.

•

25% of physicians would recommend medicine as a career regardless of health reform.

•

12% would not recommend medicine as a career now but feel that they would recommend it as a career if health reform passes

The opinions expressed in the article linked to above represent those of The Medicus Firm only. That article does not represent the opinions of the New England Journal of Medicine or the Massachusetts Medical Society. And the review of articles on the Web confirms this was not published in The New England Journal of Medicine. Now you have full disclosure.

“And note that “The report appeared in Recruiting Physicians Today, an employment newsletter produced by Massachusetts Medical Society, “the publishers of the New England Journal of Medicine.” The report also appeared on the NEJM “CareerCenter” website, but was taken down on March 17. Zeis also said that this article “was written by The Medicus Firm.” ”

————

LAGNIAPPE: More info on Twitter to answer a few questions

If you join Twitter, which is free, the tweets do not go to your email if case you are worried about that. And you only get tweets from those you “follow”. You can check your tweets online AND you can put a small program on your BlackBerry or IPhone and the tweets will collect there. You look at them as desired. Nothing beats Twitter for breaking news! It is easy to join.

I have two programs for my tweets on my IPhone. You only need one. But the second one has a few extra features. Think of it as having a sunroof or leather seats. The two I have are: Tweetie and Echophon. Get them at the Apple ITunes Webpage under “Apps”. Both work very well.

For the BlackBerry, look at TwitterBerry:

http://orangatame.com/products/twitterberry

TinyTwitter: http://tinytwitter.com

If you want more info, write me a note and I will recommend my favorite book about Twitter.

—————

Stay well.

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Comments (0)

TOP

DJP Update 3-15-2010 Shell games and the health bill; PAC donations of “health professionals” by organization; President Obama’s speech today in Strongsville, Ohio

Mar 15

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP Update 3-15-2010 Shell games and the health bill; PAC donations of “health professionals” by organization; President Obama’s speech today in Strongsville, Ohio

ITEM ONE: Shell games and the health bill

Yes, the “reconciliation bill” released last night is a shell. Sort of a place-holder. The final version has not been posted. Yet we are told the bill must be rushed through this week! And now the deals begin. Remember the old movies and the “shell game”? Guess where the pea is. But slight-of-hand gives the win to the dealer of the shells. Hard to get rid of that memory as one watches the drama unfolding in D.C. But be VERY CAREFUL reading what is in the “shell” as some of those items may remain. Instead of trust but verify, one should consider: don’t trust promises, verify every item in the bill to be voted, assuming it does get a true vote rather than the “Slaughter Solution” which would bypass a vote on the actual bill. Watch for the deals and the failure to remove some of the shocking deals placed in the Senate bill. Be on the lookout for replacement of the Brooklyn Bridge, adding to Mount Rushmore National Memorial in South Dakota, and on and on. But I jest. I certainly hope so. But be on the lookout for retention of the Senate special favors. I do predict the SGR will not get a permanent fix. I can hear it now, “It just couldn’t be done at this time, Doctor. Keep donating to our party and we will continue to work on it. And get some knee-pads when you come to pay homage to the power-brokers in Washington, DC. That helps when you genuflect. We have the power and we command loyalty and a show of obedience.”

Speaking of donations, that will be in Item Two.

Meanwhile, check out this Weblink to the Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2010/03/14/AR2010031401388.html?wpisrc=nl_pmopinions

It gives the opinion of Paul Ryan of Wisconsin, the ranking Republican on the House Budget Committee. He gives his criticism of the current bill and the reconciliation game, offers alternatives, Patients’ Choice Act, as well as his own plan, “A Roadmap for America’s Future, and then ends with this:

“If this debate had actually been about health care, we could have worked together to get a grip on costs, make quality care more accessible, address exclusions for preexisting conditions and realign the incentives of insurance companies with those of patients and doctors. Yet this process — including its embarrassing conclusion — demonstrates that the debate has never been about health-care policy but, instead, paternalistic ideology.

“Should the Democrats’ health-care train wreck make it to the president’s desk, it will be a pyrrhic victory, and its devastating consequences will take their toll on our health-care system, our budget and our economy.”

———

ITEM TWO: PAC donations of “health professionals” by organization as reported on page 34 of January 11, 2010 issue of Modern Healthcare. Twenty organizations are listed. The info comes from the Federal Election Commission on July 17, 2009 for Jan. 1, 2007 to Dec. 31, 2008.

Check it out. Here are a few examples. The #1 donor is the American Dental Association ($1,923,390). Note that the dentists are not covered under most of the onerous government provisions physicians are. 55% of donations went to Democrats. #2 is the American Medical Association ($1,464,450) and 56% went to Democrats. The American College of Cardiology is listed as #13 and gave $678,416 of which 59% went to Democrats. Note the “limited-license” folks:

American Podiatric Medical Association gave $658,500 and 72% went to Democrats. The American Nurses Association gave $562,466 and 86% went to Democrats. Interesting, for sure. Does any of this increase the interest in “scope of practice” issues when these groups go to Washington? Does the proposed new legislation increase the power of these groups? You decide.

What the article doesn’t mention is the donations from the trial lawyers as they are not health professionals. I don’t have the time to do the research and compare apples to apples but if you have nothing to do, you can research it yourself. A quick look on the Federal Election Commission Website ( /www.fec.gov ) shows, for a different period, the following for the new name of ATLA “American Association for Justice” PAC: $3,252,346 distributed for the 2009-2010 cycle. See http://query.nictusa.com/cgi-bin/cancomsrs/ But to be fair, research the same dates. As for cash on hand, see this link http://www.fec.gov/press/press2009/20090415PAC/documents/27top50tradecash2008.pdf and note AAJ is #5 and AMA is #23 as of Dec 31, 2008.

Enough of this diversion.

——–

ITEM THREE: President Obama’s speech today in Strongsville, Ohio

President Obama, as usual, made effective use of the rhetorical device “Anaphora”, the repetition of a word or phrase at the beginning of a series in his speech today in Ohio. See Page 89 of the Communication chapter in my book, “On Leadership…” for other examples of anaphora used by President Ronald Reagan and Winston Churchill. Churchill example: “We shall fight on the beaches, we shall fight in the fields, …”. President Obama does anaphora well. President Obama today also said, “We need courage!” “This is not about elections.” “…waiting for us to lead!” “Do what’s right!” “I don’t know about the politics.”

I certainly agree with the statements of ” We need courage”; I certainly agree with “Do what’s right!” I certainly agree that Congress and the President should do what is in the best interest of the patients and the USA. What I don’t agree with is the current bill that Congress is trying to pass. So we can all be for covering the uninsured. We can all be for putting the patient in charge. We all can be for reducing the cost of medical care. But we must examine the bill to see if it does that or merely makes the situation worse and leads to fiscal disaster and loss of access to care. So words are great but one must have the proper policy to make those words come true and get to the destination stated by the words. You can’t get to the French Quarter in New Orleans by swimming across Lake Pontchartrain to the North Shore. Wrong direction!

Let every organization interested in this health system reform debate reflect on “Courage” and “Do what’s right!”. And forget the politics and seats at tables. Do the right thing and no one can criticize you for whatever happens if you stay true to the policy and principles of the organization. And there comes a time when someone in an organization has to speak up and not fall prey to “groupspeak” or “true believer” status. Emulate Dr. John Snow of London in the Cholera epidemic and follow the facts no matter what the “leaders” say you must do. That is how progress is made and lives saved. The Nation waits. The Nation watches. This is the final play in this drama. May each and everyone sleep well at night knowing they entered the arena, they fought the good fight, and at the end they were unbowed.

On Thursday through Saturday, Robin and I attend a meeting, the International Conference on World War II, March 18-20, at the National World War II Museum in New Orleans, http://www.ddaymuseum.org/

We are inspired always when we attend seminars there. Men and women who had the courage to fight and die for liberty and freedom in the Second World War. Lots of sacrifices made then. We all should keep in mind that courage. I also will start back with interviews tomorrow and hope that all doctors can speak out, do interviews, and reach out to the Representatives in Congress. Don’t let the folks in Congress said, “If only you had contacted me.”

Oh, yes, don’t forget to drop the AMA Board a note about your views. Easy to reach them. As I have stated in previous emails, put first name period last name AT ama-assn.org

Examples:

President: James.Rohack@ama-assn.org

Chair: Rebecca.Patchin@ama-assn.org

You can get the list of all on the Board at AMA Website. Go to: http://www.ama-assn.org/ama/pub/about-ama/our-people/board-trustees/our-members.shtml

Effective two-way communication is essential for leadership. Remember, this is the week!

Stay well.

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Comments (0)

TOP

DJP Update 3-14-2010 House vote count Senate health bill – still short & full press on to get more votes; Meanwhile AMA…; Patient Privacy in GB; LAGNIAPPE

Mar 14

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP Update 3-14-2010 House vote count Senate health bill – still short & full press on to get more votes; Meanwhile AMA…; Patient Privacy in GB; LAGNIAPPE

Let’s do AMA first. Meanwhile AMA…

AMA responds in writing to individual doctors as well as the Coalition of State Medical and National Specialty Societies who urge in writing with good arguments that AMA openly oppose the Senate bill and encourage the House not to vote for it. AMA refuses to do so stating, in writing, to those letter writers that AMA is studying and negotiating. Well, let me not summarize AMA’s position. Read the letter yourself from AMA Board Chair:

I have received your letter that urges the AMA to immediately and publicly announce opposition to passage of the Patient Protection and Affordable Care Act (H.R. 3590) by the House of Representatives without waiting to analyze legislative language in a reconciliation bill that will alter provisions in the Senate bill.

The views expressed in the attached sign on letter have been respectfully and thoroughly considered by the AMA leadership.

The AMA continues to be engaged in active discussions with the Administration and Congressional leaders on modifications of the Independent Payment Advisory Board as it applies to physician. These efforts go well beyond sending letters staking out a position and involve potential provisions in the reconciliation bill that would benefit physicians and their patients. Issuing a letter of opposition prior to the conclusion of current discussions on the IPAB provisions would foreclose the ability to secure significant policy changes.

The reconciliation legislation will alter the Senate passed bill in a number of ways. With House floor votes on a reconciliation bill not expected before March 19 (and possibly later) there is still time and opportunity for the AMA to forcefully register its views on the final health system reform package. We believe the proper course is to defer a decision on whether to urge Congress to oppose or support passage of the final bill until it is apparent that we are no longer able to secure important modifications and after we have analyzed the legislative language for the reconciliation bill.

Over the next several days the AMA will provide a steady stream of communications on critical decisions with far-reaching consequences for physicians, patients and the nation.

Sincerely

Rebecca J Patchin, MD

————-

DJP Comment: Individual doctors, after careful consideration, have respectfully responded to the letter of the AMA and pointed out that the “Independent Payment Advisory Board” is just one of many onerous provisions in the Senate bill. Even if that item was removed, the bill still is a disaster. As one doctor active in AMA said to the Board, “Why do we think we can negotiate something in the reconciliation bill when we were unable to negotiate anything of significance in the original bill?” He also pointed out there already is a 36% loss of AMA membership in his state! He added “Do you not see the benefits of defeating bad legislation and starting over?”

Another doctor, prominent in his specialty leadership and active in the AMA House of Delegates also wrote the AMA Board and pointed out at least 16 onerous provisions in the Senate bill and specifically listed 16 of them. He urged the board to “immediately reject HR 3590.”

Congratulations to these individual doctors and to the Coalition of State Medical and National Specialty Societies for having the courage and leadership to speak out and try to save AMA from continuing a losing approach to health system reform.

No phone conferences with the House of Delegates sometime in the future can justify continuing this position of AMA. Many will think the phone conference will be used as “cover”. AMA policy is clear. Implement it now and that means opposing this Senate bill. Future students of AMA history will not give AMA the benefit of “Too little, too late.” The criticism will be harsher and AMA will become a non-player in the politics of Medicine. And what percent of dues-paying members will AMA have at that time? For the pilots among you, this is a “flat-spin” down to a crash! (Flat Spin. “A spin in which the tail of the aeroplane drops and the machine rotates in an almost horizontal plane. Recovery from a flat spin is difficult and sometimes impossible.”)

NOW CONGRESS and VOTES

DJP Comment about Congress: The vote count varies from hour to hour depending on who is speaking with you. At the moment, I believe it is about 5 votes short for passage of the Senate bill in the House. But to believe that, you have to assume that what someone is telling you at this moment will be the position taken at the vote. All sorts of additions and promises can influence votes as we have witnessed in the Senate deals. Be confident that the vote in the House will take place without delay the moment the majority vote is obtained, if it is obtained. That could be in the next few days and the “reconciliation vote” could be an express train that passes AMA up as AMA waits at the station! AMA opposing the bill immediately could alter the history of this bill and give cover to those Democrats who are looking for an excuse to vote against it! But I keep repeating myself. Sorry for rehashing old news!

The latest idea floated is the alleged “Slaughter Solution”. See last article excerpt below.

——-

Excerpt from WSJ online: http://online.wsj.com/article/SB10001424052748703457104575121604005269006.html?mod=WSJ_hpp_MIDDLTopStories

By GARY FIELDS and DARRELL A. HUGHES

WASHINGTON—White House adviser David Axelrod conceded that efforts to secure enough support to pass the party’s health-care bill was proving “a struggle,” but voiced confidence that Democrats would ultimately get enough votes.

Mr. Axelrod was one of several Obama administration and Democrat leaders who took to the airwaves on Sunday to talk about the health-care overhaul, as the Democrats’ push to pass one of President Barack Obama’s signature initiatives enters what could be a final stage.

Asked on CNN’s “State of the Union” whether he thought Democrats had the votes to pass the bill, Mr. Axelrod said: “I think we will have the votes to pass this. Obviously this is a struggle.”

House Minority Leader John Boehner (R., Ohio), appearing on the same show, was less sanguine. If House Speaker Nancy Pelosi (D., Calif.) “had [the] 216 votes [needed to pass the legislation in the House], the bill would be long gone,” he said.

——–

EXCERPT from Reuters: http://www.reuters.com/article/idUSN1414766520100314

White House confident of House approval this week

(Adds Gibbs, Boehner quotes, details)

By John Whitesides

WASHINGTON, March 14 (Reuters) – White House officials on Sunday confidently predicted quick final passage of healthcare reform but a top Democratic vote-counter said the party still needs to line up more support in the House of Representatives.

With President Barack Obama’s sweeping healthcare overhaul headed for a final House vote this week, House Democratic Whip James Clyburn said Democrats were short for now of the 216 votes needed but he was confident they could find them.

“We don’t have them as of this morning, but we’ve been working this thing all weekend, we’ll be working it going into the week, I’m also very confident that we’ll get this done,” Clyburn, the No. 3 House Democrat who is entrusted with lining up the party’s votes, said on NBC’s “Meet the Press.” …..

———–

EXCERPT about “Slaughter Solution” to Senate bill in House from info at Washington Examiner quoting National Journal’s Congress Daily

House Democrats looking at ‘Slaughter Solution’ to pass Obamacare without a vote on Senate bill UPDATED!

By: Mark Tapscott

Editorial Page Editor

03/10/10 4:17 PM EST

Read more at the Washington Examiner: http://www.washingtonexaminer.com/opinion/blogs/beltway-confidential/House-Democrats-looking-at-Slaughter-Solution-to-pass-Obamacare-without-a-vote-on-Senate-bill-87267402.html#ixzz0iC692IsI

Would House Speaker Nancy Pelosi and her fellow House Democratic leaders try to cram the Senate version of Obamacare through the House without actually having a recorded vote on the bill?

Not only is the answer yes, they would, they have figured out a way to do it, according to National Journal’s Congress Daily:

“House Rules Chairwoman Louise Slaughter is prepping to help usher the healthcare overhaul through the House and potentially avoid a direct vote on the Senate overhaul bill, the chairwoman said Tuesday.

“Slaughter is weighing preparing a rule that would consider the Senate bill passed once the House approves a corrections bill that would make changes to the Senate version.

“Slaughter has not taken the plan to Speaker Pelosi as Democrats await CBO scores on the corrections bill. ‘Once the CBO gives us the score, we’ll spring right on it,’ she said.”

Each bill that comes before the House for a vote on final passage must be given a rule that determines things like whether the minority would be able to offer amendments to it from the floor.

In the Slaughter Solution, the rule would declare that the House “deems” the Senate version of Obamacare to have been passed by the House. House members would still have to vote on whether to accept the rule, but they would then be able to say they only voted for a rule, not for the bill itself.

Would that rationale fly with the public? Is it logical? Of course not. ……….

————————

DJP comment: And remember that the folks in the House of Representatives will be voting on the Senate bill without knowing the exact wording in the so call “reconciliation bill”. A word here, a word there, and suddenly the bill has a new meaning. What a mess! No wonder Congress has such a low favorable rating. “Voter unhappiness with Congress has reached the highest level ever recorded by Rasmussen Reports as 71% now say the legislature is doing a poor job.” http://www.rasmussenreports.com/public_content/politics/mood_of_america/congressional_performance

—————

Patient Privacy in Great Britain: this just in. Here is an excerpt. Go to link for full article. A lesson for USA?

http://www.timesonline.co.uk/tol/life_and_style/health/article7061017.ece

From The Sunday Times

March 14, 2010

Briefing: NHS database

Doctors have accused the government of entering the personal medical records of NHS patients into a central system without their consent

Breakneck speed

NHS accused of ignoring patients’ right to opt out

The confidential medical records of patients are being placed on a new National Health Service database without their consent, it emerged last week. The British Medical Association (BMA) accused the government of rushing the project through “at breakneck speed”, uploading patients’ details before they have had a chance to object. It comes amid fears that information will be targeted by hackers, and follows allegations that the government is hurrying to finish the project before the Conservatives can cancel it, as they have promised. In a letter to ministers published last week, Hamish Meldrum, the BMA chairman, urged the government to suspend the scheme, which he said risked damaging patients’ relationship with their doctors.

…..

In April 2007 a report by the House of Commons public accounts committee concluded: “This is the biggest IT project in the world — and it is turning into the biggest disaster.” Last October, it was revealed that more than 14,000 people were being forced to wait at least six months for hospital treatment or tests because staff at Barts and the London NHS Trust, one of the first health authorities to upgrade to the system, had lost track of patients when the computerised records were introduced.

Security fears

Doubts over government’s ability to look after data

Since HM Revenue & Customs lost computer disks containing the details of 25m child benefit recipients in 2007, the government’s appetite for retaining personal data and questions over its ability to guard it have come increasingly under the spotlight. …….

———

LAGNIAPPE:

“Ozymandias”, the 1918 sonnett of Percy Bysshe Shelley, is writing that I reflect on during this Congressional battle. As one commentator said, the poem reflects “Pride before the Fall”.

Think of the “spin” about the Senate bill; think about the math used to promote it; think about the view that the bill will not solve the problems it purports to fix; think about the arrogance that the Public doesn’t understand how more government control will help. What is the problem with starting over with specific changes that truly would benefit patients and keep doctors in practice? No rational reason is given for not starting over. Health system reform doesn’t need 2700 pages of law that the majority of the public is against. Reform can be done in 40 pages or less. Significant events occurred with less words: think Declaration of Independence; think U.S. Constitution and the Bill of Rights portion of the Constitution. Passing a bill with disaster in the details may give rise to a celebration for those in power at the moment but the long-term consequences will not make an addition on their CV that history will praise.

Ozymandias

BY PERCY BYSSHE SHELLEY

I met a traveller from an antique land,

Who said—“Two vast and trunkless legs of stone

Stand in the desert. . . . Near them, on the sand,

Half sunk a shattered visage lies, whose frown,

And wrinkled lip, and sneer of cold command,

Tell that its sculptor well those passions read

Which yet survive, stamped on these lifeless things,

The hand that mocked them, and the heart that fed;

And on the pedestal, these words appear:

My name is Ozymandias, King of Kings;

Look on my Works, ye Mighty, and despair!

Nothing beside remains. Round the decay

Of that colossal Wreck, boundless and bare

The lone and level sands stretch far away.”

http://www.poetryfoundation.org/archive/poem.html?id=175903

———

Stay well.

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Comments (0)

TOP

DJP Update 3-12-2010 AMA HSR Bulletin; Coalition of State Medical & National Specialty Societies letter to Congress; Lagniappe

Mar 12

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP Update 3-12-2010 AMA HSR Bulletin; Coalition of State Medical & National Specialty Societies letter to Congress; Lagniappe

Lots going on in Congress! We certainly do live in interesting times!

Meanwhile, here is some information from two sources. First, AMA’s Health System Reform Bulletin in part.

———

From: health.system.reform.bulletin@enews.ama-assn.org

Subject: Timeline announced for health system reform legislation

Date: March 12, 2010 5:23:58 PM CST

March 12, 2010

Here’s your regular update on efforts by the American Medical Association (AMA) to work with lawmakers in reforming the nation’s health care system in a way that provides quality, affordable health care for all.

Speaker Pelosi announces timeline for reform legislation

House Speaker Nancy Pelosi informed House Democrats today that there are plans to hold a House floor vote on health system reform in the coming week, and said that members should be prepared to stay in session through next weekend and into the following week, if necessary. The House Budget Committee is scheduled to start the process on Monday, March 15, with a mark-up of the reconciliation bill scheduled to begin at 3 p.m. and conclude at midnight.

Legislative language for the reconciliation bill, which will contain amendments to the Senate-passed health system reform legislation as well as a college student aid package, has not yet been circulated. It has been widely reported that at least two provisions designed to obtain key Senate votes will be eliminated by the reconciliation bill and that the tax on high-cost health plans will be modified to apply only to individuals with incomes of more than $250,000.

Currently, the House plans to hold a single floor vote that will include the reconciliation provisions and the health reform bill passed by the Senate on Christmas Eve. After House passage, the original Senate bill will be sent to President Obama for signature and the reconciliation bill will be sent to the Senate for passage. Details on the reconciliation bill are expected to be released by the administration and House leadership on or before Monday.

At press time, the reconciliation legislative language had yet to be finalized. The AMA continues to be involved in ongoing discussions with administration officials and congressional leaders regarding necessary changes in the Independent Payment Advisory Board provisions that apply to physicians.

————

Now the second source. Meanwhile, here is the letter sent to Congress from the Coalition of State Medical and National Specialty Societies:

Go to: http://www.donaldpalmisano.com/html/djp_update/coalition_djp.pdf

or you can access it from the tweet I sent out:

http://twitter.com/djpNEWS

85,000 doctors oppose #hcr #Senate bill – 3-10-2010 letter to Congress http://tinyurl.com/y9dx5we

———————

Excerpt from letter’s introduction:

———

The undersigned state and national specialty medical societies — representing more than 85,000 physicians and the millions of patients they serve — are writing to oppose passage of the “Patient Protection and Affordable Care Act” (H.R. 3590) by the House of Representatives.

The changes that were recently proposed by President Obama do not address our many concern with this legislation, and we therefore urge you to draft a more patient-centered bill that will reform the country’s flawed system for financing healthcare, while preserving the best healthcare in the world. While we agree that the status quo is unacceptable, shifting so much control over medical decisions to the federal government is not justified and is not in our patients’ best interest. We are therefore united in our resolve to achieve health system reform that empowers patients and preserves the practice of medicine — without creating a huge government bureaucracy.

There are a number of problems associated with H.R. 3590 as passed by the Senate in December, including: …….

(MORE EXCERPTS)

-undermines the patient-physician relationship and empowers the federal government with even greater authority….

-The bill is unsustainable from a financial standpoint.

-Largely unchecked by Congress or the courts, the federal government would have unprecedented authority to change the Medicare program through the new Independent Payment Advisory Board and the new Center for Medicare & Medicaid Innovation. Specifically, these entities could arbitrarily reduce payments to physicians for valuable, life-saving care for elderly patients — …….

-The bill is devoid of proven medical liability reform measures that have been shown to reduce costs in demonstrable ways.

Our concerns about this legislation also extend to what is not in the bill. Two important issues

include:

-The right to privately contract is a touchstone of American freedom and liberty.

-For healthcare reform to be successful, Medicare’s Sustainable Growth Rate (SGR) must be permanently repealed — something the Senate bill fails to do.

We are at a critical moment in history. America’s physicians deliver the best medical care in the world, yet the systems that have been developed to finance the delivery of that care to patients have failed. With congressional action upon us, we are at a crossroads. One path accepts as “necessary” a substantial increase in federal government control over how medical care is delivered and financed. We believe the better path is one that allows patients and physicians to take a more direct role in their healthcare decisions. By encouraging patients to own their health insurance policies and by allowing them to freely exercise their right to privately contract with the physician of their choice, healthcare decisions will be made by patients and physicians and not by the government or other third party payers.

—————

DJP Comment: Please read the entire letter at the link above.

Note the organizations signing the Coalition letter plus the three former presidents of AMA who are associate members of this Coalition. Only organizations that sit in the AMA House of Delegates can be full voting members in this Coalition. Consider having your organization join. Contact David Cook at Medical Association of Georgia: DCook@mag.org

Medical Association of the State of Alabama

Medical Society of Delaware

Medical Society of the District of Columbia

Florida Medical Association

Medical Association of Georgia

Kansas Medical Society

Louisiana State Medical Society

Missouri State Medical Association

Medical Society of New Jersey

South Carolina Medical Association

American Academy of Facial Plastic and Reconstructive Surgery

American Association of Neurological Surgeons

American Society of Breast Surgeons

American Society of General Surgeons

Congress of Neurological Surgeons

Daniel H. Johnson, Jr., MD

AMA President 1996-1997

Donald J. Palmisano, MD, JD, FACS

AMA President 2003-2004

William G. Plested, III, MD, FACS

AMA President 2006-2007

————

DJP Comment: This letter to Congress by the Coalition of State Medical & National Specialty Societies is not sent on behalf of insurance companies, lawyers, drug companies, or any other people opposed to health system reform. These organizations and individuals in the Coalition of State Medical & National Specialty Societies want health system reform done properly and they helped pass AMA policy that binds AMA. In fact, you know most of them. The message in this Coalition letter is AMA policy. Wouldn’t it be great if AMA sent such a letter! Clock continues to tick. We watch, we wait.

Spread the word to defeat the current bills being pushed through Congress. And keep reviewing the poem “If” by Kipling when people attack you personally, allege sinister motives, and refuse to deal with the facts. Remember, Santa Claus is not going to supply the funding for this disaster bill. Nor is Santa Claus going to restore your liberty to privately contract with patients without penalty. Congress will not go to a indemnity payment and allow private contracting. That would mean doctors would not have any need to beg each year about the inadequate payment by government. That would mean the folks in Congress would lose power over doctors! And it might affect their political contributions. Reality is what is written in the bill and not some fanciful dream of what it might mean or could be. Reality exists. Organized Medicine needs to stop being treated like a puppet! And it is easy to do. Just say no to the bill and state what is needed to put the patients in control with the doctor as trusted advisor. Let patients have money at risk when they make medical choices. Let information flow easily to patients so they can make those choices wisely.

Never forget that the individuals in Congress and the administration are not going to have the skills to save the life of a patient in the ER, drain the blood clot pressing on the brain of a child who was hit by a car while chasing his basketball that went into the street, help a woman deliver a baby that has the shoulder stuck in the pelvis, and the myriad of other caring events every day in the life of physicians in this great Land of Liberty. The current situation exists only because of the sanction of the victim. In this case, the doctors and patients are the victims. End the political games and let statesmanship enter the negotiations. Get rid of fear!

Lagniappe: I will be interviewed sometime between 8:00 a.m. and 9:00 a.m. Central, tomorrow Saturday, most likely around 8:30 a.m. for about 20 minutes. The radio station is WGSO 990 AM in New Orleans and the show is “Baldy and the Blond” (Tom Kowitz and Michele Gaudin) You probably can get it on the Web if you wish to listen live. WunderRadio App on the IPhone will pick up all Internet connected radio statiions regardless where you live or you can listen via computer and Web. Go to: http://www.nola.com/wgso/ or the livefeed at: http://wgso.com/?page_id=129

The podcast most likely will be at: http://wgso.com/?cat=24

Stay well.

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

This DJP Update goes to 2221 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

Comments (0)

TOP

DJP Update 3-11-2010 Senate Parliamentarian “kills an option for moving health bill”; more about the quest for votes; Meanwhile AMA plans phone conf sometime in future

Mar 11

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP Update 3-11-2010 Senate Parliamentarian “kills an option for moving health bill”; more about the quest for votes; Meanwhile AMA plans phone conf sometime in future

ITEM ONE: Senate Parliamentarian…

ITEM TWO: More about quest for votes

ITEM THREE: AMA plans “potential” phone conference… (and a few words from Senate Harkin about “SGR” and perhaps a fix “a few years away.”

ITEM ONE: Senate Parliamentarian states Senate bill must be passed and signed by President before Senate can act on a companion reconciliation bill.

DJP comment. If these media reports are correct, then the only way the Senate Majority can get around this is to have the U.S. Vice-President overrule the Parliamentarian OR fire the Parliamentarian and get one with a different view. Either would be a media disaster!

http://www.rollcall.com/news/44110-1.html

Ruling Kills an Option for Moving Health Bill

By David M. Drucker

Roll Call Staff

March 11, 2010, 2:30 p.m.

The Senate Parliamentarian has ruled that President Barack Obama must sign Congress’ original health care reform bill before the Senate can act on a companion reconciliation package, senior GOP sources said Thursday.

The Senate Parliamentarian’s Office was responding to questions posed by the Republican leadership. The answers were provided verbally, sources said.

House Democratic leaders have been searching for a way to ensure that any move they make to approve the Senate-passed $871 billion health care reform bill is followed by Senate action on a reconciliation package of adjustments to the original bill. One idea is to have the House and Senate act on reconciliation prior to House action on the Senate’s original health care bill.

Information Republicans say they have received from the Senate Parliamentarian’s Office eliminates that option. House Democratic leaders last week began looking at crafting a legislative rule that would allow the House to approve the Senate health care bill, but not forward it to Obama for his signature until the Senate clears the reconciliation package.

Meanwhile, Senate Majority Leader Harry Reid (D-Nev.) moved Thursday to put Senate Republicans on the defensive over health care, sending a letter to Minority Leader Mitch McConnell (R-Ky.) in which he dared the GOP to vote against reform.

——————–

Also see article about Parliamentarian at: http://www.businessweek.com/news/2010-03-11/health-care-bill-path-complicated-by-parliamentarian-update1-.html

Excerpt:

House Democrats are seeking assurance that the reconciliation changes will become law. Lawmakers in the chamber originally sought to have the Senate act first on reconciliation; then they wanted Obama to delay signing the 10- year, $875 billion Senate bill until the changes were passed.

Jim Manley, a spokesman for Senate Majority Leader Harry Reid of Nevada, declined to comment. Illinois Senator Dick Durbin, the No. 2 Senate Democrat, said on March 9 that he understands why some House Democrats might not want to trust that the Senate will act on the reconciliation changes.

‘Right to Be Skeptical’

“The House has a right to be skeptical,” Durbin told reporters. “They have almost 300 bills they’ve passed” that are “somewhere lost in the Senate.”

The news from Senate Republicans, who are unanimously opposed to the legislation, comes on the same day that House and Senate leaders said they had reached agreement on the majority of the language in the new reconciliation bill. The leaders presented the outlines of the plan to House Democrats today.

“The decisions are made, the choice has to be made” by lawmakers, House Speaker Nancy Pelosi told reporters.

Reid today formally notified McConnell that the Democrats plan to use reconciliation. Republicans say the process would be an abuse of Senate procedures.

————–

ITEM TWO: New information about the potential votes for and against the Senate bill when it gets into the House.

Dems Look To Health Vote Without Abortion Foes

The Associated Press

Erica Werner

March 11, 2010

http://www.ajc.com/business/dems-look-to-health-363244.html

EXCERPTS:

WASHINGTON — House leaders have concluded they cannot change a divisive abortion provision in President Barack Obama’s health care bill and will try to pass the sweeping legislation without the support of ardent anti-abortion Democrats.

——

“We will finish the job,” Senate Majority Leader Harry Reid, D-Nev., wrote in a letter to his Republican counterpart describing the path ahead.

Said Sen. Tom Harkin, D-Iowa: “The stars are aligning for victory on comprehensive health reform. The end is in sight.”

——–

ITEM THREE: AMA sent out an email to delegates and alternates under the name of the Speaker and Vice-Speaker (Sent: Wed, Mar 10, 2010 5:15 pm.) Unfortunately, as a former president of AMA who has a non-voting seat in the House of Delegates with microphone privileges, I am not on the email list for this information. Fortunately, one of the delegates on the DJP Update list sent it to me. In summary, the AMA email said things are “fluid” and

“The AMA will review the legislative language for the reconciliation bill promptly when it is finalized and made available. This work could be completed as early as next week. Wehope to convene an HOD conference call after we have reviewed and analyzed the final legislative language. Please watch your email for scheduling and logistical information on the potential upcoming HOD conference call.”

—–

DJP: Meanwhile “Rome is burning” and the U.S. House will vote the MOMENT the vote count gives a majority. That could be any hour. The closed doors will open and the vote will be taken. The AMA “potential upcoming HOD conference call” will be like ordering one more test on a patient who is bleeding and needs immediate operation. The patient may die in the interim. Decision-making is critical in leadership. If AMA came out against the onerous Senate bill, the bill would not pass in the House as AMA opposition would give “cover” to those Democrats who are on the fence.

Meanwhile, the big “SGR” negotiation has another surprise, namely the statement by Senator Harkin:

Date: March 9, 2010

Julian Pecquet and Seth Freedland

Harkin Acknowledges Permanent SGR Repeal Could Be A Few Years Away

A permanent ‘doc fix’ is unlikely this year and may have to wait a “couple, three years” for the federal budget to get in order, Senate health committee Chair Tom Harkin (D-IA) said Tuesday morning. The comments come just days after the American Medical Association sent a letter to Senate leaders saying it opposes a short-term payment patch of any duration.

Answering a question during a CQ/HealthBeat conference, Harkin said Congress “should have fixed it a long time ago,” but now “with the deficit as high as it is, it’s hard to think about taking all that money and moving it up front to fix the problem. It’s much easier to dribble it out a little bit at a time, year after year. But at some point, we’re going to have to bite the bullet.”

“Now, is that going to happen this year?” Harkin said. “I don’t think so. Hopefully if we get out of our slump in the next couple, three years, start moving up, then perhaps we can make some fix in that.”

—–

DJP Comment: I predict Senator Harkin is correct. There will be no permanent fix of the SGR this year! If that is what our AMA is waiting for in the negotiations, AMA will be waiting like the Spartans at Thermopylae. But the Spartans put up such a heroic fight that history remembers them for all time. AMA can be a powerful voice and a powerful actor. Time to act. Time to operate. Medicine is in shock. Words mean something but actions define the person and the organization. And yes, if AMA policy was passed into law, the right to privately contract without penalty, we would not have to spend a minute on “SGR” or other price-fixing schemes. The issue would be between politicians and the public. How long must we tolerate these abuses!

Today was my seminar I teach at Tulane Medical School entitled “Leadership in Medicine”. A good group of young, soon to be graduate doctors. I try to give them hope that Medicine can be saved from the politicians. Their future is bright if they are allowed to use their creativity and conquer diseases that we now can only offer comfort for. Let’s give them a chance and not shackle them.

Stay well.

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Comments (0)

TOP

DJP Update 3-9-2010 AMA & The Final Vote in Congress on Health System Reform; Background info DJPNEWS on Twitter

Mar 09

Posted by Dr. Donald Palmisano in DJP Updates, Random Thoughts

DJP Update 3-9-2010 AMA & The Final Vote in Congress on Health System Reform; Background info DJPNEWS on Twitter

ITEM ONE: AMA & The Final Vote in Congress on Health System Reform

Tick Tock, Tick Tock; Time is of the essence. The advocates in the Administration and in Congress are having closed door meetings to try and get a majority vote in the House to pass the Senate bill. The moment the necessary number of votes are in favor there will be an immediate vote. As of this moment, there are not enough votes in the House of Representatives to pass the Senate bill. But lots going on behind the scenes. Remember the revelations when the Senate bill was passed as the public read the fine print of the 2700 page disaster in the details bill that emerged. Can’t get the book “Animal Farm” out of my mind when I review the actions of Congress: some are more equal than others.

Now our AMA. AMA has been silent of late as to AMA position of the vote about to be taken in the House of Representatives. AMA was not at the last President Obama press conference on stage with the other stage doctors and I did not see a representative of AMA in the audience of white coats.

It is time for AMA to state to the public and send a letter to Congress that AMA opposes the Senate bill. Do a clear and unequivocal press release that states opposition. All along AMA kept saying it is working to get changes in the bills. Well, the changes did not come.

One of many examples of items AMA opposed in the Senate bill. Still in the bill!

Independent Medicare Advisory Board

( This except above from AMA: http://www.ama-assn.org/ama/pub/health-system-reform/news/december-2009/ama-comments-hr-3590.shtml )

The better fix for payment is for AMA to boldly state no price-fixing by government! Let government decide what it can pay and let doctors and patients negotiate the rest. I am tired of people saying doctors can’t be trusted!

Time to enter the arena, AMA! Reread Shakespeare’s Henry V speech on St. Crispian’s Day:

————

We few, we happy few, we band of brothers;

For he to-day that sheds his blood with me

Shall be my brother; be he ne’er so vile,

This day shall gentle his condition;

And gentlemen in England now-a-bed

Shall think themselves accurs’d they were not here,

And hold their manhoods cheap whiles any speaks

That fought with us upon Saint Crispin’s day.

————

Time for AMA to enter the field of battle. Doctors are looking for warriors to save the patient-physician relationship and the Senate bill will not decrease cost, will not increase quality, and will give a false sense of access: an insurance card that has no doctor on the other end to do the treatment. In addition, the funny math will bankrupt this Country. Let this bill fail and put forth a bill that truly addresses the current problems. Allow health insurance purchase across state lines, get real proven medical liability reform and put some penalty on those attorneys who file suits without merit, use tax credits, convert Medicaid that currently is bankrupting states into a defined contribution, allow private contracting without penalty, and more: FOLLOW SPECIFIC AMA POLICY!

It is tough trying to convince members not to quit AMA. Give us some help, AMA!

ITEM TWO: Go to http://twitter.com/djpNEWS to see recent postings on the funny math Congress is using.

Especially see: DJPNEWS: Importance of analysis! RT @bridgettwagner How government lies about cost ’savings’ | Kyle Wingfield: http://bit.ly/bo7ix7

Stay well and a special welcome to the orthopedic surgeons in New Orleans for their annual meeting! Stop by the National WWII Museum here for a powerful reminder of the cost of Liberty.

http://www.aaos.org/education/anmeet/anmeet.asp

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

This DJP Update goes to 2209 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

Comments (0)

The DJP Update

DJP Update 3-19-2010: More breaking news & it is encouraging! Today 240,000 doctors in surgical coalition come out against health bill.

DJP 3-19-2010 afternoon ALERT: AMA comes out in support of Senate bill now in House; AMA Phone conference summary; LAGNIAPPE: Time for a JAZZ Funeral for AMA so we can remember the good times in the past.

DJP Update 3-19-2010 Anesthesiologists (ASA) say NO on health bill; AMA HoD conference call today at Noon; LAGNIAPPE: Thoughts from the past as you fight for patients and physicians

DJP 3-18-2010 Update: State Medical Associations speak out regarding health bill in Congress; Meanwhile AMA still studying; By the way, health bill train pulling out of station

DJP Update 3-17-2010 President Obama exclusive interview today; DJP comments about this and AMA; Physician survey: 46% primary care out of Medicine or want to leave if health bill passes; LAGNIAPPE

DJP Update 3-15-2010 Shell games and the health bill; PAC donations of “health professionals” by organization; President Obama’s speech today in Strongsville, Ohio

DJP Update 3-14-2010 House vote count Senate health bill – still short & full press on to get more votes; Meanwhile AMA…; Patient Privacy in GB; LAGNIAPPE

DJP Update 3-12-2010 AMA HSR Bulletin; Coalition of State Medical & National Specialty Societies letter to Congress; Lagniappe

DJP Update 3-11-2010 Senate Parliamentarian “kills an option for moving health bill”; more about the quest for votes; Meanwhile AMA plans phone conf sometime in future

DJP Update 3-9-2010 AMA & The Final Vote in Congress on Health System Reform; Background info DJPNEWS on Twitter

Recent Posts

Categories