The DJP Update

DJP Update 1-26-2010 AMA letter of today by AMA President has right to privately contract without penalty! Thanks!! Now we are advocating AMA policy.

This went to President Obama and Congress today. I hope ads to the public also will be done.

Good job, Dr. Rohack!

Except from letter:

See full letter in attachment.

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 2194 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.

DJP Update 1-25-2010 Health System Reform: AMA “says it’s still on board”

The question is, “on board” for what? The American public has clearly rejected the Senate and House bills. AMA needs to be very specific about what it supports. If AMA still supports the House and Senate bills, then AMA also has not listened to the physicians of America and has not learned the lessons of the recent elections, especially the Massachusetts race for U.S. Senate.

NOW is the time for AMA to say:

——-

Yes, we need health system reform and we have SPECIFIC AMA policy developed over many years that will lower costs, cover the uninsured, fix the broken medical liability system, and keep the patient in control of his/her medical decisions with the doctor as trusted advisor. After reflection, we realize that the Senate and House bills will not lower costs and will lead to rationing and a decrease in the quality of Medicine in addition to creating unsustainable deficits. We stand ready to give you our specific plan and we refer you to our AMA PolicyFinder on our AMA Website. It is full of policy developed in a transparent and democratic way that we find, upon reflection, sorely lacking in the recent activities in Congress. Liberty is an essential part of America and Congress must return the right of patients and physicians to privately contract without penalty. Allow balance-billing. Allow doctors to forgive the copay if the patient and physician agree. Eliminate coercion. Price-fixing always leads to loss of availability or service or product. Just like gravity, the consequences do not disappear by wishing it away on Earth. And yes, see summary of AMA policy in JAMA May 12, 2004 article detailing Individual ownership, tax credits, market enhancements (such as purchasing health insurance across state lines, etc.) and more.

——

Of course, AMA did not say that. But there is still time. Rarely do circumstances give one a second chance to correct a mistake. But the time is now. See article excerpts below about “on board.” Now the best way to clarify “on board” is to say: Yes, we are on board, but (then repeat the paragraph I gave above about specific AMA policy.)

http://blogs.marketwatch.com/healthmatters/2010/01/25/with-health-reform-in-limbo-groups-issue-call-to-arms/

• January 25, 2010, 7:21 PM EST

•

See WSJ affiliated HEALTH MATTERS HOME PAGE »

With health reform in limbo, groups issue call to arms

KRISTEN GERENCHER’S Health Matters

EXCERPTS FROM ARTICLE

——

Health-care reform hangs in the balance after last week’s Massachusetts special election changed the balance of power in Washington. Now many interest groups that spent much of the last year negotiating with lawmakers are in wait-and-see mode ahead of President Obama’s State of the Union address on Wednesday. But groups representing doctors, seniors and women rallied their troops Monday, urging lawmakers to press on with reform efforts despite tough new political realities.

The merits of the bills haven’t changed, AARP Spokesman Jim Dau said….

The American Medical Association, which represents about a fourth of U.S. doctors and endorsed the House bill in November, says it’s still on board.

“The Massachusetts Senate election has complicated the prospects for comprehensive health reform, but the crisis of the uninsured remains very real to millions of Americans who have reduced access to health care because they don’t have coverage,” AMA President J. James Rohack said in a prepared statement. “Our nation still needs reform of the health-care system, and AMA will stay engaged in the process to get the best outcome for patients and physicians.”

On Monday, the American Academy of Family Physicians, American College of Physicians and American Osteopathic Association sent a letter to Obama and Democratic leaders expressing continued support for health-reform legislation, including ensuring a “sufficient supply of primary-care physicians and other specialties facing shortages.” The letter also mentioned malpractice reform, which may gain renewed favor if Obama wants to court Republican support for a revamped attempt.

The doctor groups also are pressing for separate resolution of a scheduled payment cut, the product of a longstanding problem known as the sustainable growth rate formula.

The American Public Health Association went on record Monday as well.

—–

Meanwhile, while we wait for such an AMA statement that I suggested above, more Congressional upsets will be set into motion and the doctors who wait in vain for the SGR price-fixing formula to be eliminated will face daily the burdens of trying to keep the medical office open as draconian cuts are implemented and consultation codes are eliminated. Also, various medical coalitions will get more active and specialty societies will become more active as the AMA becomes tossed into the losing column and dues revenue is rapidly lost like the water breaking the levees in New Orleans during Hurricane Katrina. That was a disaster and the aftermath of AMA’s actions will be another disaster. Historians will one day ask, what happened to the AMA? By the way, do you think the AMA letter sent today had what we have discussed multiple times and is among AMA’s highest advocacy priorities, namely, the right to privately contract… Check it out. I could not find it on AMA Website with AMA search engine but I did find this info about the letter and ad at AARP. The goal is to fix the SGR but it doesn’t say anything about the right to privately contract. Too bad. Another lost opportunity. Why write about privately contracting in “On the Road” discussed in recent DJP Update if we are not going to advertise it to the public. AMA policy states AMA must advocate private contracting with out penalty publicly!

http://www.aarp.org/aarp/presscenter/pressrelease/articles/aarp_ama_sgr_ad.html

and watch video at AARP Website: http://www.aarp.org/health/insurance/articles/new_aarp_ama_ad_calls_on_congress_to_fix_physician_pay.html

BREAKING NEWS: Two items:

-President Obama to Push 3-Year Spending Freeze on Non-Security Discretionary Spending

DJP comment: wonder if that will affect the “doctor fix” regardless of what the official word is emerging from the negotiating table hidden from CSpan and the public. Hmm…

-Meanwhile, 90 prominent Shreveport, Louisiana physicians took out a half-page newspaper ad today in the Shreveport Times and included their names.

A Shreveport doctor summarized the wording in the ad when he sent me the ad:

“This is an open letter to the Citizens of Northwest Louisiana regarding Health System Reform, signed by 90 of Shreveport’s prominent physicians.

Note the salient points:

• The AMA does not speak for us on Health System Reform.

• The House and Senate Bills are faulty on their merits and in their scope.

• Physicians are not alone in opposition to these Bills.

• Reform is still needed, but more limited legislation will work.

• It is time to start over on Health System Reform.”

——–

The practicing physicians in America are not going to take it anymore. They will mobilize for action. The ad is just one example of the frustration.

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 2194 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.

DJP Update 1-22-2010 Dramatic news from AMA! Hallelujah! Private contracting & balance billing in today’s AMA President’s blog

Here is an exciting development about the AMA policy to privately contract without penalty and balance bill as per long-standing AMA policy. As you know, I lamented in the DJP Update 1-21-2010 that AMA was not advocating this policy in the media and in the letter to Senator Reid that was sent out yesterday. I also could not find the letter on the AMA Website.

A specialty society legislative director found the letter about SGR fix on AMA Website and sent me the link:

http://www.ama-assn.org/ama/pub/health-system-reform/ama-aarp-moaa-house-call.shtml

Unfortunately, as was my concern, there is nothing about private contracting without penalty!

HOWEVER, TODAY AMA PRESIDENT DR. JIM ROHACK WROTE HIS COLUMN ENTITLED: “BLOG: ON THE ROAD WITH DR. ROHACK” AND ALSO SENT OUT A TWEET WITH A LINK TO HIS ARTICLE OF TODAY, 1-22-2010. The title of the article is “How we should pay physicians for medical care”.

http://www.ama-assn.org/ama/pub/road-doctor-rohack.shtml?plckController=Blog&plckBlogPage=BlogViewPost&UID=21ae8cdf-e382-40c9-87cf-32c8561d0531&plckPostId=Blog%3a21ae8cdf-e382-40c9-87cf-32c8561d0531Post%3a7186ac13-6afb-4718-8cbc-d35d4c94684e&plckScript=blogScript&plckElementId=blogDest

or get to it by the tweet shorter URL: http://bit.ly/89JmiD

Full tweet is:

AmerMedicalAssn

#AMABlog: AMA President J. James Rohack, MD, talks about how physicians should be paid for medical care. http://bit.ly/89JmiD

And Hallelujah, the article states in part,

——

It’s pretty clear to me. Those who vote against fixing the SGR permanently want to ration care by denying access. This may appear to be harsh but it is the only realistic conclusion.

One way to deal with the increasing volume of medical services is to make sure access to those services is limited. Some say that the National Health Service in the United Kingdom controls costs by having only 30 percent of physicians who are non-primary care specialists, practice in regional hospitals.

——

But we have seen physicians take a different approach by dropping out of Medicare and privately contracting with their patients for professional services. The penalty is that has to be done for two years and effects all patients.

Before 1997, physicians had the ability to bill Medicare patients the difference between their fee needed to keep their office viable and what Medicare paid for the services. As the cost for office upkeep measured by the Medicare Economic Index has continued to rise while Medicare payment has not kept pace (currently 20 percent less in 2009 fees compared to what should be paid), the financial problems are only getting worse.

If Congress would lift that ban on private contracting for the full fee for services and allow the physician to provide services on an individual basis and get paid to keep their office viable and not have to drop out of the Medicare program, it would allow accountability to occur at the point of contact.

———–

End of excerpts.

Wow! Thank you, Dr. Jim Rohack! Now send that blog article to everyone in Congress!! That public communication with copies to Congress is exactly what the AMA House of Delegates mandated. Let’s do it! Let’s restore liberty to patients and physicians.

Last night I said in the DJP Update 1-21-2010:

——

“The ship of Congress is in chaos at this moment and AMA needs to cut loose our towed AMA ship before it hits the shoals with the current majority. Let it not be said that AMA membership got so low in 2010 that AMA ceased to exist as a membership organization. AMA needs to exist and it needs the current leadership to stand tall and stop giving the impression of genuflecting for political expediency.

——

Today’s article by AMA President Dr. Rohack gives hope that the tow ropes have been cut! ONWARD!

And thanks to Dr. Jim Rohack!

This is a week to remember!

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 2198 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.

DJP Update 1-21-2010 AMA sent letter today to Senator Reid regarding SGR; But what about private contracting without penalty!!

Background: AMA also sent letter on December 21, 2009 to Senator Reid supporting H.R. 3590, the “Patient Protection and Affordable Care Act,” as amended.

The complete AMA letter can be found at: http://www.ama-assn.org/ama/pub/health-system-reform/ama-supports-hr-3590.shtml

Nothing in that posted letter at the link above about AMA policy of the right of patients and physicians to privately contract without penalty. That policy is among the AMA highest advocacy priorities.

Today I have been informed that AMA and AARP sent a letter to Leader Reid and Speaker Pelosi today calling for permanent repeal of the Sustainable Growth Rate (SGR) formula. To that end, Sen. Reid has placed the House-passed SGR bill (H.R. 3961) on the Senate calendar. These efforts come in advance of the expiration of the two-month SGR “patch” included in last year’s Defense appropriations bill (P.L. 111-118); the patch expires February 28, triggering cuts of over 21 percent in Medicare physician payment levels absent further action.

Have you seen the letter? It is not on AMA Website as of tonight and doesn’t show up with search engine on AMA site or on Internet. Do you think you will find AMA policy about the right of patients and physicians to privately contract without penalty in that letter? I doubt it! If not, then AMA fails to learn the lesson of the need to publicly advocate for this policy as mandated by the AMA House of Delegates. I look forward to reading the letter. If you have it, please send me a copy.

I did get a fax from AMA yesterday urging a call to my senators asking them to permanently repeal the SGR. But there was no mention in the fax of the substitute price-fixing formula and no mention of private contracting. I assume the letter was sent to all AMA members.

Of course the SGR needs to be thrown out. But to replace it with another price-fixing formula does not solve the problem. We need the right of Americans to privately contract without penalty. Why should patients and doctors be denied this part of our liberty? Let Congress decide what it can pay for services delivered to patients on government programs and then get out of the way of liberty and Free Enterprise. With private contracting without penalty there won’t be the difficulty of finding a doctor! Let competition reign.

The upset in the U.S. Senate race came about, in my opinion, because Congress refused to listen and used the power of the majority to force bills through the Senate and the House. To me that represents the arrogance of power and the consequences are seen in the Massachusetts election. When will AMA make the point to Congress and in ads to the public about the AMA policy of private contracting? We wait in vain. How long must AMA members tolerate this? So sorry to continue repeating myself!

AMA prestige has been diminished greatly by the actions of supporting bills in Congress that almost 500,000 physicians are on record in Congress as opposing. Health System Reform is needed but use AMA specific policy previously quoted in other DJP Updates. The ship of Congress is in chaos at this moment and AMA needs to cut loose our towed AMA ship before it hits the shoals with the current majority. Let it not be said that AMA membership got so low in 2010 that AMA ceased to exist as a membership organization. AMA needs to exist and it needs the current leadership to stand tall and stop giving the impression of genuflecting for political expediency.

———

Medpage Today has an article today on the topic of the SGR entitled: “With Time Running Low, AMA, AARP Push Permanent SGR Fix”

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18094

Some excerpts:

WASHINGTON — The American Medical Association (AMA) was hoping the momentum of healthcare reform would carry along legislation that would finally repeal the much-despised sustainable growth rate (SGR) formula that governs Medicare payments to doctors.

——

The SGR was developed in 1997 as a way to prevent Medicare payments from growing too quickly. The formula indexes reimbursements to changes in the gross domestic product (GDP). But healthcare spending has been growing much faster than GDP, so applying the SGR formula would have resulted in actual reimbursement cuts year after year.

——

“We’ve had assurances from Sens. Reid and Baucus that now is the time for a permanent fix,” he said, referring to Majority Leader Harry Reid (D-Nev.) and Finance chairman Max Baucus (D-Mont.).

—–

The “doctor payment fix” bill passed by the House — which would replace the SGR formula a with an annual payment increase equal to 1% more than the growth in the GDP (2% more for primary and preventive care physicians) was placed on the Senate’s legislative calendar on Wednesday, but there is no indication of when the measure will be taken up.

——-

The AMA and AARP, along with the Military Officers Association of America, hosted a Webcast Thursday with representatives in states where new TV ads will air, urging constituents to contact their senators to ask them to fix how doctors are paid under Medicare.

——-

Both the AMA and AARP publicly supported healthcare reform. And both groups said they remain hopeful that reform will still pass, even if it takes longer than anyone expected.

——

And see CBO report on this issue of H.R. 3961 and the SGR: http://cbo.gov/ftpdocs/107xx/doc10704/hr3961.pdf

—

And so it goes. Exciting times. There will be winners and losers. Let’s hope patients and physicians are not the main casualties.

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 2198 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.

Subject: DJP Update 1-19-2010 News bulletin: Scott Brown wins in Massachusetts; Listen up, Washington, DC

8:25 p.m. Central Time

It all started in Massachusetts prior to the Declaration of Independence. Now Massachusetts does it again.

Scott Brown wins. Martha Coakley concedes the election for US Senate seat from Massachusetts in Special Election for seat formerly occupied by Senator Kennedy. At this moment results show Brown ahead by 6%. AP also projects Brown winner with 84% of vote counted.

Time for Washington, DC to listen up. Pay attention to the people and do health system reform in a transparent manner with input from all.

Never give up!!

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/

——–

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.

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 2198 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.

Subject: DJP Update 1-18-2010 The Eyes of America are on Massachusetts – Election tomorrow!

This will be one of the most exciting U.S. Senate races in our lifetime because of the ramifications for health system reform. You already know that.

Physicians are engaged in the debate around the Nation. Folks on this DJP Update list sit on both sides of the debate about the current bills being rushed through Congress. We are so fortunate to be Americans and have the opportunity to express our views on important topics without fear of what others suffer in some countries where freedom does not exist.

A few updates.

Here is a tweet I send out a few minutes ago via DJPNEWS on Twitter: NYTimes: Democrats May Seek to Push Health Bill Through House http://tinyurl.com/yzpytnd

——

A wonderful Massachusetts physician in the AMA House of Delegates who we all know is exercising her First Amendment rights about the Massachusetts election at: http://iwvoice.org/

——–

Tune in tomorrow night! And regardless of outcome, watch what will happen in Congress. Like a rock thrown across the surface of a pond, there will be ripples! Dramatic ones! Never give up on Americans. They can be kept in the dark only so long and then they speak up. ——-

Today is a holiday dedicated to Dr. Martin Luther King, Jr. and here is a quote from Dr. King:

“Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that. Hate multiplies hate, violence multiplies violence, and toughness multiplies toughness in a descending spiral of destruction….The chain reaction of evil–hate begetting hate, wars producing more wars–must be broken, or we shall be plunged into the dark abyss of annihilation.”

Martin Luther King, Jr., Strength To Love, 1963.

——–

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.

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 2198 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.

Subject: DJP Update 1-5-2010 ITEM ONE: Upcoming talk – “Health System Reform – The Arrogance of Power”; ITEM TWO: Do words mean something?; LAGNIAPPE – talented physician artist

DJP Update 1-5-2010 ITEM ONE: Upcoming talk – “Health System Reform – The Arrogance of Power”; ITEM TWO: Do words mean something?; LAGNIAPPE – talented physician artist

ITEM ONE: DJP Update 1-5-2010 Upcoming talk – “Health System Reform & The Arrogance of Power”

I will deliver the keynote address on February 4, 2010 at the meeting in Orlando Florida of the combined sections meeting of The American Laryngological, Rhinological and Otological Society, Inc. aka The Triological Society.

I selected as the title of my talk, “Health System Reform & The Arrogance of Power”.

Considering what has occurred in the health system reform debate this year, I believe the title is appropriate. I will not repeat all of the special deals for votes in the Senate. That has been covered in a previous DJP Update. But do consider how the public has been left out of the negotiations and the end runs planned to avoid a conference committee of the different House and Senate bills. Secrecy is of great value in searching for those who wish to attack America but it has no place in health system reform. We are Americans, not the enemy.

I believe what I said in the Epilogue of my book, “On Leadership – Essential Principles for Success”, is especially pertinent today:

—–

Page 230: “I believe Americans are disgusted and apathetic about the partisanship, patronage and scandals that continue to stifle Congress. The behavior in the halls and chambers of Congress also does not reflect the Declaration of Independence’s conclusion, ‘And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.’ It appears that many in Congress are not pledging their ‘Fortunes,’ but rather working hard to increase their own.”

—–

ITEM TWO: DO WORDS MEAN SOMETHING?

Now here are a few excepts about promises and reality.

Negotiate health care reform in public sessions televised on C-SPAN

Below are comments about transparency by then-candidate Senator Obama in 2008:

To achieve health care reform, “I’m going to have all the negotiations around a big table. We’ll have doctors and nurses and hospital administrators. Insurance companies, drug companies — they’ll get a seat at the table, they just won’t be able to buy every chair. But what we will do is, we’ll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies. And so, that approach, I think is what is going to allow people to stay involved in this process.”

Sources: Town hall meeting on Aug. 21, 2008, in Chester, Va.

See more at St. Petersburg Time site: http://www.politifact.com/truth-o-meter/promises/promise/517/health-care-reform-public-sessions-C-SPAN/

Also see AP report at: http://news.yahoo.com/s/ap/20100105/ap_on_en_tv/us_health_care_overhaul_tv

“”Obama pledged during a presidential debate in January 2008 that he would be “bringing all parties together, and broadcasting those negotiations on C-SPAN so that the American people can see what the choices are.””

———-

The following is posted at C-Span Website today:

http://www.c-span.org/

Democratic leadership is considering bypassing a formal conference committee in resolving health care legislation differences between the House and Senate. House Speaker Nancy Pelosi said, “there has never been a more open process” and “we will take the route that gets the job done.”

—–

C-Span television sent letter to Congress and reminded President of promise for transparency in negotiations.

http://www.c-span.org/pdf/C-SPAN%20Health%20Care%20Letter.pdf

EXCERPT of December 30, 2009 letter

“President Obama, Senate and House leaders, many of your rank-and-file members, and the nations’s editorial pages have all talked about the value of transparent discussions on reforming the nations’s health care system. Now that the process moves to the critical stage of reconciliation between the Chambers, we respectfully request that you allow the public full access, through television, to legislation that will affect the lives of every single American.”

———

I read the above quote from C-Span on a Washington, DC area 30 minute radio interview this morning (G. Gordon Liddy Show with former Congressman Ernest Istook of Oklahoma as host. You can listen to the Podcast or download it at: http://www.radioamerica.org/POD_ggl.htm

Now on another topic, here is an example of the need to read the fine print in the bills in Congress – danger to HSAs

http://www.john-goodman-blog.com/congress-declares-war-on-hsas/

Read what how the patient in control Health Savings Account coverage could be destroyed with the current bills being pushed in Congress.

Here is an excerpt from article by Ron Bachman posted at John Goodman’s Blog site:

But be sure to read the entire article!

—–

“While Congress has been debating health reform, employers have been creating new consumer-driven plans that lower costs and improve the quality of care. More than half of employers now offer consumer-driven options, including Health Savings Accounts (HSAs) and by 2010, nearly 18 million people will be enrolled.

“Federal legislation can stop progress in its tracks, however. The Senate proposal, for example, does not directly outlaw HSA-eligible plans; but it restricts HSA options in insidious ways that will delay, deny, defeat and ultimately kill them.”

——-

LAGNIAPPE: Many of you know Dr. Susan Adelman, pediatric surgeon and former AMA Board member. Sue is now retired from Medicine and is using her gift for art creation full-time. Check out her Website to see her paintings, jewelry, and sculpture she has for sale. Very impressive! Go to: www.artandjewelryofsue.com

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.

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 2181 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.

Subject: DJP Update 1-1-2010 Breaking news: A Mayo Clinic division in Arizona stops taking Medicare patients; Example of the results of government price fixing; Happy New Year!

DJP Update 1-1-2010 Breaking news: A Mayo Clinic division in Arizona stops taking Medicare patients; Example of the results of government price fixing; Happy New Year!

Throughout recorded history, price-fixing leads to scarcity of services or products. It is no different in Medicine. I have written about this many times in the DJP Updates and spoke of it in interviews and speeches and wrote about it in Op-Ed articles. As you know, some groups have entered into a Faustian bargain with those who now control the supermajority of votes in Congress and the Administration. Instead of fighting to restore liberty of contract without penalty, some medical organizations have gone along with the disaster in the details bills being pushed through the House and Senate.

These organizations keep saying they have a promise from Congress that the onerous SGR/GDP price-fixing formula will be replaced with another price-fixing formula sometime “soon.” The “soon” is no doubt the need to get the “doctor-fix” out of the bills, an exercise in “funny math” to present different numbers to the Congressional Budget Office. The promise is beginning to sound like vaporware! But even if another price-fixing formula emerges, this is not a win! What these groups fail to understand is you can’t expect to survive by changing the length of the chains that bind you or giving you an extra serving of food. Medicine doesn’t belong in chains. No crime has been committed! One must realize that giving up an essential liberty is non-negotiable.

The proper way to negotiate is to say that Congress should decide what Congress can pay for services to individuals in government plans and allow the patient and physician to negotiate the rest WITHOUT PENALTY. But alas, these groups apparently missed that course in negotiating. Do they believe that genuflecting to those in power with hopes of an increase in benefits will win them prestige or the accolades of history? This great Country of America was not born with that approach. This great Country of America was not sustained with that approach. Americans died on battlefields defending our liberty.

And please, don’t write and tell me that physicians have the right to privately contract now with all patients. Sure, you can contract in Medicare but you are kicked out for two years for just one contract for one Medicare-covered service! To tell me physicians have the right to contract in Medicare is akin to telling me a grocery has the right to turn down a demand from a mob member for protection money. Sure, the grocer can turn down the request but it is highly likely there will be harmful consequences!

It is never to late to cancel the Faustian bargain! Throughout history, people have made mistakes and later attained greatness by admitting their error and moving forward on principles. Just read history books. Just read the Bible. Stories abound of such redemption.

And now the breaking news about Mayo.

EXCERPT FROM BLOOMBERG ARTICLE DECEMBER 31, 2009 FOUND AT:

http://www.bloomberg.com/apps/news?pid=20601087&sid=aHoYSI84VdL0

———–

Clinic in Arizona to Stop Treating Some Medicare Patients

By David Olmos

Dec. 31 (Bloomberg) — The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,'” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

SECOND EXCERPT:

Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues. Congress last week postponed for two months a 21.5 percent cut in Medicare reimbursements for doctors.

AND THIRD EXCEPT:

Mayo’s decision may herald similar moves by other Phoenix- area doctors who cite inadequate Medicare fees as a reason to curtail treatment of the elderly, said John Rivers, chief executive of the Phoenix-based Arizona Hospital and Healthcare Association.

“We’ve got doctors who are saying we are not going to deal with Medicare patients in the hospital” because they consider the fees too low, Rivers said. “Or they are saying we are not going to take new ones in our practice.”

———-

DJP Comment: The Mayo action is just the beginning!

LAGNIAPPE: Happy New Year! We still can save Medicine. Get involved. One vote in the Senate (60 votes needed for cloture in Senate and exactly 60 votes obtained) and three votes in the House can stop this disaster in details duo of bills (220-215 was vote for H.R. 3962 tri-committee bill).

Stay well and Happy New Year! Hope you had a wonderful holiday season. Robin and I had all the grandkids in town and four stayed overnight yesterday! What an adventure! Let’s save Medicine for our kids and grandkids and not give them a future portrayed in “We the Living” or “Dr. Zhivago”: A future of bankruptcy, scarcity, and lack of liberty.

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.

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 2181 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.

Subject: DJP Update 12-29-2009: AMA – Amazing logic and view on medical liability reform

DJP Update 12-29-2009: AMA – Amazing logic and view on medical liability reform

One of AMA’s Twitter postings of today, December 29, 2009:

AmerMedicalAssn
#AMAblog: How medical liability reform and Medicare’s SGR formula are addressed in Senate legislation. http://bit.ly/7WPVzD

http://bit.ly/7WPVzD

takes one to:

Blog: On the Road with Dr. Rohack

Excerpt from the AMA blog:

—–

“Over the weekend I received an e-mail from a long-time AMA member asking how he and his fellow members would benefit from health system reform legislation the Senate passed on Christmas Eve. In his e-mail, he wrote that he found no mention in the bill of two issues that are of particular concern to many physicians: medical liability reform and permanent repeal of Medicare’s SGR formula. I’d like to explain how both, which are among the AMA’s seven critical elements for reform, are addressed in the Senate bill.

“The Senate bill contains $50 million for medical liability reform funding for state pilots, and that is in addition to the $25 million President Obama already directed the Agency for Healthcare Research and Quality to provide in grants. The AMA has heard loudly from states that have caps on noneconomic damages—such as California and Texas—that they are opposed to any federalization of tort reform that puts their state reforms at risk. During the George W. Bush administration, when the majority in Congress was Republican, the starting bid for caps in the Senate was double that of California and Texas and was opposed. So scientific testing of alternatives to caps is valid and a move forward to reducing unnecessary costs of defensive medicine.”

——

Now let’s focus on this amazing statement from AMA:

“The AMA has heard loudly from states that have caps on noneconomic damages—such as California and Texas—that they are opposed to any federalization of tort reform that puts their state reforms at risk. During the George W. Bush administration, when the majority in Congress was Republican, the starting bid for caps in the Senate was double that of California and Texas and was opposed.”

DJP Comment: First, let’s assume the statement in “On the Road” is correct that California and Texas stately loudly that they are opposed to federal tort reform that puts there reforms at risk. That is nothing new and was and is AMA policy as indicated by the two policy statements below passed by the House of Delegates, the entity that makes AMA policy that the Board must follow. Now some fact checking.

When I was president in 2003-2004, that same concern was told to AMA and AMA worked to get Federal medical liability reform that was the California MICRA model AND also had wording that preserved state law that was as good. On July 9, 2003, I had the privilege to speak to the National Press Club about medical liability reform. The Gallup Poll showed 70% of the public was in favor of the AMA proposed reform. That California model with the $250,000 cap on non-economic damages had passed the House of Representatives and the vote in the Senate on Senate bill 11 containing the same provisions was to be on July 9, 2003 after my speech. Suddenly the vote in the Senate was called early and before my speech on medical liability reform started, the vote was taken. The Senators in favor of the medical liability reform had the majority vote. However, the Democrats did a filibuster and those in favor of the liability reform could not get 60 votes to obtain cloture and thus bring it to a simple majority vote for passage. The vote for cloture was around 57 and because 60 not reached the bill died in the Senate.

TECHNICAL DETAIL for DOCUMENTATION of STATEMENT ABOVE REGARDING PROTECTING STATE LAWS SUCH AS CALIFORNIA IS POSTED HERE FROM PAGES 23 & 24 OF SENATE BILL 11.

—— This Act does not preempt or supersede
25 any law that imposes greater protections (such as a short
er statute of limitations) for health care providers and
O:\BAI\BAI03.A84
24
S.L.C.
1 health care organizations from liability, loss, or damages
2 than those provided by this Act.
3 (c) STATE FLEXIBILITY.—No provision of this Act
4 shall be construed to preempt—
5 (1) any State law (whether effective before, on,
6 or after the date of the enactment of this Act) that
7 specifies a particular monetary amount of compen8
satory or punitive damages (or the total amount of
9 damages) that may be awarded in a health care law10
suit, regardless of whether such monetary amount is
11 greater or lesser than is provided for under this Act,
12 notwithstanding section 4(a); or
13 (2) any defense available to a party in a health
14 care lawsuit under any other provision of State or
15 Federal law.
16 SEC.

——

If AMA lost that bill’s wording, I have it on my computer’s hard drive.

Why rehash this history. Because of two reasons.

1- It is possible to advocate federal reform that is akin to the California law and still preserve the law in other states that have different but also effective laws. Also the federal tort reform would preempt state constitutions that prohibit caps on damages. One example of such a prohibition is Pennsylvania. I do not say it is easy to get passed today but one can’t go against AMA policy and one can’t give up!

2- The view of a couple of states does not dictate AMA policy. The California and Texas examples are valid concerns but that can’t be used to stop seeking federal reform akin to California. If AMA decides on what will be sought in Congress based on a state voicing opposition, then AMA would not have supported the House or the Senate bills on health system reform. Many states and specialties that sit in the AMA House of Delegates oppose those bills and have told AMA about the opposition. Yet the AMA Board continues on with their view of AMA policy, disregarding a group of doctors that now represent almost 500,000 physicians recorded in the Congressional Record. And yes, there are three former AMA presidents who are listed and who have written Op-Ed pieces stating AMA made a mistake supporting these bills. Forgive me, I keep repeating myself.

For some reason I keep getting flashbacks to the Ministry of Truth in the novel 1984. History continues to change depending on the circumstance. So one must ask the question, Are AMA proclamations an excuse or a reason? The excuse doesn’t fly with the majority of physicians and the reasoning is flawed.

AND PLEASE don’t tell the world that AMA has been advocating for the right to privately contract without penalty. The current bills forbid that and those who control the bills in Congress refused to allow that amendment for private contracting. Where are the AMA ads? We are at the point of “Trust but verify.” Sadly I think we wait like those Spartans at Thermopylae.

As stated by Simonides about the Spartans who died at Thermopylae:

xe‹n’, ¢ggšllein Lakedaimon…oij Óti tÍde
ke…meqa, to‹j ke…nwn ·»masi peiqÒmenoi.

Stranger, bring the message to the Spartans that here
we remain, obedient to their orders.

————

And our fate may be the same.

Reminder of the wording:

RESOLUTION 209 AMA INTERIM MEETING IN HOUSTON”
“RESOLVED, That our American Medical Association ensure the right of patients to choose their physician and enter into private contracts for services, without penalty to patients or physicians; and be it further…”

Final Note: I am getting letters everyday from doctors who inform me they have quit AMA. So sad. I tell all of them that AMA is a wonderful organization and they should not quit. Just as they don’t give up their American citizenship when Congress makes a mistake. The solution is to get Congress to fix the mistake or vote them out of office. Get people in office in Washington who will reason and pass bills based on the facts and not funny math or with provisions that remove our liberty.

As for AMA, don’t quit but show up at the AMA meeting and have people run for office from the floor. There are three candidates from the Board who are running for president-elect. Find someone else who is not on the Board to run for the position as board members all give evidence by their silence of being in lockstep with current AMA actions. Look for a smart (easy to find in HoD) articulate (easy to find in HoD) person with courage and who is willing to make the sacrifices of being in the minority and away from his or her practice. That person would advocate for the return of the patient-physician relationship without government control.

In other words, follow the advice of former AMA president, Dr. Bill Plested, “Let’s take back the profession!” Just the quest for that office by someone from the floor will send a message. There definitely will be a run-off with 4 candidates for the office and it could be the floor candidate would make the run-off. Then we will have a test of the courage and view of the AMA House of Delegates. The outcome might determine if AMA remains a membership organization. By the way, it would be wonderful to have the current paid membership numbers at the Annual June meeting of AMA. It is ridiculous to think those numbers will not be available until AFTER the meeting. With computer speed and databases, the current number should be available daily. Give the report of renewed members as of the meeting. Don’t give the excuse that there still is a grace period to renew. Give a running total. That is an important message.

As a disconfirming opinion giver, I suspect this DJP Update will warrant a lot of hugs as per the advice of the famous business school dean, Dr. Donald Jacobs, who said, “Hug the person who brings you a disconfirming opinion.” Let’s all seek the truth. Be not afraid to ask the tough questions. As Fredrick the Great said, “A man who seeks truth and loves it must be reckoned precious to any human society.”

When I hear some folks say the current Senate and House bills are good for America, I am reminded of Lewis Carroll’s “Though the Looking Glass” quote: Alice said, “One can’t believe impossible things.” The Queen responded, in part, “I daresay you haven’t had much practice,’ said the Queen. `When I was your age, I always did it for half-an-hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”

FOOTNOTES – AMA POLICY (By the way, federal medical liability reform is among AMA’s highest legislative priorities as stated and passed by the AMA House of Delegates!)

H-435.978 Federal Medical Liability Reform Our AMA: (1) supports federal legislative initiatives implementing the following medical liability reforms: (a) limitation of $250,000 or lower on recovery of non-economic damages; (b) the mandatory offset of collateral sources of plaintiff compensation; (c) decreasing sliding scale regulation of attorney contingency fees; and (d) periodic payment for future awards of damages; (2) reaffirms its support for the additional reforms identified in Report L (A-89) as appropriate for a federal reform vehicle. These are: (a) a certificate of merit requirement as a prelude to filing medical liability cases; and (b) basic medical expert witness criteria; (3) supports for any federal initiative incorporating provisions of this type would be expressly conditional. Under no circumstances would support for federal preemptive legislation be extended or maintained if it would undermine effective tort reform provisions already in place in the states or the ability of the states in the future to enact tort reform tailored to local needs. Federal preemptive legislation that endangers state-based reform will be actively opposed. Federal initiatives incorporating extended or ill-advised regulation of the practice of medicine also will not be supported. Effective medical liability reform, based on the California Medical Injury Compensation Reform Act (MICRA) model, is integral to health system reform. (BOT Rep. S, I-89; BOT Rep. I-93-53; Reaffirmed: BOT Rep. 8, I-98; Reaffirmation A-00; Reaffirmation I-03; Reaffirmed: Sub. Res. 910, I-03)

H-435.959 Liability Reform (1) Our AMA states that liability reform is our highest legislative priority; and (2) any federal liability reform legislation advocated by the AMA shall not preempt or supersede any law that imposes greater protections for health care providers and health care organizations from liability, loss, or damages than those provided by this legislation. (Sub. Res. 215, A-02; Reaffirmed: Sub. Res. 910, I-03; Reaffirmed: CME Rep. 2, I-05)

———-

Remember, one vote change in the Senate and a few in the House stop the impending train crash for American Medicine and our patients. Let’s get to work!

Stay well and Happy New Year!

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.

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 2181 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.

Subject: DJP Update 12-28-2009 Two views on medical liability reform in particular and health system reform in general: AMA & Philip Howard

DJP Update 12-28-2009 Two views on medical liability reform in particular and health system reform in general: AMA & Philip Howard

AMA comments from AMA president:

http://online.wsj.com/article/SB20001424052748703478704574612541062948378.html?mod=djemITP

————-

Wall Street Journal December 28, 2009 Letter to the Editor

AMA Is Working With the Senate In regard to your Dec. 21 editorial “Change Nobody Believes In”: Make no mistake–the AMA is committed to permanent repeal of the broken Medicare physician payment formula that threatens access to care for seniors, military families and baby boomers. We are closer than ever to achieving that goal. On Saturday, Senate Majority Leader Harry Reid said that the Senate plans to work on the issue early in the new year, and the House has already passed legislation that repeals the current formula and updates payments to better reflect increasing medical practice costs. The two-month reprieve from the cuts will preserve access to care in the very short-term while the Senate works on permanent reform.

Our current health system is fragmented, and it’s not working for far too many patients and the physicians who dedicate their lives to patient care. Reform of our health system is needed, and the Senate bill includes key benefits that will increase choice and access while eliminating insurance company tactics like denying coverage for pre-existing conditions. It also authorizes grants to test alternative medical liability reforms that show promise in benefiting patients and reducing the impact of defensive medicine. The AMA supports passage of the amended Senate bill, and we’ll continue to work through the conference process to strengthen the bill.

J. James Rohack, M.D.

Chicago

———

But Philip Howard, Chair of Common Good ( see: http://commongood.org/ ), best-selling author regarding reforming the legal system, and recipient of AMA Presidential Citation on March 29, 2004 during my AMA presidency. He offers a different view on medical liability and current health system reform bills. Howard considers the Senate insert on medical liability reform a “trojan horse” and the current proposed bills in Congress failures in addressing the problems. He says, in part, “The culture of American health care delivery can’t be fixed by piling 2,000 pages of new law on top of a mountain range of current entitlements, regulations, and protocols.”

http://correspondents.theatlantic.com/philip_howard/2009/12/how_to_build_a_trojan_horse.php

How to Build a Trojan Horse

The Senate health care bill does nothing to address the unreliable malpractice system. Actually, it’s designed to prevent fixing the malpractice system. How the bill does this is painfully apparent to me–because I put together the first draft of a malpractice amendment at the request of a Democratic policy expert who deals with members of Congress on these issues. Here’s how the reform proposal got transformed into a bulwark for trial lawyers to bar possible reform.

–Ignore defensive medicine. The bill contains vague language about “mak[ing] the medical liability system more reliable,” but, in listing its goals, says nothing about stemming the waste of defensive medicine. Indeed, the phrase “defensive medicine” never appears in the bill.

–Make any pilot toothless. The bill supposedly encourages pilot programs to improve reliability by “increasing the availability of prompt and fair resolution of disputes.” Indeed, only when justice is reliable will health care providers focus on delivering the best care rather than making choices defensively. But the bill then removes the potential benefits of reliability by providing that any patient can “opt out” of any pilot project “at any time.” Lest anyone miss the point, the bill explicitly preserves every claimant’s ability to take the case to a jury trial, even after participating in the pilot. Instead of providing a reliable new system, the bill essentially gives claimants a choice of “heads I win, tails you lose.”

–Remove any incentives for reform. The cost of unreliable justice is so great–resulting, according to some estimates, in $200 billion in unnecessary defensive medicine annually–that most serious proposals for overhaul (including the bipartisan proposal by Senators Wyden and Bennett) have provided incentive payments for states that succeed in stemming the waste. The Senate bill omits any such incentives. The preamble of the Senate proposal makes it appear that the purpose is reform, but then, like a Trojan horse, it kills any possibility of achieving that goal. The cynicism here is breathtaking.

——–

And more from Philip Howard in the New York Daily News on how to fix the health system and why the current bills in Congress won’t work:

http://www.nydailynews.com/opinions/2009/12/21/2009-12-21_the_missing_rx_responsibility.html

http://www.nydailynews.com/opinions/2009/12/21/2009-12-21_the_missing_rx_responsibility.html?page=1

EXCERPT:

Yet Congress refuses to alter the core structure that causes this waste. The culture of American health care delivery can’t be fixed by piling 2,000 pages of new law on top of a mountain range of current entitlements, regulations, and protocols. What’s missing in American health care is a basic principle essential to all human accomplishment: Individual responsibility, in this case responsibility for prudent use of health care resources. ……..

……

Instilling individual responsibility requires more profound changes – but changes that, at least conceptually, are straightforward: (1) pay doctors based on overall results, not piecework reimbursement; (2) require patients who can afford it to pay a meaningful portion of their care; (3) minimize defensive medicine by creating a reliable system of medical justice; (4) reduce bureaucratic overhead and complexity (which also clears out the thicket in which fraud can hide).

Proponents argue that the pending bills work toward containing costs, including authorizing pilot projects for new reimbursement systems and a Medicare Advisory Board to recommend cost-saving measures. But without reorienting the delivery of care around the core principle of individual responsibility, any cost-saving proposals will ultimately die on a political vine that is nourished not by principle but by special interests.

White House chief of staff Rahm Emanuel recently dismissed critics of the proposed bills by saying that legislation is not made by “people sitting in the shade at theAspen Institute.” That may be the understatement of the year; these bills overflow with special interest giveaways.

Instead of containing costs, Congress is building support for the bills by institutionalizing the waste. Doctors get deals to lock in existing reimbursement formulas. Labor and consumer groups keep free health care, without any meaningful patient contribution. Trial lawyers veto malpractice reform.

Why do we think Congress will stand up to special interests tomorrow when it refuses to do so today?

It’s time to be realistic, not about the need to mollify special interests, but about the need for individual responsibility, by doctors, patients and everyone else. Responsibility must become the core element of American health care, just as it is for all other human activity.

Howard, a New York lawyer, is the author of “The Death of Common Sense” and chairman of Common Good.

——————————–

I encourage you to visit both sites where these articles by Philip Howard are located and post comments. I just posted one at the New York Daily News stating that one element left out in the personal responsibility article is the need to restore the right to privately contract without penalty.

DJP Reflections: Remember that one vote change in the Senate and perhaps 3 vote changes in the House will stop these bills with disaster in the details. Then effective reform can be debated and a solution won’t require over 2000 pages. Time is of the essence. What will you do to make a difference? Education, discussion, and debate on the real facts and not funny math can make a difference.

Again, Happy New Year. Hug a loved one. Get your blood pressure checked. That is a silent killer. Don’t assume you are free of hidden correctable problems.

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.

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 2181 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.