The DJP Update

Subject: DJP Update 12-27-2009: Two newspaper articles -Times of London & NY Times – about health system reform; LAGNIAPPE – Twitter tip and radio interview

Below are examples of Freedom of the Press. The first article is a view from across the ocean. The second is from the woman who knows how to turn a phrase and frequently offers critical commentary against Republicans. If time permits, go to the links and read the entire articles.

Article from the Times of London

http://www.timesonline.co.uk/tol/news/world/article6968494.ece

From The Sunday Times December 27, 2009

Horse-trading over health scars Obama
The deals struck to win support for his key healthcare reform have damaged the president as the fall in his popularity ratings shows
Tony Allen-Mills in New York

(Some Excerpts)

Yet it was clear last week, as the president flew off to Hawaii for his Christmas break, that while the Clintons put defeat behind them and cruised to two full terms in the White House, Obama may never recover from a victory that has demolished his bipartisan aspirations and which his critics have already judged pyrrhic.

It was a bizarre feature of the US healthcare debate that the longer it went on and the closer it came to a successful outcome, the lower Obama sank in opinion polls. By the time the last $100m incentives had been dished out to wavering Democratic senators last week, Obama was languishing at his lowest approval ratings of the year, with one poll showing that only 32% of Americans still think the healthcare plan is a “good” idea.

—-

Amid the 2,000 pages of small print added to the Senate’s healthcare bill are all manner of promises and pay-offs to senators protecting the special interests of their home states. Senator Harry Reid, the Nevada Democrat who has led his party’s discussions of the bill, defended the deals with wavering senators as “the art of compromise … that’s what legislation is all about”.

——

The biggest beneficiary of what one columnist dubbed “Harry [Reid]’s favour factory” was Senator Ben Nelson, a moderate Nebraska Democrat who insisted his vote was “not for sale”, but who later overcame his doubts about abortion and other issues when a clause worth $100m to Nebraska hospitals was belatedly inserted.

Other big Democratic winners included Senator Mary Landrieu of Louisiana, who successfully argued for subsidies that apply mainly to her home state; Senator Christopher Dodd, whose home state of Connecticut may land a new university hospital; Senator Bill Nelson, who won special exemptions for Florida pensioners; and Senator Patrick Leahy of Vermont, who fought off potentially punitive tax penalties.

All this presented Republican critics with an arsenal of prospective abuse that was threatening to resonate much more loudly with voters than Obama’s solemn insistence that history is being made.

“This process is not legislation. This process is corruption, declared Senator Tom Coburn, an Oklahoma Republican. Senator Lindsey Graham talked of “backroom deals that amount to bribes”.

——–

It was the crushing collapse of the Clinton health reforms, derided as HillaryCare, that largely contributed to the so-called Republican “revolution” of 1994, when conservatives led by Newt Gingrich and his Senate allies seized control of both houses of Congress.

The Democrat losses persuaded Bill Clinton to turn to Dick Morris, a shrewd political operator who steered the president away from the left of his party and encouraged him to focus on traditionally Republican virtues such as a balanced budget and toughness on crime.

By the time Clinton delivered his state of the union address in 1996 he was able to declare the “era of big government is over”. He was re-elected at a canter later that year.

Yet Obama has so far shown no sign that he plans a similar U-turn. Although polls show a substantial majority of voters remain suspicious of “big government” – an elastic term that most associate with higher taxes – the president insisted in interviews last week that he was “very enthusiastic about what we have achieved”.

——

… may distract the president from what many voters perceive as his greatest failing – an economic recovery programme that has sent the federal budget deficit soaring yet has failed to generate many new jobs.

Despite encouraging signs of a return to growth, a backlog of home repossessions and continuing restrictions on new debt continue to dog much of working-class America. Obama insisted last week that the financial rescue package he forced through at the start of the year was “the most important thing we did”, yet continuing rows over bankers collecting their Christmas bonuses have undermined the president’s claims to have introduced meaningful change.

Perhaps most dangerously, the healthcare feuding has made a mockery of Obama’s repeated pledges to mend what he used to call “the broken system in Washington”.

Obama owed his primary victory over Hillary Clinton in no small part to his depiction of the former first lady as one of “the Washington players [who] play the same old Washington game”. In his stump speech he routinely declared: “It’s time to end business-as-usual in Washington so we can bring about real change for the American people.”

Obama insists that his healthcare reforms will transform the lives of millions of Americans. Yet the empty tables of the Senate dining room suggest a different and more ominous change.

———-

New York Times – Maureen Dowd’s column December 26, 2009 – A must read article. Question: Does she really have a brother named Kevin?

http://www.nytimes.com/2009/12/27/opinion/27dowd.html?_r=5

(article access is free but one must sign in with an ID of your choice or email address and pick a password. And browser must be set to accept cookies.

http://www.nytimes.com/2009/12/27/opinion/27dowd.html?_r=5

(SOME EXCERPTS)

December 27, 2009
OP-ED CONTRIBUTOR
Oh, No! Kevin’s Back!
By MAUREEN DOWD
WASHINGTON

As my brother Kevin headed off to Christmas Eve Mass in the Maryland suburbs, I asked him how he thought the first year of Barack Obama had gone.

He didn’t have to pray long over that one. “Fine,” he replied, “if you like unmitigated disasters like the Hindenburg and the Redskins season.”

If it’s Christmas, it must be time for my conservative brother to take over my column and turn it a blazing shade of red.

—–

The Republicans, of course, got exactly what they deserved in 2006 and 2008 mainly because they acted like Democrats. Deficit spending and sex scandals are not a good recipe for success.

But by forcing through a government takeover of health care, the auto industry and the banks, the president and his Congressional henchmen have brought us in a time machine to Russia 1917. These massive changes have been done in secret and along bullying, straight party-line votes.

It is stunning to watch rich lawmakers driving their own expensive cars off the cliff and signing on to such a socialist agenda. In dismissing the tea parties and pushing through plans the American people obviously don’t want, they have made the fatal disconnect between the representatives and the represented.

President Obama continues life in the H.O.V. lane, fawned over by the press and the crowned heads of Europe. In between apologies, the president should have reminded those pompous blowhards that without our interference, they would all be speaking German.

—-

President Obama should remember that Icarus tried to fly to the sun because, as he said, “it is the only thing in the universe that can match my brilliance.” How did that work out?

Here are some reflections for 2009:

To President Obama: Thank you for saving the Republican Party and for teaching all of us that too much of anything is a bad thing.

To Bill Clinton: You did too much work on Northern Ireland for the Nobel committee. Next time, do nothing.

To Harry and Nancy: “The Twilight Zone” once had an episode where the town got the exact opposite of what it wanted. Farewell, Harry!

To John McCain: Thank you for your chivalry in banning Palin attack dogs – including my sister – from the campaign plane.

To Sarah Palin: Keep up the good work. Anyone who annoys Keith Olbermann that much is a friend to all of us.

To Glenn Beck: Thanks for being the only journalist interested in stories that used to win Pulitzer Prizes.

To Al Franken: So, 250 years of Senate tradition trashed. Stuart Smalley would have done better.

To Desirée Rogers: Get back to the gate. Vince Vaughn and Owen Wilson can’t get in.

To the Salahis: Thank you for showing us that shame has no bottom.

To Valerie Jarrett: So much for the Olympic Village in Chicago. Whoops.

To Chris Dodd: The only thing lower than your polls is your mortgage interest rate.

To Chairman of the Joint Chiefs Mike Mullen: The military should be more interested in the men and women who serve than in celebrating diversity.

To the Democratic senators: Go last next time; the bribes are much bigger.

To Sheldon Whitehouse: You, senator, are an idiot.

To Dick Cheney: You, sir, are a patriot. Thanks for firing back.

To President Bush: Thank you for your dignity. Did you really start the plague in the 14th century? Absence makes the heart grow fonder.

To Hillary: Who knew how much you would be missed?

To Al Gore: A global warming conference in the middle of a Copenhagen blizzard is not a good visual.

To Max Baucus, Eliot Spitzer and John Edwards: Party on, dudes.

To John Ensign, Mark Sanford and David Vitter: Don’t party on, dudes.

——–

LAGNIAPPE

Now putting some DJP Updates on Intrepid Resources Website. You can access from Home Page, www.intrepridresources.com

Also learning and using Twitter each day. Great tip from Barry Eisenberg, Executive Director of the American College of Occupational and Environmental Medicine (ACOEM), about decreasing size of Website links so that there can be more words in 140 character limit of Twitter’s Tweet. It works well.

Here is what Barry advised:

—–

Donald,

I notice a lot of your twits have long URLs-typical when linking to news items.

To shorten those, take (copy) the URL, go to “tinyurl.com” and paste it in. It will give you a much shorter version, freeing up more time in your message for personal text. ——–

DJP comment: Here is an example. I did a North Carolina radio interview on December 16, 2009 and it is at: http://carolinatalknetwork.com/2009/12/dr-donald-j-palmisano-md-jd-facs-on-health-care-reform/ But you can go to the URL conversion site and shorten it to: http://tinyurl.com/yhe87m5

Both will take you to the radio interview on health system reform and the latter link gives you more space for the discussion on Twitter which limits to 140 characters including spaces. If time permits, listen to the interview and note last part of interview deals with medical liability system.

——–

Drop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. The health system reform debate is not over! Stay informed. Stay active.

Finally, hard to believe the Saints lost in overtime to Tampa Buccaneers! Final score 20-17. Saints had a 17 point lead. Second loss in in a row. The Tampa Buccaneers deserve praise for that win.

Best wishes for a healthy and Happy New Year!

Donald

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 12-23-2009 5:40 pm request – Visit link and leave a comment on Senate bill

DJP Update 12-23-2009 5:30 pm request – Visit link and leave a comment on Senate bill

This is the tweet just sent:

#SenateHealth – add comment http://www.fox8live.com/mostpopular/story/Local-doctor-reacts-to-healthcare-bill/mdj1A-24hEWpsFCEJ1bKzQ.cspx

For those on DJP Update, visit link:

http://www.fox8live.com/mostpopular/story/Local-doctor-reacts-to-healthcare-bill/mdj1A-24hEWpsFCEJ1bKzQ.cspx

and leave a comment by clicking on comments at bottom right. Watch short video of interview also if you can find it at site. Click on “video” at top and then click go on left to “Top Stories” and click on

Senate moves closer to passing health care reform

Thanks.
DJP

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 12-23-2009: AMA HSR Bulletin of 12-23-2009 link and excerpt PLUS Congressional Records comments by Senators Risch and Barrasso; LAGNIAPPE: CBO BREAKING NEWS

DJP Update 12-23-2009: AMA HSR Bulletin of 12-23-2009 link and excerpt PLUS Congressional Records comments by U.S. Senators Risch and Barrasso; LAGNIAPPE: CBO BREAKING NEWS

ITEM ONE: AMA HSR Bulletin of 12-23-2009 – Comments on an excerpt

ITEM TWO: Congressional Records comments by Senators Risch and Barrasso

LAGNIAPPE: CBO BREAKING NEWS (Don’t fail to read this! Important to verify statements made in the health system reform debate!)

ITEM ONE: AMA HSR Bulletin of 12-23-2009

http://www.ama-assn.org/ama/pub/health-system-reform/bulletin/23dec2009.shtml

Read the whole bulletin so you get all views about this debate. Interesting excerpt:

“No public plan option: The revised bill does not contain a public plan option and, as noted earlier, the AMA played a key role in blocking the Medicare buy-in proposal.”

DJP comment: Is this meant to imply the AMA is against a public plan option and wants credit for blocking it? If so, why is AMA supporting the House bill that contains a public plan option? Did anyone see any AMA ads about being against the public plan option. What I still see is the joint AARP/AMA ad supporting legislation in Congress. If AMA is against the Medicare buy-in and AMA should be, based on AMA policy, then how can AMA not strongly oppose the public plan in the House bill? All of these variations lead to government control of Medicine with price-fixing and disaster for patients. Just look at the failed Medicaid system for the best example. And now Congress is about to expand Medicaid in both the House and the Senate bill!

Too bad that our AMA policy developed over many years is not being used to fix the health financing system. And if Congress refuses to use those market enhancements, AMA shouldn’t give approval of a treatment that poisons the patient and the doctor. And I would love to see AMA ask the American public and CONGRESS in ads why the right to privately contract with patients WITHOUT PENALTY is forbidden in the House and Senate bills. Why is this American liberty being denied? With the present bills, you as a physician will comply or your population of patients will be severely limited. Only the doctors who get out of the onerous system and privately contract with patients will have the liberty Americans fought and died to preserve. —– ITEM TWO: Congressional Records comments by Senators Risch and Barrasso (Thanks to Dr. David Walsworth of Monroe, Louisiana for this alert!)

U.S. Senator Jim Risch of Idaho remarks in the Congressional Record December 22, 2009 placed below. Also go to this link in the Congressional record to see part of this speech PLUS the comments of Senator (Dr.) Barrasso. Go to: http://frwebgate.access.gpo.gov/cgi-bin/getpage.cgi?dbname=2009_record&page=S13758&position=all

——EXCERPT FOLLOWS

Mr. RISCH. Mr. President, here is what this has come to. In the next 48 hours, this 2,400-some page bill is going to pass the Senate. But how did we get there? Was it done the way things are usually done in this body? Not at all. One party has been able to gather 60 votes for this. Not one person from the other party is going to vote for it. How did they get those 60 votes? Did they get it by arguing this out? They did not do that. They have bluntly, boldly, and on the front of virtually every newspaper in this country bought the votes to pass this bill, to get to the 60. They bought the last handful of votes, and they did not even buy it with their money, they bought it with the American people’s money. Now, that is wrong.

The explanation I heard from the majority leader the other day is: Well, that is the way this is done. That may be the way this is done in banana republics, that may be the way this is done in Third World countries, but this is America. The American people are outraged over this. The other party ought to be outraged.

I heard one Member quoted as saying: Well, I was too stupid to get any money for my State in there. I heard the majority leader say: You are not doing your job if you don’t have something in there for you. Where is the outrage from the other side, not only about the process but how they are getting snookered by some other members of their party? Where is the outrage?

I watched the debate on the other side and have seen Members come down and say: The American people want this. Are they living in a cave? Sure, there are a handful of American people who want this. Let me tell you who does not. The U.S. Conference of Bishops does not want it. The National Right to Life people do not want this. Not one Republican wants this. The Democrats do not want it.

Listen to what Howard Dean, the former leader of the Democratic Party, said:

At this point, the bill does more harm than good.

Ask any Democratic Governor in America. This bill transfers $25 billion in costs in unfunded mandates to the Governors and to their taxpayers. They have to come up with $25 billion. They don’t want it.

I have stood here and listened to the other side say: This is wonderful for small business. Small business is going to come out so well on this. Then why does the National Federation of Independent Business–small businesses–say:

The Senate bill fails small businesses.

The National Association of Wholesale Distributors. The Small Business Entrepreneurship Council says:

Small business group say Reid health bill more of the same–more taxes, mandates, big spending, and nothing to help lower insurance costs.

Associated Builders and Contractors is against it. The National Association of Manufacturers is against it, the Independent Electrical Contractors, the International Franchise Association. Even the labor unions have said: Don’t tax our health care benefits. We agree with them. We are on the side of the labor unions. We should not be taxing health care benefits.

But set all that stuff aside. These are all people who have an ax to grind. The American people do not want this bill. These people who are coming out here saying the American people want this bill, I don’t know whether they are not reading the newspapers, whether they are not reading their own e-mails at their office. The Quinnipiac poll that was out this morning, Tuesday through Sunday, says: 36 percent of the American public support the health care spending bill; 53 percent oppose. That is an 18-percent difference. Gallup says 61 percent of the American people don’t want this bill.

Stop coming out here saying the American people want this bill. The American people do not want it. You want it, but the American people do not want it. Leaders in your own party do not want it. The labor unions do not want it. Nobody wants this thing, and most of all small business does not want this bill.

I have listened to anecdote after anecdote from the other side. There are some very touching stories, and everybody over here is empathetic with them. But you don’t legislate using anecdotes because you are only hearing one side of the story, you are not hearing all the facts dealing with the anecdotes, and to then pat this 2,400-page bill and say this will solve that, that is not the way you legislate, and it is certainly not the way you argue a point.

I heard the other side come out here and pat the bill and say: When we pass this bill, 94 percent of American people will have insurance, will be covered by health insurance. In court, they say you have to tell the truth, the whole truth, and nothing but the truth, and that is exactly why. You cannot pat this bill and say now 94 percent of the American people are going to be covered.

Somebody listening to that will say: Gosh, what a wonderful bill. What is it going to cost? It costs $2.5 trillion to cover 94 percent of the American people. But they don’t say the bill only adds another 7 percent. The fact is, they don’t tell you that 87 percent of Americans are already covered by some kind of health insurance. So don’t say this is a grand and glorious victory because we are now going to cover 94 percent when 87 percent are already covered.

This is gimmickry at its worst, to tax for 4 years without giving any major benefits. Giving some minor benefits but holding off the major benefits

[Page: S13758] GPO’s PDF

until later is plain gimmickry. They say: Oh, look how wonderful this is. It is not going to add to the national deficits because we are going to collect taxes for 4 years, and only then are we going to start the benefits.

What do we have here? When all is said and done and you strip it away, you have $2.5 trillion and 2,400 pages that most people do not understand, higher taxes, and higher insurance premiums.

I can give you one fact that is the best reason to vote against this bill; that is, it cuts $ 1/2 trillion out of Medicare benefits. If you are a senior watching, $ 1/2 trillion of Medicare benefits is going to disappear. I heard the President say and I heard my friends on the other side say: Look, if you like your program, if you like your insurance plan, you are going to be able to keep it. Try to tell that to the people who are on Medicare Advantage. It is being stripped. It is being eliminated under this bill. Indeed, if you read the rules and regulations under this bill, the plan you have will not even exist when it is done.

You know, I have heard the other side say: Oh, you Republicans are just playing on fears of the American people. Let me tell you something. The American people are frightened. They are afraid. It isn’t just this health care bill, they have sat here for the last year, and they have watched stimulus packages costing $1 trillion. They have watched multibillion-dollar bailouts. They have seen buyouts. They have seen trillion-dollar deficits running up. They have seen the national debt now running into the trillions. And, yes, they are afraid.

But it isn’t us that is doing it to them, it is you that have done it to them. It is you that have committed the actions that have put the fear into the hearts of the American people. Don’t do this. Stop this nonsense. You have the opportunity still to stop this. You can do it. The American people don’t want this. Stop the insanity.

I yield the floor.

——-

Go to Congressional Record link above for Senator (Dr.) Barrasso of Wyoming.

Keep the faith. Americans are not stupid. They will recognize what is happening in Congress for what it is. There will be consequences.

——

LAGNIAPPE: CBO BREAKING NEWS Go to: http://cbo.gov/ftpdocs/108xx/doc10868/12-23-Trust_Fund_Accounting.pdf

Key point: “However, the additional savings by the government as a whole which represent the true increase in the ability to pay for future Medicare benefits or other programs would be a good deal smaller. The key point is that the savings to the HI trust fund under the PPACA would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs. Trust fund accounting shows the magnitude of the savings within the trust fund, and those savings indeed improve the solvency of that fund; however, that accounting ignores the burden that would be faced by the rest of the government later in redeeming the bonds held by the trust fund.”

DJP comment: The claim that the Senate bill with the latest Manager’s Amendment health reform bill both improves the solvency of the Medicare trust fund and pays for itself IS NOT supported by the CBO. This points out the dangers of rushing a bill through Congress without adequate study.

Stay well.

Donald

P.S. Thanks to all of you who have joined http://twitter.com/djpNEWS About to send out a Tweet! Drop by and join! Hear is what a typical “Tweet” looks like with the 140 character limit: CBO re health bill- not both: solvency and pays for itself: http://cbo.gov/ftpdocs/108xx/doc10868/12-23-Trust_Fund_Accounting.pdf

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 12-21-2009 – 7 p.m. edition Rapid Communication Alerts via TWITTER – Sign up for DJPNEWS

DJP Update 12-21-2009 Rapid Communication Alerts via TWITTER- Sign up for DJPNEWS on Twitter.com

Because the health system reform is moving rapidly I opened a Twitter account and will announce via tweets when a DJP Update has been posted. Time is of the essence in this debate and patients and physicians are losing the game. In times of crisis, speed of communication is an essential ingredient for success.

Therefore, if you wish to get a tweet alerting you to DJP Update and other breaking news, sign up at:

Tweets by DJPNEWS

It is free and painless. You click on “Join Today” to open an account. Put in a username and pick a password. Then go back to http://twitter.com/DJPNEWS and join.

If my brief instructions are not enough for you, go to http://www.twitip.com/how-to-set-up-a-twitter-account/ or other sites found with one of the search engines. It is really quite simple.

I still am learning the rules of the game but it is suppose to be simple and so far it is. I also just got an Apple I-Phone and added the “app” Tweetie to it. Will do a Lagniappe tech section soon about the I-Phone and why I switched from the BlackBerry. The Apple Apps are out of this world and number greater than 50,000. Many are free. But more about this high tech device later. To increase your curiosity go to: http://www.apple.com/iphone/apps-for-iphone/

NOW join up for tweets at http://twitter.com/DJPNEWS

Increase your tech knowledge and increase the brain connections to prevent memory loss in old age!

Stay well and be ready for engagement in the final debate. Let us hope it ends up better for us than for the 300 Spartans at the Battle of Thermopylae. But then history remembers them as brave souls who did not cower. They may have won without the betrayal of Ephialtes. In the end, the brave stand of these 300 inspired the Greeks to defeat the Persians later. But I tell you things you already know. Getting ready with my stories for the visit of the wonderful and curious grandkids. Truly something to be thankful for.
Donald

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 12-19-2009: President and Senators press conferences of today about reaching 60 senate votes for senate health bill

DJP Update 12-19-2009: President and Senators press conferences of today about reaching 60 senate votes for senate health bill

I hope you had the opportunity to hear President Obama and then Senator Reid et al different press conferences today. It was covered on C-Span and no doubt most of the network and cable channels. 60 votes are now lined up to get cloture as Senator Nelson of Nebraska said he will vote for cloture.

President Obama did not take any questions from the press. The senators did.

But has the American public read the new version of the Senate bill? Good luck finding that version prior to press conference. Senator Reid say that those who oppose his version “should spend a couple of days reading our mail.” What about letting Americans spend a couple of days reading the bill before forcing a vote?

The Republicans insisted on the bill being read word for word aloud in the Senate before the vote and that is being done now.

The statement also made today at press conference that “inaction is not an option.” Comment by DJP: That is a false framing of the debate. The issue is not Senator Reid’s bill versus no bill. That is not the total universe of choices. What about a choice of individual ownership of policies, tax credits, purchase across state lines, protecting health savings accounts, medical liability reform, etc. etc.? One cannot let someone frame a debate that limits choices.

Senator Baucus said at the press conference, “Our bill will be fully paid for. This is the largest tax cut since 2001.” Does he think that is true? Does he think Americans will believe that?

Senator Harkin said at the press conference that he and Senator Dodd and Senator Baucus all came to the Senate in 1975. After this press conference and watching how this bill has been handled, I suspect some Americans might think about a push to create term limits for folks in Congress.

And it was fascinating to hear the response of how the special treatment of certain senators and their states were handled in the press conference. Check out the special advantage of Louisiana, Nebraska, and a few others. Response by Senator Reid to press questioner about 100% coverage for Nebraska Medicaid “forever”, and Senator Reid said, “…You will find that a number of states are treated differently, that is compromise.” He said some of the time that is how you get their vote. I recorded that press conference and replayed it to be sure I did not hear it incorrectly.

Well, now think about the possibility of other senators asking for treats and incentives in this candy store or they might withhold votes going forward. This reminds me of the George Orwell’s “Animal Farm” book excerpt where the “Commandments” suddenly, without discussion, are reduced to a single “Commandment”, “All animals are equal but some animals are more equal than others.”

I do have the Congressional Budget Office scoring of costs letter that was issued today. Here are a few excepts.

From 12-19-2009 38 page CBO letter to Senator Reid

Excerpt from page 13 A provision that would increase Medicare’s payment rates for physicians services by 0.5 percent for 2010 was eliminated. Instead, the 21 percent reduction in those payment rates that is scheduled to occur in 2010 under current law would take effect.

DJP comment: I conclude this is funny math. Is this to reduce the CBO scoring cost of the bill to keep it under one trillion dollars? Some might say yes! Instead the senate has put a temporary hold of the payment cut in another bill. Once again, when physicians grant government the right of government to price-fix, and that is what the government programs do because they are not indemnity payments with the right of the physician and patient to privately contract for any difference in the cost of the service and what the payment from government is, the doctor and patient lose. The end result is loss of liberty and erosion of the Free Enterprise System.

Read the whole CBO letter yourself. Go to: http://www.cbo.gov/ftpdocs/108xx/doc10868/12-19-Reid_Letter_Managers.pdf

Here are a few more excepts from the CBO letter to Senator Reid without comment by me at this time. I have to go back to work now. But do note the “substantial uncertainty” language found in the letter.

EXCERPT from page 2:
——–
This estimate incorporates the effects of the manager’s amendment, which would make a number of changes to the Patient Protection and Affordable Care Act as originally proposed. The changes with the largest budgetary effects include: expanding eligibility for a small business tax credit; increasing penalties on certain uninsured people; replacing a public plan that would be run by the Department of Health and Human Services (HHS) with multi-state plans that would be offered under contract with the Office of Personnel Management (OPM); deleting provisions that would increase payment rates for physicians under Medicare; and increasing the payroll tax on higher-income individuals and families. Of the total deficit reduction of $132 billion projected to result from the legislation, the manager’s amendment accounts for about $2 billion, and the act as originally proposed accounts for the remaining $130 billion.
——-

Page 4
—– Estimated Budgetary Impact According to CBO and JCT’s assessment, enacting the Patient Protection and Affordable Care Act with the manager’s amendment would result in a net reduction in federal budget deficits of $132 billion over the 2010-2019 period (see Table 1). In the subsequent decade, the collective effect of its provisions would probably be continued reductions in federal budget deficits if all of the provisions continued to be fully implemented. Those estimates are subject to substantial uncertainty.
——-

Page 7

Starting in 2014, the legislation would establish a requirement for such residents to obtain insurance and would in many cases impose a financial penalty on people who did not do so. The bill also would establish new insurance exchanges and would subsidize the purchase of health insurance through those exchanges for individuals and families with income between 133 percent and 400 percent of the federal poverty level (FPL). Policies purchased through the exchanges (or directly from insurers) would have to meet several requirements: In particular, insurers would have to accept all applicants, could not limit coverage for preexisting medical conditions, and could not vary premiums to reflect differences in enrollees’ health. The options available in the insurance exchanges would include private health insurance plans and could include two national or multi-state plans operated under contract with OPM. Starting in 2014, most nonelderly people with income below 133 percent of the FPL would be made eligible for Medicaid. The federal government would pay all of the costs of covering newly eligible enrollees through 2016; in subsequent years, the federal share of spending would vary somewhat from year to year but would average about 90 percent by 2019. (Under current rules, the federal government usually pays about 57 percent, on average, of the costs of Medicaid benefits.) In addition, states would be required to maintain current coverage levels for all Medicaid beneficiaries until the exchanges were fully operational; coverage levels for children under Medicaid and CHIP would have to be maintained through 2019. Beginning in 2014, states would receive higher federal reimbursement for CHIP beneficiaries, increasing from an average of 70 percent to 93 percent. The legislation would also provide states with additional CHIP funding in 2014 and 2015.
——–

Page 8
Effects of Insurance Coverage Provisions

CBO and JCT estimate that provisions affecting health insurance coverage would result in a net increase in federal deficits of $614 billion over fiscal years 2010 through 2019 (see Table 4). That estimate includes $395 billion in additional net federal outlays for Medicaid and CHIP.3 It also includes $436 billion in federal subsidies that would be provided to purchase coverage through the new insurance exchanges and related spending.4 The other main element of the coverage provisions that would increase federal deficits is the tax credit for certain small employers who offer health insurance, which is estimated to cost $40 billion over 10 years. Those costs would be partly offset by receipts or savings, totaling $257 billion over the 10-year budget window, from four sources: net revenues from the excise tax on high-premium insurance plans, totaling $149 billion; penalty payments by uninsured individuals, which would amount to $15 billion; penalty payments by employers whose workers received subsidies via the exchanges, which would total $28 billion; and other budgetary effects, mostly on tax revenues, associated with the expansion of federally subsidized insurance, which would reduce deficits by $65 billion.5
——

Page 13

The penalty for not having insurance would be the greater of a flat dollar amount per person or a percentage of the individual’s income, which would increase the amount of penalties collected.
—–

And now you can see the actual 383 page amendment put forth by Senator Reid. This amendment is what the CBO “scored”. Go to:

http://democrats.senate.gov/reform/managers-amendment.pdf

Stay well.
Donald

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 12-18-2009 Weblink for interview today Morning Bell; Breaking News: Seattle Times board drops support health system reform

DJP Update 12-18-2009 Weblink for interview today Morning Bell; Breaking News: Seattle Times board drops support health system reform

ITEM ONE: Weblink for interview today on Fox Business Morning Bell with Alexis Glick in event you missed the show and my comments on health system reform

I find it hard to believe there still is no final version of the bill for anyone to study and yet Senator Reid wants to have the vote on cloture by December 24. In a book of fiction, no one would believe this. Almost 500,000 doctors recorded in Congressional Record against previous Senate version posted and majority of Americans against it in multiple polls and yet there is the rush to jam it through the Senate. In my interview today, I say this is akin to a battery on the American people. It is like a doctor who operates on a patient when the patient says no to the operation. It goes beyond a lack of informed consent. It is now assault and battery. Assault is putting us in fear of the disaster in this bill. Battery is the action upon us without our permission.

Go to: http://www.foxbusiness.com/search-results/m/27963148/former-ama-president-on-health-care.htm#q=donald+palmisano

Note: you make have to paste link into your browser if double-clicking on it doesn’t work properly

ITEM TWO: Breaking news: “The Seattle Times editorial board drops its support of the health-care-reform bills, and says Congress should focus on bolstering the economy and ending the wars in Iraq and Afghanistan.”

(DJP comment: This is a powerful message!)

http://seattletimes.nwsource.com/html/editorials/2010544086_edit20healthcare.html

President Obama, Congress should set health-care reform aside THE health-care dance in Washington, D.C., has gone on long enough. Congress needs to focus on the economy and set health care aside.

This is a change of position for us. This page supported Barack Obama for president, enthusiastically. We have supported the health-care effort until now. We still support universal coverage as a social goal.

But the longer the fight goes on, the more it feels that the timing is all wrong. The economy is wounded. Employers are hurting. The time to think about loading employers with new burdens is when they are strong. Not now.

Right now, Congress needs to focus on the economy. It needs to follow the lead of Sen. Maria Cantwell and re-enact Glass-Steagall, the law that separated investment banking from commercial banking and for 50 years helped maintain sanity on Wall Street. It needs to bolster the antitrust laws. It needs to lower the estate tax.

It needs to target the rest of the stimulus money at things that really stimulate all of these actions to provide breathing room to small- and middle-sized family businesses that were once the backbone of the economy and can be again.

It needs to rejuvenate a trade agenda, starting by ratifying the agreement with Korea.

It needs to get out of two no-win wars in Asia. These are “investments” that will never pay out.

President Obama has promised that any health-care bill he signs will not add one dime to the deficit, which already has swelled beyond anything since World War II. The president has put himself in a position where he cannot keep that promise. He has let each house of Congress come up with its own health-care bills.

The result has been chaos: The public option is in then out; the Medicare buy-in for 55-year-olds is in, then out. When the congressional dance stops, the Senate may have 60 votes, but for what? It will satisfy neither Obama’s frugal promise nor progressives’ lavish hopes. Already the Democratic Party’s former chairman, Howard Dean, says the bill is not worth passing in this form.

You know he’s right when you hear statements that something has to be passed, for political reasons. This issue is too important for that. It should wait for a unified proposal and an economy on the mend.

—–

Stay well.
Donald

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 12-11-2009 500,000 physicians entered into Congressional Record opposing Senate bill, H.R. 3590; Reflections Dateline: Plane change in Phoenix as I return to New Orleans after a meeting in California. Foreword: I did multiple radio interviews this past week. The host would ask, what do you think of the latest version of the Senate bill? I responded, what is the latest version? All we have are rumors. Why is this a secret, even kept from the majority of Senators! This is America! Let us see what is being sent to CBO. However, expansion of Medicare and Medicaid will be disasters. DJP Update 12-11-2009 500,000 physicians entered into Congressional Record opposing Senate bill, H.R. 3590; Reflections December 10, 2009 CONGRESSIONAL RECORD SENATE S12857 Mr. MCCAIN. Mr. President, I ask unanimous consent that a list of physician organizations that oppose this act, representing nearly one-half million physicians, be printed in the RECORD. There being no objection, the material was ordered to be printed in the RECORD, as follows: PHYSICIAN ORGANIZATIONS THAT OPPOSE SENATE’S PATIENT PROTECTION AND AFFORDABLE CARE ACT To date over 40 state, county and national medical societies, representing nearly one half million physicians, have stated their public opposition to the Senate healthcare overhaul bill, the Patient Protection and Affordable Care Act (H.R. 3590). It is time for Congress to slow down, take a step back, and change the direction of current reform efforts to ensure that it is done right! NATIONAL MEDICAL ASSOCIATIONS American Academy of Cosmetic Surgery, American Academy of Dermatology Association, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology Head and Neck Surgery, American Association of Neurological Surgeons, American Association of Orthopaedic Surgeons, American College of Obstetricians and Gynecologists, American College of Osteopathic Surgeons, American College of Surgeons, American Osteopathic Academy of Orthopaedics, American Society for Metabolic & Bariatric Surgery, American Society of Anesthesiologists, American Society of Breast Surgeons, American Society of Cataract and Refractive Surgery, American Society of Colon and Rectal Surgeons, American Society of General Surgeons, American Society of Plastic Surgeons, American Urological Association, Association of American Physicians and Surgeons, Coalition of State Rheumatology Organizations, Congress of Neurological Surgeons, Heart Rhythm Society, National Association of Spine Specialists, Society for Vascular Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society for Cardiovascular Angiography and Interventions, Society of Gynecologic Oncologists. STATE AND COUNTY MEDICAL ASSOCIATIONS Medical Association of the State of Alabama, California Medical Association, Medical Society of Delaware, Medical Society of the District of Columbia, Florida Medical Association, Medical Association of Georgia, Kansas Medical Association, Louisiana State Medical Society, Missouri State Medical Association, Nebraska Medical Association, Medical Society of New Jersey, Ohio State Medical Association, South Carolina Medical Association, Texas Medical Association, Westchester (NY) County Medical Society. Various letters from the multiple medical coalitions also were printed. If anyone wants the entire printing of the pertinent pages from the Congressional Record, drop me an email and I will send the attachment. Many thanks to Katie Orrico, Director of the Washington Office of the American Association of Neurological Surgeons/ Congress of Neurological Surgeons, for alerting me to this posting in the Congressional Record and forwarding the pages to me! Let me share one excerpt from a letter sent and printed in the Congressional Record citation above. I also will list the organizations that signed that letter as well as three former AMA presidents. “Senator Reid, 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. “We urge you to slow down, take a step back, and change the direction of current reform efforts so we get it right for our patients and our profession. We have a prescription for reform that will work for all Americans, and we are happy to share these solutions with you to improve our nation’s healthcare system. “Thank you for considering our views. Sincerely,” 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, Nebraska Medical Association, Medical Society of New Jersey, South Carolina Medical Association, American Academy of Cosmetic Surgery, 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. Past Presidents of the American Medical Association: 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 —— Mr. MCCAIN. Mr. President, I thank the Senator from Montana for his courtesy. ——– Reflections: Ideas and actions have consequences! When physicians stand up, the message gets out. Wouldn’t it be nice if AMA took out ads and wrote letters to Congress pointing out that the hallmark of the Free Enterprise System is the right to privately contract! And strongly advocated AMA policy which is “among our highest advocacy priorities”, namely, the AMA will “actively and publicly support the inclusion in health system reform legislation the right of patients and physicians to privately contract, without penalty to patient or physician.” After all, that is the policy! To put this concept as an addendum in a letter does not, in my opinion, carry out the mandate of actively and publicly supporting the inclusion. Millions have been spent in the co-sponsored ads with AARP. These ads are too nebulous and can be interpreted to mean many difference changes in health system reform. AMA should consult with the Geico people who use the Gecko ad approach. That delivers a message! Or the Ally Bank ads about the promise of a real toy truck and then a paper truck is given (failure to read fine print). Does this remind you of bills being pushed in Congress? See “It is a piece of Junk” at: http://www.youtube.com/watch?v=nKdIKP1arF0 for sample of one of the ads. Liberty is the absence of coercion. Let’s not give up liberty by default. On the positive side, thanks to AMA following policy to oppose expansion of Medicare, a system going bankrupt, and publicly stating so! Onward. Don’t falter. We can win this battle for our patients and colleagues! The outcome of the upcoming short and intense debate will affect Medicine for decades and could drastically influence the financial viability of America. Congress can’t keep building up debts and opening new credit cards to pay off the debts. One day the bill collector knocks on the door! “Economics in One Lesson” by Henry Hazlitt still would be a good book for Congress to read. Stay well, Donald 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.