The DJP Update

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.

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/

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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.
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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.