The DJP Update

DJP Update 3-28-2012 The last day of the SCOTUS hearings on PPACA:  Severability & Medicaid – audio & transcripts

The audio and transcripts are now posted at:

Excerpt from Supreme Court Website & my posting of actual link if the “this link” doesn’t work for you

The Court heard arguments today, Wednesday, March 28, 2012, on the Severability issue and Medicaid issue of the Patient Protection and Affordable Care Act cases. The audio recording and unofficial transcript of the oral argument on the Severability issue (Nat. Fed. Indep. Business v. Sebelius, Sec. of H&HS, 11-393; and Florida v. Dept. of H&HS, 11-400) are available at this link. The audio recording and unofficial transcript of the oral argument on the Medicaid issue (Florida v. Dept. of H&HS, 11-400) are available at this link.  http://www.supremecourt.gov/oral_arguments/argument_audio_detail.aspx?argument=11-393

Severability: http://www.supremecourt.gov/oral_arguments/argument_audio_detail.aspx?argument=11-393

Medicaid: http://www.supremecourt.gov/oral_arguments/argument_audio_detail.aspx?argument=11-400

The orders, briefs, and other information regarding the Patient Protection and Affordable Care Act cases are available at this link.

http://www.supremecourt.gov/docket/PPAACA.aspx

DJP:  Get and save this information at Supreme Court site for posterity.  This is case that will be discussed for years and the future of medical care will be affected greatly by the decision expected  in June of 2012.

To give you one example of the back and forth in the court room (need to read the entire transcript to put in context!)

This is from the Medicaid Expansion discussion in afternoon of 3-28-2012.

APPEARANCES:
PAUL D. CLEMENT, ESQ., Washington, D.C.; on behalf of Petitioners.
DONALD B. VERRILLI, JR., ESQ., Solicitor General, Department of Justice, Washington, D.C.; on behalf of Respondents.

PAGE 26:  MR. CLEMENT: The answer is no, and that’s because we’re here saying there are three things that make this statute unique.
JUSTICE SCALIA: What are your second and third? I’m on pins and needles to hear your second –
(Laughter.)
MR. CLEMENT: One is the sheer size. Two is the fact that this statute uniquely is tied to an individual mandate which is decidedly nonvoluntary. And three is the fact that they’ve leveraged the prior participation in the program, notwithstanding that …

Then continue on to page 31 and you see more evidence there is some frivolity even in Supreme Court back and forth.

More on coercion discussion in this transcript:  for example, see page 42.

JUSTICE SCALIA: You can’t imagine a case in which it is both germane and yet coercive, is what you are saying. There is no such case as far as you know.
GENERAL VERRILLI: Well, I am not prepared to — to say right here that I can — that –

JUSTICE SCALIA: I wouldn’t think that is a surprise question. I mean, you know ––
GENERAL VERRILLI: I mean, you know, Congress has authority to act and -JUSTICE SCALIA: Hey, I can’t think of one. I’m not blaming you for not thinking of one. (Laughter.)

—-
SEVERABILITY issue (the morning hearing 0f 3-28-2012) – excerpt from page 35

Justice Scalia:  …That’s an enormously different question from whether you get the votes initially to put them into the law. What — there is no way that this Court’s decision is not going to distort the congressional process. Whether we strike it all down or leave some of it in place, the congressional process will never be the same. One way or another, Congress is going to have to reconsider this, and why isn’t it better to have them reconsider it — what should I say — in toto, rather than having some things already in the law which you have to eliminate before you can move on to consider everything on balance?
MR. KNEEDLER: We think, as a matter of judicial restraint, limits on equitable remedial power limit this Court to addressing the provision that has been challenged as unconstitutional and anything else that the plaintiff seeks as relief.  Here the only…
—–
Here is an article in the Washington Post today dealing with the severability issue and giving some selected excerpts from the hearing:

Obamacare suffers a severability trainwreck at the Supreme Court
By Jennifer Rubin
If yesterday was a surprise to the liberal defenders of Obamacare, today must have been a shocker. …

Go to this link to read entire article:

http://www.washingtonpost.com/blogs/right-turn/post/obamacare-suffers-a-severability-trainwreck-at-the-supreme-court/2012/03/28/gIQAzZnxgS_blog.html
—————–
Now back to finishing my new book on leadership.  Tick Tock, the deadline approaching rapidly!
Stay well.
Donald

Some past selected DJP Updates can be found at: http://djpupdate.com/
Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, LA 70006
USA
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us
DJP Updates:  http://www.DJPupdate.com
Twitter:  www.twitter.com/DJPNEWS
YouTube:  http://www.youtube.com/user/IntrepidResources
This DJP Update goes to over 2400 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” in subject line.

DJP Update 3-27-2012 U.S. Supreme Court & PPACA hearing re INDIVIDUAL MANDATE – audio & transcript

I strongly recommend you download the audio and the transcript each day of the Supreme Court’s hearing of PPACA.  This is a very important case that deals with more than just the individual mandate for health insurance.  It is about Liberty.
Save the transcript and the audio.  It will be a collector’s item.

Here is the link for today at the U.S. Supreme Court:  http://www.supremecourt.gov/oral_arguments/argument_audio_detail.aspx?argument=11-398-Tuesday

I put a couple of excerpts from the transcript below.  You need to listen or read all of the hearing to put everything in context.

Following the excerpts are samples of some tweets I did today.  I encourage you to go to the YouTube playback of the audio of this portion placed at the Washington Post.  Also nice artwork!  It is in the link in my tweet here:  http://sns.mx/quk7y8

Excellent excerpt & art RT @iSupremeCourt: Antonin Scalia: ‘It’s supposed to be a government of limited powers’ (1:13)

Lots of opinions changed today including the oddsmakers in the betting world.

CNN legal analyst, Jeffrey Toobin, who has repeatedly stated the law would be upheld as constitutional changed his mind today.

“This was a train wreck for the Obama Administration.  This law looks like it’s going to be struck down.  I am telling you all of the predictions, including mine, that the Justices would not have a problem with this law were wrong.” …  (Not all the predictions!)

Watch the video from CNN at:  http://t.co/bQ7JRi1q

My opinion remains the same as stated in interviews and in my writings ever since the law was passed 2 years ago.
I repeated that today in a tweet:  My prediction as to constitutionality remains the same as I have written since #PPACA passed: #SCOTUS = 5-4 unconstitutional. Could be 6-3.

In addition, I did a radio show this morning in Columbus, Ohio, prior to the hearing, and predicted the the Constitution does not support upholding this law on the Commerce Clause.  Listen to interview at:  http://t.co/iinfuEEK  Remember, the “Necessary and Proper Clause” requires one of the “enumerated powers” in the Constitution be applicable.  If Commerce Clause not applicable, then you can’t make the law valid with the “Necessary and Proper Clause”.  Think of the Necessary and Proper Clause as a helper clause.  It can’t stand alone.  That is my view.  Also, I believe that is the view put forth in the Federalist Papers.  See Madison #44.  See essay by Paul Antinori at:  http://amendusconstitution.com/blog/?author=2

We will find out in June what the Supremes say!

EXCERPTS FROM TRANSCRIPT SCOTUS 3-27-2012
—-

MR. CLEMENT: Mr. Chief Justice, and may it
please the Court. The mandate represents an
unprecedented effort by Congress to compel individuals
to enter commerce in order to better regulate commerce.

The Commerce Clause gives Congress the power
to regulate existing commerce. It does not give
Congress the far greater power to compel people to enter
commerce, to create commerce essentially in the first
place.

Now, Congress when it passed the statute did
make findings about why it thought it could regulate the
commerce here, and it justified the mandate as a
regulation of the economic decision to forgo the
purchase of health insurance. That is a theory without
any limiting principle.

—-
(Note:  Donald Verrilli is  U.S. Solicitor General)

GENERAL VERRILLI: No. That’s not our
position at all, Justice Scalia. In the health care
market — the health care market is characterized by the
fact that aside from the few groups that Congress chose
to exempt from the minimum coverage requirement — those
who for religious reasons don’t participate, those who
are incarcerated, Indian tribes — virtually everybody
else is either in that market or will be in that market,
and the distinguishing feature of that is that they
cannot — people cannot generally control when they
enter that market or what they need when they enter that
market.

CHIEF JUSTICE ROBERTS: Well, the same, it
seems to me, would be true, say, for the market in
emergency services: police, fire, ambulance, roadside
assistance, whatever.

You don’t know when you’re going to need it;
you’re not sure that you will. But the same is true for
health care. You don’t know if you’re going to need a
heart transplant or if you ever will. So, there’s a
market there. In some extent, we all participate in it.

So, can the government require you to buy a
cell phone because that would facilitate responding when
you need emergency services? You can just dial 911 no
matter where you are?

GENERAL VERRILLI: No, Mr. Chief Justice.
think that’s different. It’s — we — I don’t think we
think of that as a market. This is a market. This is
market regulation. And, in addition, you have a
situation in this market not only where people enter
involuntarily as to when they enter and won’t be able to
control what they need when they enter, but when they –

CHIEF JUSTICE ROBERTS: It seems to me
that’s the same as in my hypothetical. You don’t know
when you’re going to need police assistance. You can’t
predict the extent to emergency response that you’ll
need, but when you do — and the government provides it.
I thought that was an important part of your argument,
that when you need health care, the government will make
sure you get it.

Well, when you need police assistance or
fire assistance or ambulance assistance, the government
is going to make sure to the best extent it can that you
get it.

GENERAL VERRILLI: I think the fundamental
difference, Mr. Chief Justice, is that that’s not an
issue of market regulation. This is an issue of market
regulation, and that’s how Congress — that’s how
Congress looked at this problem. There is a market.
Insurance is provided through a market system –

JUSTICE ALITO: Do you think there is a
market for burial services?

GENERAL VERRILLI: For burial services?

JUSTICE ALITO: Yes.

GENERAL VERRILLI: Yes, Justice Alito, I
think there is.

JUSTICE ALITO: All right. Suppose that you
and I walked around downtown Washington at lunch hour
and we found a couple of healthy young people and we
stopped them and we said: You know what you’re doing?
You are financing your burial services right now because
eventually you’re going to die, and somebody is going to
have to pay for it, and if you don’t have burial

insurance and you haven’t saved money for it, you’re
going to shift the cost to somebody else.

Isn’t that a very artificial way of talking
about what somebody is doing?

GENERAL VERRILLI: No –

JUSTICE ALITO: And if that’s true, why
isn’t it equally artificial to say that somebody who is
doing absolutely nothing about health care is financing
health care services.

GENERAL VERRILLI: It’s — I think it’s
completely different. The — and the reason is that the
burial example is not — the difference is here you are
regulating the method by which you are paying for
something else — health care — and the insurance
requirement I think — I mean, the key thing here is my
friends on the other side acknowledge that it is within
the authority of Congress under Article I under the
commerce power to impose guaranteed-issue and
community-rating reforms, to end — to impose a minimum
coverage provision. Their argument is just that it has
to occur at the point of sale, and –

JUSTICE ALITO: I don’t see the difference.
You can get burial insurance. You can get health
insurance. Most people are going to need health care,
almost everybody. Everybody is going to be buried or

cremated at some point.

GENERAL VERRILLI: Well, one big
difference –

JUSTICE ALITO: What’s the difference?

GENERAL VERRILLI: One big difference,
Justice Alito, is the — you don’t have the cost
shifting to other market participants. Here –

JUSTICE ALITO: Sure you do, because if you
don’t have money, then the State is going to pay for it
or some –

GENERAL VERRILLI: But that’s different.

JUSTICE ALITO: A family member is going to
pay for it.
————

EXAMPLES OF MY TWEETS TODAY
www.twitter.com/DJPNEWS

58m   Donald Palmisano ‏ @DJPNEWS
Excellent excerpt & art RT @iSupremeCourt: Antonin Scalia: ‘It’s supposed to be a government of limited powers’ (1:13) http://sns.mx/quk7y8

1h   Donald Palmisano ‏ @DJPNEWS
With #SCOTUS decisions on #Constitution it is impt to know some say fixed document & others believe it evolves & has “penumbras”. #PPACA

1h   Donald Palmisano ‏ @DJPNEWS
My prediction as to constitutionality remains the same as I have written since #PPACA passed: #SCOTUS = 5-4 unconstitutional. Could be 6-3.

1h   Donald Palmisano ‏ @DJPNEWS
Comments of Donald Verrilli, remind me of emotional pleas used when facts & law not on one’s side. #SCOTUS #PPACA

1h   Donald Palmisano ‏ @DJPNEWS
Michael Carvin not intimidated or hesitant with Justice Breyer questions; strong answers. Same confidence with other Justices. #SCOTUS

——–

Stay well.
Donald

Some past selected DJP Updates can be found at: http://djpupdate.com/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://www.DJPupdate.com

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to over 2400 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” in subject line.

DJP Update 3-26-2012 Evening edition – SCOTUS hearing on PPACA: transcript & audio available on Web: http://t.co/jGh8fXsI or http://www.supremecourt.gov/
Below are EXCERPTS FROM 92 PAGE PDF TRANSCRIPT OF 3-26-2012 oral hearing SCOTUS re PPACA

You have to read the entire transcript or listen to the audio to get the proper context.  The only purpose of these excerpts is to give you an idea of the Q & A.  MUST BE READ IN CONTEXT.  Excerpts merely give snapshots of a moment in time.  Be assured that the Supreme Court will not take as long as the case in Dickens’ Jarndyce v. Jarndyce in Bleak House, but the effects of the decision will change America if mandate upheld as constitutional.  The power for the federal government to regulate inactivity by forcing a citizen to buy something gives unlimited power to the federal government.  Where does it stop?

As for today’s arguments, I believe the case will not be delayed under the claim of the Anti-Injunction Act.  If I am correct, then the next question to be decided is the Individual Mandate.  The argument about that is tomorrow, March 27.

Entire transcript as well as audio can be obtained at link in my tweet today or as mentioned above:

Donald Palmisano ‏ @DJPNEWS

Transcript & audio of today’s #SCOTUS hearing on #PPACA now posted:  #tcot #tlot ##GOP #Dems #law #hcr

Here are the excerpts I selected for illustration purposes only.

Page 28 of 92 page PDF

ROBERT A. LONG, ESQ., Washington, D.C.; for Court-appointed amicus curiae to argue that Anti-Injunction Act applies (“invited by this Court to defend the proposition that the Anti-Injunction Act barred this litigation.” Words in quotes taken from page 77)

MR. LONG: Well, I would not argue that this statute is a perfect model of clarity, …

Page 29, Mr. Long again: …my main objection to the Solicitor General’s reading is I don’t think it makes a whole lot of sense.

Page 32

JUSTICE ALITO: General Verrilli, today you are arguing that the penalty is not a tax. Tomorrow you are going to be back and you will be arguing that the penalty is a tax.

Page 40

GENERAL VERRILLI: Well –

JUSTICE SCALIA: You don’t want to let that bone go, right?

(Laughter.)

Page 47

JUSTICE SOTOMAYOR: Is your whole point that this was inartful drafting by Congress, that, to the extent that there is an exemption under the penalty, it’s an exemption from the legal obligation?

Page 48

JUSTICE ALITO: Subsection A says directly, “an applicable individual shall ensure that the individual has the minimum essential coverage.” And you are saying it doesn’t really mean that, that if you’re not subject to the penalty, you’re not under an obligation to maintain the minimum essential coverage?

GENERAL VERRILLI: That’s correct. And we think that is what Congress is saying, both in the provision I just pointed to, Your Honor, and by virtue of the fact — by virtue of the way the exemptions work. I just think that’s the — reading this in context, that is the stronger reading of the statute.

Page 53

GENERAL VERRILLI: That’s the essence of it. They called it a penalty. They didn’t give any other textural instruction in the Affordable Care Act or in the Internal Revenue Code that that penalty should be treated as a tax –

Continued on to Page 54

CHIEF JUSTICE ROBERTS: Well, except you –

GENERAL VERRILLI: — for Anti-Injunction Act purposes.

Page 55

JUSTICE ALITO: Two former — two former commissioners of the IRS have filed a brief saying that your interpretation is going to lead to a flood of litigation. Are they wrong on that?

GENERAL VERRILLI: Yes. We don’t — you know — we’ve taken this position after very careful consideration, and we’ve assessed the institutional interests of the United States, and we think we’re in the right place.

Page 56

CHIEF JUSTICE ROBERTS: Mr. Katsas.

ORAL ARGUMENT OF GREGORY G. KATSAS ON BEHALF OF THE RESPONDENTS

MR. KATSAS: Mr. Chief Justice, and may it please the Court: Let me begin with the question whether the Anti-Injunction Act is jurisdictional.

Justice Ginsburg, for reasons you suggested, we think the text of the Anti-Injunction Act is indistinguishable from the text of the statute that was unanimously held to be non-jurisdictional in Reed Elsevier. That statute said no suit shall be instituted. This statute says no suit shall be maintained. No –
JUSTICE GINSBURG: They are different things.

JUSTICE SOTOMAYOR: Big difference, though –

Page 65

MR. KATSAS: I don’t think so, Justice Kagan, because we have an adversarial system, not an inquisitorial one. The parties maintain their lawsuits, I think, is the more natural way of thinking of it.

If I could turn — if I could turn to the merits question on the AIA before my time runs out.

The purpose of this lawsuit is to challenge a requirement — a Federal requirement to buy health insurance. That requirement itself is not a tax. And for that reason alone, we think the Anti-Injunction Act doesn’t apply.

What the amicus effectively seeks to do is extend the Anti-Injunction Act, not just to taxes which is how the statute is written, but to free-standing nontax legal duties. And it’s just –

Page 66

CHIEF JUSTICE ROBERTS: It’s a command. A mandate is a command. Now, if there is nothing behind the command, it’s sort of, well, what happens if you don’t follow the mandate? And the answer is nothing, it seems very artificial to separate the punishment from the crime.

Page 66 continued:

MR. KATSAS: I’m not sure the answer is nothing, but even assuming it were nothing, it seems to me there is a difference between what the law requires and what enforcement consequences happen to you. This statute was very deliberately written to separate mandate from penalty in several different ways.

They are put in separate sections. The mandate is described as a “legal requirement” no fewer than 20 times, three times in the operative text and 17 times in the findings. It’s imposed through use of a mandatory verb “shall.” The requirement is very well defined in the statute, so it can’t be sloughed off as a general exhortation, and it’s backed up by a penalty.

Congress then separated out mandate exceptions from penalty exceptions. It defined one category of people not subject to the mandate. One would think those are the category of people as to whom

Continue on page 67

Congress is saying: You need not follow this law. It then defined a separate category of people not subject to the penalty, but subject to the mandate. I don’t know what that could mean other than –

Page 70

JUSTICE KAGAN: But that does seem odd, to suggest that the State is being injured because people who could show up tomorrow with or without this law will — will show up in greater numbers. I mean, presumably the State wants to cover people whom it has declared eligible for this benefit.

MR. KATSAS: They — they could, but they don’t. What the State wants to do is make Medicaid available to all who are eligible and choose to obtain it. And in any event –

JUSTICE GINSBURG: Why would somebody not choose to obtain it? Why — that’s one puzzle to me. There’s this category of people who are Medicaid eligible; Medicaid doesn’t cost them anything. Why

Continue on page 71

would they resist enrolling?

MR. KATSAS: I — I don’t know, Justice Ginsburg. All I know is that the difference between current enrollees and people who could enroll but have not is, as I said, on the — is a $600 million delta. And –

Page 77

CHIEF JUSTICE ROBERTS: Mr. Long, you were invited by this Court to defend the proposition that the Anti-Injunction Act barred this litigation. You have ably carried out that responsibility, for which the Court is grateful.

MR. LONG: Thank you.

CHIEF JUSTICE ROBERTS: We will continue argument in this case tomorrow.

(Whereupon, at 11:41 a.m., the case in the above-entitled matter was submitted.)

———

Stay well.
Donald

Some past selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to over 2300 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” in subject line.

DJP Update 3-26-2012 The Game is on!  PPACA enters SCOTUS field today; link to audio;  Lagniappe

Today PPACA goes before the United States Supreme Court (SCOTUS) for oral arguments.  The hearing will last through Wednesday and a decision will emerge no later than the last week in June of 2012.

(The “Patient Protection and Affordable Care Act” (P.L. 111-148) was enacted on March 23, 2010 and amended shortly thereafter by the “Health Care and Education Reconciliation Act of 2010” (P.L. 111-152) as enacted on March 30, 2010.
Referred to as “PPACA” or “ACA” or “Obamacare”)

1- ISSUES: Here is a graph that gives the issues and possible outcomes:  http://ohpcenter.org/writings/handouts/COHP-SCOTUS-PPACA-infographic.jpg

Monday:  Tax or penalty; does Anti-injunction law apply?  If declared tax, then no review by court until collected and that would be in 2014.

Tuesday:  Individual Mandate!  Is it constitutional?  If ruled constitutional, America will be changed dramatically.  Liberty at risk!

Wednesday Morning:  Is Individual Mandate severable?  Can it be removed and the rest of the law remain intact?  Remember, there is NO severability clause in this law.

Wednesday Afternoon:  Is the requirement for the states to expand Medicaid as a condition of receiving funding constitutional?

2- AUDIO of oral arguments and Q & A: Delayed broadcast several hours after each session.  Go to:  http://www.supremecourt.gov/

Here is what SCOTUS posted about availability of audio and filed briefs etc. :  http://www.supremecourt.gov/ The Patient Protection and Affordable Care Act oral argument audio and transcript links will be posted here following the argument sessions on March 26th, 27th, and 28th. Further information is available at this link.  http://www.supremecourt.gov/publicinfo/press/viewpressreleases.aspx?FileName=pr_03-16-12.html

The orders, briefs, and other information regarding the Patient Protection and Affordable Care Act cases are available at this link.  http://www.supremecourt.gov/docket/PPAACA.aspx

Be sure to read George Will’s column concluding that the individual mandate violates contract law.  Coercion!  http://tinyurl.com/8xlveez

Also daily analysis of court hearing by general counsel of AAPS is at:  http://www.freemedipedia.org/wiki/Main_Page

——–
A sample of tweets & retweets at www.twitter.com/DJPNEWS are below.  Remember, you don’t have to sign up for Twitter to read DJPNEWS postings on Twitter.  Just put on browser link bar the following link for quick access:

www.twitter.com/DJPNEWS

Donald Palmisano ‏ @DJPNEWS

Medicine: USA has to decide if it wants perfumed popinjays & “providers” sprewing legal platitudes & gov mandates or doctors who save lives
——

Donald Palmisano ‏ @DJPNEWS

George Will & “Obamacare’s Contract Problem” re @IJ #Amicus http://tinyurl.com/8xlveez #ContractLaw #PPACA #SCOTUS #hcr #Liberty #tcot #tlot
——-

Art Fougner ‏ @sonodoc99

@DJPNEWS @MSSNYTweet “@ohpcenter: Next week’s Supreme Court review of Obamacare explained in one simple pic: http://ohpcenter.org/writings/handouts/COHP-SCOTUS-PPACA-infographic.jpg”
Retweeted by Donald Palmisano

————-

Donald Palmisano ‏ @DJPNEWS

Exactly! #SCOTUS RT @ohpcenter: If Congress can regulate inactivity, then what can’t it mandate? http://shar.es/pZDvg #cohp #ppaca #hcr
——–

24 Mar

Donald Palmisano ‏ @DJPNEWS

Impt info & audio link of ct MT @AAPSonline: AAPS Gen Counsel analysis q day of #SCOTUS arguments. http://eepurl.com/kjbOf #hcr #ACAtastrophe
——–

LAGNIAPPE:  Yesterday, March 25, 2012, three memorable activities:  1- Robin & I celebrated our anniversary!  2- Orleans Parish Medical Society had a brunch for the 50-years-in-practice doctors.  We attended.  A fine group of caring, compassionate doctors.  What they have seen & done over the years!  3- March 25 also is National Medal of Honor Day (Public Law 101-564).  More info about the law at:  http://www.homeofheroes.com/moh/history/day.html

If you want inspiration, read the stories of these heroes.  Go to:  http://www.cmohs.org/   You can find the stories at:  http://www.cmohs.org/recipient-archive.php

Stay tuned.  P.S. working hard to meet my new book deadline to get text and photos to publisher!  And a tip of hat to Dr. Mario Calonje who caught my typo for the date of D-Day Normandy.  Yes, it is June 6, 1944.  I corrected on my blog.

P.S. A poem about the Supreme Court Hearing by Dr. Richard Reece in his March 26, 2012 blog posting:  http://medinnovationblog.blogspot.com/

Stay well.
Donald

Some past selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to over 2300 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” in subject line.
——–

DJP Update 3-23-2012 Excerpt from Kaiser Health News re PPACA and Supreme Court hearing on it; DJP Reflections

http://www.kaiserhealthnews.org/Stories/2012/March/22/health-industries-supreme-court-case.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+khn+%28All+Kaiser+Health+News%29

Health Industries Weigh In On Supreme Court Case
By Jay Hancock

KHN Staff Writer

Mar 22, 2012

EXCERPT

Insurers have chosen not to defend the massive dividend for their industry that many believe makes the law most vulnerable. The “individual mandate” requires almost everybody to buy health insurance or pay a fine – a major concession the lobby got at the bargaining table. But insurers are not taking a stand on whether the mandate is an unconstitutional abuse of federal power, as the law’s opponents contend.

“I don’t think the public or the courts recognize our industry for its constitutional expertise,” said Karen Ignagni, chief executive of America’s Health Insurance Plans, an industry lobby.

Insurers do express strong views on what the court should do if the mandate is tossed out. Their memo to the justices joins more than 130 other briefs, the largest number of “friend of the court” briefs ever filed for a Supreme Court case.

Hospitals, the law’s most energetic health-industry defender, urge the court to uphold the entire health overhaul act. Drug makers just want the legal case and resulting uncertainty to be over.

The American Medical Association, the largest doctor lobby, supports the law and is working to influence rules for insurance exchanges and other components. But, like the largest drug trade group, it has filed no briefs with the court.

“There have been ample statements on all sides of the issues,” said AMA President Dr. Peter Carmel. “Our focus now is on assuring effective implementation of the law and on securing further improvements.”

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END of EXCERPT

DJP Reflections: Imagine if on D-Day, June 6, 1944, Operation Overlord, General Eisenhower received word that the British and Canadians had decided to land at Calais rather than joining the Americans landing at Normandy.  What a disaster it would have been.

Those involved in the care of patients need to go back to first principles and decide what approach gives ethical science-based care the best chance of survival.  What approach preserves Liberty and does not lead us down the road to serfdom?  In my view, as stated many times, going back to my first testimony to Congress in 1976, the more government involvement in Medicine, the worse off we are.

Never forget Section 1801 in original Medicare Law found at 42 U.S.C. 1395:  Prohibition against any Federal interference

…Nothing …shall be construed to authorize any Federal officer of employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, … or compensation of any…person providing health services…

——

Law passed.  Promises made and put into law and subsequently broken.

This may give you some indication why so many individuals and groups of practicing physicians are forming new entities and coalitions and speaking out.  Those individuals are practicing medicine and realize the current environment and the new rules and regulations are impossible for the practice of medicine that puts the patient in control with the doctor as trusted advisor.

The end.  And yes, some will get off the list because they disagree.  So be it.

Live long and prosper.  Hug a loved one today.

Donald

P.S. Interview went well today.  Tip of the hat to Dr. Jerry Goldstein who caught typo in last night’s DJP Update.  Today, the 23, is Friday, not Thursday.  Errors happen when tired!  Thanks, Jerry.  I corrected it at blog site:  www.DJPupdate.com

Stay well.
Donald

Some past selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to over 2300 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” in subject line.

DJP Update 3-22-2012 Radio shows on 3-23 re PPACA and a recent Op-Ed re IPAB; next week PPACA & U.S. Supreme Court!

Tomorrow is the 2nd anniversary of the passage of PPACA.  I will do interviews in morning on this topic.

Radio shows I will be doing Friday morning, March 23, 2012
————
KCRH 740 AM Morning News in Houston:  I will be on at 5:45 a.m. Central
http://mattpatrick.iheart.com/pages/mattpatrick.html
Host:  Matt Patrick
———–

KTTR 99.7 FM / 1490 AM The Morning Majors in Rolla, MO:  I will be on at 8:30 a.m. Central
http://www.resultsradioonline.com/page.php?page_id=19517
Hosts:  Lee Buhr w/Bill Bates

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Here is my Op-Ed on IPAB on 3-19-2012 in the Daily Caller and why IPAB needs to be repealed now.
http://dailycaller.com/2012/03/19/repeal-ipab-now/

You can read the entire article at the link above.  Here is the last paragraph of the Op-Ed:

In short, seniors’ health is too important to play politics with, even when the political goals are commendable. Speaker John Boehner and Majority Whip Eric Cantor must do all in their power to remove IPAB from the books as soon as possible and still pursue larger efforts to repeal the whole Affordable Care Act because of its pernicious effects on the practice of medicine.

Read more: http://dailycaller.com/2012/03/19/repeal-ipab-now/#ixzz1pu1IxTr1
———-

The vote to repeal the 15-member, presidentially-appointed committee, known as the Independent Payment Advisory Board (IPAB) occurred today in the House of Representatives and it passed with 7 Democrats joining.  See my retweet of Dr. Burgess tweet below.

The bill’s author is Congressman Phil Roe (R-TN), a physician.  In addition to IPAB repeal, the bill contained the following medical liability reform:  “The House bill also included a provision to impose a $250,000 cap on noneconomic damages and to limit the contingency fees lawyers can charge in medical malpractice cases.”  Plaintiff trial lawyers are working against that provision!

Both items in this bill are AMA policy approved by the House of Delegates.  Here is an article:  http://www.modernphysician.com/article/20120322/MODERNPHYSICIAN/303229991/ama-applauds-house-passage-of-ipab-repeal-bill?utm_source=articlelink&utm_medium=website&utm_campaign=TodaysHeadlines

——
My retweet of Dr. Burgess tweet:

Donald Palmisano ‏ @DJPNEWS
7 Democrats=yes RT @michaelcburgess: 223 to 181 vote from the House of Representatives sends bill to the Senate to repeal #obamacare IPAB

More info at:  http://www.cbsnews.com/8301-503544_162-57402817-503544/house-votes-to-repeal-part-of-health-care-law/

——–
And next week, one of the most important issues ever to go before the United Supreme Court will have 3 days of oral arguments re PPACA.  In short, it is all about Liberty and how far can the Congress go in dictating what Americans must do.  You already know my opinion as to what I believe the Court will do.

Stay well.
Donald

Some past selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to over 2300 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” in subject line.

DJP Update 3-1-2012 Breaking news! New 5000 doctor survey: “FUTURE OF HEALTHCARE SURVEY” = 9 out of 10 physicians unwilling to recommend Medicine as a profession

DJP Comment:  SPREAD THE WORD!  All elected officials need to see this.  This is equivalent of “Hello, Houston, we have a problem”. Apollo 13.  Now it is “Hello, America, we have a problem.” Your Doctor, as she closes her office.

Game plan for health system reform in Washington, DC not working so well.  And a one doctor repeatedly says, medical liability reform is healthcare reform.  A threat to the doctors is a threat to the patients.  If you can’t find a doctor in your hour of need, what value are medical advances in treatment and technology?

Let’s get this to go viral on Twitter and other means on Internet’s World-Wide-Web.

Press Release:
Two links to press release of The Doctors Company

http://www.thedoctors.com/TDC/PressRoom/PressContent/CON_ID_004671

http://t.co/iJN3BzwA

Entire Study
Go to either page and click on link entitled FUTURE OF HEALTHCARE SURVEY

http://www.thedoctors.com/TDC/PressRoom/PressContent/CON_ID_004671

http://tinyurl.com/7d7jxum

————————————-
PRESS RELEASE
Nine Out of 10 Physicians Unwilling to Recommend Health Care As a Profession, Exacerbating Anticipated Physician Shortage

Physician Survey Respondents Indicate They Are Actively Discouraging Individuals from Entering the Medical Profession, While Also Contemplating Early Retirement

Napa, California—March 1, 2012—The Doctors Company, the nation’s largest insurer of physician and surgeon medical liability, today announced results from the largest physician survey conducted to date on the future of health care in America. More than 5,000 physician members within The Doctors Company organization responded to the independent survey, and the overwhelming indication is that concerns surrounding a shortage of health care professionals may be exacerbated by current physician sentiment regarding the profession. Specifically, nine out of 10 physician respondents indicate an unwillingness to recommend health care as a profession. In addition, 43 percent of respondents indicate that they are contemplating retiring within the next five years as a result of transformative changes occurring within America’s health care system. A copy of the Future of Health Care Survey is available on The Doctors Company Knowledge Center.

“The physician sentiments expressed in the Future of Health Care Survey are deeply concerning and disheartening,” said Donald J. Palmisano, MD, JD, FACS, former president of the American Medical Association and member of The Doctors Company Board of Governors. “For years, the medical profession has been predicting a shortage of health care professionals. Today, we are perilously close to a true crisis as newly insured Americans enter the health care system and our population continues to age. Unfortunately, we may be facing a shift from a ‘calling,’ which has been the hallmark for generations among physicians, that could threaten the next generation of health care professionals.”

Nearly 32 million newly insured individuals will be entering America’s health care system by 2016,i increasing demands on America’s health care professionals. The result is an anticipated shortage of primary care physicians and nurses needed to care for the millions of newly insured individuals entering the health care system.ii This will necessarily increase the number of patients treated per physician, making it nearly impossible to maintain or improve the quality of patient outcomes. Sixty-five percent of respondents believe the current legislative initiatives designed to reduce health care expenses are insufficient to effectively address the underlying causes of costly defensive medicine. Furthermore, the physicians surveyed expressed concern that the increase in patient volume will reduce the attention they are able to give to each patient, with 60 percent of respondents indicating that the pressures to increase patient volume will negatively impact the level of care they can provide. Fifty-one percent of respondents feel their ability to grow and maintain patient relationships will be adversely affected. These concerns have led an overwhelming nine out of 10 physicians to actively discourage friends and family members from pursuing careers in medicine. Finally, 43 percent of respondents indicate that they are contemplating retiring in the next five years as a result of the immense change that the health care system is undergoing.

“As an organization founded by physicians for physicians, The Doctors Company takes pride and great care in providing our physician members with assistance and health care insights wherever possible, and the findings from this survey are no exception,” said Richard E. Anderson, MD, FACP, chairman and chief executive officer of The Doctors Company. “The response from our membership on the future of health care was stunning. Although we recognized that changes in health care delivery were impacting all facets of our members’ practice, the vehement, negative reactions are of real concern. When reviewing the complete survey results, the overarching sentiment is that current legislation will likely have a negative impact on the practice of medicine and will not address the scourge of defensive medicine in America.”

“We believe that physicians, and other health care professionals, need to be involved in the discussions, and we support our members who choose to become involved and voice their concerns and opinions on the future of America’s health care,” Dr. Anderson continued.

About the Future of Health Care Survey
The Doctors Company surveyed its members on the future of health care, receiving over 5,000 responses from physicians and surgeons across the nation. The survey signifies an unparalleled representation of the nation’s physicians’ attitudes, perceptions, and intent related to the major factors contributing to the transformative changes in America’s health care system, including health care reform. The survey was designed with accuracy and honesty as first priorities. Therefore, a large pool of respondents was surveyed without incentives of any kind.

The Doctors Company conducted this survey to decipher emerging industry challenges and provide support to its membership. Additional information and full survey results can be found online at www.thedoctors.com/future.

About The Doctors Company
Founded by doctors for doctors in 1976, The Doctors Company is relentlessly committed to advancing, protecting, and rewarding the practice of good medicine. The Doctors Company is the nation’s largest insurer of physician and surgeon medical liability with 71,000 members, $4 billion in assets, and an A rating from both A.M. Best Company and Fitch Ratings.

i See Congressional Budget Office, “Estimate of the Effects of the Insurance Coverage Provisions Contained in the Patient Protection and Affordable Care Act (Public Law 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152)” (March 2011).
ii Appleby, J. “A Guide to Health Insurance Exchanges.” Kaiser Health News. July 10, 2011.

———————

See The Doctors Company tweets about this at:  www.twitter.com/thedoctors

Also, my tweets are at:  www.twitter.com/DJPNEWS

Stay well.
Donald

Some past selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to over 2300 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” in subject line.