DJP Update 3-21-2010 Congress & Health System Reform: Dreams & Deals & possible surprises in the big vote today!
Health System Reform debate continues in Congress and key votes will be taken tonight. Truly a day to remember. It will be remembered by some as dreams fulfilled and other as deals galore. Of course the historians who look at what happened today will proclaim that it is amazing that few who voted really understood the true meaning of what was in the bill and it is shocking that obvious flaws in reasoning were not deal-killers. And I say that regardless of whether you believe this is the path to government takeover of Medicine or you wish that Congress had done more, namely institute a single-payer.
Obviously this Senate bill modified by the amendments in the House are not budget neutral or save money. If the bill did reduce the Federal deficit, there would not have been a need to add in the “savings” from government taking over the student loan business. And of course, the so called “doc fix” is not in the bill. This truly is a shell game and the Public now is disgusted with the activities in Congress. As for the proposed immediate benefits, more people will be on Medicaid. A failed system that is bankrupting states will now have more people put on the program as another unfunded mandate on states despite promises to pay some additional money for a while. Look at Medicaid, look at TennCare, look at Dirigo Health in Maine and try to learn some lessons. Another lesson is unfolding in Massachusetts. Why not let they experiment come to a conclusion? Meanwhile, the lawsuits will start from multiple state attorney generals asking the courts to rule the law unconstitutional because they believe the Supremacy Clause doesn’t apply when the Federal government violates the Constitution.
The family medicine doctors will get Medicaid payments to equal Medicare payments. So the chains will be lengthen a little and they will be given more exercise room in the prison. Meanwhile, the SGR supposedly is promised to be changed in the future. But no private contracting without penalty. That would be a rational solution to restore Liberty. Too bad all of this wasn’t delayed for a month to give President Obama the opportunity to go on his Australian visit and learn from the Australians who are paying 30% of the private insurance costs to get more people out of the public system AND the Australian government allows private contracting without penalty. They allow balance-billing of what the government doesn’t pay.
As for keeping the youngsters longer on the parents’ policy and eliminating limits and preexisting conditions, what about the increase in premiums for that? If you give more coverage the cost will go up. If you price-fix, eventually the insurance company stops selling policies just like doctors increasing limit Medicaid and Medicare patients in their practice because the cost of delivering care is more than the government payment. That is basic economics just like gravity exists on Earth. And I won’t even get into the increase in IRS agents etc.
There are real problems in the health delivery system because of the medical insurance system, government involvement and mandates and the current tax system that discriminates against individuals. Pre-existing conditions are just one of the problems that are real concerns and need to be fixed but the current bill is not the correct fix.
As for negotiating, note that those groups who got what they want, withheld their support until they got it. AMA gave the support for the equivalent of vaporware. And now calling it qualified support is embarrassing, in my opinion. No private contracting without penalty. We still have that prohibition in Medicare & Medicaid and the new law, if passed, will continue the same. No medical liability reform. More government involvement, the creation of the unelected, unaccountable Independent Payment Advisory Board (IPAB), and much more bad news.
As for saying it was the ethical thing to do, I agree ethics is extremely important and one should make sure that any proposed law protects the patients and does what is in the best interest of the patient. Remember AMA ethical principle number 3:
III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
So if you conclude the law or proposed law is not in the best interest of the patient, you have an obligation to oppose it. And over 500,000 physicians through their organizations have said to vote NO on this bill in Congress. The public is against this bill in multiple polls. But the train rushes on to passage.
Specific AMA policy could have fixed the problems in the health delivery system. Instead, we are going to adversely affect the medical miracles being done every day in America. Nurses and other professionals will not be able to take over and do the heart transplants, brain surgery, and all of the other technological advances. Our superbly trained and experienced physicians who do quality work working with state of the art equipment is why leaders in other countries, like the Canadian Premier of Newfoundland & Labrador, come to the USA. Premier Danny Williams recently went to Miami for his heart procedure. See article below.
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http://www.google.com/hostednews/canadianpress/article/ALeqM5h0QC7bditrEb3wYz_6_b-gsGGDxA
EXCERPT from ARTICLE in 2010 about Newfoundland and Labrador Premier Danny Williams
‘My heart, my choice,’ Williams says, defending decision for U.S. heart surgery
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Taxes will increase, deficits will increase, unemployment will increase and in the end, doctors will be blamed. Count on it. Meanwhile, there are people in the USA who want to get jobs. There are people in other parts of the world who want to destroy us and they probably are laughing at our focus and Congressional antics as they plot. And we play games in Congress. Shell games of hidden taxes and illusory savings and Humpty Dumpty language riddles. What will our allies think of our word and promises as they watch how we treat each other in Congress. Sad day for us. And the day the doctors are blamed, one must be alert to government mandating that as a condition of maintaining one’s medical license, doctors must participate in government programs filled with mandates and price-fixing. Eternal vigilance is in order.
BUT this drama is not over. Consider this possible scenario and surprise. The House passes the Senate bill tonight and it goes to the President. Meanwhile, the reconciliation “fix” passes the House and when it gets to the Senate, the Parliamentarian suddenly appears as the oracle who opines that some of those items, important to Democrats who gave their vote because of those “fixes”, are not allow under the rules! Remember the “Byrd Rule” in the Senate. Wow! Wouldn’t it be nice to know what the Parliamentarian thinks of all of these “fixes” and whether they will be allowed BEFORE the vote on the Senate bill and the reconciliation bill in the House. Otherwise, the Senate bill is the law of the land as soon as the President signs it. Democrats in the House ought to be very careful and demand that they see the ruling of the Parliamentarian BEFORE they vote!
Here is a link at ABC News that discusses a theory akin to that.
http://blogs.abcnews.com/thenote/2010/03/senate-fight-starts-gop-says-senate-parliamentarian-will-kill-fixits-bill.html
Stay well.
Donald
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Congress shell game=low poll#s RT @Senate_GOPs: AP: Medicare fix would push health care into the red http://bit.ly/ahEoPZ #tcot #hcr
8:01 PM Mar 19th via Echofon
No need of funny math of #Congress if patients & docs allowed to privately contract fees & no penalty! Liberty! Medicare forbids! #hcr
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