DJP Update 4-12-2010 More on the price-fixing SGR cloture vote today; A comment on ethics; A comment on character; A GA state senator speaks out!
ITEM ONE: A MESSAGE FROM AMA ABOUT SGR
From: hod.advocacy.update@enews.ama-assn.org
Subject: Senate Invokes Cloture on Temporary SGR Patch
April 12, 2010 5:13:42 PM CDT
This afternoon, the Senate invoked cloture on the motion to proceed to H.R. 4851 by a vote of 60-34, which extends a number of expiring programs, including a reprieve from the 21 percent Medicare physician payment cut that was originally scheduled to take effect on January 1. Other expiring programs addressed by the bill include extended unemployment insurance benefits and COBRA subsidies for the unemployed. As of press time, no bipartisan deal has been reached to facilitate quick passage of H.R. 4851. In the absence of such an agreement, under Senate procedure, a vote on final passage of the bill may not occur until the end of this week.
As you know, the Centers for Medicare and Medicaid Services (CMS) instructed its carriers to refrain from processing any claims for services provided on or after April 1 for 10 working days, to minimize administrative complications and other disruptions that would result from calculating payments that reflect a rate reduction that Congress is expected to overturn. That 10 day grace period expires on Wednesday, April 14. If Congress fails to pass H.R. 4851 or similar legislation by close of business on Wednesday, Medicare law will require carriers to begin processing claims for services provided in April with the 21 percent cut. That said, we still expect Congress to pass legislation that retroactively restores payments to levels in place prior to April 1.
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DJP COMMENT: How long are physicians going to tolerate these abuses by Congress? How long will it take for AMA to realize that their “seat at the table” was a loser deal.
Here are my predictions. First, a repeat of what I have said before: one cannot let the other person in negotiations frame the debate! Currently the debate is framed that Congress has the right to set physicians’ fees. AMA gives us the impression that a “permanent fix” is a win and AMA defines permanent fix as a change from the SGR price-fixing formula to some other price-fixing formula! A Medical Economic Index formula is just one example of another losing proposition if it represents price-fixing and doctors cannot balance-bill. If doctors can’t privately contract without penalty, doctors lose!
With that background, it is my considered opinion that there will not be a “permanent fix” before November elections. The most doctors can expect is the delay in implementation of the cuts in payment of doctors’ fees. That is all doctors can expect as long as doctors continue to genuflect to the apparent power-wielders currently in Congress. What will happen if the leadership of AMA continues on the current path is continued servitude of doctors to Congress. Remember, only doctors can fix the aneurysms, transplant the hearts, and all of the wonders of modern science that skilled bright doctors learned after many, many years of training.
Doctors have the key to the current shackles. We just need the courage to say enough is enough. Stop playing games with our patients and our profession. And a message to AMA: Stop selling the good deal we all got with passage of this disaster bill. The latest letter from AMA says, “32 million uninsured American will gain access to health coverage”….”No lifetime caps…..” and on and on. Of course premiums will go up or the companies will go out of business. We need real competition, not central-planning.
But when does this expansion of coverage start. Today? No. Is it a plan for the majority like Congress? No, it is multiple schemes but it includes the failed Medicaid for millions. The payment is so low the patients have trouble finding doctors. But today for implementation of Medicaid expansion? No! Not until 2014! Wonder if all of these delayed dates have anything to do with elections?
One last comment: In the end, the government will not lower the cost of medical care with the present law. The next step will be to blame doctors. Then doctors will be told that they must comply or their medical license will be removed. Save some of these predictions as I don’t know if I have much more time to spend going to meetings and being told “we know better.”
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ITEM TWO: ETHICS
And if you are not depressed yet, read what might be in store for the future if government gets full control of Medicine. Read what these authors state. One co-author is Dr. Ezekiel Emanuel, advisor to the President and brother of Rahm Emanuel, chief of staff in White House.
Read this Lancet article yourself to confirm I am not making this up or misquoting. And note the date of the article: 2009.
EXCERPTS:
Principles for allocation of scarce medical interventions
Govind Persad, Alan Wertheimer, Ezekiel J Emanuel
Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We
evaluate eight simple allocation principles that can be classifi ed into four categories: treating people equally, favouring
the worst-off , maximising total benefits, and promoting and rewarding social usefulness. No single principle is
sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined
into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points
systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the
complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates
prognosis, save the most lives, lottery, and instrumental value principles.
Lancet 2009; 373: 423–31
Department of Bioethics,
The Clinical Center, National
Institutes of Health, Bethesda,
Maryland, USA (G Persad BS,
A Wertheimer PhD,
E J Emanuel MD)
Correspondence to:
Ezekiel J Emanuel,
Department of Bioethics,
The Clinical Center, National
Institutes of Health, Bethesda,
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Second Excerpt:
Many thinkers have accepted complete lives as the appropriate focus of distributive justice: “individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate.”1,75,76 Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system.
Consideration of the importance of complete lives also supports modifying the youngest-first principle by prioritising adolescents and young adults over infants (figure). Adolescents have received substantial education and parental care,
investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfi lment requires a complete life.77 As the legal philosopher Ronald Dworkin argues, “It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies and worse still when an adolescent does”;78 this argument is supported by empirical surveys.41,79 Importantly, the prioritisation of adolescents and young adults considers the social and personal investment that people are morally entitled to have received at a particular age, rather than accepting the results of an unjust status quo. Consequently, poor adolescents should be treated the same as wealthy ones, even though they may have received less investment owing to social injustice.
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DJP Comment: If that doesn’t make you ill, then perhaps we have a vastly different view of medical ethics! If only this was a bad dream. But it is their recommendation and it portrays a sad time for infants! I think I remember the history of such schemes in countries that did treat people differently. Dangerous to allow those in power to determine what will be done with your life.
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ITEM THREE: A Debate about the character of our country.
Read a debate at: http://incharacter.org/pro-con/president-obama-said-the-health-care-debate-was-about-the-character-of-our-country/
concerning the statement of President Obama that the health care debate was about the character of our country.
Read both the “Yes” and the “No” at the link above. I believe Heather R. Higgins nails the “No” extremely well. Heather R. Higgins is chairman of the board of the Independent Women’s Forum and vice chairman of the board of the Philanthropy Roundtable. Here is her view:
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One of collectivism’s many false promises is that somehow it improves the character of a people. If this were true, Eastern Bloc countries would have been the most virtuous of all. The fact that this was manifestly not the case – indeed that the inverse seems to hold, at least when judging by metrics such as personal charity — should cause us pause. As we move to create a system wherein people think that “everyone can live at everyone else’s expense” (to quote Bastiat), we are likely to witness the erosion of the country’s character.
The recently-passed health care legislation is arguably the most significant example: not only will it fail to improve the national character (as proponents have promised), it in no way reflects our current character. If implemented this law will undermine that character as surely as it will the quality of our heath care.
There is a distinctive American national character, well described in the Pew global surveys. It emphasizes personal freedom, a willingness to tolerate large differences in personal wealth, a strong religious base, a larger number of voluntary associations, and certain key virtues: a high level of charitable contributions, a more intense work ethic than one finds in Europe, a higher level of patriotism, and a faith that views hard work and individual responsibility as key to success.
In contrast, the health bill is premised on the idea that people should expect to be taken care of. This law is more aligned with the sentiments of a European social democracy where hard work is devalued and income inequalities condemned. In the health bill, personal freedom and individual choice are replaced with bureaucratic dictates, one-size-fits-all parameters, and the removal of responsibility and consequence from individuals. Citizens are infantilized as wards of the state. But that’s only the beginning of the adverse consequence that this travesty will have on our national character.
Some damage has already been done. The process of the law’s passage was itself sordid and contrary to basic principles of integrity and good government. Not only was it replete with self-serving deals, it employed deliberately misleading accounting gimmicks to feign fiscal probity. Selfishly self-serving, immediate gains will be paid for by future taxpayers. In whose estimation, outside of thuggish dictators who also share the “by any means necessary” vice, is such corruption and short-sightedness admirable?
Proponents of the law sold it as virtue. Yet what virtue is there in being charitable with someone else’s money? The law further presumes that those who work in government are somehow more virtuous (and wiser) than the rest of us: that they are better positioned to make life and death decisions about care and to decide how much of our income we must allocate to insurance, regardless of our specific circumstance.
Yet in fact, human failings are just as inevitable and predictable, maybe more so, among those endowed with government’s power. Just in the last weeks we have learned of self-serving bureaucrats at the Veterans Administration, a political patronage system controlling access to Chicago’s schools, and that government workers have granted themselves significantly higher salaries than those holding comparable private sector jobs. Our founders wanted to keep government from becoming our master precisely because they understood power’s ability to corrupt.
Specific provisions of the law will clearly encourage vice: guaranteed issue, for example, is certain to induce many who otherwise would have responsibly bought insurance to abstain until care is needed. Yet most profoundly, the entire structure of government-run healthcare is designed to replace our current character — personal responsibility, obligation, gifts and gratitude — with rights, claims, and a sense of entitlement.
For any readers who assume, condescendingly, that conservatives who object to government run programs are selfish, penurious, harsh, and uncaring, let me assure them that conservative concerns rest on the recognition that, as history has consistently shown, they not only don’t work, they make things worse. Instead of realizing the utopian promises that are used to sell them, they eventually, invariably, create new, often more severe problems.
We don’t have to look to ex-Soviet states, South American dictators or to Europe’s soft, ambition-robbing socialism, to learn this lesson. You can look to our nation’s own founding, which was run as an early version of “from each according to his ability, to each according to his need.” Plymouth Colony’s experience is typically taught as an economic parable of the tragedy of the commons. Yet those economic effects were caused by the system’s devaluing of virtue. Remove both positive and negative consequences for actions, and you diminish human spirit and ambition. You rob individuals of the capacity and inclination to act charitably, as well as to strive for excellence. Plymouth was only saved when they returned to a character model that valued individual responsibility and voluntary personal, rather than mandatory collective, charity.
Today, Americans are the most charitable people in the world. Yet what will happen to this instinct as we replace gratitude for a gift with a mentality of entitlement, and the obligation of the citizen to take care of his neighbor with the expectation that government will protect all? We should expect people to curtail giving, and more to look for handouts. And as charity suffers, the government burden will grow.
The ethic of individual responsibility has made America exceptional. We don’t think that we are better than anyone else, but ever since our Declaration of Independence , we’ve understood that essential to maximizing each individuals potential is limiting government’s duties to securing our rights to life, liberty, and the pursuit of happiness. And because we see rights as being eternal (not created by government), and a birthright of each person, we value the individual life–from the most premature baby to the most senior citizen–embracing the belief that if you wish to fight to preserve your precious and valuable life, that you have that inalienable right.
The health care legislation contemplates panels deciding for you whether you have sufficient quality of life, and collective arbitrary decisions on what “society” can “afford”. That moves us to the utilitarian European model, where the elderly are pressured not to take up hospital beds and, really, to not be selfish but go die faster. And that makes sense: if you think that the government, not the patient, decides who gets treated, then government also gets to determine who should die.
Ironically, collectivism erodes the social fabric precisely to the extent that it enables people to evade both responsibilities and consequences. That’s why ultimately, the great failing of this health care bill isn’t that it will fail to control cost, erode the quality of care, and result in rationing, but that it will destroy the virtues that make America exceptional.
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One more reading assignment. Check out the statement today by Senator Preston W. Smith in the Georgia Senate. My son alerted me to this speech and I retweeted it.
http://twitter.com/djpNEWS
Powerful message RT @MagCapitol Sen. Smith’s speech to the Senate today. www.prestonsmith.org/default.asp?pt=newsdescr&RI=177
Here are a couple of EXCERPTS:
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Address to the Georgia State Senate
Senator Preston W. Smith
April 12, 2010
Abraham Kuyper once said, ”When principles that run against your deepest convictions begin to win the day, then battle is your calling and peace has become sin. You must at the price of dearest peace lay you convictions bare before friend an enemy with all the fire of your faith.” Today I rise to speak during our debate about the process by which this bill and others come before our Senate body for consideration. As you may know, when I was elected in my late twenties, I was the youngest member of the State Senate then serving. Today, four terms later, I am still the youngest member of the Senate, although I am now equal to, or greater, in seniority to the majority of our members.
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Moreover during the debate on House Bill 307, the President Pro Tem argued that we should take from those who have two coats and give to those who have none. This is almost as pure a definition of wealth redistribution and socialism as you can possibly craft. And the fact that such a system is passed under threat of the government penalizing you with a worse result is also a central tenant of a socialistic system. If a person voluntarily surrenders his coat to someone less fortunate, that is an example of Christian charity. But, if they are forced to do so in some ‘Robin Hood’ scheme by the government, that is a nearly perfect example of socialism in action.
But it is really not about the issue. You can spin that anyway you want. Reasonable people can reasonably disagree about the best policy. I am a conservative. That means something to me. I believe in limited government with lower taxes, free enterprise, personal responsibility and a strong defense. I also believe that we have allowed ourselves to become far too dependent upon government to provide the needs of our society. I do not apologize for that belief.
Let me share one analogy with you. If you go out into the woods and build a fenced-in pen, you would never be able to get a deer, wild boar or any other wild animal to voluntarily enter that pen and cage himself. But there is a very simple way to accomplish the same goal. Place some food for the animal to eat. After a couple of weeks, continue place the food in the same place while you begin construction on the pen. On the last day, place the food in the same place and leave the gate open. The wild animal will voluntarily enter the pen to eat the food and you can close the gate. The same animal that would never have surrendered his freedom to enter a cage, will voluntarily do so once it has become dependent on your handout. We became great as a nation of free men who once placed a high value on our liberty. And the survival of our Republic depends upon the retention of those freedoms.
In feudal times, the surfs in medieval Europe only paid 1/3 of their income to the King and no textbook considers them free men. Yet today, many Americans pay more than 50% of their income to the governing authorities through combined federal, state and local taxes. When are we going to blow the whistle and say, “Enough!” The founders of our country would never have agreed to our enslavement to a government so big as to give you everything you want and so powerful as to take away everything you have. But, over time, like that wild and free animal, we have sacrificed our freedom at the alter of security. We have become so dependent upon the provision of Government to meet every need that we find ourselves in a cage having voluntarily surrendered our precious liberties for the solace of servitude.
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Members of the Senate, hear me now. If this raw exercise of power can be used to crush me today, it will be used on you tomorrow. If your votes are controlled, why are you here? We have seen this type of leadership exercised just last year in the House of Representatives. We know where that leads. And, those that so easily forget the lessons of our history are certainly condemned to repeat them.
We have men and women fighting and dying around the world to preserve our freedoms. You give lip service to their heroism but you mock their sacrifice when you don’t even allow us to vote the conviction of our conscience freely. How has it possibly gotten to this point where people are so afraid of our so-called leaders that they will give up their vote and the voice of their constituents in order to maintain some position. Are you really controlled that easily? Some might say that your position of influence is important to represent your district, but how can that possibly be if the price of maintaining the position is giving up that voice of your constituents. (DJP emphasis added)
Is this really America? Can you really condemn the backroom arm twisting and deals cut in Washington DC when you do the same thing here? Last week, we heard that voting for this was one of the “tough votes.” That it took “courage” – that it was “leading” and “governing.” This was despite overwhelming evidence that Georgians don’t want us to raise taxes. That is precisely what President Obama was criticized for arguing to twist arms and get votes to pass a healthcare bill that the majority of Americans opposed. He said the time had come to govern, to lead, to make the tough choices – meaning to pass something that was against the will of the very constituents that elected them. That is precisely what happened here on Thursday night.
And, I will tell you something else. I firmly believe that when you attempt to improperly influence a legislator’s vote through promises of reward or threats of recrimination, I believe it is unethical, immoral and illegal. I have a constitutional right to vote for my constituents and I should never be subject to bullying, intimidation or harassment because anyone wants to force me to cast my vote in some other way. That constitutional right is not diminished or superseded by a caucus position on an issue. That is one of the rawest forms of political corruption. And it must stop if our government is going to regain and earn the trust of her citizens.
To my leaders, I say, “Is your title that valuable to you? That you would punish those who stand on principle even if you quietly agree with them?” When you lay down at night, do you revel in being a leader when that leadership means you crush your friends who have faithfully stood beside you just because they are convicted not to vote for a tax increase?
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You recruited me to be an independent voice and a man with a backbone of steel who would not cave in to pressure. I shared with you my conviction on the issue of raising taxes. Rather than respecting that, you sought to break my will with a procedural move and in doing so have forced me to choose my principle or my caucus. You are proud of my intellect when you agree with me but are quick to dismiss my conviction when I won’t yield to your will. Georgia’s citizens expect and deserve true leaders today. They deserve people of principle who will stand up and vote their conscience regardless of the consequences.
People still marvel at why no republicans seemed to stand up and call their leaders out in Washington when they had the majority. They all seemed to mindlessly walk in goose-step fashion regardless of the consequences. I have experienced the pressure of a patronage system and I know why. No one wants to be bought, traded, coerced, intimidated, or harassed into voting against their conscience. And the consequences are severe.
But if someone had stood up and voiced concern over their direction, Republicans probably would not be in the situation we find ourselves in Washington today. I did not want to lose my chairmanship of Judiciary. I believe I have worked hard and earned the respect of my colleagues on both sides of the isle in that role. But, I will never allow any assignment to become so valuable to me that I would violate my word, vote against the conviction of my conscience, or cease being an independent voice for my constituents.
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But, if you don’t respect the people of Northwest Georgia enough to let their voice be heard through my independent representation of them, then perhaps you should take your chairmanship and give it to a puppet who will feel indebted to you and is willing surrender his constituents’ voice. I do not need your position to have respect. And, I do not need your title to have honor.
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DJP: Read the entire speech to put it in context.
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In the next DJP Update, I will try to include a discussion of the book, “Compulsory Medical Care and the Welfare State” by Melchior Palyi written in 1949. Dr. Juan Watkins sent it to me.
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.
RECENT TWEETS and RETWEETS by DJPNEWS:
Cloture but vote to delay perm fix of SGR doctor pay a loser. Need private contracting&no penalty! Via @SenateFloorhttp://bit.ly/ceV0gN
about 1 hour ago via web
Powerful message RT @MagCapitol Sen. Smith’s speech to the Senate today. www.prestonsmith.org/default.asp?pt=newsdescr&RI=177
about 1 hour ago via web
Had a great group of #Tulane med students today in my seminar “Leadership in Medicine” Impressive students yesterday too in PublicHealth
9:06 PM Apr 8th via web
Chart questioning the cost of health care overhaul in @NYTimes http://tinyurl.com/yjw2fnb Thanks @Grace-MarieTurner @Galen alert
8:58 PM Apr 8th via web
Thanks! RT @B_Ivory Dr. Donald Palmisano, 2003-4 Pres AmerMedAssoc. just gave a great speech in my class, great discussion on hlt reform..
9:31 PM Apr 7th via Echofon
Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/
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