828 at the Mall -- Americans are the best!

Yes, the hyena is looking good.  Well rested. 

She wanted me to resume the blog, especially after we got back from 828 in Washington, D.C.  So, we've been going over the pictures and discussing the message.  But then I received a package in the mail.  And I had to share this experience with you.

The package came from one of a pair of sisters that I met that morning before the program started.  I was walking around with my camera, watching people and asking some if they minded if I took their picture, and just chatting, when I asked these sisters if I could take their picture. 

Then we were just talking about why we had decided to come, where we were from, things like that, when I admired the shirts they were wearing. 

Turns out one of them, Vicki, did the embroidery.

And then Vicki offered to send me one for myself.  I was surprised, but excited.  She asked what kind of shirt I would like.  I said she should market them because they are classy and unique. I offered to pay for it, but of course she said no.

I hadn't forgotten about the shirt.  I did believe she would send it because she said she would, and that is the kind of person she is. 

That is the kind of person who was there that day.

We exchanged contact information and yesterday my shirt arrived in the mail along with a nice note.  This is a close up of the picture on the left.  One the right is the phrase, "Restoring Honor 8-28-10."

I'll have more to say and show about that day, but for now, I just want to admire my new shirt.

And reflect on the nature of Americans.  You can still find good solid honest people anywhere you go, if you care to look. 

God bless America.

What does Pelosi's health care bill do for us?

I guess you are all aware that the House passed Pelosi's revised health care bill a few days ago. It was rushed through very urgently, even though it was nearly 2,000 pages in length.

Betsy McCaughey, Ph.D., is a patient advocate and former Lt. Governor of New York State. She is the founder and Chairman of the Committee to Reduce Infection Deaths and been instrumental in making hospital infections a major public issue. She is widely published and regarded as a health policy expert.

Dr. McCaughey wrote an article in the Wall Street Journal on November 7, 2009 in which she picked out passages she felt were important and referenced each issue with the actual page number from the House bill.

What the Pelosi Health-Care Bill Really Says
Here are some important passages in the 2,000 page legislation. OPINION / NOVEMBER 7, 2009
By BETSY MCCAUGHEY

The health bill that House Speaker Nancy Pelosi is bringing to a vote (H.R. 3962) is 1,990 pages. Here are some of the details you need to know.

What the government will require you to do:

• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.

• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.

On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.

• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.

• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.

• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less.

Eviscerating Medicare:

In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.

• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."

The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.

• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.

• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.

• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."

Questionable Priorities:

While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.

• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."

These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.

• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.

• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."

• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.

For the text of the bill with page numbers, see www.defendyourhealthcare.us.

Thought you'd like to know.

Later,
Carol

How much money are we really printing?

I've been hearing here and there that we are printing a lot of money, but it never seemed to be a big issue.  It wasn't really in the news, never on the front page, so I never knew whether to believe it or not.  So, I set out to see if I could find out what's going on with our money. 

I looked at a lot of information, but when I came across this video, I knew I had to share it.  For those of you who don't like Glenn Beck, all I can say is that he can be obnoxious, but he does his research.  He challenges anyone to find errors in his reporting and he always has his references ready.

The chart in this video came from the Federal Reserve.  Take from it what you want.

Remember the Beer Summit? No Photoshop needed

Remember the story in July about the interaction between Professor Henry Louis Gates Jr. and Sergeant James Crowley?  Gates, a black Harvard professor, was arrested by Crowley July 16 for disorderly conduct outside his home after police responded to a report of a possible burglary.  Professor Gates complained that he was the victim of a "rogue" officer while Sgt. Crowley said Gates accused him of racism while he was simply trying to do his job.  President Obama, a personal friend of Gates, admitted that he contributed to "ratcheting it up" when he commented that the Cambridge Police Department had "acted stupidly" when he didn't know the facts of the case.

In hopes that the incident could become a "teachable moment to improve race relations" for the country, President Obama invited both men to have a beer with him in the White House to discuss the incident and move on.

I found an interesting photo on the White House web site of the three men entering the Rose Garden.  You can view the photo online at http://www.whitehouse.gov/blog/Over-Beers/.

Notice the white police officer helping the black professor down the steps (while the President strides confidently forward)?

What's left to say?

Later,
Carol

http://www.cnn.com/2009/US/07/27/gates.harvard.obama/index.html
http://www.huffingtonpost.com/2009/07/30/beer-summit-begins-obama-_n_248254.html

Why should tort reform be a part of healthcare reform?

There seems to be a lot of confusion about what tort reform is and what it means when it is applied to health care reform. I don't think there is any question that trial lawyers are against tort reform and lobby heavily to prevent it, but that doctors want it. Unfortunately, the American public is skeptical about the motives of both of those groups. So should you be for it or against it?

It's not so much the cost of malpractice insurance, or the cost of malpractice trials, that affects healthcare costs in terms of tort reform. It's the constant awareness of the potential of being sued that causes doctors to order multiple, expensive and often unnecessary tests.

Patients have a lot of confidence in the ability of our healthcare system to correctly evaluate, diagnose and treat just about any adverse condition that a human might experience. However, patients also have been educated about many common as well as unusual and rare diseases, their symptoms, and what type of tests that are available for diagnosis. So when they show up in a doctor's office, they often come with expectations as to what tests they need, and they are getting more and more outspoken as to what they want and expect.

In medical school, doctors are taught early on that, when you hear hoof beats, think of horses, not zebras. In other words, common conditions occur commonly, and uncommon conditions occur uncommonly. So it is wise to consider initially that the condition is what is appears to be, a common and usually easily evaluated and treated condition. It is reasonable to only consider that the condition is uncommon when there is evidence for that.

But patients don't want to assume the best. They want to rule out the worst. And that essentially always requires testing, sometimes a lot of testing. But they have insurance, they pay their premiums, multiple tests won't require financial risk on their part, so they ask or even demand that the condition they fear be ruled out.

This puts the doctor in, on many levels, an uncomfortable position. If the doctor refuses to order the requested testing, the patient will likely become angry, and the relationship that should be one of trust and cooperation becomes adversarial. It's very likely that the patient will then seek another opinion and another opportunity to obtain what he or she feels is a "right."

The only way that the doctor can hope to preserve any positive relationship with a patient like this is to acquiesce and order what is almost always unnecessary testing. The doctor may try to explain his or her reasoning to the patient, and if the patient has confidence in that doctor, a reasonable approach might be agreed on. But even that outcome is difficult to reach since the explanation takes time. It is far easier and faster to go ahead and order testing. Everyone leaves the encounter (relatively) happy. The doctor-patient relationship is preserved. The tests will almost always come back negative and the patient will tell friends how wonderful the doctor is.

For those of you who are thinking the obvious question, but what happens if the patient really does have the feared disease? If the disease is not apparent enough for the doctor to suspect that is may indeed be present, then it is almost always reasonable to observe the patient for a period of time. If the condition is mild, then the patient will get better without extreme measures, and many thousands of dollars will have been saved. If the patient does not improve, or shows additional symptoms, then further testing will be considered. That is how medicine has been practiced for a long time. Every sprained ankle does not need an MRI to rule out cancer.

The doctor may well also consider that if the patient has a poor outcome, for any reason, then a lawsuit might be filed. Most doctors want to have a good relationship with their patients. They want their patients to get well. And when a lawsuit is filed by a patient because of a poor, or even unsatisfactory outcome, it hurts. It leads to worry and anxiety. Someone is very publicly accusing this person of being a bad doctor, a bad person, of not knowing what they are doing. Malpractice lawsuits can drag on for years, even if the doctor did nothing wrong. They cause stress, anxiety, embarrassment, and self doubt. It becomes very easy and reasonable to go ahead and order those tests when that possibility is present.

So how might tort reform affect healthcare spending?

In an article from MSNBC.com, Limiting malpractice lawsuits can save big: Fear of lawsuits makes some docs order costly tests that may be unneeded, the CBO weighs in.

The latest analysis from the nonpartisan Congressional Budget Office estimates that government health care programs could save $41 billion over ten years if nationwide limits on jury awards for pain and suffering and other similar curbs were enacted. Those savings are nearly ten times greater than CBO estimated just last year.


"Recent research has provided additional evidence that lowering the cost of medical malpractice tends to reduce the use of health care services," CBO Director Douglas Elmendorf wrote lawmakers, explaining the agency's shift. Previously, CBO had ruled that any savings would be limited to lower malpractice insurance premiums for doctors, saying there wasn't clear evidence physicians would also change their approach to treatment.


Defensive medicine
On Friday, Elmendorf essentially acknowledged what doctors have been arguing for years: fear of being sued leads them to practice defensive medicine. Some doctors will order a $1,500 MRI for a patient with back pain instead of a simple, $250 X-ray, just to cover themselves against the unlikely chance they'll be accused later of having missed a cancerous tumor.

Of course, there are other issues involved in this discussion. But I believe this is one angle that many Americans have not considered.

Later,
Carol

Do doctors really support this health care bill?

After the endorsement of the House Democrats' health bill yesterday by the AMA, President Obama made the following comments:

"They would not be supporting it if they really believed that it would lead to government bureaucrats making decisions that are best left to doctors," he said of the AMA. "They would not be with us if they believed that reform would in any way damage the critical and sacred doctor-patient relationship."

I just found an interesting web site put together by a group of doctors here in Atlanta.  The web site is docs4patientcare.org and it has some good resources for more information about this whole health care "crisis" and what is being suggested as solutions.  I thought that their Proposed Alternatives for Effective Healthcare Reform were especially reasonable, so I thought I'd pass them along.


Docs4PatientCare Proposed Alternatives for Effective Healthcare Reform:



•There is no logical reason to hastily pass this legislation by a predetermined deadline. We have one chance to get this right.


•Bring "all" stakeholders together to help assure a meaningful and sustainable reform by considering many recommendations and proposals.


•Adopt a patient-centered approach to healthcare reform that empowers patients and promotes freedom of choice.


•Use the power of government to assist the uninsured obtain health coverage through modification of the tax code, such as tax credits and vouchers.


•Reduce high insurance premiums by opening up patient risk pools across the entire nation, thereby diffusing risk.



•Allow the individual/family to be the "owner" of the policy making their health care coverage portable and available if they lose their job or move to a new place of employment. This will eliminate exclusion from the new employer's plan for a “pre-existing” health issue and also eliminate a waiting period to qualify for enrollment.


•Encourage and expand Health Savings Accounts. Tax-Free savings vehicle for planned and/or unexpected medical expenses.


•Tort Reform. The costs to our healthcare system secondary to the practice of defensive medicine are over $100 billion annually, or $2,000 per family.


•Insurance Reform. Guarantee insurability due to pre-existing illness. Eliminate Insurance company antitrust exemption.


So what is wrong with a little common sense?

I'm also putting in a link to an article entitled Obamacare and Me, written by a physician who has practiced medicine here in Atlanta for many years.  In it he reflects on his experiences with Medicare and Medicaid and gives his thoughts on what the new healthcare plan would mean for Americans.  I think it's well written.  And I think most physicians would agree with these comments.


Later,
Carol

Congress Funds Study on How To Avoid Constituents, Stay in Office

I’ve thought about doing something like this for a while, but I heard something today that is so unbelievable that I have to pass this along. So I’m going to continue to comment on news items that I think we should all be aware of. Obviously I don’t have a staff to research all of these but I will make my best effort to only pass along what was said or what happened, and you can interpret for yourself what it may mean. (Although I will add my own thoughts as well. It’s my blog.)

I welcome comments or questions, and especially additional information that might color the interpretation. I also welcome suggestions of additional resources, especially those that offer an opposing view. 

This is an article is from the Heritage Foundation:
http://blog.heritage.org/2009/10/28/congress-funds-study-on-how-to-avoid-constituents-and-stay-in-office/

(Underlined words are links.)

Congress Funds Study on How to Avoid Constituents, Stay in Office•

Posted October 28th, 2009 at 5.13pm in Ongoing Priorities.

This Friday, the tax payer funded Congressional Management Foundation (CMF) is hosting a briefing for Members of Congress and their staff on their new study: Online Town Hall Meetings: Exploring Democracy in the 21st Century. The CMF study consisted of 21 town hall meetings where Members of Congress and CMF provided a moderator: “spoke via voice over IP, and constituents asked questions and made comments by typing them. Only off-topic, redundant, unintelligible, or offensive questions were screened, and only questions asked by people who had not yet asked a question were prioritized.”

CMF does not say what qualifies as offensive, but if this summer is any indication that definition would include anything that the Congressman did not want to talk about. In other words, this report urges Congressmen not to actually interact with their constituents, but to avoid them altogether by holding safe town halls they can completely control. And what did CMF find where the results of these Potemkin town halls?

The online town halls increased constituents’ approval of the Member. Every Member involved experienced an increase in approval by the constituents who participated. The average net approval rating (approve minus disapprove) jumped from +29 before the session to +47 after. There were also similar increases in trust and perceptions of personal qualities – such as whether they were compassionate, hardworking, accessible, etc. – of the Member.

The lesson: avoid your constituents’ inconvenient questions and your approval ratings will rise. And this is a taxpayer funded study. Here is the grant from the National Science Foundation.

Congress is actually using your tax dollars to pay social scientists to find ways they can avoid actually talking to their constituents while improving their chances of reelection.


Here are some interesting details. The grant was funded in 2004. Twenty of the facilitated online town hall meetings took place in 2006 with U.S. Representatives and one took place in 2008 with a U.S. Senator.

The report was funded by a grant from the National Science Foundation. In other words, our taxpayer dollars went to fund a study on how to avoid the people who elected them. We elected them to represent us. And we pay their salaries, and their pensions, and their healthcare when we pay our taxes.

Not only did this manipulative study look at how to avoid us, the results show that in the process their approval ratings soared.

Remember this when congressional elections come up next time. Did any member of congress think this was outrageous enough to tell us about it? And did any member of the press think this was worth telling us about?



More later.
Carol