Tag Archives: Healthcare

Life, Liberty and the Pursuit of Practice Happiness

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Most physicians, by our very nature, are not inclined to make waves, especially when it comes to politics. Those that are interested in getting involved may actually run for office, or, like me, resort to writing a blog in an effort to make their opinions heard. Others get caught up in professional organizations such as state medical societies, specialty associations or other national organizations. For the more ambitious, making periodic trips to Washington, DC, to lobby their representatives gives them a sense of active participation in “the system.” I know, I’ve done all these things myself (except running for office) with little to show for the effort.

The fact is, as individual doctors we have very little power to change anything that happens in the political arena. And, while it is true that as a collective we could have significant influence, it doesn’t appear likely that physicians will ever unite behind any single idea, philosophy or action plan. We are indeed a dysfunctional group of cats, and will not be herded no matter how desperate our circumstances become.

This past weekend I heard Andrew Schlafly, Esq., the General Counsel for the Association of American Physicians and Surgeons give a talk on what he referred to as “A War on Doctors.” He accurately described the coordinated efforts by hospitals, third party payers and the government, all designed to control physicians through employment, intimidation, regulation and economic coercion. None of the strategies or tactics he described came as any new revelation to the audience comprised almost exclusively of doctors, but it did serve to focus the discussions that occurred for the duration of the meeting.

Our current healthcare payment system is at the heart of this war on American Medicine. It is an unchallenged fact that healthcare related costs have escalated to the point where they threaten our national financial security. But if you look at where the money actually goes, it isn’t into the pockets of doctors. Estimates place the percentage of total healthcare spending that goes to pay physicians at between 10% and 12% of the healthcare budget. The bulk of the payments go to hospitals, pharmaceutical and device manufacturers, insurance companies, and a myriad of secondary and tertiary “providers” of various health related goods and services. It would then seem reasonable to ask, why wage war on the docs? Simple, we are the easiest targets.

The general lack of organization among physicians makes it possible to manipulate us using the strategies and tactics mentioned above. Similar efforts don’t work well against massive hospital groups and industrial giants, each of whom maintain multi-million dollar lobbies designed specifically to improve their relative position in the system, or at the very least, maintain their status quo. The arguments are also easily made that physicians are responsible for ordering all those expensive tests… and doctors prescribe all those useless drugs… and they are the ones who perform those unnecessary procedures… and they keep people in hospitals for no apparent reason other than money… So, it only follows that doctors must be brought to heel or appropriately punished. Besides, all doctors are rich, right?

I do not wish to imply that America’s doctors are the victims here. In large part we have unwittingly brought this war upon ourselves. For more than 30 years now, the vast majority of doctors have been systematically lured into participating in what has become a corrupt third party payment system. They have passively, and in a some cases actively, participated in “contract medicine” where the payers have subtly and systematically seized control over medical decision making. Problems arise whenever the absolute loyalty and commitment of physicians to their patients becomes an inconvenient obstacle to either the political or economic gain of the payer. Their answer is to attack the physician’s core principles contained in the Code of Medical Ethics. Their weapons include complex economic incentive programs shrouded in innocent sounding names names like “quality improvement”, “gain sharing”, “pay for performance”, and the latest effort, which is tucked neatly inside Obamacare, “Accountable Care Organizations”. Failure to comply with these efforts results in harsh penalties, including both financial penalties and professional sanctions. The strategy is clear, offer small carrots followed by a very large set of sticks.

By all appearances this war is not likely to end well for the doctors. We have limited ammunition, no coordinated strategy or battle plan, and few if any allies. Many physicians have already given up on the idea of independence. It is for this reason that I, and many like me, have chosen a path less traveled. One that can only be referred to as individual, passive non-participation. For the last 12 years I have not participated in any third party contract-based payment schemes, and as of January 2013, I have opted out of the Medicare program. For me, this was a difficult decision, but it was the only option I could see that would allow me to be a truly independent physician.

Some will undoubtedly criticize my stance as being contrary to their interpretation of the Hippocratic Oath. Others may consider me to be selfish and uncaring. To them I would simply offer my signed “Independent Physician’s Rights and Obligations Pledge” as proof of my intent. I’m not sure if any of my colleagues will assume a similar strategy since, as I said, we are all a bunch of cats, and it is not my intent to suggest this is the only course of action. However, I believe that as an American, I have the inalienable right to life, liberty and the pursuit of happiness, including the joy of practicing my life’s work for the benefit of those who seek my help without pressure or interference from the government or any other controlling entity.

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The Independent Physician’s Rights and Obligations Pledge

As an independent practicing physician, I hereby acknowledge my role is central to ensuring quality care for all patients. I further recognize the potentially disruptive nature of outside influences on the patient-physician relationship, including various methods of payment. Through this pledge I hereby reaffirm my unconditional commitment to my patients, my colleagues and my profession, and to maintaining my SPIRIT as a physician.

I pledge, to provide personal healthcare to all those who I am privileged to treat, in accordance with my training and experience with a spirit of personal Service.

I pledge, to uphold, defend and perpetuate the time-honored ethics of the medical Profession.

I pledge, to conduct my practice with openness, honesty, fairness and personal Integrity.

I pledge, to keep the time-honored patient-physician relationship based on mutual trust, mutual respect and mutual Responsibility.

I pledge, to establish just and appropriate fees for the services I provide, treating all patients fairly and with compassion, free from any third party attempts to influence my professional judgment or Independence.

I pledge, to work within the community of physicians to ensure the medical profession remains self-regulating and self-governing with respect to education, training, quality assurance and peer review, according to our time-honored Tradition.

Now, before all who are my witness, I accept and embrace these fundamental rights and obligations freely and without reservation, and declare my willingness to abide by them to the best of my ability.

Robert Sewell, MD

 

The opinions expressed are my own and do not necessarily reflect those of any organization or group. please feel free to review other posts on www.spiritofhealthcare.com and check out my clinical site at www.robertsewellmd.com

The Medical Profession In The Brave New World Of Healthcare

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The difference between a job and a profession is a matter of ownership. Anyone who is applying for employment understands that the job they seek actually belongs to someone else. It is typically offered by an individual or a corporation who defines the job and determines who is qualified to perform it. If the job holder is unable or unwilling to do the work, the owner takes the job back and finds someone else to fill the position.

By contrast, a professional owns their own job, having obtained the requisite knowledge and skills through very specific education, training and subsequent experience. Each professional is also charged with being a steward of the profession they have dedicated their life’s efforts to achieving. This stewardship requires the establishment and maintenance of an accepted set of core principles, and it is those core principles that define the profession to the rest of the world.

As a physician, my profession’s core principles have been in existence for about 2,500 years. They have been modified somewhat over the centuries, but by and large they have remained relatively constant since they were first outlined by Hippocrates. His rules for the profession were relatively simple; first do no harm, always do what is best for the patient, consider the patient before self, create no mischief and keep confidential what you see and hear. There is nothing specific in the Hippocratic Oath about charges or payments for physician’s services, but it concludes with the statement, “if you keep this oath, it will be granted to you to enjoy life and the practice of this art, respected by all men in all times.”

Through the ages patients have relied on the physician’s adherence to this basic Code of Medical Ethics as the fundamental basis for the social contract, commonly referred to as the patient/physician relationship. However, in recent years we have witnessed a steady erosion of that relationship as the practice of medicine has centered more on payments than patients. When America’s physicians allowed the camel’s nose of third party payers under their tent, they invited an assault on their time-honored ethics. For decades the patient/physician relationship has been under siege by a variety of forces associated with our convoluted payment system. Does your doctor do what he or she believes is best for you, or follow some “best practice guidelines” offered by a public or private bureaucrat who is holding the purse strings?

For a century and a half the American Medical Association has been the standard bearer for the Code of Medical Ethics in this country, and at one time nearly every physician was a member of that organization. But, since the mid 1960‘s AMA membership has declined steadily until today more than 80 percent of America’s doctors are not members. The reason for the mass exodus from the AMA is simple. Most physicians believe that it is no longer representative of the core values of their profession. As a delegate to the AMA House of Delegates for the last 4 years, I witnessed for myself how the “Business of the House” focuses far more on the finances, politics and social engineering efforts surrounding healthcare than it does in preserving and improving the art, science and ethics of medicine.

At the Interim Meeting of the AMA HOD I was reminded of just how far our professional leadership has drifted away from its core values. The AMA President, Dr. Jeremy Lazarus, gave a speech during the opening session. He called on America’s physicians, “To move from divisiveness to diplomacy, from conflict to collaboration, from the narrow self interest of personal gain to the national interest of mutual goals.” He went on to say, “We need to have a difficult but necessary conversation with the public and our leaders about the tough choices ahead. In June, the AMA passed ethics policy that calls on physicians to be stewards of the resources society entrusts to us. To follow policies on issues such as: Cost versus Value. End of Life Care. The responsibility of patients to own their own health. The need for more public health investment. The very unsustainability of the system itself – absent fundamental change.”

Dr. Lazarus was presenting the AMA’s new strategic plan that promises to discard those core principles which are centered on the individual patient, and replaces them with a new ethical code that shifts the profession’s priorities to meeting the collective good. In his remarks he accused physicians of being selfish, suggesting that we should “… listen to our heart and be driven by science – and not the latest fad or the biggest pile of cash. Knowing in our heart that a medical school diploma is not a treasure map.” Perhaps the new AMA strategy was best summed up when Dr. Lazarus said, “It seems to me the stars have aligned in such a way that our loftiest aspirations are exactly what’s needed now to transform our health care system. And to embrace a new set of core values – ones better suited to integrated care… It once made sense for physicians to value autonomy, independence, and self-sufficiency. But the game has changed.”

This new AMA plan and strategy are merely a continuation of the organizations trend over the last 50 years, which clearly runs contrary to the traditional Code of Medical Ethics. So, it comes as no surprise that the next step will be to make the needed alterations to that pesky code. The Speaker of the House, Dr. Andrew Gurman, spoke to this issue shortly after Dr. Lazarus. He told the delegates that over the next few sessions there was much work to be done on a number of important issues. At the top of the list was the need to “revise” the AMA’s Code of Medical Ethics to be more relevant given the changing healthcare environment. The objective seems obvious. The ethics of Hippocrates simply won’t allow physicians to participate in such things as Accountable Care Organizations, Pay-for-Performance Initiatives, Gain Sharing, Resource Stewardship, Cost versus Value, End of Life Care and other similar euphemisms, each of which translate into rationed care orchestrated by the physician.

The “Brave New World of Healthcare” has become one in which payers exert more and more pressure on physicians to manage costs, and professional organizations abandon their core principles for political expediency. Not surprisingly, many physicians are overwhelmed by this changing environment and feel compelled to seek the safety of employment by a hospital or large integrated system. But when they do, their commitment to individual patients becomes subordinate to the rules of their employer, and their profession with its defining code of ethics is lost forever in favor of job security.

Robert Sewell, MD, FACS

 

 

The opinions expressed are my own and do not necessarily reflect those of any organization or group. please feel free to review other posts on www.spiritofhealthcare.com and check out my clinical site at www.robertsewellmd.com

Observations on Politics, Profiteering “Incentives”, and the Struggle for a Profession’s Soul

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Robert W Geist, MD

The new 2010 federal Patient Protection and Affordable Care Act (ObamaCare) attempts to control society’s rising cost of care, but does so by expanding on an ethically questionable payment system. The system increases the control of managed care “payers”, HMO corporations and government agencies, by paying physicians monetary incentives for reducing the amount of care they provide. The specific objective is to encourage all healthcare providers to limit patient use of private health insurance premiums as well as tax dollars.

The law calls for the creation of Accountable Care Organizations (ACOs) consisting of hospitals and staff physicians, merged into risk-bearing, gate-keeper insurance corporations with fixed global budgets. The amount of money allocated to each ACO is determined based on auctions of populations of insured lives to be serviced, on a per capita basis. When payers contract only with risk bearing ACO corporations, clinicians are effectively forced into gate-keeping contracts, since unaligned and independent clinics or individuals would be totally excluded from this type of payment program.

To implement these market controls, ObamaCare creates a powerful public-private cartel system. In the new system merged ACO-HMO insurance corporations are shielded by virtue of the sovereignty of the federal government from legal challenge for any activities that limit competition and/or fix prices. These shields were established through the 2011 waivers of federal anti-trust, anti self-referral, and anti fee-splitting patient protection laws.

Demand for healthcare services will naturally increase as a byproduct of this politically motivated and tax-subsidized system. Clinicians at the bedside will continue to be powerless to reverse this demand inflation unless coerced into the role of gate-keepers denying services. Likewise, there will be a continuation of the kind of quality distortions, which have resulted from decades of government price-fixing and previous failed managed care rationing methods. One can predict that these economic “fatal flaws” of this legally insulated, gate-keeping system will lead to a progressive deterioration in overall access to quality healthcare in America.

The pretext of ObamaCare as a “social good” to control cost and improved quality, has been used to justify highly questionable means, including patient auctions and monetary incentives, which reward rationed care. Under this system, patients can, and very likely will, lose the protection of law, as this law now legalizes corporate-government profiteering for rationing access. This is also how the medical profession and individual physicians can be coerced into losing their professional soul—the ancient covenant of loyalty to each patient.

Why Obamacare Must Be Repealed

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Over the last two years I have made a number of efforts to outline the problems with what we affectionately call Obamacare. It is unclear whether those efforts have been effective or not, but these have been my best efforts. However, I just watched a video called “The Determinators Movie” which far exceeds any effort I could ever summon. Please watch it now, and forward it to everyone you know, because sooner or later we will all be patients.

Forestalling the Demise of Freedom

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I am attaching an e-mail letter I received recently without specific permission, but, you will see at the end there is a request to forward it to everyone, thus the inclusion in this blog. I actually thought about trying to rewrite this in my own words, but I’m not sure there is any way I could deliver this message any more clearly than this author has.

Obama’s Second Term Transformation Plans

The 2012 election has often been described as the most pivotal since 1860. This statement is not hyperbole. If Barack Obama is re-elected the United States will never be the same, nor will it be able to re-capture its once lofty status as the most dominant nation in the history of mankind.

The overwhelming majority of Americans do not understand that Obama’s first term was dedicated to putting in place executive power to enable him and the administration to fulfill the campaign promise of “transforming America ” in his second term regardless of which political party controls Congress. That is why his re-election team is virtually ignoring the plight of incumbent or prospective Democratic Party office holders.

The most significant accomplishment of Obama’s first term is to make Congress irrelevant. Under the myopic and blindly loyal leadership of Harry Reid and Nancy Pelosi, the Democrats have succeeded in creating an imperial and, in a second term, a potential dictatorial presidency.

During the first two years of the Obama administration when the Democrats overwhelmingly controlled both Houses of Congress and the media was in an Obama worshipping stupor, a myriad of laws were passed and actions taken which transferred virtually unlimited power to the executive branch.

The birth of multi-thousand page laws was not an aberration. This tactic was adopted so the bureaucracy controlled by Obama appointees would have sole discretion in interpreting vaguely written laws and enforcing thousands of pages of regulations they, and not Congress, would subsequently write.

For example, in the 2,700 pages of ObamaCare there are more than 2,500 references to the Secretary of Health and Human Services. There are more than 700 instances when he or she is instructed that they “shall” do something, and more than 200 times when they “may” take at their sole discretion some form of regulatory action. On 139 occasions, the law mentions that the “Secretary determines.” In essence one person, appointed by and reporting to the president, will be in charge of the health care of 310 million Americans once ObamaCare is fully operational in 2014.

The same is true in the 2,319 pages of the Dodd-Frank Financial Reform Act. which confers nearly unlimited power on various agencies to control by fiat the nation’s financial, banking and investment sectors. The bill also creates new agencies, such as the Consumer Financial Protection Bureau, not subject to any oversight by Congress. This overall process was repeated numerous times with other legislation all with the intent of granting unfettered power to the executive branch controlled by Barack Obama and his radical associates.

Additionally, the Obama administration has, through its unilaterally determined rule making and regulatory powers, created laws out of whole cloth. The Environmental Protection Agency on a near daily basis issues new regulations clearly out of their purview in order to modify and change environmental laws previously passed, and to impose a radical green agenda never approved by Congress. The same is true of the Energy and Interior Departments among many others.

None of these extra-constitutional actions have been challenged by Congress. The left in America knows this usurpation of power is nearly impossible to reverse unless stopped in its early stages.

It is clearly the mindset of this administration and its appointees that Congress is merely a nuisance, and can be ignored after they were able to take full advantage of the useful idiots in the Democrat controlled House and Senate in 2009-2010, and the Democrat Senate in the current Congress.

Additionally, Barack Obama knows after his re-election a Republican controlled House and Senate will not be able to enact any legislation to roll back the power previously granted to the Executive Branch, or usurped by them. His veto will not be overridden as there will always be at least 145 Democratic members of the House or 34 in the Senate in agreement with or intimidated by an administration more than willing to use Chicago style political tactics.

The stalemate between the Executive and Legislative Branches will inure to the benefit of Barack Obama and his fellow leftists.

The most significant power Congress has is the control of the purse-strings as all spending must be approved by them. However, once re-elected, Barack Obama, as confirmed by his willingness to do or say anything and his unscrupulous re-election tactics, would not only threaten government shutdowns but would deliberately withhold payments to those dependent on government support as a means of intimidating and forcing a Republican controlled Congress to surrender to his demands, thus neutering their ability to control the administration through spending constraints.

Further, this administration has shown contempt for the courts by ignoring various court orders, e.g. the Gulf of Mexico oil drilling moratorium, as well as stonewalling subpoenas and requests issued by Congress. The Eric Holder Justice Department has become the epitome of corruption as part of the most dishonest and deceitful administration in American history. In a second term the arrogance of Barack Obama and his minions will become more blatant as he will not have to be concerned with re-election.

Who will be there to enforce the rule of law, a Supreme Court ruling or the Constitution? No one. Barack Obama and his fellow-travelers will be unchallenged as they run roughshod over the American people.

Many Republicans and conservatives dissatisfied with the prospect of Mitt Romney as the nominee for president are instead focused on re-taking the House and Senate. That goal, while worthy and necessary, is meaningless unless Barack Obama is defeated. The nation is not dealing with a person of character and integrity but someone of single-minded purpose and overwhelming narcissism. Judging by his actions, words and deeds during his first term, he does not intend to work with Congress either Republican or Democrat in his second term but rather to force his radical agenda on the American people through the power he has usurped or been granted.

The governmental structure of the United States was set up by the founders in the hope that over the years only those people of high moral character and integrity would assume the reins of power. However, knowing that was not always possible, they dispersed power over three distinct and independent branches as a check on each other.

What they could not imagine is the surrender and abdication of its constitutional duty by the preeminent governmental branch, the Congress, to a chief executive devoid of any character or integrity coupled with a judiciary essentially powerless to enforce the law when the chief executive ignores them . Americans must come to grips with this moment in time and their historical role in denying Barack Obama and his minions their ultimate goal. All resources must be directed at that end-game and not merely controlling Congress and the various committee chairmanships.

Steve McCann, May 12, 2012

Please forward this to all you can, maybe together we can save America for ourselves and those who will follow after us

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I would only add, if we (the American public) accidentally overheard this President telling Russian President Putin that he would have a lot more flexibility after the election, how many other “deals” has Obama made with those who would seek to destroy our freedoms and the American way of life? Now is a time for choosing. “We The People” of this great nation must stand against the tyranny that Abraham Lincoln warned us about 150 years ago. He said  “America will never be destroyed from the outside. If we falter and lose our freedoms, it will be because we destroyed ourselves.”

 

As an American…

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I received a letter recently from a young, black, conservative physician named Dr. Robin Armstrong. He was recently elected to the Republican National Committee from Texas and is obviously a supporter of the Romney/Ryan ticket. However, the specific points he made in his letter were more than just the usual partisan politics; they were a plea to all Americans to come to our collective senses and change the direction of our nation. Dr. Armstrong said,

“As a proud American, I am offended that Barack Obama has attacked our institutions that have made our nation great!

As a Texan, I am angry that Barack Obama has abused his executive authority to attack our voter ID laws, and to attack the oil and gas industry with radical environmental restrictions and regulations!

As a Christian, I am disappointed this president has abused his office to impose his will and his values on religious institutions despite the clear violation of the First Amendment!

As a Conservative, I am offended this president considers me his enemy and a greater danger to our nation than radical Islamists!

As an African American, I am saddened this president’s policies have expanded the welfare state, skyrocketed the black unemployment rate to 14.4%, and further isolated our community!

As a Physician, I am frightened by Barack Obama’s unconstitutional assault on the healthcare industry, which will lead to bankruptcies in both government budgets and healthcare quality!

As a Taxpayer, I am angry this president wants to raise my taxes even further because he thinks I do not pay my fair share!

President Obama has stated he wants to fundamentally change our nation.  He is well on his way and he must be stopped!”

There is really nothing to add to Dr. Armstrong’s arguments except to say, as each of us is awakened to the fact that our freedoms and our very way of life are being stolen from us, and our posterity, it is our duty and our moral obligation to do whatever we can to arouse those around us before our current American Nightmare becomes the new and permanent American Reality.

Make no mistake, Barack Obama is a Marxist, socialist and should he win re-election, even if he loses Democrat control of the Senate, he will continue to seize more and more power through executive orders.

We were warned about the process we are now witnessing by none other than Abraham Lincoln when he said, “America will never be destroyed from the outside. If we falter and lose our freedoms, it will be because we destroyed ourselves.”

 

Is It Really About Healthcare?

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If you’ll recall, two years ago this past spring we were all watching the activities of our Congress with a great deal of anxiety. The healthcare reform process exposed the truly seedy side of the political gaming that goes on in Washington everyday, to one degree or another. But in this instance the eyes of the American public were a bit more focused than usual, and no matter which side you favored, the backroom deals and strong arm tactics had to make you more than a little uncomfortable with the way power was being wielded. What we saw was anything but representative of the will of the people.

In the end, both the House and Senate passed the President’s healthcare reform strictly along party lines, with votes being cast by elected representatives who freely admitted they had not even read the bill. So now, in the wake of all that, the question we should be asking ourselves is why? Why is controlling or overseeing individual’s personal healthcare such a big deal to this current administration and their minions in the Congress? The answer is actually very simple and it has absolutely nothing to do with ensuring the public health or the citizens’ wellbeing; its all about Power and Money.

For elitists who aspire to power, often based on their perceived superior intellect, the easiest way to achieve it is to first convince the masses that they require the government’s help to meet a specific need. The success of this philosophy relies heavily on a combination of fear and protection; something right up this Chicago gang’s alley. We’ve all heard the statement, “never let a crisis go to waste” and the reason is that public fear is a natural product of any crisis. But, if fear doesn’t actually exist, then you can create it using anecdotes and hyperbole. Once fear is well established the power-seekers can step in and offer protection and security in the form of a magnanimous government solution.

So, why start with healthcare? Simple, it is far easier to create a sense of fear over an emotionally charged issue like breast cancer or the sudden severe injury of a child than it is for any of the “necessities of life” like housing, food, clothing or virtually anything else we use or depend on everyday. It’s natural to be concerned and even a bit anxious over the potential impact of an unexpected illness or injury and all it takes to turn that anxiety into a full-blown crisis-level fear, which demands a government solution, is the injection of the final element – money, or the potential loss of it.

Clearly, government control of healthcare has been a goal of “progressives” in this country for more than a hundred years. When the liberal factions of the Democrat party gained control of both houses of Congress and the Presidency in 2008 their long awaited opportunity finally presented itself. They were quick to point to private insurance companies as being guilty of raising premiums and reducing coverage at the expense of the consumer, and on that score they were correct. “Reform” became their rallying cry without specific mention as to what exactly needed reform. Change for the sake of change alone was considered by many to be reason enough to overturn what has been the best healthcare system in the world. After all, “this is a Crisis!”

While the subsequent developments have been very upsetting to those of us in medicine who have dedicated our lives to providing that care, it should be truly frightening to every American based on where it will most certainly lead. Using the time-tested approach of “fear and protection” our increasingly dependent society appears to be ripe for the progressive destruction of all personal freedoms and individual liberties by our leaders drunk on Power and Money. Their newest target – entrepreneurs and small business owners who in the words of President Obama, “If you’ve got a business, you didn’t build that. Somebody else made that happen.” Obviously, healthcare reform was simply the first step toward “fundamentally changing America.”

Thomas Jefferson has been widely quoted in recent years on a number of issues, but in one of his somewhat less famous writings he said to Edward Carrington in Paris, May 27, 1788, “The natural progress of things is for liberty to yield, and government to gain ground.”   I pray to God it isn’t so.

 

The opinions expressed are my own and do not necessarily reflect those of any organization or group. please feel free to review other posts on www.spiritofhealthcare.com and check out my clinical site at www.robertsewellmd.com

Stop Calling It Obamacare

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By Adrain Murray

When Mitt Romney went before the convention of the NAACP and said that as president he would repeal “Obamacare”, he was roundly and predictably booed.  In doing so, he stepped into a carefully laid trap.

Why is the Patient Protection and Affordable Care Act routinely referred to as “Obamacare”?  Surely no one seriously believes President Obama wrote the 2,700 page bill or, for that matter, even knows what is in it.  Yet the act is commonly labeled President Obama’s signature piece of legislation, the crowning achievement of his first term.

Even Nancy Pelosi would not take credit for authoring the bill, famously declaring we had to pass it in order to find out what’s in it.  So if the president didn’t write the Affordable Care Act and the Speaker of the House didn’t know what was in it, why is it called Obamacare?

One could make the argument that it’s just laziness on the part of the media, which revels in finding the lowest common denominator to explain complex issues.  One could argue that it is political posturing by Republicans who want to saddle the president with responsibility for what is undeniably an unpopular law.  One could argue it is the president himself, trying to take legislative credit for something he had nothing to do with, popular or not.  In fact Obama, a supporter of a single payer system, actively campaigned against many of the provisions that have ended up as cornerstones of the ACA law.

One could make a lot of arguments, but calling the Affordable Care Act “Obamacare” is a huge tactical error.  Why?  Because naming the law after Obama personalizes it and, as Romney learned from the NAACP audience, opposing Obamacare equals opposing Obama and the only reason anyone opposes Obama is, of course, because he is black.  To those inclined to think as such, opposing the complete government takeover of the healthcare system and changing the status of Americans from private citizens to property of the state is, quite simply, racist.  It also distracts from the true question that should be asked:

Who, precisely, wrote the Patient Protection and Affordable Care Act and why?

Our first clue comes from testimony given by Peter Orszag, then-Director of the Office of Management and Budget, before Congress in August of 2009.  “Ultimately,” he said, “without structure in place to help contain health care costs over the long term as the health market evolves, nothing else we do in fiscal policy will matter much, because eventually health care cost will overwhelm the federal budget.”

If Orszag had been addressing the board of directors of Wellpoint, the nation’s second largest managed health care company, such a statement might seem perfectly proper.  But, even accepting the wildly suspicious claim that 30 million Americans were uninsured, that’s still just 10% of the population.  If 90% of Americans in 2009 were covered by private insurance, why would health care costs overwhelm the federal budget?  It is more likely that rising health care costs would soon overwhelm the nation’s health insurance providers.

According to Kaiser Permanente, total health insurance costs in 1980 were $286 billion.  By 2010, they had increased nearly tenfold to $2.3 trillion.  As the population ages, that number is expected to soar.  According to federal estimates, health care costs will double in the next decade and are likely to double again by 2030, when 70 million Americans – fully 20% of the population – will be over the age of 65.  Could such dire estimates have provided the health insurance industry with a powerful $10 trillion incentive to move this looming liability off their balance sheets and onto the backs of the American taxpayer?

In May 2010, after final passage of the current health care law, Senator Max Baucus, from whose Finance Committee the legislation emerged, stood before the Senate and members of the press to publicly thank the person he credited with making it all happen:

“I wish to single out one person, and that one person is sitting next to me. Her name is Liz Fowler. Liz Fowler is my chief health counsel. Liz Fowler has put my health care team together. Liz Fowler worked for me many years ago, left for the private sector, and then came back when she realized she could be there at the creation of health care reform because she wanted that to be, in a certain sense, her professional lifetime goal. She put together the White Paper last November–2008–the 87-page document which became the basis, the foundation, the blueprint from which almost all health care measures in all bills on both sides of the aisle came.”

So who is Liz Fowler?  Prior to joining Baucus’ staff as the senior advisor on health care, she was Vice President of Public Policy and External Affairs for none other than the aforementioned number two insurance company, Wellpoint.  Not to put too fine a point to it, but the chief lobbyist for AHIP (America’s Health Insurance Plans), a national trade organization of over 1,300 insurers, infiltrated the Senate Finance Committee and wrote a law to benefit not the American people, but the entire insurance industry.  As it turns out, the Patient Protection and Affordable Care Act is not intended to make health insurance more affordable for the American people.  It is designed to make the American people more affordable for the health insurance industry.

As it further turns out, Baucus’ staff was infested with Wellpoint hirelings.  Prior to Fowler arriving on scene, the chief advisor on Senator Baucus’ team was Michelle Easton.  Upon passing the baton to Ms. Fowler, Easton went to work as a lobbyist for Wellpoint at Tarplin, Downs and Young, a DC-based lobbying firm founded in 2006 “specializing in strategic consulting and policy development with a particular focus on health care”.

Keep turning the wheel, though, and we come to Stephen Northrup.  Northrup was the chief health advisor to Wyoming Senator Mike Enzi when Enzi pushed similar health care legislation in 2006.  Prior to joining Enzi’s staff, Northrup was the executive director of the Long Term Pharmacy Alliance, an organization that played a lead role in drafting the mother of all giveaways to Big Pharma, Medicare Part D.  Not surprisingly, the revolving door and interchangeable roles of advisors/staff/lobbyists eventually lead Northrup in 2007 to Wellpoint, where he served as Vice President of Federal Affairs.

The insurance lobby, tired of decades of failed attempts to influence Congress to create a national health care plan which would immunize them from the looming trillions of dollars in liabilities they faced as the boomer generation aged, simply decided they would infiltrate Congress instead and write the legislation themselves.  Time, after all, was running out.

But simply enacting the legislation was not enough.  Big Insurance also demanded a seat at the table when it came time to actually drafting the regulations and implementing the law, since incompetent government bureaucrats could not be trusted to enact regulations and procedures that would fully indemnify the insurance lobby to its complete satisfaction.  Which brings us to the return of Liz Fowler, the author of the Affordable Care Act who is now the Deputy Director of Consumer Information and Oversight at the U.S. Department of Human Services, sort of an industry cop on watch to be sure government employees do what they are told.

Despite Big Insurance’s success in pulling off one of the most intricate swindles in the history of mankind by transferring tens of trillions of dollars of liabilities from their balance sheets to that of the Treasury Department, all to be paid for by massive tax increases on the American people (or fees, if you’re still arguing about the Commerce Clause in the increasingly irrelevant Constitution), the whole transaction would certainly deserve a special place in the pantheon  of lawlessness were it not for the decidedly unhappy outcome it will have for the true victims of this crime – the American citizens, who are now merely the property of an insurance industry that has a vested interest in keeping them healthy while they are still useful.  Those 22 year-olds who are today gleeful that they can stay on Mommy and Daddy’s insurance for a few more years won’t be quite as cheerful in 2030 when they are called before a panel Liz Fowler will undoubtedly have had a role in creating to explain why their cholesterol level has increased or are informed that certain substances detected in their last blood test indicated they are surpassing the monthly limit on pepperoni pizzas.  After being sent home with a hefty fine and orders to adhere to a strict diet of carrot sticks and mineral water, along with the latest behavioral modification drug developed by the recent merger of Pfizer and Merck, they may well wish they had been paying attention back in 2012, when there was still a chance to put a stop to it all.

In the meanwhile, it would be nice if certain political figures would put a stop to feigning political courage by mockingly referring to this legislation as Obamacare.  Obama didn’t write it or read it and there is nothing caring about it.  Call it what it is:

The Health Insurance Industry Protection Act.

You could also call it the end of freedom.

 

This post was authored by Adrian Murray is a business man in Fort Worth, Texas (President and CEO of Painless Performance Products) and an ardent Conservative thought leader in the North Texas community. It is with his expressed permission that this incredible piece is offered here. Thank You Adrian for your patriotism.

A Second Declaration Of Independence – “If Not Now, When?”

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Two hundred and thirty-six years ago a small group of brave souls stood up to what was at the time the most powerful nation on earth, declaring their independence from the tyranny of the British Crown. The Sugar Act of 1764, the Stamp Act of 1765, and the Declaratory Act of 1766 (Collectively known as the Townsend Acts) along with the Quartering Act of 1765 and the Tea Act of 1773 all lead to the uprising of the colonies and the American Revolution. Today we are faced with a tyranny of a different sort, which is similarly unacceptable. The Patient Protection and Affordable Care Act of 2010 (Obamacare) has now been upheld by the Supreme Court on a rather thinly veiled technicality. Its not a tax, but its constitutional because it really is a tax. No matter what you call it, this law represents historically the most significant overreach by our own government, and all freedom loving Americans should vigorously oppose it.

As a physician I am privileged to represent the American Society of General Surgeons both as a Delegate to the American Medical Association and as a representative to the Coalition of State Medical and National Specialty Societies; a rather loose consortium of conservative organizations within the AMA, where we’re in the minority to be sure. Following the annual meeting of the AMA House of Delegates in Chicago in June, 2011, we were frustrated by the fact that the House reaffirmed existing AMA policy, supporting a government requirement that every American purchase health insurance, the so-called individual mandate. In the wake of that defeat our Coalition came away without a clear understanding of what our next move should be. Various e-mail threads since then have failed to define a coherent physician-lead strategy. One such series of communications was titled “What is the Battle Plan?” While some would prefer the term Game Plan, either way its clear that we’re talking about a critical contest.

It seems obvious that before any competition one must first determine what is the object of the battle, or game. The problems that exist within the healthcare system are myriad, but central to every argument is one question. Is healthcare a basic human right and therefore the responsibility of government to provide for its citizens, or is it a benefit that has been developed by a civilized society and should be available to those who exercise individual responsibility to obtain it? Not surprisingly this question is quite polarizing, both for healthcare professionals (notice I didn’t use the demeaning term “providers”) and for the public as a whole. This is obviously a complicated issue for which there is no simple answer.

It is ridiculous to imply that American healthcare is bad, as some have claimed. It is the best in the world, but its also the most expensive, and no matter what anyone says, this fact is the sole reason behind the impassioned pleas for reform. Part of the reason our system is so expensive is because there are so many hands in the cookie jar. For years special interest groups have invested heavily in obtaining power within the ranks of government and they were actually the authors of the more than 2,000 page healthcare reform act.

The AMA is often considered to be the doctors’ special interest group, but It is important to recognize that the AMA, and all doctors for that matter, were only peripherally involved in the process of producing Obamacare. AMA leaders were wooed by the White House, but not as potential authors of the new law. Instead they were relegated to the role of commentators. Then during the actual public debate, they inexplicably seemed content just to be at the table, failing to recognize that our profession was indeed the main course. AMA leadership openly supported some elements of the bill, but the public never heard about the parts they objected to. AMA leaders told their dwindling membership (now less than 17% of America’s physicians) that problem areas, like the Independent Payment Advisory Board (IPAB) and the flawed Medicare payment system known as the Sustainable Growth Rate formula (SGR), would be “fixed” when the House and Senate versions came to conference committee. But, as we all found out, aggressive back-room politicians who recognized their opportunity (“If not now, when?”), worked in concert with the giddy media to push the Senate bill through unaltered. In no small way, AMA statements that sounded like doctors supported the bill helped put it on the President’s desk. The total lack of transparency and last minute parliamentary maneuvering made this perhaps the most shameful act of legislative cowardice in American history.

Whether you agree with the concept of universal health insurance or not, (again note I didn’t say universal healthcare because they are clearly not one and the same) the question remains whether it is the role of the government to command it. Patronizing lawmakers have told America’s physicians and our patients that this Congress and this President know what is best for us, and that we’ll like this new system once we get used to the idea. That reminds me of a statement made during a campaign by a gubernatorial candidate in Texas a few years back. He offered this advice to any woman being raped. “As long as it’s inevitable, you might as well lay back and enjoy it.” Well, obviously he lost the election, and based on the results of the 2010 midterm elections, a clear majority of Americans have not yet learned to “enjoy it”, preferring instead to fight back. Many of my fellow physicians have joined in that fight through organizations like the Association of American Physicians and Surgeons and Docs4PatientCare. So to the rest of my colleagues, and to the patients we serve, I would offer the following as a guide for our collective efforts.

  1. What is the objective of this fight? Repeal the ENTIRE law that we unaffectionately call Obamacare, and start over to create a patient centered system that encourages personal responsibility and rewards individuals for good health practices rather than punishing those who refuse to submit to some government mandate.
  2. What is the Battle Plan? Practicing physicians must get to work, joining other similarly minded groups and individuals to save our beloved profession. This battle starts with winning the hearts and minds of our fellow physicians. Our message must be that the future of healthcare relies on the individual physician’s moral compass and professional ethics and responsibility, not arbitrary controls mandated by any third party, be they the Federal government or private insurance companies. If we provide clear leadership for those who have lost faith in their representative organizations we will be able to effectively call up the vast militia of practicing physicians to join the fight. They will in turn be able to marshal the support of their patients who intuitively trust their doctors and want us to lead the way.
  3. What is our first engagement? Our main obstacle to achieving the basic objective of repealing Obamacare is the current uncompromising administration in Washington. Therefore, our primary mission must be to change the current regime. Unlike the Patriots in Philadelphia in the summer of 1776, we can accomplish this change at the polls, but it will not be easy. Between now and November 6, 2012 we must work tirelessly to turn the political tables on those who believe they know what is best for us and all our fellow citizens. There is a true urgency to get to work immediately as the elections are just four months away. Our battle cry in this effort should include that now famous phrase “if not now, when?”

Our God given freedoms and individual rights are like a handful of sand. We don’t lose them all at once; rather they slip through our fingers one grain at a time. The election this coming November has become our final opportunity for “We The People” to declare our independence from a government which openly seeks to control our personal health and individual wellbeing. If we fail in this effort to change the course of this nation now, how can we hope to retain any of our precious few remaining freedoms for ourselves or our posterity.

“The best way to predict your future is to create it.” Abraham Lincoln.

 

The opinions expressed are my own and do not necessarily reflect those of any organization or group. please feel free to review other posts on www.spiritofhealthcare.com and check out my clinical site at www.robertsewellmd.com