The Homa Files

OK, everybody knows that under ObamaCare insurance companies will have to allow parents to cover their “adult children” until age 26:

SEC. 2714. EXTENSION OF DEPENDENT COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE .
(a) In general – A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age. [Effective 6 months after enactment.]

The way the media is covering this aspect of the plan, there seems to be a presumption that this is a free-rider program — just add them to the policy and pay the same premium. 

I don’t think so …

If the adult-child (whatever the heck that is) were to buy their own policy, the price would probably be about $5,000. 

It’s hard to imagine that insurance companies will just give $5,000 of extended family coverage for free.

And, I can’t imagine that employers will pick up any part of the tab as an employee benefit — why should they ?

So, parents will have the opportunity to shell out $5,000 to provide each of their adult-children with health insurance.

I predict major outrage when people figure out that that this isn’t a free lunch …

* * * * *

Sidenote:

Married adult-children aren’t covered … but the statute is silent on the children of unmarried adult-children. 

Just watch this one develop …

Excerpted from CBS.com: Most Want GOP to Keep Fighting on Health Bill, March 24, 2010

A CBS News poll finds that nearly two in three Americans want Republicans in Congress to continue to challenge parts of the health care reform bill.

The poll finds that 62 percent want Congressional Republicans to keep challenging the bill, while 33 percent say they should not do so. Nearly nine in ten Republicans and two in three independents want the GOP to keep challenging. Even 41 percent of Democrats support continued challenges.

The poll’s findings suggest an improvement in perceptions of the legislation: While 37% approved of it before the vote, 42% approved afterward.

[Ken’s Take: only a 5 pt bump, and 42% is way less than a majority !]

Full article:
http://www.cbsnews.com/8301-503544_162-20001117-503544.html

The tax on union’s Cadillac heath insurance benefits doesn’t kick in until 2018.

The fat cats’ payroll tax on dividends and capital gains doesn’t start until 2013 (whew !).

But, no such reprieve for those evil tanning salons.

According to Bloomberg, indoor tanning salons must start charging customers a 10 percent tax beginning today … the first major reform of the U.S. health-care overhaul signed into law by President Barack Obama.

These guys  sure know how to go for the jugular …

* * * * *

Bloomberg, Health-Care Overhaul Changes to Start Taking Effect This Year
http://www.bloomberg.com/apps/news?pid=20601087&sid=aa32kl.M09T4

Every doctor I’ve talked to says he loses mucho money on MediCare and Medicaid patients — that shouldn’t be new news to anyone.

Some tell me that Medicaid patients are especially troublesome because they account for a disproportionate “no shows” — patients who schedule an appointment but don’t post for it.  Why ?  No skin in the game.

ObamaCare is largely funded by containing physician reimbursements on MediCare and Medicaid  … concurrent with swelling the Medicaid rolls by about 15 million people.

In the past, docs have offset their MediCare and Medicaid  losses by, in effect, charging privately insureds more.

So what’s going to happen ?  It’s pretty easy to predict:

1. The ‘natural’ proportion of gov’t insured patients (MediCare and Medicaid) will increase.
2. Docs will try to cross subsidize them by increasing privately insured rates.
3. But, ObamaCare police will cap the private insurance premiums.
4. So, docs will start restricting the number of gov’t insured patients they treat … some will stop treating gov’t insured patients all together.
5. Then, ObamaCare police will will call “foul” and mandate that all doctors must treat a minimum number of gov’t insured patients.

Just wait and see … you can smell this one a mile away (from the White House)

Here’s an interesting twist I haven’t heard from the TV pundits …

Under ObamaCare, everybody has to buy health insurance — even healthy folks who want to opt out.

If you don’t have health insurance, you get fined … most recently, I heard that the fine has been pared down to $250 annually.

How will it be enforced ?

Well, the bill adds over 15,000 IRS agents to police it.

[Analytical note: that means that the new agents have to nail about 6 million scofflaws each year just to cover their comp & benefits … each agent will have to find and nail about one each day]  

This morning, I heard a Congressional shill say that each year — as part of the 1040 process — people will be asked if they are in compliance with law and have health insurance.

If they answer yes, they are asked to provide substantiation.

If they answer no, they have to pay the fine.

Isn’t that self-incrimination?  Isn’t that protected by the 5th amendment ?

If this process works ok for ObamaCare, why not extend it to other areas of the law ?

For example, ask people if they have complied with all speed limits when driving. If they self-incriminate, fine ’em.

Maybe ObamaCare has uncovered a whole new way to raise revenues and offset the deficit …

Right from Stupak’s office … note the date (March 19, 2010) … At least he waited 2 days until he switched his vote from no to yes …  for chump change compared to what Dodd, Landrieu, and the SEIU got … gezz Bart, if you’re going to sell your soul, at least go for some serious money.

Fool me once, shame on you.

Fool me twice, shame on me.

What about the 3rd, 4th, 5th times ?

Doesn’t Bart Stupak learn ?

To refresh your memory:

• Back in November, pro-life Rep. Bart Stupak scored what he thought was a victory and the House passed an amendment to its ObamaCare bill limiting the use of tax-payer funds for abortions.
• But, immediately after the vote, pro-choice Dems expressed confidence that “controversial language on abortion would be stripped from a final healthcare bill” via legislative maneuvering.
• Then , House Dem leadership told Stupak and his pro-life buddies to take a hike …  because  liberal Dems want the government to fund abortions.
  https://kenhoma.wordpress.com/2010/03/15/why-is-stupak-surprised-that-his-amendment-was-trashed/

Sunday, to get Stupak to vote yes on ObamaCare, the President promised to issue an Executive Order that, in effect, restores the Stupak Amendment to the final bill — after the fact.

Well, a couple of potential bumps in Bart’s road:

1. The President has to do what he promised … hmmm.
2. Some legal pundits are saying that the Executive Order has little or no force — the passed law will prevail in high courts
3. A President can rescind an Executive Order at any time

This time when Lucy pulls the football away, Stupak will have no one but himself to blame.

He’ll deserve to feel more ‘stupid’ than ‘Stupak’.

The trillion dollar ObamaCare program gets funded roughly half through MediCare cuts — mostly elimination of Medicare Advantage — and half from tax hikes, including …

• A .9% increase in Medicare payroll taxes on couples with income of more than $250,000 a year.
• Extension of Medicare payroll taxes (3.8%) to unearned income: dividends, interest, and capital gains.
• A 10% excise tax on customers of indoor tanning salons.
• Additional fees on insurance companies, pharmaceutical companies and medical device manufacturers, including $33 billion over ten years on fees on drug makers
• A tax on individuals without qualifying coverage, maximum penalty set at 2.5% of income
• An excise tax on high-premium insurance plans, equal to 40% of premiums paid on plans costing more than $27,500 annually for a family, starting in 2018
  http://online.wsj.com/public/resources/documents/st_healthcareproposals_20090912.html

* * * * *

Ken’s Qs:

1) Since I’ve been TurboTaxing my 2009 taxes, I’m curious: Is the magic $200,000 / $250,000 Gross Income, Adjusted Gross Income, or Taxable Income ?  That makes a big difference, and I haven’t seen a single reference clarifying it.  Anybody know ?

2) If some body hits the $200,000 / $250,000 kill point, is is all income taxed at the higher rate, or just marginal income above that rate ? Anybody know ?

3) How can a serious piece of legislation single out tanning salons for extinction — and let the Beverly Hills facelift doctors run free ? (Rhetorical question)

4) I’m still eager to see the 15,000 new IRS agents running around repo’ing big screens from folks who don’t have health insurance ?

5) If the reconciliation bill doesn’t get thru the Senate — does Obama’s deal with the unions — giving them a pass on the Cadillac plans — vaporize ?

This is going to get very interesting as folks understand the implications …

Rarely can I pair two of Grandma Homa’s bromides together …

The dog has, indeed, caught the bus.

I think that Team Obama will soon realize that they accomplished the easy part of their healthcare takeover: getting the lemmings to pull the voting levers.

Now, they have to implemented the largest government program in recent history.  This, from an administration that has shown no implementation capability at all.  Think stimulus; mortgage / foreclosure programs; cash for clunkers, caulkers, etc.; GITMO closing; underwear bombers ratted out by parents.

The only aspects of the program that I can imagine getting implemented are the tax hikes and the elimination of MediCare Advantage since they only require swipes of a pen.

To ObamaCare supporters: I don’t want to hear any whining from you, you got what you wished for …

The trillion dollar ObamaCare program gets funded roughly half through MediCare cuts — mostly elimination of Medicare Advantage — and half from tax hikes, including …

• A .9% increase in Medicare payroll taxes on couples with income of more than $250,000 a year.
• Extension of Medicare payroll taxes (3.8%) to unearned income: dividends, interest, and capital gains.
• A 10% excise tax on customers of indoor tanning salons.
• Additional fees on insurance companies, pharmaceutical companies and medical device manufacturers, including $33 billion over ten years on fees on drug makers
• A tax on individuals without qualifying coverage, maximum penalty set at 2.5% of income
• An excise tax on high-premium insurance plans, equal to 40% of premiums paid on plans costing more than $27,500 annually for a family, starting in 2018
  http://online.wsj.com/public/resources/documents/st_healthcareproposals_20090912.html

* * * * *

Ken’s Qs:

1) Since I’ve been TurboTaxing my 2009 taxes, I’m curious: Is the magic $200,000 / $250,000 Gross Income, Adjusted Gross Income, or Taxable Income ?  That makes a big difference, and I haven’t seen a single reference clarifying it.  Anybody know ?

2) If some body hits the $200,000 / $250,000 kill point, is is all income taxed at the higher rate, or just marginal income above that rate ? Anybody know ?

3) How can a serious piece of legislation single out tanning salons for extinction — and let the Beverly Hills facelift doctors run free ? (Rhetorical question)

4) I’m still eager to see the 15,000 new IRS agents running around repo’ing big screens from folks who don’t have health insurance ?

5) If the reconciliation bill doesn’t get thru the Senate — does Obama’s deal with the unions — giving them a pass on the Cadillac plans — vaporize ?

This is going to get very interesting as folks understand the implications …

This guy hits the nail on the head …

Do Democrats realize that we really have crossed the Rubicon?

In the future when the Republicans gain majorities (and they will), the liberal modus operandi will be the model — bare 51% majorities, reconciliation, the nuclear option, talk of deem and pass, not a single Democrat vote — all ends justifying the means in order to radically restructure vast swaths of American economic and social life.

Is someone unhinged at the DNC?

They just blew up any shred of bipartisan consensus when their President polls below 50%, the Democratically-controlled Congress below 20%, and health care reform less than 50%.

Usually unpopular leaders and their unpopular ideas seek the shelter of minority rights and prerogatives.

What will they do when they are in the minority—since they’ve entered the arena, boasted “let the games begin” and shouted “by any means necessary”?

We’ve Crossed the Rubicon
http://pajamasmedia.com/victordavishanson/weve-crossed-the-rubicom/2/

All the pundit chatter is that the healthcare vote is a lock this afternoon.  The logic, Pelosi wouldn’t be calling the vote is she wasn’t certain to muster 216 votes.

Well, last fall, they took TARP to the floor for a vote — believing that they had the votes.  The outcome: it lost.  [See the article below to jog your memory]

Of course, TARP was modified slightly and a second vote was taken.  It passed.

The difference with ObamaCare: if it loses today, any structural modifications will have to go through normal legislative channels — not the hood-winking reconciliation process.  No way it wins straight up.

I put the odds of passage at 80-20 … but want to be on the record, just in case the long odds hit

* * * * *

September 30th, 2008

TARP unexpectedly voted down by US House yesterday

Yesterday the US House of Representatives unexpectedly turned down by a fairly small margin the Troubled Asset Rescue Plan (TARP) put forth by the Treasury.

This quite remarkable twist of events, with all the world watching, has left investors highly uncertain about what comes next.

It is still possible that an amended version of the bill could be brought back to the floor.

At this stage, it is not clear whether major concessions will be necessary, or whether minor changes to the bill would be enough to secure the incremental (mostly Republican) votes necessary for passage.

http://www.mrforex.org/2008/09/30/tarp-unexpectedly-voted-down-by-us-house-yesterday/

Punchline: Mitt Romney — the former Massachusetts governor — enacted something very similar to the Obama health plan. It isn’t working well.  Costs are up, folks are gaming the system, and people with insurance can’t get in to see doctors. Uh-oh.

* * * * *

Excerpted from WSJ: The Failure of RomneyCare, March 16, 2010

The Bay State is suffering from what the Massachusetts Medical Society calls a “critical shortage” of primary-care physicians.

As one would expect, expanded insurance has caused an increase in demand for medical services. But there hasn’t been a corresponding increase in the number of doctors.

As a result, many patients are insured in name only: They have health coverage but can’t find a doctor.

Fifty-six percent of Massachusetts internal medicine physicians no longer are accepting new patients.

For new patients who do get an appointment with a primary-care doctor, the average waiting time to see a doctor is 44 days.

As Dr. Sandra Schneider, the vice president of the American College of Emergency Physicians, told the Boston Globe last April, “Just because you have insurance doesn’t mean there’s a [primary care] physician who can see you.”

The difficulties in getting primary care have led to an increasing number of patients who rely on emergency rooms for basic medical services. Emergency room visits jumped 7% between 2005 and 2007.

Officials have determined that half of those added ER visits didn’t actually require immediate treatment and could have been dealt with at a doctor’s office — if patients could have found one.

* * * **

The promise that getting everyone covered would force costs down also is far from being realized.

One third of state residents say that their health costs had gone up as a result of the 2006 reforms.

A typical family of four today faces total annual health costs of nearly $13,788, the highest in the country. Per capita spending is 27% higher than the national average.

Insurance companies are required to sell “just-in-time” policies even if people wait until they are sick to buy coverage. That’s just like the Obama plan.

There is growing evidence that many people are gaming the system by purchasing health insurance when they need surgery or other expensive medical care, then dropping it a few months later.

Some Massachusetts safety-net hospitals that treat a disproportionate number of lower-income and uninsured patients are threatening bankruptcy. They still are treating a large number of people without health insurance, but the payments they receive for uncompensated care have been cut under the reform deal.

Full article:
http://online.wsj.com/article/SB10001424052748703625304575115691871093652.html?mod=djemEditorialPage_h

Punchline: First, the Mayo Clinic in Arizona stopped accepting Medicare patients.  Now, Walgreens drugstores across the state of Washington won’t take any new Medicaid patients, saying that filling their prescriptions is a money-losing proposition — the latest development in an ongoing dispute over Medicaid reimbursement.

Isolated instances or the start of a trend ? I’ll bet trend …

* * * * *

Excerpted from Seattle Times: Walgreens – no new Medicaid patients, March 17, 2010

Effective April 16, Walgreens drugstores across the state won’t take any new Medicaid patients, saying that filling their prescriptions is a money-losing proposition — the latest development in an ongoing dispute over Medicaid reimbursement.

In a news release, Walgreens said its decision to not take new Medicaid patients stemmed from a “continued reduction in reimbursement” under the state’s Medicaid program, which reimburses it at less than the break-even point for 95 percent of brand-name medications dispensed to Medicaid patents.

Walgreens follows Bartell Drugs, which stopped taking new Medicaid patients last month and Ritzville Drug Company in Adams County announced in November that it would stop participating in Medicaid.

Doug Porter, the state’s director of Medicaid, said Medicaid recipients should be able to readily find another pharmacy because “we have many more pharmacy providers in our network than we need” for the state’s 1 million Medicaid clients.

Fred Meyer and Safeway said their pharmacies would continue to serve existing Medicaid patients and to take new ones, though both expressed concern that the reimbursement rate is too low for pharmacies to make a profit.

Washington was reimbursing pharmacies 86 percent of a drug’s average wholesale price until July, when it began paying them just 84 percent.

“Washington state Medicaid is now reimbursing pharmacies less than their cost of participation,” said Jeff Rochon, CEO of the Washington State Pharmacy Association.

Pharmacies that continue to fill Medicaid prescriptions at the current state reimbursement rate are “at risk of putting themselves out of business altogether,” he said.

Full article:
http://seattletimes.nwsource.com/html/localnews/2011367936_walgreens18m.html

Next to “systemic risk” — which loosely translates to “don’t hold anybody accountable” … my top hair-pulling buzz-phrase is “deficit neutral” … which loosely translates to “there’s a tax increase even bigger than the spending increase” …  clever word-smithing that has people’s eyes largely off the flood of new and increased taxes.

From IBD, 15 reasons why a government takeover of the finest medical system in the world makes no sense at all:

1. The people don’t want it!

This should have some bearing on decision-making.  In the latest Rasmussen poll, 53% opposed Obama’s reform while 42% were in favor. More than four in 10 “strongly” opposed; just two in 10 “strongly” favored. This jibes with other surveys.

2. Doctors don’t want it!

A survey of 1,376 practicing physicians found that 45% of all doctors would consider leaving their practices or taking early retirements if the proposed reforms became law … nearly 30% said they’d quit the profession under the plans being considered.

3. Half the Congress doesn’t want it!

Not a single Republican backed the health care bill that cleared the Senate on Christmas Eve 60-39.  The lone Republican “aye” in the House has since switched to “no.”  Adjusting for reps who are no longer in Congress, the House vote today at 216-215 in favor.

Note: Members of Congress have already exempted themselves from whatever they inflict on us.

4. People are happy with the health care they’ve got!

Polls show that 84% of Americans have health insurance and satisfaction rates average 87%.

5. It doesn’t even cover all the people they set out to cover!

Supporters of government-run health care say there are as many as 47 million Americans — 9 million to 10 million of them illegal aliens — without medical insurance. The plans, however, will put only 31 million of the uninsured under coverage.

6. Costs will go up, not down!

Democrats say their plans will cost less than $1 trillion over the first decade, but independent analysts put the cost at $2.5 trillion over the first 10 years.

7. Real cost controls are nowhere to be found!

The Democrats are offering no meaningful tort reform that will help push down the high malpractice insurance premiums that are a burden to doctors and their patients. Nor are they considering any other cost-saving provisions, such as allowing the sale of individual health plans across state lines or easing health insurance mandates.

8. Insurance premiums will rise, not fall!

One goal of nationalizing health care is to lower costs, to bend the spending curve downward. Yet, as Democratic Sen. Dick Durbin acknowledged Wednesday, that won’t be the case.

“Anyone who would stand before you and say, ‘Well, if you pass health care reform, next year’s health care premiums are going down,’ I don’t think is telling the truth,I think it is likely they would go up.”

9. Medicare is already bankrupting us!

The Medicare trust fund, which has unfunded obligations of $37.8 trillion, will be insolvent in 2017.

10. There aren’t enough doctors now!

Last month, 26% of physicians said they had been forced to close, or were considering closing, their solo practices. Providing coverage for an additional 31 million Americans when the number of doctors is shrinking won’t improve our health care.

11. The doctor-patient relationship will be wrecked!

The latest IBD/TIPP Poll, taken just last week, found that Americans, by a wide 48% to 26% margin, believe the doctor-patient relationship will decline if the Democrats’ plan is passed.

12. Medical care will also deteriorate!

IBD/TIPP has also found that 51% of Americans believe care would get worse under government control. … 72% disagreed with administration claims that the government could cover 47 million more people with better-quality care at lower cost.

13. Rationing of care is inevitable!

Health care is not an unlimited resource and must be rationed, either by the individual, providers or government. In Britain and Canada, where the government does the rationing, medical treatment waiting lists are sometimes deadly and quite often excessively long.

14. Private health insurers will be destroyed!

Added mandates and price controls will force many insurers to simply get out of the health plan business because it will no longer be profitable.

15. It’s probably unconstitutional!

One way to help bring down the number of uninsured is to demand that those without coverage buy health plans.  Constitutional scholars say any such mandate would likely draw a legal challenge.

Sourced from IBD: Why Health Bill Makes No Sense, 03/12/2010
http://www.investors.com/NewsAndAnalysis/Article.aspx?id=527217

Punchline: Buyers, beware: President Barack Obama says his health care overhaul will lower premiums by double digits, but check the fine print.

Note: from the left-leaning AP, not FNN.

* * * * * 

Excerpted from Associated Press: Fact Check Premiums would rise under Obama plan, Mar 16, 2010

Visiting a Cleveland suburb this week, the president described how individuals and small businesses will be able to buy coverage in a new kind of health insurance marketplace, gaining the same strength in numbers that federal employees have.

“You’ll be able to buy in, or a small business will be able to buy into this pool,” Obama said.

“And that will lower rates, it’s estimated, by up to 14 to 20 percent over what you’re currently getting. That’s money out of pocket.”

And that’s not all.

Obama asked his audience for a show of hands from people with employer-provided coverage, what most Americans have.

“Your employer, it’s estimated, would see premiums fall by as much as 3,000 percent,” said the president, “which means they could give you a raise.”

A White House press spokesman later said the president misspoke.

* * *

Premiums are likely to keep going up even if the health care bill passes, experts say.

If cost controls work as advertised, annual increases would level off with time. But don’t look for a rollback.

Instead, the main reason premiums would be more affordable is that new government tax credits would help cover the cost for millions of people.

Listening to Obama pitch his plan, you might not realize that’s how it works.

“There’s no question premiums are still going to keep going up. There are pieces of reform that will hopefully keep them from going up as fast. But it would be miraculous if premiums actually went down relative to where they are today.”

The statistics Obama based his claims on come from two sources. In both cases, the caveats got left out.

An analysis by the Congressional Budget Office found that large employers would see premium savings of at most 3 percent compared with what their costs would have been without the legislation. That would be more like a few hundred dollars instead of several thousand.

The claim that people buying coverage individually would save 14 percent to 20 percent comes from the same budget office report. But the presidential sound bite fails to convey the full picture.

The budget office concluded that premiums for people buying their own coverage would go up by an average of 10 percent to 13 percent, compared with the levels they’d reach without the legislation. That’s mainly because policies in the individual insurance market would provide more comprehensive benefits than they do today.

The premium reduction of 14 percent to 20 percent that Obama cites would apply only to a portion of the people buying coverage on their own — those who decide they want to keep the skimpier kinds of policies available today. The president usually alludes to that distinction in his health care stump speech, saying the savings would accrue to those people who continue to buy “comparable” coverage to what they have today.

And, those costs would only go down if, in fact, swarms of currently healthy uninsured young people join the risk pool — reducing average payouts and spreading insurance company overhead costs.

Full article:
http://news.yahoo.com/s/ap/20100317/ap_on_bi_ge/us_health_overhaul_fact_check

Punchline: the uninsured already receive about 50 percent to 70 percent of the care of the insured from hospitals, clinics and doctors

* * * * *
Excerpted from Newsweek: The Illusion of ‘Reform, March 15, 2010

You probably heard that insuring the uninsured will dramatically improve the nation’s health.

The uninsured don’t get care or don’t get it soon enough. With insurance, they won’t be shortchanged; they’ll be healthier. Simple.

Think again.

Expanding health insurance would result, at best, in modest health gains.

Why ? 

• many uninsured are fairly healthy — about two-fifths are between 18 and 34;
• some are too sick to be helped;
• some have problems rooted in personal behaviors — smoking, diet, drinking or drug abuse; and
• the uninsured already receive about 50 percent to 70 percent of the care of the insured from hospitals, clinics and doctors.

* * * * *

Whatever their sins, insurers are mainly intermediaries; they pass along the costs of the delivery system.

In 2009, the largest 14 insurers had profits of roughly $9 billion; that approached 0.4 percent of total health spending of $2.472 trillion.

This hardly explains high health costs.

Full article:
http://www.realclearpolitics.com/articles/2010/03/15/obamas_health_proposal_is_the_illusion_of_reform.html

Story line:

(1) Dems tout that the AMA supports ObamaCare.  But, the AMA represents less than 25% of doctors, and has a vested interest — they get paid millions by the government to manage “treatment codes” used for reimbursements.

(2) The NEJM surveyed the broader base of doctors and concluded: “A very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.”

(3) Specifically, almost half of primary-care physicians said that they would either want to leave medicine or that they would be “forced out” by the changes to the system.

(4) The “changes” they cite: more regulations, gov’t coming between them and patients, lower reimbursements, continuing threat of junk law suits.

* * * * *

Details:

According to a survey published in the latest issue of the New England Journal of Medicine:

• Nearly one-third of all practicing physicians may leave the medical profession if President Obama signs current versions of health-care reform legislation into law …  If a public option were included in the legislation, the number jumps to 45.7%.
• 46% of primary-care physicians said that they would either want to leave medicine or that they would be “forced out” by the changes to the system.
• A majority of physicians said health-care reform would cause the quality of American medical care to “deteriorate” and it could be the “final straw” that sends a sizeable number of doctors out of medicine.

“Many physicians feel that they cannot continue to practice if patient loads increase while pay decreases.”

The survey shows that many doctors already find their situations difficult:

• 36% said that they would not recommend medicine as a profession to others, regardless of whether health-care reform passes;
• 27% would still recommend medicine as a career, but not if the current reform proposal passes.
• In total, 63 percent of doctors would not recommend the profession after health-care reform passes.

96 percent of the physicians surveyed  favor of health reform, in some form or fashion … but relatively few are in favor of the current legislation.

* * * * *

But the AMA says doctors are in favor …

Congressional Democratic leaders ,have said that doctors favor the bill and are part of an “unprecedented coalition” of doctors rooting for its passage. The claim is based on the American Medical Association’s endorsement of the legislation in Congress.

According to the Bureau of Labor Statistics, in 2008 there were 661,400 physicians and surgeons within the United States. Of that number, 250,000 are members of the American Medical Association (AMA) — and nearly 100,000 of those are medical students.

Full article:
http://cnsnews.com/news/article/62812

* * * * *

Key Findings from thePhysician Survey: Health Reforms Potential Impact on Physician Supply and Quality of Medical Care
New England Journal of Medicine, Mar. – Apr. 2010 

Physician Support of Health Reform in General

• 62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.
• 28.7% of physicians are in favor of a public option.
• 3.6% of physicians prefer the “status quo” and feel that the U.S. health care system is best “as is.

Health Reform and Primary Care Physicians

• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

Health Reform, Public Option, and Practice Revenue/Physician Income

• 41% of physicians feel that income and practice revenue will “decline or worsen dramatically” with a public option.
• 30% feel income will “decline or worsen somewhat” with a public option.
• 9% feel income will “improve somewhat” with a public option, and 0.8% feel income will “improve dramatically” with a public option.

Health Reform, Public Option, and Physician Supply

• 72% of physicians feel that a public option would have a negative impact on physician supply, with 45% feeling it will “decline or worsen dramatically” and 27% predicting it will “decline or worsen somewhat.
• 24% of physicians think they will try to retire early if a public option is implemented.
• 21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.

Health Reform and Recommending Medicine to Others as a Career

• 36% of physicians would not recommend medicine as a career, regardless of health reform.
• 27% would recommend medicine as a career but not if health reform passes.
• 25% of physicians would recommend medicine as a career regardless of health reform.
• 12% would not recommend medicine as a career now but feel that they would recommend it as a career if health reform passes

Source:“Physician Survey: Health Reform’s Impact on Physician Supply and Quality of Medical Care,”
The Medicus Firm, http://www.TheMedicusFirm.com

Story line:

(1) Dems tout that the AMA supports ObamaCare.  But, the AMA represents less than 25% of doctors, and has a vested interest — they get paid millions by the government to manage “treatment codes” used for reimbursements.

(2) The NEJM surveyed the broader base of doctors and concluded: “A very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.”

(3) Specifically, almost half of primary-care physicians said that they would either want to leave medicine or that they would be “forced out” by the changes to the system.

(4) The “changes” they cite: more regulations, gov’t coming between them and patients, lower reimbursements, continuing threat of junk law suits.

* * * * *

Details:

According to a survey published in the latest issue of the New England Journal of Medicine:

• Nearly one-third of all practicing physicians may leave the medical profession if President Obama signs current versions of health-care reform legislation into law …  If a public option were included in the legislation, the number jumps to 45.7%.
• 46% of primary-care physicians said that they would either want to leave medicine or that they would be “forced out” by the changes to the system.
• A majority of physicians said health-care reform would cause the quality of American medical care to “deteriorate” and it could be the “final straw” that sends a sizeable number of doctors out of medicine.

“Many physicians feel that they cannot continue to practice if patient loads increase while pay decreases.”

The survey shows that many doctors already find their situations difficult:

• 36% said that they would not recommend medicine as a profession to others, regardless of whether health-care reform passes;
• 27% would still recommend medicine as a career, but not if the current reform proposal passes.
• In total, 63 percent of doctors would not recommend the profession after health-care reform passes.

96 percent of the physicians surveyed  favor of health reform, in some form or fashion … but relatively few are in favor of the current legislation.

* * * * *

But the AMA says doctors are in favor …

Congressional Democratic leaders ,have said that doctors favor the bill and are part of an “unprecedented coalition” of doctors rooting for its passage. The claim is based on the American Medical Association’s endorsement of the legislation in Congress.

According to the Bureau of Labor Statistics, in 2008 there were 661,400 physicians and surgeons within the United States. Of that number, 250,000 are members of the American Medical Association (AMA) — and nearly 100,000 of those are medical students.

Full article:
http://cnsnews.com/news/article/62812

* * * * *

Key Findings from thePhysician Survey: Health Reforms Potential Impact on Physician Supply and Quality of Medical Care
New England Journal of Medicine, Mar. – Apr. 2010 

Physician Support of Health Reform in General

• 62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.
• 28.7% of physicians are in favor of a public option.
• 3.6% of physicians prefer the “status quo” and feel that the U.S. health care system is best “as is.

Health Reform and Primary Care Physicians

• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

Health Reform, Public Option, and Practice Revenue/Physician Income

• 41% of physicians feel that income and practice revenue will “decline or worsen dramatically” with a public option.
• 30% feel income will “decline or worsen somewhat” with a public option.
• 9% feel income will “improve somewhat” with a public option, and 0.8% feel income will “improve dramatically” with a public option.

Health Reform, Public Option, and Physician Supply

• 72% of physicians feel that a public option would have a negative impact on physician supply, with 45% feeling it will “decline or worsen dramatically” and 27% predicting it will “decline or worsen somewhat.
• 24% of physicians think they will try to retire early if a public option is implemented.
• 21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.

Health Reform and Recommending Medicine to Others as a Career

• 36% of physicians would not recommend medicine as a career, regardless of health reform.
• 27% would recommend medicine as a career but not if health reform passes.
• 25% of physicians would recommend medicine as a career regardless of health reform.
• 12% would not recommend medicine as a career now but feel that they would recommend it as a career if health reform passes

Source:“Physician Survey: Health Reform’s Impact on Physician Supply and Quality of Medical Care,”
The Medicus Firm, http://www.TheMedicusFirm.com

Ken’s Take: Didn’t anybody smell a rat when Natoma Canfield — the uninsured leukemia letter-writer — couldn’t appear with Obama because she was getting treatment  … at the Cleveland Clinic no less.

Turns out that:

(1) she is getting healthcare (which is different from health insurance)

(2) she is being treated by the prestigious Cleveland Clinic

(3) The Cleveland Clinic says not to worry about the bills …

(4) … because, Natoma already qualifies for Medicaid. 

(5) She hasn’t bothered to sign up … probably too busy writing letters

* * * * *

Excerpted from WTOP / AP: Woman championed by Obama eligible for aid, March 16, 2010

A woman championed as the Obama administration’s emblem for health care reform does not have to choose between her home and her health, according to officials at the Ohio hospital where she is being treated.

With a self-reported annual income of about $6,000, Natoma Canfield is a prime candidate for financial aid in the form of Medicaid – the federal health care program for low-income and disabled people – and charitable assistance.

And the Cleveland Clinic said it has no intention of putting out a lien on Canfield’s house — or letting the billing process interfere with her treatment.

“It appears that I think she’ll be fine,” said Lyman Sornberger, the hospital’s executive director of patient financial services. “By nature of the fact that she was not early on rejected by either program, that’s a key indicator that she will most likely be eligible.”

Despite the grim reality of Canfield’s fight against cancer, hospital officials say it’s not the case that she can have either a home or her health.

Like any patient who walks through the Clinic’s doors without medical coverage, Canfield was immediately assigned an adviser to help assess whether she was eligible for financial aid, hospital officials said.

Canfield said Tuesday that she had just met with her adviser in her hospital room before undergoing a round of chemotherapy in the afternoon.

“I will have to apply for Social Security disability and then something called Medicaid,” she said.

Asked whether she had understood what Medicaid was, she said: “I heard of it but I didn’t really realize what it was.”

Full article:
http://wtop.com/?nid=106&pid=0&sid=1913750&page=1

Punchline: If universal coverage makes appointments harder to get (and it will !), emergency room use may increase. That’s called an unintended consequence.

* * * * *
Excerpted from Newsweek: The Illusion of ‘Reform, March 15, 2010

How often have you heard the emergency-room argument?

The uninsured, it’s said, use emergency rooms for primary care. That’s expensive and ineffective. Once they’re insured, they’ll have regular doctors. Care will improve; costs will decline. Everyone wins.

Great argument.

Unfortunately, it’s untrue.

A study by the Robert Wood Johnson Foundation found that the insured account for 83 percent of emergency room visits, reflecting their share of the population.

After Massachusetts adopted universal insurance, emergency room use remained higher than the national average, reports an Urban Institute study.

More than two-fifths of visits represented non-emergencies.

People said it was “more convenient” to go to the emergency room or they couldn’t “get (a doctor’s) appointment as soon as needed.”

If universal coverage makes appointments harder to get, emergency room use may increase.

Full article:
http://www.realclearpolitics.com/articles/2010/03/15/obamas_health_proposal_is_the_illusion_of_reform.html

Punchline: Reps in swing districts can either vote with their constituents or jump off a cliff. Why is that a difficult decision?

* * * * *

Excerpted from WSJ: Swing Districts Oppose Health Reform, Mar 15, 2010 

Democratic leaders cite national polls that show support for individual provisions of the bill as a reason to pass this reform. Yet vulnerable politicians should be warned: Responses to questions about individual benefits, particularly when removed from a cost context, are different from those on the whole bill.

Voters in key congressional districts are clear in their opposition to the proposed health-care reform.

That’s one of the findings of a survey that will be released today by the Polling Company on behalf of Independent Women’s Voice. The survey consisted of 1,200 registered voters in 35 districts represented by members who could determine the outcome of the health-care debate.

The survey shows astonishing intensity and sharp opposition to reform, far more than national polls reflect.

• For 82% , the heath-care bill is either the top or one of the top three issues for deciding whom to support for Congress next November.
• 60% want Congress to start from scratch on a bipartisan health-care reform proposal or stop working on it this year.
• Majorities say the legislation will make them and their loved ones, the economy and the U.S. health-care system worse off.
• 70% would vote against a House member who votes for the Senate health-care bill with its special interest provisions.
• 75% disagree that the federal government should mandate that everyone buy a government-approved insurance plan
• 81% say any reform should focus first on reducing costs.
• 75% agree that Americans have the right to choose not to participate in any health-care system or plan without a penalty or fine.
• 60% of the voters surveyed will vote for a candidate who opposes the current legislation and wants to start over.
• Over 1/3 of respondents say they will actively work against a candidate who votes the wrong way or for the candidate who votes the right way.

That translates into specific concerns with the Senate legislation—and none of these objections would be addressed by the proposed fixes.

Over 70%—indeed in several districts over 80%—of respondents, across party lines, said that the following information made them less supportive:

• mandates that individuals purchase insurance or face penalties;
• cuts Medicare Advantage;
• will force potentially millions to lose existing coverage;
• will cost an estimated $2.3 trillion over its first 10 years; and it will grant unprecedented new powers to the Health and Human Services secretary.

These are the constituents of the members whose votes will matter most this week. Perhaps, if this republic is still the people’s, those members should heed those they claim to represent.

Full article:
http://online.wsj.com/article/SB10001424052748704416904575121541779736742.html?mod=djemEditorialPage_h

Back in November, pro-life Rep. Bart Stupak scored what he thought was a victory and the House passed an amendment to its ObamaCare bill limiting the use of tax-payer funds for abortions.

Stupak’s language not only prohibits abortion coverage in the public insurance option included in the House bill. It would also prevent private plans from offering coverage for abortion services if they accept people who are receiving government subsidies.

Abortion-rights supporters called it a “de facto” abortion ban and mounted an intense but unsuccessful lobbying campaign against it.

http://thehill.com/blogs/blog-briefing-room/news/66969-senior-dem-confident-stupak-amendment-will-be-stripped

* * * * *

But, immediately after the vote, pro-choice Dems expressed confidence that “controversial language on abortion would be stripped from a final healthcare bill” via legislative maneuvering.

Excerpted from The Hill: Senior Democrat is ‘confident’ that Stupak amendment will be stripped, 11/09/09

A House Democratic leader said Monday she’s “confident” controversial language on abortion will be stripped from a final healthcare bill.

Rep. Debbie Wasserman Schultz (D-Fla.), the Democrats’ chief deputy whip in the House, said that she and other pro-abortion rights lawmakers would work to strip the amendment included in the House health bill that bars federal funding from subsidizing abortions.

“It was extremely painful for me to feel compelled to vote for a bill that contained that kind of restriction on a woman’s ability to make her own reproductive choices,” Wasserman Schultz said.

“We’re all going to be working very hard, particularly the pro-choice members, to make sure that’s the case.”

Pelosi Calls Stupak’s Bluff on Abortion:

Anti-choice zealot Rep. Bart Stupak (D-Mich) overplayed his hand. House Majority Leader Steny Hoyer announced today that the House Democrats will move forward without a deal on abortion coverage.

Why are they finally telling Stupak to pound sand after endless rounds of negotiations? First off, Pelosi had the strategic advantage of having very little to offer Stupak and his shadowy band of anti-choice Democrats. Second, Stupak’s alleged coalition is looking more like a paper tiger every day.
http://bigthink.com/ideas/19045

* * * * *

Bart Stupak — the pro-life Democrat leading the charge in the House against passage of the Senate health insurance reform bill — said Friday that Henry Waxman — a key House committee chairman —  told him that Democrats want abortions to be paid by a federally-funded nationalized health insurance system.
http://www.youtube.com/watch?v=-yDtPRSBKyM

My bet: yes …

* * * * *

BTW: Catholic Bishops are OK with the House language, but oppose the Senate language.

“U.S. Conference of Catholic Bishops has said the Senate-passed health care bill fails our moral criteria and must be changed.

The abortion funding problems in the Senate Bill extend well beyond the premium division scheme.

click for details:
http://catholickey.blogspot.com/2010/03/usccb-clarifies-politico-comments-still.html

Nobody should be surprised by this move …

President Barack Obama appears ready to reverse his position and allow unpopular deal-sweetening measures in the hopes of finding Democratic support for legislation.

To clinch support, Obama is backing away from his insistence that senators purge the legislation of a number of lawmakers’ special deals.

Taking a new position, the White House will only object to state-specific arrangements, such as an increase in Medicaid funding for Nebraska, ridiculed as the “Cornhusker Kickback.”  That’s being extended to all states.

The new rule: provisions that could — under prescripted circumstances affect more than one state are OK.

That means deals sought by senators from Montana and Connecticut would be fine — even though last week they were singled out as items Obama wanted removed.

There was resistance, however, from two committee chairman, Democratic Sens. Max Baucus of Montana and Chris Dodd of Connecticut, and the White House has apparently backed down.

Excerpted from AP: Obama heads to Ohio looking for health care votes, Mar 15, 2010 
http://news.yahoo.com/s/ap/20100315/ap_on_bi_ge/us_health_care_overhaul

Punchline: At a time the the country is bursting at the economic seams with high debt and unfunded liabilities, the push is on to up spending by another trillion dollars … and up taxes to cover it.  Bad idea.  This excerpt cuts to the chase.

* * * * *

Excerpted from Forbes: Uncommon Sense – Wrong Bill At The Wrong Time, 03.10.10

Even before President Obama rammed through his trillion-dollar-plus stimulus/bailout packages last year, there was a growing sentiment that the country’s top priority ought to be tackling the entitlement programs whose liabilities are like a swelling aneurysm in the brain of the body politic waiting to rupture.

• The combined unfunded liabilities of Medicare and Social Security–the federal health care and the pension programs for the elderly — are $107 trillion, seven times the current GDP.
• Medicaid, the joint federal-state health insurance program, is consuming on average 21% of state budgets, their single biggest ticket item even before ObamaCare dumps another 16 million people into the program, expanding the Medicaid population by 25%.
• State and local government owe their employees a trillion dollars in pension and other benefits than they have funds to deliver.

There are not enough taxpayers in the country or creditors in China capable of financing all these promises.

* * * * *

Expanding this massive, multifarious entitlement state even more strikes most normal people as sheer lunacy — especially now that it is visibly coming apart at the seams.

• General Motors and Chrysler–the corporate version of the public welfare state in which unions had negotiated the best wage and pension deals in the free world — have already been forced into a taxpayer-financed bankruptcy.
• California, America’s most European state, is technically bankrupt, thanks to the ubiquitous influence on the state budget of its public unions and its entitlement spending.
• The deficits and debt of the so-called European PIGS (Portugal, Italy, Greece and Spain) — the social democracies whose cradle-to-grave welfare policies are the inspiration behind Obama’s programs –are on the brink of bankruptcy. Greece, the most vulnerable of the lot, has a deficit of 12.7% of the GDP–not that much higher than America’s 10.6 %.

ObamaCare could well become President Obama’s Iraq.

It will exacerbate the crisis of the entitlement state, requiring someone else to step forward and clean up the fiscal mess he is creating.

Full article:
http://www.forbes.com/2010/03/09/obamacare-health-democrats-congress-opinions-columnists-shikha-dalmia.html?boxes=opinionschannellighttop

Interesting factoid from USA Today:

People in their 20s have the highest uninsured rate of any age group in the country

They make up nearly a third of the 46 million uninsured.

Under the health care overhaul bills, about 10 million lower-income young adults would qualify for Medicaid, or for government subsidies to buy private insurance.

About 5 million young adults will have to buy health care insurance or pay a penalty (aka. a ‘fine’, a ‘tax’) of $695, or 2.5% of their annual income, whichever is higher.

Full article:
http://www.usatoday.com/money/industries/health/2010-03-08-youthhealth08_ST_N.htm

Ken’s Take: I’m a strong proponent of putting all employer paid benefits — health insurance included — on employees taxable W2s and providing a liberal deduction ( say, the lesser of $5,000 per dependent or the taxpayer’s cash outlay.)  Unfortunately, the UAW and SEIU don’t like the idea …

* * * * *
Excerpted from Washington Post: Obama in the Wilsonian Tradition, March 11, 2010

The bold move that the nation needs is a transition from the irrationality of employer-provided health insurance.

Employer-paid insurance is central to what David Gratzer of the Manhattan Institute calls “the 12 cent problem.”

That is how much of every health care dollar is spent by the person receiving the care.

Hence Americans’ buffet mentality — we paid at the door to the health care feast, so let’s consume all we can.

John McCain had the correct prescription for health care during the 2008 campaign.

He proposed serious change — taxing employer-provided health care as what it indisputably is, compensation, and giving tax credits, including refundable ones, for individuals to purchase insurance.

Instead, ObamaCare will subsidize insurance purchases for families of four earning almost $100,000 a year … a redundant reminder of unseriousness about the nation’s fiscal mismanagement.

Full article:
http://www.realclearpolitics.com/articles/2010/03/11/in_the_wilsonian_tradition_104733.html

Candidate Obama pledged not to use reconciliation for healthcare legislation when he was stumping.  So much for campaign promises.

There’s a greater risk to the Dems if they use the process to pass ObamaCare: if the GOP retakes a majority of the Senate, it can use the same process to repeal the legislation.  After all, an unequivocal precedent will have been set.  Oops.

* * * * *

Excerpted from WSJ: The Trouble With ‘Reconciliation’, March 11, 2010

Fear not, sayeth Speaker Pelosi, all will be fixed with the magic dust known as “reconciliation” —a  process that allows budget and spending bills to move through the Senate with 51 votes instead of 60.

But, if Democrats use reconciliation to enact health-care reform, this fight isn’t likely to end this year.

Democrats are resorting to reconciliation because that would allow them to avoid a Republican filibuster.

That leaves Republicans free to use the same process to repeal ObamaCare that Democrats are using to enact it.

It means that for the next several election cycles every GOP Senate candidate can campaign on the promise to be that 51st vote for repeal.

House Democrats would be foolish to trust a process that has deeply alienated the American public. There are lots of reasons for Democrats to worry that voters will punish them for passing this reform.

Full article:
http://online.wsj.com/article/SB10001424052748703701004575113831577327418.html