"The American people will never knowingly adopt Socialism. But under the name of liberalism they will adopt every fragment of the Socialist program, until one day America will be a Socialist nation, without knowing how it happened." ~(1948) Norman Thomas, Six-time Socialist Cadidate for US Presidency
Over the Thanksgiving holiday our Senators will be home. The 11/21 vote was to move the matter to debate once they return from the holiday.
I urge each and everyone of you to visit their Senator’s office with the message they seem to not have heard. Vote for this Healthcare bill, and you better prepare for retirement.
To that end:
MAKE SURE TO DROP OFF A “HAPPY RETIREMENT” GREETING CARD!
This is our last chance to be heard! If you can’t get to their office just drop one in the mail! Find the addresses here: http://www.senate.gov/ . A list of Democrat Senators up for re-election in 2010 is here: http://www.fireandreamitchell.com/2009/11/21/a-list-of-democrat-senators-up-for-re-election-in-2010/
TIP 1: If there is already someone geared up to run against them, be sure to mention that candidate by name in a note, so they know that YOU KNOW who their competition is! Even better make sure they know you will be working on the competition’s campaign if you are so inclined!
TIP 2: Think about presenting them with a big beautiful Mylar Balloon for a little extra pizazz!!
TIP 3: Spend some quality crafty time with family and like-minded friends to deliver custom-crafted cards and doo-dads.
TIP 4: No time to go to the card shop? Here’s a free retirement card template you can print and send! http://office.microsoft.com/en-us/templates/TC103754971033.aspx?CategoryID=CT101433941033 ht
TIP 5: Get a group together, meet up at a specific day/time and throw a party! Cards, balloons, cake, noise makers! Sing “For He’s a FOLLY Good Fellow,” give them a Barney the Dinosaur watch as a departing gift!
TIP 6: Film the delivery and/or party. Take pictures during your visit or scan your card! Post them here! (We do love your creativity, folks, but PLEASE stay on topic or your image will be deleted)
TIP 7: If your Senator is not there to see you, at least request the office manager. I believe this will provide more impact.
Again, please be sure to invite EVERYONE YOU KNOW!
This is too important not to post. It corroborates EVERYTHING I thought was true about this bill and all the provisions I have investigated thus far. Folks, if this thing passes it will be hell to be an American citizen. In addition to all the new taxes she speaks of for insurance premiums and necessary medical devices, your State will also have to get revenue from somewhere to cover the imposed hike in Medicaid mandates. By the way, the money fairy is a myth, so don’t believe those Detroiters that stand in line waiting form Obama money.
I have been sitting quietly on the sidelines watching all of this national debate on healthcare. It is time for me to bring some clarity to the table by explaining many of the problems from the perspective of a doctor.
First off, the government has involved very few of us physicians in the healthcare debate. While the American Medical Association has come out in favor of the plan, it is vital to remember that the AMA only represents 17% of the American physician workforce.
I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.
The following letter is rapidly circulating around the country. Americans everywhere identify with this 53-year-old woman. She has given us a voice. Once you read this, you may want to forward it to your friends…
I’m a home grown American citizen, 53, registered Democrat all my life. Before the last presidential election I registered as a Republican because I no longer felt the Democratic Party represents my views or works to pursue issues important to me. Now I no longer feel the Republican Party represents my views or works to pursue issues important to me. The fact is I no longer feel any political party or representative in Washington represents my views or works to pursue the issues important to me. There must be someone. Please tell me who you are. Please stand up and tell me that you are there and that you’re willing to fight for our Constitution as it was written. Please stand up now. You might ask yourself what my views and issues are that I would horribly feel so disenfranchised by both major political parties. What kind of nut job am I? Will you please tell me?
Well, these are briefly my views and issues for which I seek representation:
One, illegal immigration. I want you to stop coddling illegal immigrants and secure our borders. Close the underground tunnels. Stop the violence and the trafficking in drugs and people. No amnesty, not again. Been there, done that, no resolution. P.S., I’m not a racist. This isn’t to be confused with legal immigration.
Two, the TARP bill, I want it repealed and I want no further funding supplied to it. We told you no, but you did it anyway I want the remaining unfunded 95% repealed. Freeze, repeal.
Three: Czars, I want the circumvention of our checks and balances stopped immediately. Fire the czars. No more czars. Government officials answer to the process, not to the president. Stop trampling on our Constitution and honor it.
Four, cap and trade. The debate on global warming is not over. There is more to say.
Five, universal healthcare. I will not be rushed into another expensive decision. Don’t you dare try to pass this in the middle of the night and then go on break. Slow down!
Six, growing government control. I want states rights and sovereignty fully restored. I want less government in my life, not more. Shrink it down. Mind your own business. You have enough to take care of with your real obligations. Why don’t you start there..
Seven, ACORN. I do not want ACORN and its affiliates in charge of our 2010 census. I want them investigated. I also do not want mandatory escrow fees contributed to them every time on every real estate deal that closes. Stop the funding to ACORN and its affiliates pending impartial audits and investigations. I do not trust them with taking the census over with our taxpayer money. I don’t trust them with our taxpayer money. Face up to the allegations against them and get it resolved before taxpayers get any more involved with them. If it walks like a duck and talks like a duck, hello. Stop protecting your political buddies. You work for us, the people. Investigate.
Eight, redistribution of wealth. No, no, no. I work for my money. It is mine I have always worked for people with more money than I have because they gave me jobs. That is the only redistribution of wealth that I will support. I never got a job from a poor person.. Why do you want me to hate my employers? Why — what do you have against shareholders making a profit?
Nine, charitable contributions. Although I never got a job from a poor person, I have helped many in need. Charity belongs in our local communities, where we know our needs best and can use our local talent and our local resources. Butt out, please. We want to do it ourselves.
Ten, corporate bailouts. Knock it off. Sink or swim like the rest of us. If there are hard times ahead, we’ll be better off just getting into it and letting the strong survive. Quick and painful. Have you ever ripped off a Band-Aid? We will pull together. Great things happen in America under great hardship. Give us the chance to innovate. We cannot disappoint you more than you have disappointed us.
Eleven, transparency and accountability. How about it? No, really, how about it? Let’s have it. Let’s say we give the buzzwords a rest and have some straight honest talk. Please try — please stop manipulating and trying to appease me with clever wording. I am not the idiot you obviously take me for. Stop sneaking around and meeting in back rooms making deals with your friends. It will only be a prelude to your criminal investigation. Stop hiding things from me.
Twelve, unprecedented quick spending. Stop it now. Take a breath. Listen to the people. Let’s just slow down and get some input from some nonpoliticians on the subject. Stop making everything an emergency. Stop speed reading our bills into law. I am not an activist. I am not a community organizer. Nor am I a terrorist, a militant or a violent person. I am a parent and a grandparent. I work. I’m busy. I’m busy. I am busy, and I am tired. I thought we elected competent people to take care of the business of government so that we could work, raise our families, pay our bills, have a little recreation, complain about taxes, endure our hardships, pursue our personal goals, cut our lawn, wash our cars on the weekends and be responsible contributing members of society and teach our children to be the same all while living in the home of the free and land of the brave.
I entrusted you with upholding the Constitution. I believed in the checks and balances to keep from getting far off course. What happened? You are very far off course. Do you really think I find humor in the hiring of a speed reader to unintelligently ramble all through a bill that you signed into law without knowing what it contained? I do not. It is a mockery of the responsibility I have entrusted to you. It is a slap in the face. I am not laughing at your arrogance. Why is it that I feel as if you would not trust me to make a single decision about my own life and how I would live it but you should expect that I should trust you with the debt that you have laid on all of us and our children. We did not want the TARP bill. We said no. We would repeal it if we could. I am sure that we still cannot. There is such urgency and recklessness in all of the recent spending.
From my perspective, it seems that all of you have gone insane. I also know that I am far from alone in these feelings. Do you honestly feel that your current pursuits have merit to patriotic Americans? We want it to stop. We want to put the brakes on everything that is being rushed by us and forced upon us. We want our voice back. You have forced us to put our lives on hold to straighten out the mess that you are making. We will have to give up our vacations, our time spent with our children, any relaxation time we may have had and money we cannot afford to spend on you to bring our concerns to Washington Our president often knows all the right buzzword is unsustainable. Well, no kidding. How many tens of thousands of dollars did the focus group cost to come up with that word? We don’t want your overpriced words. Stop treating us like we’re morons.
We want all of you to stop focusing on your reelection and do the job we want done, not the job you want done or the job your party wants done. You work for us and at this rate I guarantee you not for long because we are coming. We will be heard and we will be represented. You think we’re so busy with our lives that we will never come for you? We are the formerly silent majority, all of us who quietly work, pay taxes, obey the law, vote, save money, keep our noses to the grindstone and we are now looking up at you. You have awakened us, the patriotic spirit so strong and so powerful that it had been sleeping too long. You have pushed us too far. Our numbers are great. They may surprise you. For every one of us who will be there, there will be hundreds more that could not come. Unlike you, we have their trust. We will represent them honestly, rest assured. They will be at the polls on voting day to usher you out of office. We have cancelled vacations. We will use our last few dollars saved. We will find the representation among us and a grassroots campaign will flourish. We didn’t ask for this fight. But the gloves are coming off.. We do not come in violence, but we are angry. You will represent us or you will be replaced with someone who will. There are candidates among us when he will rise like a Phoenix from the ashes that you have made of our constitution.
Democrat, Republican, independent, libertarian. Understand this. We don’t care.. Political parties are meaningless to us. Patriotic Americans are willing to do right by us and our Constitution and that is all that matters to us now. We are going to fire all of you who abuse power and seek more. It is not your power. It is ours and we want it back. We entrusted you with it and you abused it. You are dishonorable. You are dishonest. As Americans we are ashamed of you. You have brought shame to us. If you are not representing the wants and needs of your constituency loudly and consistently, in spite of the objections of your party, you will be fired. Did you hear? We no longer care about your political parties. You need to be loyal to us, not to them. Because we will get you fired and they will not save you. If you do or can represent me, my issues, my views, please stand up. Make your identity known. You need to make some noise about it. Speak up. I need to know who you are. If you do not speak up, you will be herded out with the rest of the sheep and we will replace the whole damn congress if need be one by one. We are coming. Are we coming for you? Who do you represent? What do you represent? Listen. Because we are coming. We the people are coming.
Obama and Democrat Congressional leaders uncorked the bottle and the peoples’ Genie is out.
He’s not happy, this Genie. In normal times, he sits there quietly inside the bottle. Sometimes watching. Mostly not. He finds politics boring, if not disgusting.
He sat and watched in silence as the TARP bill passed. Told the sky was falling, he looked up and saw it wasn’t. But he shrugged, trusting the bipartisan nature of the effort. Then, as TARP rolled out, he stood up. The bailouts plowed a furrow across his forehead; his eyebrows lowered; his gaze intensified. But he stayed inside the bottle.
Along came the Stimulus Bill. Or, in the language of the big spenders, The American Recovery and Reinvestment Act of 2009. The Genie smelled the bacon through the glass bottle. He heard the squeals coming next from the Omnibus Appropriations Act of 2009. Another stampede of pigs.
Inside the bottle, the Genie’s leaned forward, pressing his hands and nose flat against the glass. As he watched banks and car companies yield to government control, his jaw slid up. His lips pressed tight. His breathing shortened. But he stayed inside the bottle.
In his peripheral vision he saw a dancing troupe dressed like Cossacks enter the side door of the White House and disappear within. The Czars had come. The Genie watched, and wondered.
The debate over a public option in health care has exposed a core public policy issue that until now has been seen only at the local level: what services should be provided directly by the government and its employees versus simply having the government ensure access to those services in the open market. Enlightened conservatives like the late Jack Kemp, who respected the power of free markets but wanted to make sure that low- and moderate- income citizens were empowered to benefit from them, have argued passionately that government has a moral obligation to ensure access to these services but a near-equal obligation to stay out of the service business itself. Kemp—and Al Gore, incidentally—once said government works best when it steers rather than rows, otherwise it tends to become bloated and—when competing with private firms—gluttonous. Indeed, in the few opportunities I had to discuss Kemp’s populist ideas with him, he was quick to cite the painful experiences of local service firms and non-profits in their competition against federally subsidized, book-cooking and rule-bending local governments.
Our various levels of government provide many essential services, from the city planning and law enforcement to safety inspection and professional licensing. These particular types of services are direct expressions of the government’s police power, and so are rightfully and for the most part confined to public providers. A second service category is more discretionary, which means they could be provided by the private market but, for both good and bad reasons, the government has intervened as the monopoly provider. These usually include mass transit, water and sewer services, etc. Rarely—as in almost never—has a government allowed private firms to continue to compete for customers once it has established itself as a provider, and truly never on a level playing field.
For example, private jitney services are forbidden in most US cities, especially in densely-traveled bus corridors (i.e., where the customers are). And as President Obama prepares to push billions of new dollars into intercity high-speed passenger rail, Amtrak is already claiming with legislative justification that it has a monopoly to operate the trains in almost every corridor in which the services are being planned, despite the existence of dozens of US and global companies eager to do so. Solid waste collectors are routinely blocked from offering their services in service areas attended to by a public operator. And then there’s K-12 education, where any family using anything other than government schools must pay twice (once through their property taxes and again through tuition), while the poor are economically prohibited from choosing at all. In fact, many public union teacher contracts allow the sale of surplus school property to almost anyone, such as liquor store operators and shopping mall developers, but not to private school foundations that might build a competing facility. Reduce…
Other barriers are less obvious but equally effective. They amount to cheating, and they have a huge and readily calculable cost to taxpayers. Here’s how they work:
1. Cooked Cost Accounting: For a time in the 1990’s, numerous city governments invited private companies to bid against their public in-house operations to provide services ranging from wastewater treatment to city vehicle maintenance. Unfortunately, the cities usually limited the contracts to 3-5 years, too short to allow private firms to recover the cost of the equipment they’d have to buy or to earn back their other start-up costs. Moreover, when comparing their own service costs to the private option, the government usually left out much of its general overhead and long-term liabilities, such as pensions and equipment replacement, arguing that they would have to carry those costs whether the service was contracted out or not. The private competitors, on the other hand, had no choice but to include these costs in their bid. So they often lost. Once the private competition was wiped out or otherwise deterred, the public operator breathed a big sigh of relief and usually returned to its normal cost escalation or lower service level.
2. Debt and Capital Subsidies: Government debt is subsidized by federal taxpayers; that is, the interest on the government’s debt is generally tax-free, while interest on a private provider’s debt is taxed at combined rates of up to 50 percent. This means that, by comparison, taxpayers pays up to half of the debt service cost of public option vis-a-vis private companies. The result is that public operators can borrow at 3 or 4 percent while private service and infrastructure companies—and health insurers—must raise their capital in private debt and equity markets at normal, much-higher rates. Even worse, the equity component of a private operator’s financing is taxed twice: once at the corporate level (corporate income tax) and then again at the individual shareholder level. Government providers almost never include the enormous taxpayer cost of these subsidies in a public-versus-private comparison.
3. Implicit Service and Revenue Guarantees: There are two main types of public service operating agencies: internal enterprise fund units, such as the Chicago Department of Aviation, and independent public authorities, such as the Port Authority of New York and New Jersey. Bonds issued by or on behalf of internal enterprise funds may or may not have the explicit backing of the participating government; that is, the government has varying hurdles (sometimes none) it must clear to backstop one of its financially underperforming business units. This contrasts somewhat with bonds issued by independent (but still government-owned) public authorities, which are usually prohibited by their covenants from being backstopped by general government revenue. But what governments can almost always do fir their captive operators is to direct customers, and therefore revenue, to its business units. It does so by adding additional communities to its client base (e.g., incorporating smaller suburban jurisdictions into its service area, thus improving its economies of scale) or by driving private providers out of the market, either through regulation or temporary or customer-class marginal cost pricing. It can also use its monopolist oligopolist pricing power to simply raise rates to cover bloated costs.
4. Artificial Scale: The government is almost always the largest provider of public-use services in its region. A private company hoping to provide potable water or other infrastructure alternatives therefore finds itself competing against not just the “natural monopoly” aspects of infrastructure, with miles of existing pipe and connections already in the ground, but against the enormous economies of scale that benefit the government in the first place. It’s the same advantage that a handful of private companies like Wal-Mart and Verizon enjoy because of the relative size of their customer base. It manifests itself in enormous, competition-killing way, including input pricing (e.g., Wal-Mart’s power to squeeze its suppliers) and installed service structure, such as Verizon’s numerous cell towers in its Bell-legacy regions. The US health insurance market has a large number of private providers, but state-by-state regulation has kept many of them confined to their regional customer base. A Fannie Med public option, by contrast, would operate nationally and, as Medicare does in many cases, would surely use its scale to force its will on hospitals, doctors and drugmakers while other insurers pick up the real tab.
5. The Fannie Mae Lesson: Fannie Mae and Freddie Mac were supposed to be stand-alone, corporate-like purchasers of home mortgages (this should be sounding familiar already). The authorizing legislation that created them and the language of their founding charters refer many times to their full operating and financial independence from the government and, by exclusion and more, the absence of taxpayer liability for any possible corporate mishaps. In its subsequent competition with other firms offering the same mortgage bundling services, the feds were never supposed to be able to step in. But that’s exactly what happened in late 2008, to the tune of hundred billions of dollars of taxpayer dollars. You can be absolutely certain that the new managers of any public option—and most of its prospective customers—will remember that comforting golden parachute. And while the Congressional Budget Office can tell you how costly it is to taxpayers, Lehman Brothers can tell you how it is not to have had it.
No doubt President Obama will make promises that the House and House-Senate conference committee’s won’t keep when it comes to the financial independence and honest accounting of the public health insurance option. But even if they don’t explicitly empower a new public entity to cheat as it competes with private insurers, and even if they do offer the usual platitudes about ensuring a level playing field, there are at least five big reasons and many billions of dollars of experience to convince you not to believe a word of it.
The 2009 legislative session is sure to be a battlefront for competing interests looking to shape the future of our health care system. The growing concern by the general public and politicians about the increasing costs of health care and of the disparities in its delivery have conspired to make this one of the top priorities for Congress and the incoming administration. Evidence for this is clearly present in the prominent role the issues of health care quality and accessibility played in the 2008 presidential campaigns. The political reality is that those espousing a role for increasing government regulation have, for the first time, entrenched themselves solidly in a position to effect the changes they uphold. The room for effective opposition to this agenda is limited, placing the integrity of the Americas health care system more at the mercy of this politically and professionally unidimentional group than ever before.
People who oppose this particular plan for reforming our system share the concerns over health care delivery in this country. They stand resolutely united in the quest to provide better health care in a more efficient and affordable way. However, this group believes that greater government intervention in such a complex and intricate segment of our society will only serve to increase the costs of delivering care and diminish its quality. They hold a view that promotes a stronger role for personal responsibility and accountability in both the delivery and acquisition of health care. They are innately concerned about the future of the American health care workforce and the effects that greater administrative demands and diminished reimbursements will have on the people that deliver this care.
Unfortunately, there is an ocean of misinformation and miscategorization working against this movement. The misrepresentation of the shortcomings of our present health care system is being afforded greater validity by the American public, and attempts at correcting these errors are quickly fading.
Amazingly, the advocates of this alternative viewpoint, the keepers of the more accurate assessment regarding the state of the delivery of our health care, have been egregiously quiet. They will discuss their disappointment over the changes being imparted upon them and their trade in professional conventions and physicians cafeterias throughout the country. But, either because of despair or simply as a result of a lack of time, these overworked professionals are not voicing their concerns to the public in an effective way. During their meetings, you may hear them warn of the untoward effects government-mandated health care is sure to have on patients and the dissatisfaction with which our citizenry will respond to them. You may even hear these pillars of the health care delivery system discuss their intentions to abandon their careers, or at the very least find a cushion that will allow them to rely less on health care for their livelihood. However, as these individuals dispel from their forums to continue their relentless efforts at caring for others and stem the course of human disease, the microphone is left open for those who have the time such as lawyers, public health experts, economists, academicians and certain legislators, to propagate their brand of misinformation regarding health care in the United States, the overwhelming majority of this group not ever having earned the privilege of laying a stethoscope on a patient.
This book is written in an attempt to reverse the trend of sociopolitical silence on the part of the medical community and as a megaphone for those whose views about health care reform are otherwise not being delivered.
HEALTH CARE REFORM: THE TRUTH
Biography of Julio Gonzalez, M.D.
Dr. Julio Gonzalez is a board certified orthopaedic surgeon in private practice in Venice, Florida. Born and raised in Florida he received his undergraduate degree from the University of Miami with a major in biology and a minor in chemistry. He pursued his medical studies at the University of Miami School of Medicine and graduated in 1990. Between 1990 and 1995, he served naval reserves, first as an intern in internal medicine at Portsmouth Naval Hospital and then for four years with the fleet where he was stationed in Jacksonville, Florida and served on two overseas deployments.
Upon completing his naval service in 1995, Dr. Gonzalez then pursued internship training in general surgery before completing his training in Orthopaedic Surgery at the University of Florida/Shands Hospital Urban Campus in Jacksonville Florida. He then participated in a knee reconstructive and sports medicine fellowship in Orlando, Florida. He practiced in Orlando, Florida for four years before relocating to Venice where he has been in solo practice ever since.
Dr. Gonzalez has been active in organized medicine, serving as Florida Orthopaedic Society Delegate to the Florida Medical Associations House of Delegates and Florida Councilor to the American Academy of Orthopaedic Surgeons He is an Active Fellow in the American Academy of Orthopedic Surgeons and a member of the Board of Directors of the Florida Orthopaedic Society. Dr. Gonzalez sits on the Board of Censors for the Sarasota County Medical Society and serves as Chief of Staff Elect and Surgery Section Chief Elect at Venice Regional Medical Center. He is a member of the American Medical Association.
His literary accomplishments include co-authoring the Dictionary of Orthopaedic Terminology (2007) and founding the Journal of Orthopaedic History set to launch in early 2009.
He lives in Venice with his wife, Dr. Gina Arabitg, and their two children.
South Florida Geriatric Care Manager Amy Seigel, RN, CCM Testifies on Need for Coordinated Health and Elder Care
Health care reform is at the top of President Obama’s agenda, and he is looking for Congress to present a solid plan by this summer. In anticipation of this deadline, members of Congress are busy gathering tools and ammunition for the mammoth undertaking to revamp our current health care system.
As part of this preparation, health care practitioners from across the country recently gathered on Capitol Hill to brief members of Congress on specific recommendations to improve health care delivery.
Leading this charge was the National Academies of Practice, a consortium of 10 different medical disciplines committed to changing and improving health care. NAP Vice President of Policy and founder of Biscayne Institutes of Health & Living in Miami, Dr. Marie DiCowden, explains, “We need to expand the traditional model of care so it focuses on interdisciplinary care for both preventive and primary care.”
One of these practitioners, Amy Seigel, a Certified Nurse Care Manager and founder of Advocare Care Management of South Florida, provided testimony related to the needs of the senior population. Seigel provided two compelling examples of the need for more coordinated elder care.
One example illustrated how one senior’s continued denial for routine care by her HMO led to amputation of her fingers, resulting in the loss of her ability to continue as a caregiver for her husband. The ultimate consequence – loss of independence, faster progression to skilled nursing, and more burden on the U.S. taxpayer.
Her next example hit very close to home with the legislators.
Seigel read testimony from one of her clients, the wife of a former US Senator. She pointed out that even with the excellent benefits of U.S. Senate insurance combined with Medicare, the couple had difficulty with an overwhelming and fragmented medical system. Though they were fortunate to have a Nurse Care Manager to help them navigate the system, many seniors cannot afford or are not aware of this type of assistance.
The testimony concluded that community and home based services such as Geriatric Nurse Care Managers could help reduce unnecessary ER visits, increase access to appropriate services, and better coordinate multiple medical practitioners and prescription medications.
One of the hottest topics among medical professionals today is national healthcare reform. And while there have been some policy statements released on the subject, the fact is, no one really knows what to expect. For this reason, the Florida Orthopaedic Society (FOS), along with other state medical and specialty organizations, is working to keep its members up-to-date on all of the information available.
“A great number of people are concerned with the idea of government-directed or government-controlled healthcare reform,” explained Julio Gonzalez, M.D., a member of the FOS Board of Councilors. “There are many different ideas out there about how that can look—whether it’s a universal single payer system, which is the classic idea of universal healthcare, or a multipayer, government-directed system. There aren’t a lot of details available on which way the administration, and the leadership in the House and Senate, want to direct the plan.”
For the past year, Dr. Gonzalez has been heavily involved in the healthcare reform debate. “I was catapulted to a much higher level of debate after reading Call to Action: Healthcare Reform 2009 by Senate Finance Committee Chairman Max Baucus,” he explained. “When I read about the amount of government intervention, manipulation and oversight inherent in the plan, I was appalled. I felt threatened, for myself and for my patients.”
In answer to the Montana senator’s paper, Dr. Gonzalez wrote a book entitled Health Care Reform: The Truth. He also began working with state medical organizations to inform their members, and started a grass-roots group, The Alliance for Responsible Healthcare Reform, to bring more attention to the issues. Through this group, medical professionals from all sectors, including nursing homes, physical therapy groups and hospitals meet with district congressman to voice their concerns.
According to Dr. Gonzalez, there are many factors that need to be addressed in the healthcare reform debate, including the timeline of the reform itself. “I find it appalling and irresponsible that the Legislature wants to come out with a bill by June, and have it ready to go before the president by October 15,” he explained. “By all accounts, they are revamping the way we deliver healthcare in this country in what is essentially a four-month process, without sharing the contents of their bill with the public for discussion and debate.”
While a few policy statements have provided a general overview of the plan, Dr. Gonzalez, and many other medical professionals, are alarmed by the lack of detail on funding, logistics and short- and long-term goals. “I went to Washington, D.C. in April, and met with Republican and Democratic members of Congress,” he explained. “Not only does the public not know what’s in the bill, but even members of both parties are not familiar with what it contains.”
Of specific interest to medical specialty groups are issues dealing with the loss of autonomy for patients in choosing the provider and the type of healthcare they receive, and the concept of bundling payments to a hospital. “A hospital will get reimbursed for all of the care provided to the patient, and then they are responsible for deciding how and to whom they divvy up the payments,” said Dr. Gonzalez. “This is going to cause a lot of politicking between different team member within the patient care delivery system who should be working together.”
The ‘budget neutral’ concept, in which general physicians receive enhanced reimbursements at the expense of specialty physicians, is also a sticking point. “A budget-neutral approach to increasing reimbursement for generalists and primary care at the expense of specialists ignores the fact that there is a universal shortage of physicians, affecting specialists and generalists alike,” said Dr. Gonzalez. “Enhancing reimbursement of one group at the expense of the other will lead to shortages in specialty care like you see in Canada and Europe.”
Dr. Gonzalez is also alarmed by the government’s idea of not allowing physicians to own hospitals, citing conflict-of-interest. “Some of the greatest hospitals in the country—the Mayo Clinic, Cleveland Clinic, New York University Hospital for Specialty Surgery, Venice Regional Medical Center in Florida—were all created by physicians,” he said. “This concept ignores the fact that physician expertise and involvement lead to the creation of top-notch medical centers.”
Until the actual bill comes out, Dr. Gonzalez is working with a number of organizations to raise awareness, and encouraging people to review the bill with thought, an open mind, insight and research. “It is imperative that patients know what’s coming, and determine if this is what they really want,” he said. “I have a feeling that the American patient really doesn’t want to have the government dictate what will happen in the exam room.”
Preliminary Analysis of the House Democrats’ Health Reform Proposal
Yesterday CBO released a preliminary analysis, conducted with the staff of the Joint Committee on Taxation (JCT), of H.R. 3200, the America’s Affordable Health Choices Act of 2009, as introduced by several House committees on July 14. Earlier this week, CBO released a preliminary report on the health insurance coverage provisions of the bill; this latest report added analysis of the other provisions.
According to CBO’s and JCT’s assessment, enacting H.R. 3200 would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period. That estimate reflects a projected 10-year cost of the bill’s insurance coverage provisions of $1,042 billion, partly offset by net spending changes that CBO estimates would save $219 billion over the same period, and by revenue provisions that JCT estimates would increase federal revenues by about $583 billion over those 10 years.
By the end of the 10-year period, in 2019, the coverage provisions would add $202 billion to the federal deficit, CBO and JCT estimate. That increase would be partially offset by net cost savings of $50 billion and additional revenues of $86 billion, resulting in a net increase in the deficit of an estimated $65 billion.
The figures released yesterday do not represent a complete cost estimate for the legislation. In particular, the estimated impact of the provisions related to health insurance coverage is based on specifications provided by the committee staff, rather than on a detailed analysis of the legislative language. (The estimates for other spending provisions reflect the specific legislative language. JCT has separately published its estimates of the effects of revenue provisions contained in H.R. 3200.) In addition, the figures do not include certain costs that the government would incur to administer the proposed changes and the impact of the bill’s provisions on other federal programs, and they do not reflect any modifications or amendments made after the bill was introduced. Nevertheless, this analysis reflects the major net budgetary effects of H.R. 3200.
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