More Questions on Health Care

Lee Cary has presented more questions that people should be asking their representatives but unfortunately few are.I am honored to be able to post them here.

Some wonder why the questions are not being asked and I have done a bit of speculating on the question and come up with perhaps a valid reason. In the 2008 election 53% of the voters cast their vote for the current occupier of the White House and it would seem that 95% of them are still sleeping or feeling the tingling up or down their leg so they don’t ask questions just as they didn’t prior to voting they simply follow like lemmings going over the cliff. That number is changing for the better it seems so perhaps during recess of Congress we will see more questions being asked by this group of folks. The other folks who didn’t vote for the current occupier don’t seem to be asking too many questions either. Many of them have simply shrugged and said ,”well we will have to live with it for the next four years”. Unfortunately that kind of thinking is what can lead to four more years of expanding socialism in the US. 45% or so are asking questions and this is a good thing because their representatives are going to have to have some answers for these folks if they want to be re-elected in 2010.

May I suggest that you join the percentage of folks who are asking questions regardless of your political affiliation.

Section 1121, Sustainable Growth Rate Reform, Subsection (c), Limitation On Physicians' Services Included in Target Growth Rate Computation To Services covered Under Physician Fee Schedule, stipulates a change in the language of the Social Security Act in section 1848(f)(4)(A) which today reads as follows:

"(A) Services included in physicians' services.-The term ‘physicians' services' includes other items and services (such as clinical diagnostic laboratory tests and radiology services) specified by the Secretary, that are commonly performed or furnished by a physician or in a physician's office, but does not include services furnished to a Medicare+Choice plan enrollee."

Obamacare proposes to change the language in the SSA bill to the following:

"(A) Services included in physicians' services.-The term ‘physicians' services' includes other items and services for which payment under this part is made under the fee schedule under this section, for services for practitioners described in section 1842(b)(18)(C) on a basis related to such fee schedule, or for services described in section 1861(p) (other than such services when furnished in the facility of a provider of services), but does not include services furnished to a Medicare+Choice plan enrollee."

Social Security Act 1842(b)(18)(C) reads: "A practitioner described in this subparagraph is any of the following: (i) A physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)). (ii) A certified registered nurse anesthetist (as defined in section 1861(bb)(2)). (iii) A certified nurse-midwife (as defined in section 1861(gg)(2)). (iv) A clinical social worker (as defined in section 1861(hh)(1)). (v) A clinical psychologist (as defined by the Secretary for purposes of section 1861(ii)). (vi) A registered dietitian or nutrition professional."

And, SSA Section 1861(p) refers to: "The term ‘outpatient physical therapy services' means physical therapy services furnished by a provider of services, a clinic, rehabilitation agency, or a public health agency, or by others under an arrangement with, and under the supervision of, such provider, clinic, rehabilitation agency, or public health agency to an individual as an outpatient..."

So what's the change? Well, it looks like the physician services covered in the existing SSA is downgraded by the definition of "practitioner" as meaning one of the non-physician specialists in the SSA section 1842(b)(18)(C) list above.

SO, is the sustaining growth rate cut in costs outlined in Section 1121(c) of the Obamacare bill gained by reducing physician services for seniors and low income persons who need it the most?

Section 1122, Misvalued Codes Under The Physicians Fee Schedule, offers a revision of SSA Sec. 1848 which includes adding this language:

"(i) In General.-The Secretary shall establish a process to validate relative value units under the fee schedule under subsection (b).

(ii) Components And Elements Of Work.-The process described in clause (i) may include validation of work elements (such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk) involved with furnishing a service and may include furnishing a service and my include validation of the pre, post, and intra-service components of work."

SO, Obamacare is going to measure how much stress a physician is under and quantify their technical skill in order to pay accordingly? How's that work? (Particularly since only one "practicing physician" is required to be on the plan's board chaired by the Surgeon General.) Is the government going to put some sort of stress meter on the doc's wrist and require them to download readings to a central stress-monitoring data base (CSDB)?

Section 1145, Treatment Of Certain Cancer Hospitals, proposes to add a paragraph (18) to section 1833(t) of the Social Security Act. The addition pertains to specialized cancer hospitals. It reads:

"(18) Authorization Of Adjustment For Cancer Hospitals.- (A) Study.-The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection as determined appropriate by the Secretary).

(B) Authorization Of Adjustment.-Insofar as the Secretary determines under paragraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011."

So, what's 1886(d)(1)(B)(v) about? [WARNING: Skip this next part if you're not into the minutia of understanding cancer treatment options and go straight to the next "SO,".] Here's how that section reads in the Social Security Act:

"(I) a hospital that the Secretary has classified, at any time on or before December 31, 1990, (or, in the case of a hospital that, as of the date of the enactment of this clause, is located in a State operating a demonstration project under section 1814(b), on or before December 31, 1991) for purposes of applying exceptions and adjustments to payment amounts under this subsection, as a hospital involved extensively in treatment for or research on cancer,

(II) a hospital that was recognized as a comprehensive cancer center or clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of April 20, 1983, that is located in a State which, as of December 19, 1989, was not operating a demonstration project under section 1814(b), that applied and was denied, on or before December 31, 1990, for classification as a hospital involved extensively in treatment for or research on cancer under this clause (as in effect on the day before the date of the enactment of this subclause), that as of the date of the enactment of this subclause, is licensed for less than 50 acute care beds, and that demonstrates for the 4-year period ending on December 31, 1996, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E), or

(III) a hospital that was recognized as a clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of February 18, 1998, that has never been reimbursed for inpatient hospital services pursuant to a reimbursement system under a demonstration project under section 1814(b), that is a freestanding facility organized primarily for treatment of and research on cancer and is not a unit of another hospital, that as of the date of the enactment of this subclause, is licensed for 162 acute care beds, and that demonstrates for the 4-year period ending on June 30, 1999, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E); and, in accordance with regulations of the Secretary, does not include a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital (as defined by the Secretary). A hospital that was classified by the Secretary on or before September 30, 1995, as a hospital described in clause (iv) shall continue to be so classified notwithstanding that it is located in the same building as, or on the same campus as, another hospital."

SO, what impact will Obamacare have on hospitals across the country that specialize in cancer treatments? (If the knee-jerk answer is "none"...) Well, Section 1145, which proposes to add language to the Social Security Act, seems to indicate that when their specialized care is more expensive than "other hospitals" furnishing cancer treatment, their costs may not be covered by Obamacare.

So what's the expected impact on those hospitals and their cancer patients?

Time is running and folks we had better be asking our representative these questions when they are in the area for August break. If you fail and this fiasco passes you will have no one to blame but yourself.

More on HEALTH CARE

In follow up to HEALTH CARE here are some legitimate questions that Congress and “We the People” should be asking and demanding answers for.

Lee Cary at American Thinker has set forth these very troublesome questions to OBAMACARE and I take the opportunity to share them here with you.

*(Page 30) According to Section 223, Payment Rates For Items And Services, “The Secretary [of the Treasury] shall establish payment rates for the public health insurance option for services and health care providers consistent with this section and may change such payment rates in accordance with section 224.”

Also, according to Section 225, Provider Participation, there are two schedules of payment terms for physicians. Preferred Physicians “agree to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.” And, Participating, Non-Preferred Physicians “who agree not to impose charges…that exceed the ratio permitted under section 1848(g)(2)(C) of the Social Security Act.

Section 1848(g)(2)(C) reads: “(C) After 1992.—For physicians' services furnished in a year after 1992, the 'limiting charge' shall be 115 percent of the recognized payment amount under this part for nonparticipating physicians or for nonparticipating suppliers or other persons.”

SO, Timmy Geithner will be responsible for deciding how much physicians make? (How does he do that when he can’t accurately calculate his own taxes?) What’s the projected cumulative impact on the income of U.S. physicians?

*(Page 167) Section 59B, Tax On Individuals Without Acceptable Health Care Coverage, “In the case of any individual who does not met the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of (1) the taxpayers’ modified adjusted gross income for the taxable year, over (2) the amount of gross income specified in sections 6012(a)(1) with respect to the taxpayer.”

SO, why is this plan sometimes referred to with the words “health care choices” when my only choices are to comply or pay a tax penalty? Exactly what are these “choices”?

*(Page 170) According to Section 59M (p. 171), “(2) Nonresident Alien. Subsection (a) [pertaining to the tax on individuals without acceptable health care coverage] does not apply to any individual who is a non-resident alien.”

SO, who pays for the health care for those in the U.S. on J-1 and F-1 visas? We citizen taxpayers?

(Page 59) Section 431, Disclosures To Carry Out Health Insurance Exchange Subsidies, amends section 6130 of the IRS Code of 1986 with language that enables the Health Choices Commissioner [in a previous installment of this series referred to as the “Commish”] access, via written request to the Secretary of the Treasury [Timmy Geithner], to taxpayer records including: “(i) taxpayer identity information with respect to such taxpayer; (ii) the filing status of such taxpayer; (iii) the modified adjusted gross income of such taxpayer; (iv) the number of dependents of the taxpayer; (v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof)…”

SO, with my tax information available within the enormous bureaucracy required to stand-up “America’s Health Choices Act of 2009” how long before this information becomes available to operatives of the political party in power at the time? And, when can we expect affluent citizens to be denied government healthcare payment because their net worth is identified as beyond a certain level? Oh, and by the way, just how many more government employees will be hired to staff Obamacare? And, of what government workers’ union are they likely to become members?

: (Tracking through this one will hurt, but it’ll pay off - at the very end.) The Obamacare bill makes amendments to the Social Security Act (SSA), thereby requiring the reader to toggle back-and-forth between the two bills, as well as the IRS Code. Here goes:

*(Page 42) SSA, Section 1848, Subsection (j) reads as follows:
“(1) Category.—For services furnished before January 1, 1998, the term ‘category’ means, with respect to physicians' services, surgical services (as defined by the Secretary and including anesthesia services), primary care services (as defined in section 1842(i)(4)), and all other physicians' services. The Secretary shall define surgical services and publish such definitions in the Federal Register no later than May 1, 1990, after consultation with organizations representing physicians.

(2) Fee schedule area.—The term ‘fee schedule area’ means a locality used under section 1842(b) for purposes of computing payment amounts for physicians' services.

(3) Physicians' services.—The term ‘physicians' services’ includes items and services described in paragraphs (1), (2)(A), (2)(D), (2)(G), (2)(P) (with respect to services described in subparagraphs (A) and (C) of section 1861(00)(2)), (2)(R) (with respect to services described in subparagraphs (B), (C), and (D) of section 1861(pp)(1)), (2)(S), (2)(W), 2(AA), (3), (4), (13) (14) (with respect to services described in section 1861(nn)(2)), and (15) of section 1861(s) (other than clinical diagnostic laboratory tests and, except for purposes of subsections (a)(3), (g), and (h) such other items and services as the Secretary may specify).

(4) Practice expenses.—The term ‘practice expenses’ includes all expenses for furnishing physicians' services, excluding malpractice expenses, physician compensation, and other physician fringe benefits.”

Now, the pending House version of the healthcare deform, oops, reform bill proposes (in Section 1121, pages 241-244) to add a 5th paragraph to the SSA that reads as follows:

“(5) Service Categories.-For services furnished on or about January 1,2009, each of the following categories of physicians’ services (as defined in paragraph (3)) shall be treated as a separate ‘service category’ (A) Evaluation and management services that are procedure codes (for services covered under the title for – (i) services in the category designated Evaluation and Management in the Health Care Common Procedure Coding System (established by the Secretary under subsection (c)(5) as of December 31, 2009 and as subsequently modified by the Secretary); and (ii) preventative services (as defined in section 1861(iii) for which payment is made under this section. (B) All other services not described in subparagraph (A). Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.”

[Here, as elsewhere in life, the devil is in the details – sometimes the last detail.]

SO, as the incomes of physicians who specialize are brought, by this bill, into income equivalency with general practitioners (AKA family practice or primary care physicians), how will that impact the incentive for med students to specialize by undertaking years of additional training, often incurring substantial additional medical school debt and deferred income? Do primary care physicians represent a disproportionate percentage of the physicians that supports this bill?

Why aren’t these questions being asked?

Footnote:

*(PAGE numbers correspond with earlier post on HEALTH CARE)

The Walls Come Tumbling Down

It appears that the Canadians are more aware of the happenings in the US than fawning Lame Stream Media. Needless to say the LSM will never report anything as objective as the Canadian Press since they are in the pocket of “the One” and would do nothing to disturb the tingle that runs up or down their legs each time he opens his mouth ,even though it seems more of late he sticks his foot in deeper and deeper. It makes one wonder if he has been taking lessons from his “closeted’ VP Joe, foot in mouth, Biden.

The article was written in June of 2009 but is even more accurate today given the decline in poll number of “the One”.

Read it and I am sure you will agree that this report is very accurate in summing up “the Chief Occupier”.

The Canadian Press and Obama

"A shallow, manipulative and egotistical amateur who is in over his head" The Canadian Press.

http://www.thecanadianpress.com/about_cp.aspx?id=104
Obama's White House is Falling Down
By Daniel Greenfield Thursday, June 11, 2009

In the sixth month of his presidency, Obama has turned an economic downturn into an economic disaster, taking over and trashing entire companies, and driving the nation deep into deficit spending expected to pass 10 trillion dollars.

Abroad, Obama seems to have no other mode except to continue on with his endless campaign, confusing speechmaking with diplomacy. It is natural enough that Obama, who built his entire campaign on high profile public speeches reported on by an adoring press, understands how to do nothing else but that.

Ego driven photo op appearances and clueless treatment of foreign dignitaries

While the press is still chewing over Obama's Cairo speech, this celebrity style coverage ignores the fact that Obama's endless world tour is not actually accomplishing anything. Instead his combination of ego driven photo op appearances and clueless treatment of foreign dignitaries have alienated many of America 's traditional allies. Those who aren't being quietly angry at Obama, like Brown, Merkel or Netanyahu, instead think of him as as absurdly lightweight, as Sarkozy, King Abdullah or Putin do.

While his officials carry out their dirty economic deeds, Obama responds to any and every crisis as if it were a Mickey Rooney and Judy Garland musical, with a cry of, "Let's put on a show." Thus far Obama has put on "shows" across America , Europe and the Middle East . And what the adoring media coverage neglects to cover, is that Obama's shows have solved absolutely nothing. They have served only as high profile entertainment.

Neither alienating America 's traditional allies, through a combination of arrogant bullying and ignorance, nor appeasing America 's enemies, has yielded any actual results. Nor does it seem likely to. Islamic terrorism is not going anywhere, neither are the nuclear threats from North Korea and Iran . While Obama keeps smiling, the global situation keeps growing more grim.

At home, if Obama was elected as depression era entertainment, the charm of his smiles and his constant appearances on magazine covers appear to be wearing thin on the American public. Despite the shrill attacks on Rush Limbaugh or the Republican Enemy of the Weak-- the Democratic party of 2009, is polling a lot like the Republican party of 2008. The Democrats have suddenly become the incumbents, and the only accomplishment they can point to is lavish deficit spending, often on behalf of the very same corporations and causes they once postured against.

The European Union Parliament's swing to the right cannot be credited to Obama, though doubtlessly some European voters seeing socialist economic crisis management on display in the world's richest country decided they wanted none of it, but it is part of a general turning against federalism. And Obama's entire program is dependent on heavily entrenching federalism at the expense of individual and state's rights. Yet that is precisely his achilles heel with independent voters who are polling against more taxes and expanded government. And no amount of speeches by Obama can wish away his 18 czars or the national debt he has foisted on generation after generation of the American people.

That leaves Obama with a choice between socialism and the independent voter. And thus far he has chosen socialism.

Obama's tactic of hijacking Bush Administration era policies on the economy and the War on Terror, and exploiting them as trojan horses to promote his own agenda, have left him coping with a backlash from his own party, as well as general Republican opposition.

His Czars are meant to function as the bones in an executive infrastructure accountable to no one, but a lack of accountability isn't just another word for tyranny, but for incompetence. A functional chain of command is accountable at multiple levels if it is to function effectively. Obama's White House by contrast is in a state of over-organized chaos, the sort of organized disorganization that undisciplined egotistical leftists naturally create for themselves, complete with multiple overlapping levels of authority and no one in charge but the man at the top, who's too busy doing other things to actually be in charge.

Dennis Blair as National Intelligence, who collaborated with the Muslim genocide of Christians in East Timor , trying to muscle out the CIA to create his own intelligence network, is typical of the kind of chaos being spawned by every chief in an expanding government bureaucracy working to make sure that all the Indians answer to him. Similarly the National Security Council wrestling with the State Department, highlighted by Samantha Power getting her own specially created NSC position to butt heads with Secretary of State Hillary Clinton, illustrates the state of conflict and chaos in American foreign affairs. A state of chaos so pervasive that incompetence has now become commonplace, and no one can even be found to double check the spelling of a Russian word that is meant to be the theme of American's diplomatic reconstruction with Russia , or to pick out a gift for the visiting British Prime Minister.

The death of Chrysler at the hands of Fiat and the UAW

Meanwhile on the economy, Obama exploited the ongoing bailouts, transforming them from bailouts into takeovers meant to shift the balance of power in what had been a democracy and socially engineer not only corporations, but the lives of ordinary Americans. But the public's patience with corporate bailouts is at an end, most Americans were never happy with them to begin with, and want them to end. The death of Chrysler at the hands of Fiat and the UAW might look like a victory in the union ranks, but it doesn't play too well outside Detroit . And tacking on CAFE standards that will kill the pickup truck and the SUV will badly erode Obama in the swing states, if exploited properly in 2010 and 2012. Despite the constant media barrage, orchestrated out of the White House, the public is growing disenchanted with the performance of Obama and the Democrats.

With unemployment booming and the economy dropping, the jobs aren't there and the spending is out of control. Republicans today are polling better on ethics and the economy, than the Democrats are. That shows a trend which is likely to register in the mid-term elections in 2010, in the same way that the EU parliamentary elections served as a shock to the system.

In the opposition, Republicans are free to embrace the rhetoric of change, to champion reform and push libertarian ideas about the size and scope of government. In turn all Obama has is his celebrity fueled media spectacle world tour. A charade now serving as a parallel to the depression era entertainment that functioned as escapism in a dour time. But before long, it may be Obama that the American public will want to escape from.

A shallow, manipulative and egotistical amateur who is in over his head

Obama has tried to play Lincoln, Reagan, JFK and FDR-- but in the end he can only play himself, a shallow, manipulative and egotistical amateur who is in over his head, and trying to drag the country down with him. Obama's White House is falling down and while the flashbulbs are still glittering and the parties are going on in D.C. and around the world, Obama and the Democratic Congress may be headed for a recession of their own.