Showing posts with label republicans. Show all posts
Showing posts with label republicans. Show all posts
Tuesday, May 10, 2011
Doctor in the House: an interview with author Congressman Michael Burgess, M.D.
When Dr. Michael Burgess gave up delivering babies in favor of kissing them, most physicians thought he was crazy.
After reliving the September 11th World Trade Center nightmare in his head for weeks, the successful obstetrician decided to run for Congress in his Republican district of North Texas against the well-funded and well-named son of then Majority Leader Dick Armey.
Not only did Burgess win, but he has quickly become the thought leader of American medicine in the United States Congress.
In his new best-selling book, Congressman Dr. Burgess retells the story of his first years in the House of Representatives where another nightmare unfolded: the Democratic creation of Obamacare.
His work is entitled Doctor In The House and it contains the prescription necessary to heal the ills of American health care.
In this blog we engage in a spirited discussion with Dr. Burgess. Let us know what you think.
Saturday, March 12, 2011
"docdano. com Live" Protesting in Wisconsin: Is Obamacare at the root of the debate?
I spoke last night to a group of young physicians at a venue across the street from the Wisconsin State Capitol at the height of the protest against the state government.
Amid the drum beats and screams of union organizers chanting how workers' rights would be eternally devastated because of the loss of collective bargaining, I lectured to a group of resident physicians on the benefits that await patients with the explosion in health care technology.
The root of the problem centers around a state, like almost all in the country, that is saddled with loss of tax revenues due to the downturn in the economy. This has resulted in massive budget deficits and hard choices.
Many states including Wisconsin have ushered in a flurry of Republicans who ran on campaigns of no new taxes, the need to cut waste and spending, and more state's rights.
So that's what the Republican Governor did from day one in office.
He first attempted to limit spending on education to trim the budget, but because of collective bargaining the negotiation of this type of decrease in the state spending was not palatable to the unions.
It didn't matter, really, because the Republicans had the votes to pass it anyway.
But instead of voting on this budgetary issue, the Democrats chose to flee to the land of Obama in Illinois to prevent the state legislature from reaching the critical number of votes to make a quorum.
For three weeks this stalled the debate and decision on the issue, until the Republicans decided to pull out the budget issues (which require the quorum) and vote instead on non-budgetary items - like collective bargaining.
So this lead to more protests.
I literally visited with hundreds of people in Wisconsin over the past week and different opinions abound from every direction.
Clearly if you are a member of the "haves" then you have no desire to give up a benefit.
That's normal.
One person told me that his daughter is a unionized teacher and she pays a whopping $23 a month for health care insurance with no deductible. Even if you factor in that there might be some requirements for her to see certain physicians in network or limitations on formulary and specialist access, this is still a bargain.
He went on tell me that the Governor's proposal would have raised this to $123 per month. I don't know if these numbers are accurate, but the change in benefit structure certainly spurred part of the protest that had national attention.
If you've read this blog before, you know that I'm not a fan of the Obamacare bill. And I think you are seeing in Wisconsin one end of the spectrum of the problems with the bill.
Let me show you why.
To pay for the extra benefits offered under the bill (like no pre-existing illness exclusion, limitations on the right of rescission of insurance if you're too sick to be in the plan, or extended coverage for children), then there will have to be either more money (read tax dollars or higher premiums) or a decline in benefits for those that are members of the "haves."
It's really that simple.
State governments who have been charged with implementing many of the provisions of the federal health care bill don't have the ability to print money or sell treasury bonds. Their only source of revenue is tax dollars.
A significant part of Obama's plan was to provide health insurance for "all Americans." And, unfortunately, a large number of the uninsured were to be covered with the under funded, limited access Medicaid system -- much of which is paid for by the states.
Finding revenue for Medicaid means that other state funded services - like education, or health benefits for teachers - have to be cut and shifted.
That is the only possible way to fund insurance for the "have nots."
I've been derided for one of my statements in the past, but I stand by it: the Obamacare health regulation was the largest transfer of wealth in American history.
So the union supported President now finds himself supporting the union backed protesters who are fighting against changes in state government that would be used to pay for the health care bill that he (and the unions) supported.
Wisconsin is only a microcosm of what is happening in every state that is now grappling with implementing the federal health legislation in a time of budget crisis.
It is an expensive bill, and now we are starting to pay the price.
I'm a big fan of expanding health care access and coverage for the "have nots." A country like the United States should be ashamed for having citizens that don't have access to quality health care. I'm just not a supporter of the big, expensive, inefficient and over-reaching federal health care bill that was passed last year.
Let's face it: the bill cost the taxpayers almost $1 trillion.
The payment for the bill is due now.
And lest you think that non-government workers will get a free ride and this is just an issue for state employees - it will filter down to every American.
As health plans shift to include the new benefits, pay the taxes and fees that are now required by the IRS, and see declining membership due to employees shifting to government subsidized insurance products there will no doubt either be an increase in your health care premiums or a reduction in your benefits.
The problem is that for many insured Americans there is no union to fight for your corporate benefits.
It will be left up to you.
One Wisconsin young man told me that maybe the Republicans should have left Congress when the health care bill was passed.
I reminded him that democracy doesn't work this way. We elect people to represent us and sometimes we win, and sometimes we lose.
I think the Obamacare bill is failure, but I believe strongly that we can keep what's good and fix what's broken. We just have to continue the debate, make compromises, and yes, probably make some sacrifices.
So it probably won't be the last protest I'll attend. Maybe next time I'll get to carry a sign...I'm not much of a drum beater.
- Posted using BlogPress from my iPad
Amid the drum beats and screams of union organizers chanting how workers' rights would be eternally devastated because of the loss of collective bargaining, I lectured to a group of resident physicians on the benefits that await patients with the explosion in health care technology.
The root of the problem centers around a state, like almost all in the country, that is saddled with loss of tax revenues due to the downturn in the economy. This has resulted in massive budget deficits and hard choices.
Many states including Wisconsin have ushered in a flurry of Republicans who ran on campaigns of no new taxes, the need to cut waste and spending, and more state's rights.
So that's what the Republican Governor did from day one in office.
He first attempted to limit spending on education to trim the budget, but because of collective bargaining the negotiation of this type of decrease in the state spending was not palatable to the unions.
It didn't matter, really, because the Republicans had the votes to pass it anyway.
But instead of voting on this budgetary issue, the Democrats chose to flee to the land of Obama in Illinois to prevent the state legislature from reaching the critical number of votes to make a quorum.
For three weeks this stalled the debate and decision on the issue, until the Republicans decided to pull out the budget issues (which require the quorum) and vote instead on non-budgetary items - like collective bargaining.
So this lead to more protests.
I literally visited with hundreds of people in Wisconsin over the past week and different opinions abound from every direction.
Clearly if you are a member of the "haves" then you have no desire to give up a benefit.
That's normal.
One person told me that his daughter is a unionized teacher and she pays a whopping $23 a month for health care insurance with no deductible. Even if you factor in that there might be some requirements for her to see certain physicians in network or limitations on formulary and specialist access, this is still a bargain.
He went on tell me that the Governor's proposal would have raised this to $123 per month. I don't know if these numbers are accurate, but the change in benefit structure certainly spurred part of the protest that had national attention.
If you've read this blog before, you know that I'm not a fan of the Obamacare bill. And I think you are seeing in Wisconsin one end of the spectrum of the problems with the bill.
Let me show you why.
To pay for the extra benefits offered under the bill (like no pre-existing illness exclusion, limitations on the right of rescission of insurance if you're too sick to be in the plan, or extended coverage for children), then there will have to be either more money (read tax dollars or higher premiums) or a decline in benefits for those that are members of the "haves."
It's really that simple.
State governments who have been charged with implementing many of the provisions of the federal health care bill don't have the ability to print money or sell treasury bonds. Their only source of revenue is tax dollars.
A significant part of Obama's plan was to provide health insurance for "all Americans." And, unfortunately, a large number of the uninsured were to be covered with the under funded, limited access Medicaid system -- much of which is paid for by the states.
Finding revenue for Medicaid means that other state funded services - like education, or health benefits for teachers - have to be cut and shifted.
That is the only possible way to fund insurance for the "have nots."
I've been derided for one of my statements in the past, but I stand by it: the Obamacare health regulation was the largest transfer of wealth in American history.
So the union supported President now finds himself supporting the union backed protesters who are fighting against changes in state government that would be used to pay for the health care bill that he (and the unions) supported.
Wisconsin is only a microcosm of what is happening in every state that is now grappling with implementing the federal health legislation in a time of budget crisis.
It is an expensive bill, and now we are starting to pay the price.
I'm a big fan of expanding health care access and coverage for the "have nots." A country like the United States should be ashamed for having citizens that don't have access to quality health care. I'm just not a supporter of the big, expensive, inefficient and over-reaching federal health care bill that was passed last year.
Let's face it: the bill cost the taxpayers almost $1 trillion.
The payment for the bill is due now.
And lest you think that non-government workers will get a free ride and this is just an issue for state employees - it will filter down to every American.
As health plans shift to include the new benefits, pay the taxes and fees that are now required by the IRS, and see declining membership due to employees shifting to government subsidized insurance products there will no doubt either be an increase in your health care premiums or a reduction in your benefits.
The problem is that for many insured Americans there is no union to fight for your corporate benefits.
It will be left up to you.
One Wisconsin young man told me that maybe the Republicans should have left Congress when the health care bill was passed.
I reminded him that democracy doesn't work this way. We elect people to represent us and sometimes we win, and sometimes we lose.
I think the Obamacare bill is failure, but I believe strongly that we can keep what's good and fix what's broken. We just have to continue the debate, make compromises, and yes, probably make some sacrifices.
So it probably won't be the last protest I'll attend. Maybe next time I'll get to carry a sign...I'm not much of a drum beater.
- Posted using BlogPress from my iPad
Location:State Capitol, Madison, Wisconsin
Tuesday, February 22, 2011
Re-bamacare: Is health care reform now a problem for Republicans?
The public relations nightmare for the Obama administration's health care plan last year now seems to be a problem for the Republicans.
Republican lawmakers have long wanted more intense reforms of insurance laws that purport to stream line the system, lower cost, and cut out redundancy.
Of course the concern for patients is that the only sure fire way to lower health care costs is to restrict access and therefore lower utilization.
Patient advocates have long been skeptical of Republican promoted health care (read: insurance reforms) because below the surface the bills seem to be reminiscent of old war style cronyism: pandering to the insurance companies and corporate medicine.
True or not, that's not the purpose of my discussion today. This is more about the table turning anti-Obamacare public sentiment that is now being carefully redirected toward these Republican proposals.
Particularly in state legislatures where lawmakers are now struggling to balance state budges with escalating deficits, every possible revenue source or cost cutting move is being critically examined.
On the surface many of these ideas seem plausible -- directly employee physicians so that their prescribing and ordering habits can be controlled.
Given that the most expensive piece of medical equipment in America right now is the pen, this would seem to be on target.
Limit tests or procedures, force the use of quality guidelines and metrics, cross share lab to prevent redundancy, and put physicians smack in the middle of a care management team to increase quality and value for patients.
And to make more money for the corporate entities involved.
The problem is not whether something like these rules need to be implemented -- they do -- the problem is that absent proper oversight and restraint the slippery slope of profits and revenue would suggest that patients might get the short end of the stick.
Just imagine if your physician was told to use a certain drug, a certain provider for a procedure or diagnostic test, a particular institution for your surgery -- your choice would be gone as would that of the physician.
Now certainly we are all going to have give up some health care decision freedom as we move to limit the exponential rise in health care expenditures.
But patients and physicians need the opportunity for some autonomy in the doctor-patient relationship.
Whether it is contractural protections against wrongful termination, protections against adverse hospital decisions, prohibitions against forced admissions, or whistleblower protections, physicians need to maintain some degree of separation from the unintended consequences of corporate America.
Patients need this as well.
What's been fascinating to watch is that in multiple states where Republicans are using the budget shortfall as a steam roller to clear a path for any proposal that seems to save money, the health care changes related to employment and insurance reform seem to be hitting a snag.
Dubbed "____-bamacare" depending on the lawmaker in question, use of this phrase immediately conjures up negative sentiment not only among the public but also among fellow Republicans who might not be so forward educated on the benefits at stake.
This is particularly evident in Texas where Lieutenant Governor David Dewhurst is seeing push back on his proposals to expand corporate control of health care.
From visiting with hundreds of patients its clear that monkeying with anything to do with a patient's health care choices, particularly now in this post-Obamacare sensitivity, is a risky move.
It is likely that good proposals will also potentially fall on the sword with our President's plan.
Patients seem to be tired of government intervention in health care. They recognize the need for changes in the cost, but they are still not convinced that government or big business is in the best position to make these decisions.
They are probably right.
- Posted using BlogPress from my iPad
Republican lawmakers have long wanted more intense reforms of insurance laws that purport to stream line the system, lower cost, and cut out redundancy.
Of course the concern for patients is that the only sure fire way to lower health care costs is to restrict access and therefore lower utilization.
Patient advocates have long been skeptical of Republican promoted health care (read: insurance reforms) because below the surface the bills seem to be reminiscent of old war style cronyism: pandering to the insurance companies and corporate medicine.
True or not, that's not the purpose of my discussion today. This is more about the table turning anti-Obamacare public sentiment that is now being carefully redirected toward these Republican proposals.
Particularly in state legislatures where lawmakers are now struggling to balance state budges with escalating deficits, every possible revenue source or cost cutting move is being critically examined.
On the surface many of these ideas seem plausible -- directly employee physicians so that their prescribing and ordering habits can be controlled.
Given that the most expensive piece of medical equipment in America right now is the pen, this would seem to be on target.
Limit tests or procedures, force the use of quality guidelines and metrics, cross share lab to prevent redundancy, and put physicians smack in the middle of a care management team to increase quality and value for patients.
And to make more money for the corporate entities involved.
The problem is not whether something like these rules need to be implemented -- they do -- the problem is that absent proper oversight and restraint the slippery slope of profits and revenue would suggest that patients might get the short end of the stick.
Just imagine if your physician was told to use a certain drug, a certain provider for a procedure or diagnostic test, a particular institution for your surgery -- your choice would be gone as would that of the physician.
Now certainly we are all going to have give up some health care decision freedom as we move to limit the exponential rise in health care expenditures.
But patients and physicians need the opportunity for some autonomy in the doctor-patient relationship.
Whether it is contractural protections against wrongful termination, protections against adverse hospital decisions, prohibitions against forced admissions, or whistleblower protections, physicians need to maintain some degree of separation from the unintended consequences of corporate America.
Patients need this as well.
What's been fascinating to watch is that in multiple states where Republicans are using the budget shortfall as a steam roller to clear a path for any proposal that seems to save money, the health care changes related to employment and insurance reform seem to be hitting a snag.
Dubbed "____-bamacare" depending on the lawmaker in question, use of this phrase immediately conjures up negative sentiment not only among the public but also among fellow Republicans who might not be so forward educated on the benefits at stake.
This is particularly evident in Texas where Lieutenant Governor David Dewhurst is seeing push back on his proposals to expand corporate control of health care.
From visiting with hundreds of patients its clear that monkeying with anything to do with a patient's health care choices, particularly now in this post-Obamacare sensitivity, is a risky move.
It is likely that good proposals will also potentially fall on the sword with our President's plan.
Patients seem to be tired of government intervention in health care. They recognize the need for changes in the cost, but they are still not convinced that government or big business is in the best position to make these decisions.
They are probably right.
- Posted using BlogPress from my iPad
Location:Jacksonville, Florida
Friday, November 5, 2010
Dear Santa: I want a Medicare fix
Well it's that time of year again.
No, not Thanksgiving or Christmas, or even the venerable Interim Meeting of the AMA. It's the time that physicians nationwide anticipate another mandatory cut in Medicare reimbursement rates.
This time the recurrent temporary fix will result in a cut of 23.6 percent on December 1st. Assuming political gridlock the rate will fall another fraction of 6.5 percent on January 1.
History dictates that there will be lobbying, bluffing, puffing and even some "take my toys and go to my room" childish attitude but in the end Congress will create another "fix". In the past this has been to stabilize payment rates to a Victorian-era fee schedule (ok, 1997 or so) and set up an expiration schedule that again is measured in months.
But this year might be different. Or, at least it threatens to be.
American voters stampeded to the polls to vote out the status quo in favor of a new Republican House and a "lack of cloture" Democratically impotent Senate. Many of these new Republicans campaigned on the promise of fiscal responsibility (read: make the Bush tax cuts permanent and curb spending, including entitlement programs).
The Republicans have as a group pledged to cut $100 billion in January.
Now enter the AMA.
This association is again lobbying for a fix -- though now it is not the "permanent fix" but rather a tempered 13-month patch to give physicians at least a year to worry until the next SGR induced armageddon.
But will this new Congress support the AMA proposal? I don't think so.
Rumors abound to the cost of the AMA idea but it ranges between $17 billion to upwards of $20 billion. I'm certainly not an insider, but a new Republican congressman might find it challenging to explain to those tea party goers about why one of his first actions was to vote to support a double digit entitlement extension.
The other options are also mind stretching.
The lame duck Democratic controlled body could pass a 1 month extension and leave it up to the Republicans to spend the money in 2011. Or, they could use the pout strategy and just grind out the final month with the cut in place with Medicare physicians having to deal with a very arduous Christmas present.
So what will happen? It's anybody's guess but a likely outcome will be a compromise of sorts.
It would be fairly easy to disguise a three or four month fix as part of a January revenue bill to add some permanence to the Bush era tax cuts. This would of course create another type of March Madness, but it also would only cost a minuscule five or six billion. Chump change.
There is the issue of raising the debt ceiling that will have to survive a potential Senate filibuster by one of our new freshman Kentucky senators who will be calling for a balanced federal budget. This ophthalmologist turned tea drinker may not see eye to eye with adding more money to a spending bill -- even if it would be good for patients.
But no one said it would be easy.
- Posted using BlogPress from my iPad
No, not Thanksgiving or Christmas, or even the venerable Interim Meeting of the AMA. It's the time that physicians nationwide anticipate another mandatory cut in Medicare reimbursement rates.
This time the recurrent temporary fix will result in a cut of 23.6 percent on December 1st. Assuming political gridlock the rate will fall another fraction of 6.5 percent on January 1.
History dictates that there will be lobbying, bluffing, puffing and even some "take my toys and go to my room" childish attitude but in the end Congress will create another "fix". In the past this has been to stabilize payment rates to a Victorian-era fee schedule (ok, 1997 or so) and set up an expiration schedule that again is measured in months.
But this year might be different. Or, at least it threatens to be.
American voters stampeded to the polls to vote out the status quo in favor of a new Republican House and a "lack of cloture" Democratically impotent Senate. Many of these new Republicans campaigned on the promise of fiscal responsibility (read: make the Bush tax cuts permanent and curb spending, including entitlement programs).
The Republicans have as a group pledged to cut $100 billion in January.
Now enter the AMA.
This association is again lobbying for a fix -- though now it is not the "permanent fix" but rather a tempered 13-month patch to give physicians at least a year to worry until the next SGR induced armageddon.
But will this new Congress support the AMA proposal? I don't think so.
Rumors abound to the cost of the AMA idea but it ranges between $17 billion to upwards of $20 billion. I'm certainly not an insider, but a new Republican congressman might find it challenging to explain to those tea party goers about why one of his first actions was to vote to support a double digit entitlement extension.
The other options are also mind stretching.
The lame duck Democratic controlled body could pass a 1 month extension and leave it up to the Republicans to spend the money in 2011. Or, they could use the pout strategy and just grind out the final month with the cut in place with Medicare physicians having to deal with a very arduous Christmas present.
So what will happen? It's anybody's guess but a likely outcome will be a compromise of sorts.
It would be fairly easy to disguise a three or four month fix as part of a January revenue bill to add some permanence to the Bush era tax cuts. This would of course create another type of March Madness, but it also would only cost a minuscule five or six billion. Chump change.
There is the issue of raising the debt ceiling that will have to survive a potential Senate filibuster by one of our new freshman Kentucky senators who will be calling for a balanced federal budget. This ophthalmologist turned tea drinker may not see eye to eye with adding more money to a spending bill -- even if it would be good for patients.
But no one said it would be easy.
- Posted using BlogPress from my iPad
Location:37,000 feet over Arizona
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