By Elizabeth Lee Vliet, M.D.

Egypt’s crisis has raised alarms about national security and economic impact for Americans if regime change leads to an anti-US government controlling a strong ally in the Middle East. This crisis raises another more personal concern for Americans that has been overlooked by the national media: the security and availability of your electronic medical records in the event of a government-imposed “kill switch” for the Internet.

Many Americans still do not know that hidden in the February 2009 American Recovery and Reinvestment Act, known as the “Stimulus” bill, was a provision that by 2014, physicians, hospitals, and other medical settings are to implement electronic medical records keeping systems. In 2015, penalties will be levied against physicians and health care facilities that do not implement use of electronic medical records.

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By George Watson, D.O.,  

Virginia Attorney General, Kenneth T. Cuccinelli, II, said, “It is a great day for the Constitution. This case is not about health insurance. It is not about healthcare. It’s about liberty.” 

In Commonwealth of Virginia v. Kathleen Sebelius, Judge Henry E Hudson found that Congress cannot expand the Commerce Clause of the U.S. Constitution to force people to buy a product.  

We the People could not agree more with Attorney General Cuccinelli that “this case is not about…healthcare.” Judge Hudson, on the first page of his opinion refers to “the health care scheme adopted by Congress in the Patient Protection and Affordable Care Act.” 

It is a scheme to grab control of medical care and the $2.4 trillion spent in delivering and receiving medical care, under the guise of helping the uninsured (by forcing insurers to sell coverage for pre-existing conditions without “discriminatory” premiums based on medical history). It is a scheme by greedy politicians looking for more CONTROL over everyone’s liberty. 

The very name of the act itself is a case of government fraud of the first degree. There will be no Patient Protection, as your records will be sent to the government, and we know how careful the government is to prevent Wikileaks. 

Affordable Care Act is another fraud by this President and his minions, Pelosi and Reid.  Instead of honestly dealing with the problems, they have manipulated the whole process as they try to dictate their socialist agenda to every citizen. They have used bribes of money for computers as bait to catch unthinking doctors who will, to receive paltry bonuses, turn over your most private health information to the bureaucrats. They have placed mandates on the States that will lead to bankruptcy of the States if they don’t restrict care, which means it will not be Affordable and you will not receive Care. But it is an Act. They “act” as though they are really concerned about you, but they use a legitimate problem to further their illegitimate deeds. 

Health and Human Services Secretary Sebelius stated, “The Act is an important, but incremental, advance that builds on prior reforms of the interstate health insurance market over the last 35 years.” She “points to congressional findings that the insurance industry has failed to take corrective action to eliminate barriers which prevent millions of Americans from obtaining affordable insurance.” But it is the government that creates the barriers! She should know. She spent 11 years as executive director and chief lobbyist for the Kansas Trial Lawyers, then 8 years as a state representative and 8 years as state insurance commissioner, before being elected governor of Kansas. 

Sebelius knows that we don’t need tens of thousands of pages of implementing rules for the twenty three hundred-page “Act.” She knows that rescinding laws that favor insurance companies over their subscribers and doctors would be faster and less costly—except for the congressmen who accept the “donations” from the insurance companies’ lobbyists. She had eight years as Kansas insurance commissioner to stand up for the people. But that was not her agenda. 

In Sebelius’s argument for the individual mandate (“minimum essential coverage”), she promotes “the notion that an individual’s decision not to purchase health insurance is in effect “economic activity.” She insists that “the Minimum Essential Coverage Provision is a necessary measure to ensure the success of its larger reforms of the interstate health insurance market.” All that We the People desire is the option to purchase insurance across state lines. 

Judge Hudson said the Minimum Essential Coverage “penalty lacks logical limitation as it could apply to transportation, housing or nutritional decisions.” And he said, “Salutatory goals and creative drafting have never been sufficient to offset an absence of enumerated powers.”  

We the People thank you, Judge Hudson, for protecting our Constitutional liberty!

Dr. George Watson, Past-President of the Association of American Physicians, practiced traditional-insurance-based osteopathic family medicine for 23 years. In 2003, he canceled all insurance contracts and OPTED OUT of Medicare. He continues to work 100% for the patients--not the insurance companies. He has been a member of the Board of Directors of the AAPS since 2006. Dr. Watson is an outspoken advocate for the practice of private medicine, the patient-doctor direct model. He has been interviewed by Fox News Channel and multiple networks. Dr. Watson has spoken at numerous Tea Parties and has recently testified in State of Kansas Senate hearings on amendments to the state constitution to reaffirm the 10th Amendment of the U.S. Constitution and an amendment to affirm Health Care Freedom for all Kansans. Additional information on Dr. Watson: Before medical school, George Watson, D.O., was an Air Force officer winning the Husik Trophy in Navigator Training and Air Medal with oak leaf clusters for combat missions in Vietnam in the F-4 Phantom. During medical school, at Kansas City University of Medicine and Biosciences, he completed the Air Force Flight Surgeons Course with honors, later serving in the 184th Fighter Group in F-16's.

By:  Alieta Eck, MD 

Will you trust the government to keep all of your personal medical information private and are they even capable of this? With Wikileaks, a master hacker was able to bribe a disgruntled government worker to help him access millions of very sensitive documents and e-mails and send them into cyberspace for all to see.  So if top-secret documents are now accessible to unauthorized viewers, what would stop this same hacker from putting all of your personal medical records out there? 

In ObamaCare, the federal government is offering every physician $44,000 in taxpayer dollars to set up a new electronic medical record system. And if this is not enough of an incentive, Medicare is threatening to cut doctors’ pay in the next few years if they do not sell out their patients’ privacy. One of the specifications will be that these records be accessible online to “authorized users,” most notably the government. We are promised very strict privacy measures so that the records can never fall into the wrong hands. Oh, really? 

In 1996 the federal bureaucracy unveiled the Health Insurance Portability and Accountability Act, commonly known as HIPAA. By 2003, all of our patients had to sign forms certifying that they knew of the “privacy measures” used by our office. Pharmacies had to set up stand-back lines where the next patient would not overhear the sensitive discussion on how to take one’s antibiotics or high blood pressure medicines. Charts in our office were to be placed face down so passersby could not see who was visiting the doctor. We were all supposed to feel more confident that our government made rules for very good reasons. 

So why does the government want to see your medical records? Might it be planning to limit your care once you reach a certain age or develop a certain level of mental deficiency? Knowledge of recent history suggests that governments can use such information to blackmail and smear those considered troublemakers or enemies of the state. Now it is offering to pay for access, but later the government could make your doctor’s license to practice medicine dependent on complying with the EMR mandate. History tells us it is not a good thing when a government has total control of physicians. 

Medical students are taught to ask whether there is a gun in the house, ostensibly to use this as a way to remind parents to keep them out of the reach of children. But now this will be part of the medical record that goes online, and hackers might be able to use this information to target certain families. The possibilities are endless. Information is power– the power to do good but also the power to destroy.  

Are all electronic medical records bad? No. I am a great proponent of EMRs when they are confined to my office or a hospital. They help me organize the information I need to better care for my patients. 

The listing of current medicines is easy to keep up to date and I can always go back to find out why I stopped others. I can see at a glance what operations my patient had and when. I can look at the family history to be extra vigilant lest my patient be susceptible to the same illnesses. But can doctors practice good medicine with the old-fashioned paper charts? Of course they can. They just must be allowed to use what works best for them. 

I took the Oath of Hippocrates which states I will keep the conversations between myself and my patient private. Accordingly, my electronic medical records will never go online. They are confined to a server right in my office and the privacy of my patients is fully protected. 

Do not depend on the government to protect your medical records. Under ObamaCare, the government seeks the right to mine your most private information just as it wants to peer under your clothing in the airport.  This is another important reason why ObamaCare must be repealed.

Alieta Eck, M.D. graduated from the Rutgers College of Pharmacy in NJ and the St. Louis School of Medicine in St. Louis, MO. She studied Internal Medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ and has been in private practice with her husband, Dr. John Eck, MD in Piscataway, NJ since 1988. She has been involved in health care reform since residency and is convinced that the government is a poor provider of medical care. She testified before the Joint Economic Committee of the US Congress in 2004 about better ways to deliver health care in the United States. In 2003, she and her husband founded the Zarephath Health Center, a free clinic for the poor and uninsured that currently cares for 300-400 patients per month utilizing the donated services of volunteer physicians and nurses.  Dr. Eck is a long time member of the Christian Medical Dental Association and in 2009 joined the board of the Association of American Physicians and Surgeons. In addition, she serves on the board of Christian Care Medi-Share, a faith based medical cost sharing Ministry. She is a member of Zarephath Christian Church and she and her husband have five children, one in medical school in NJ.

 By Elizabeth Lee Vliet, M.D. 

By:  Richard Amerling, M.D., 

The landslide Republican victory, in taking the House and electing some strong conservatives to the Senate, can be interpreted as a mandate to rein in government spending, and specifically to repeal ObamaCare, as these issues were clearly behind the large turnout.  There is still a very real possibility the Supreme Court will find the “individual mandate” to buy private insurance unconstitutional.  If this provision is thrown out, it’s hard to see how the law survives, since the mandate is needed to finance it. 

Now is an excellent time to construct a conservative alternative vision for true reform of our health care delivery system.  Since most current problems with the health care system stem from government, a conservative plan should seek to reduce its role. 

It goes without saying that the Patient Protection and Affordable Care Act must be repealed since, like all the laws passed by this administration, it does precisely the opposite of what its name suggests.   By massively increasing the health care bureaucracy at the expense of actual providers of care, it will make care harder to access and more expensive.   Many physicians will take early retirement and the already great physician shortage will be exacerbated.  

The law is too large and complex to waste time foraging for items to salvage.  There is a great risk of leaving behind hidden mandates and rules that will be harmful.  Better to scrap the whole thing.  With Democrat Senators running scared for their jobs in 2012, it is conceivable the Senate would also vote for repeal (Harry Reid notwithstanding).  But not even the most generous view of Barack Obama’s ideological flexibility has him signing a repeal bill, and a veto override is out of the question for now. 

It may be possible, however, to enact affirmative measures that make ObamaCare irrelevant.  Here are some common sense, free market proposals, many of which were proposed and discussed, but ignored by the President and the Congressional leadership in the run-up to passage of ObamaCare.

1. Transfer the tax deduction for health care spending from employers to individuals. This would end the absurdity of purchasing health insurance at the “company store,” a practice that limits individual choice and liberty, nourishes a sense of dependency, and promotes overuse of care.  This policy, an accident of WW II wage and price controls, was the “original sin” in health care financing; doing away with it would empower consumers to shop for the best plan for their families, which will lower premiums.

2.  Remove barriers to the interstate sale of health insurance.   There is broad agreement on this proposition.  It would increase choice and competition between insurers and drive down premiums by effectively ending state mandates that drive them up. 

3. Deregulate and allow greater contributions to Health Savings Accounts.  These fabulous tax shelters give individuals more control over their health spending, and, coupled with an inexpensive policy to cover catastrophic illness (i.e., true insurance), are all most people need.  By returning most health care purchasing decisions to consumers, spending will immediately be slowed and prices curbed.   This is the conservative, free market, already tested and proven way to “bend the cost curve down.” 

4. Follow the recommendations of the bipartisan Breaux Commission and give Medicare beneficiaries a means-tested stipend to buy private insurance.  This solution came during the Clinton era but was too free-market to pass muster with Bill and Hillary.  With Medicare moments from insolvency, there should again be a bipartisan consensus to reform this behemoth.

5. Transfer (gradually) all Medicaid responsibility to the states.  Federal support for Medicaid allows much greater spending than would otherwise occur.  It forces frugal states to subsidize lavish coverage in New York, California, and elsewhere.  States should have complete freedom to organize their Medicaid systems along their own priorities, in exchange for losing, over perhaps five years, the federal subsidy.  This would encourage states to find innovative ways of providing health insurance for the poor, such as individual health accounts, or subsidies to buy private insurance.

The latter two points would allow the mammoth Center for Medicare and Medicaid Services to be mothballed, though Medicare could retain a role as insurer of last resort for those with pre-existing, expensive, chronic diseases.

6. Institute a “loser pays” system for medical malpractice to cut frivolous lawsuits.  The ability to launch a lawsuit (and this applies beyond medical malpractice) with minimal financial risk is the reason behind the explosion of malpractice litigation, with all the associated costs.  Tort reform at the federal level would require the Senate to override the trial lawyers’ veto, which could be a problem.  This reform should be pushed at the state level.

7. Finally, for true patient protection, let’s propose a constitutional amendment to guarantee the individual’s right to privately contract for medical care.  This will eliminate for all time the threat to the private practice of medicine and assure that, no matter what system is in place, patients will always be allowed to spend their own money on care.

The above points are clear, simple and practical solutions. They empower the individual and greatly reduce malignant government influence and unburden the taxpayer.  It is the conservative way forward on health care.

---

Richard Amerling, MD is a nephrologist practicing in New York City.  He is an Associate Professor of clinical medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center.  Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981.  He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania.  He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).

ObamaCare is a wildly unpopular law for anyone who knows anything about healthcare.  The election proved that.  Physicians came together in Washington, DC to film the following national ad:

Perhaps it is time for the politicians to admit that the government cannot provide health care.  Period.  All government can do is set up an administrative scheme that pays many people to decide who qualifies for which government program, gives out entitlement “insurance” cards, but then underpays for the actual care.  Bureaucrats get paid while physicians do not.  Taxpayers get fleeced.

Before 1965, the administrative costs in a doctor’s office were negligible, especially when it came to caring for the poor. Typically the doctor would not even bother to write out a bill.  For the average patient, the doctor charged a reasonable fee and if the patient had insurance, it was his job to get reimbursed.  People bought “hospitalization” insurance policies.

Today the poor seek Medicaid– the huge federal/state program that entitles the recipient to “free,” care. But since the physicians must fill out forms only to be given a fraction of a reasonable fee several months later, most refuse to take Medicaid at all. So Medicaid recipients with sore throats inappropriately clog up the emergency rooms with twice the frequency of the uninsured.  The system is expensive for taxpayers, demeaning to patients and generally unworkable.

An innovative solution to our health care crisis would involve several layers of care. 

The first layer could involve the average person paying his doctor directly for services rendered.  Paperwork would be minimal, patient-physician confidentiality would be maintained, and prices would be kept down by simple competition.  Living healthy lifestyles would save money.

A second layer would be personally obtained, non-cancelable health insurance for unforeseen major medical maladies and accidents. These policies should have the coverage and deductible that fit a family budget. The states should merely oversee that the contract terms are met, but not mandate what is to be covered.

Thirdly, safety net non-governmental charity clinics could to be scattered throughout every county in every state with each clinic deciding ways to determining the eligibility of those seeking the free care. 

The Zarephath Health Center was started in central New Jersey in 2003 and uses volunteer physicians and nurses to provide free care to the poor.  Patients include the homeless, the mentally ill, the jobless, the undocumented immigrants and even patients with Medicaid cards.  Physicians there diagnose and care for patients with acute and chronic illnesses.  The patients are treated with kindness by those who are willing to donate their time, and currently 300-400 patients get free care each month.

The cost to provide services at the ZHC comes to $15 per patient visit compared to $150 per patient visit at the federally qualified clinic in the neighboring town. The latter clinic has huge bureaucratic administrative overhead and collects funds from the federal and state governments and the patients.  They are constantly asking government for more money.

The Federal Tort Claims Act of 1996 provides free medical malpractice coverage for professionals who volunteer at any free clinic. Freed from the specter of frivolous lawsuits, the physician can offer common sense care leaving compliance up to the patients.

Why not devise a similar plan with state rather than federal government involvement?
We could set up a system where the physicians donate, say, four hours per week in free care.  A surgeon might agree to take on one charity case per week.  Then, to compensate the professionals who donate their time and expertise, each state could agree to provide full medical malpractice coverage for their entire practice.  Such coverage is already provided for physicians who work or teach in medical school university hospitals. The state would not be laying out money for medical malpractice insurance, but just agree to pay the costs of litigation and payouts.

The result?  Poor patients would get care.  Physicians would be rewarded with lower office overhead, not having to pay expensive medical malpractice premiums.  Taxpayers would not have to fund the enormous Medicaid bureaucracy or payments for actual office-based care to the poor.  Unnecessary defensive medical tests would be eliminated causing health insurance premiums to drop for everyone. The number of lawsuits would diminish.

It is time to think “outside the box,” come up with workable solutions, and lower the cost of healthcare for all.  President Obama said he is willing to entertain any reasonable proposals. Let’s start the discussion.  Charity care and tort reform– perfect together!
__________________________________________________________________________________________________________________________________________
 
Dr. Alieta Eck, MD graduated from the Rutgers College of Pharmacy in NJ and the St. Louis School of Medicine in St. Louis, MO. She studied Internal Medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ and has been in private practice with her husband, Dr. John Eck, MD in Piscataway, NJ since 1988. She has been involved in health care reform since residency and is convinced that the government is a poor provider of medical care. She testified before the Joint Economic Committee of the US Congress in 2004 about better ways to deliver health care in the United States. In 2003, she and her husband founded the Zarephath Health Center, a free clinic for the poor and uninsured that currently cares for 300-400 patients per month utilizing the donated services of volunteer physicians and nurses.  Dr. Eck is a long time member of the Christian Medical Dental Association and in 2009 joined the board of the Association of American Physicians and Surgeons. In addition, she serves on the board of Christian Care Medi-Share, a faith based medical cost sharing Ministry. She is a member of Zarephath Christian Church and she and her husband have five children, one in medical school in NJ.

By : Jane M. Orient, M.D.

Many of the issues swirling around before this election are mere distractions. At its center is the giant power struggle between the ruling elite and productive Americans.

The appealing message from our rulers is “empowerment.” But this does not mean empowerment of the uninsured, the unemployed, food stamp recipients, illegal aliens, and other needy persons. It means consolidation of power at the top, and the disempowerment of any potential rivals: successful industries, prosperous professionals, even small businesses that are still solvent and independent. Like small doctors’ practices.

Giving people a handout instead of a hand up never makes them stronger. It makes them more dependent, and turns them into an army of pawns who can be counted on to do the will of those who feed them. They reliably vote for their supposed benefactors. And some of them also register illegals to vote, disrupt town halls or tea parties, key cars displaying signs for challengers, steal campaign signs, disseminate slander, and try to intimidate people. If things get really bad, they could become an army of rioters, looters, and worse.

The productive Americans who work every day, mind their own business, take care of their families, obey the law, and make the country function are being bled through redistributive taxes, which primarily benefit those who will soon be strong enough to trample their liberties and reduce them to poverty. The tax donors will have to cooperate with the rulers, and censor their own protests—or else.

NPR sent a message through Juan Williams. If they can do it to someone with an audience as large as his, nobody is safe from the thought police.

Nowhere is the threat to professionals and those whom they serve more apparent than in ObamaCare—if you read the actual law and not the glossy flyers sent by Medicare at taxpayer expense.

The requirements of the law are so costly and onerous that most physicians, if they continue to practice at all, will be forced into “accountable care organizations.” Accountable to whom? To the System, that is to the elite “decisionmakers.” Accountable for what? For reducing “costs” (that means spending on medical care), and for implementing “best practices.”

The first target is the “elderly” (those over the age of 65), and others who might be near the “end of life,” since that is where most of the medical money goes. Not incidentally, judging by the crowd at tea parties, older Americans can also be a problem just because they know something of American history and have lived most of their lives in a free society.

We have heard that ObamaCare is funded partly by redistributing Medicare “savings” of some $500 billion over 10 years. This is less than half a truth. If the 10-year period starts with full implementation in 2014 rather than in 2010, the amount is $800 billion, states Peter Ferrara in his book The Obamacare Disaster. And over the first 20 years of implementation, the amount rises to nearly $3 trillion.

ObamaCare advocates claim they can do this by cutting out the 30 percent of services that are “unnecessary,” as determined by them. A knee replacement, for example, probably doesn’t save your life—it is not “necessary” to be able to walk or to be pain free. And it will also cut out “fraud”—which increasingly is defined to include “unnecessary” services, as well as those coded incorrectly or not meeting the established “standard of care.”

There are no death panels. And no euthanasia.  In fact, the law takes care to specify that physicians and institutions are protected against discrimination or retaliation for refusing to participate in physician-assisted suicide.

However, this protection explicitly does not extend to refusal to participate in overmedication or withdrawal of treatment or food and water. More ominously, we already see state laws proposed to immunize physicians from criminal or civil liability, or discipline for carrying out the terms of a POLST form (Physician Orders for Life-Sustaining Treatment), though they may be disciplined for failure to do so.

Keep in mind that these days “life-sustaining treatment” includes food and water, especially if “artificially” administered, say because the patient is too heavily medicated to be able to swallow. Such “palliative sedation” is a new subject for discussion in the medical journals that have been advocating Obama-style “reform” for decades. No, the sedative doesn’t kill the patient—it just keeps her more comfortable while she is dehydrating, and also keeps her from taking deep breaths or moving around.

So within two weeks she is dead—if not from the underlying disease, then from dehydration, or the pneumonia or blood clots resulting from immobility.

It’s not a very long stretch to envision doctors being prosecuted for failing to carry out patients’ alleged wishes for early death through sedated dehydration.

Before it comes to that, doctors will just be co-opted into the System, or marginalized as being “greedy,” “disruptive,” or “paranoid” if they insist on following the Oath of Hippocrates.

In the days just before the election, incumbents are desperate. They will do anything to prevent reasoned debate on the central issue of where America is headed—toward the consolidation of central government power. They may even admit to minor errors and promise to “tweak” fundamentally flawed laws like ObamaCare. Look for a blitz of attack ads, false accusations, and outright election fraud.

“Reformers” talk a lot about “fragmentation”—of things like medical care. Their real fear is fragmentation of their power. That’s what a thorough housecleaning this election would mean. It would give Americans who believe in our founding principles a chance to take back our country.

Failure to seize this opportunity probably spells the death of freedom–and literal death, for the most vulnerable first.

Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University of Arizona College of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943. Complete curriculum vitae posted at www.drjaneorient.com.

By Elizabeth Lee Vliet, M.D.
 
ObamaCare’s promises to cut costs really mean cutting care, especially expensive cancer care, which often occurs at what will soon be the “end of life.” America’s leading position in cancer care will fall off a cliff, taking your life with it.
 
The “changes” to be forced on us starting in 2013 do not provide “hope.” For cancer patients, ObamaCare’s “change” is a drastic threat to your survival.
 
ObamaCare deals a body blow to our state of the art cancer treatment. Multiple “hits” in the healthcare bill include: (1) Medicare fee cuts to cancer specialists, resulting in payments that may be below the cost of staying in business; (2) cutbacks in coverage for the screening tests that pick up early cancers, such as prostate specific antigen (PSA), mammograms, Pap smears, and colonoscopies; (3) onerous and costly government mandates and regulations, interfering in physician-patient decisions for allowed treatments; (4) de-labeling (i.e., disapproving) some cancer drugs to save money, already started with Avastin for aggressive late stage breast cancer, and (5) denials of life-saving treatments, copying the UK’s National Health Service rationing board (Dr. Donald Berwick’s stated goal). The UK rationing board (N.I.C.E.) now denies many new cancer drugs for leukemia, multiple myeloma, stomach, lung, breast and prostate cancers.
 
Other ObamaCare hits to cancer care: new taxes on medical devices and drugs for state of the art treatment; reduced approvals for and delays in access to diagnostic MRIs and CT scans; and a projected doctor shortage of 91,000 in ten years according to the American Association of Medical Colleges, and as high as 200,000 estimated by Merritt, Hawkins and Associates.
 
Adding a further knock out punch: the worst newly created ObamaCare feature–the Independent Payment Advisory Board.  IPAB sets up government appointed experts mandated to control your medical care. This new IPAB subverts our normal appeal and review process because this government panel is completely independent and not subject to review by Congress, judges, or medical experts.  Under ObamaCare rules, decisions of the IPAB cannot be overturned or appealed.
 
IPAB is structured to keep their decisions isolated from our ability as patients and physicians to influence them or to have a voice in our medical treatment.
 
Even more diabolical, the ObamaCare bill restricts the right of future Congresses to amend or appeal this legislation.  There is only a short two-week window of time in late January 2017 during which this board could be discontinued, and only with a supermajority vote in Congress.  It is unprecedented to have such an attempt to restrict future Congressional decisions.
 
It is an ugly picture.  Government panels focused on cutting costs instead of saving lives when the USPHS Task Force recommended cutting back mammograms for women in the fall of 2009.   Their reduced screening recommendation was not based on new medical information.  It was based on cost analysis.  They admitted we saved more lives by starting to screen women with mammograms at age 40, but it cost more to save those lives.  Your life became a number for the bean counters. 
 
The outcry from women’s groups, cancer specialists, radiologists and other physicians resulted in political pressure that stopped that change.  But will we be able to stop it again as costs mount and the new head of Medicare and Medicaid, Dr. Donald Berwick, pushes forward with his stated goal of “rationing with our eyes open”?
 
Be very clear:  ObamaCare cutbacks will affect the quality and timeliness of your cancer care. Ironically and in a cruel twist, it is YOUR taxpayer money being “saved” by rationing YOUR care. 
 
The political elite, however, including members of Congress, who voted for this monstrosity, will continue to have rapid access to the best diagnostic and treatment options, as has always happened with government-run medicine.  You suffer the effects of rationing and cutbacks.  The political elite do not. 
 
Which will you choose?
(1)   ObamaCare promises of “free” healthcare like Canada and Britain…with a shorter life?
Or
(2)    You and your doctor keeping the right to decide on life-saving cancer treatment, free of government control…and with it a chance to live longer?
 
In the United States, we now have a 92% survival rate for prostate cancer vs. the UK’s 51%; a 35% longer survival rate for colon cancer compared with the British; a 25% longer survival for breast cancer than European women; and 50% of the new cancer drugs launched in the last decade. Men in the United States have a 66% survival for sixteen different types of cancer. In Europe, the survival is 47% for the same sixteen cancers. Americans enjoy a 90% survival for five cancers: prostate, breast, thyroid, testicular and melanoma.  In Europe, only one cancer in one country has a 90% survival rate (testicular) (France) has a 90% survival rate. World leaders frequently come here for their cancer treatment.
 
Do you want “change” to mean a higher cancer death rate and lower survival?
 
On November 2, you decide.

Elizabeth Lee Vliet, M.D. is a women’s health specialist who received her M.D. degree and internship in Internal Medicine at Eastern Virginia Medical School, then completed specialty training at Johns Hopkins School of Medicine. She received B.S. and M.Ed. degrees from The College of William and Mary in Virginia. Dr. Vliet is the 2007 recipient of The Voice of Women award from the Arizona Foundation for Women in recognition of her pioneering advocacy for the overlooked hormone connections in women’s health. Dr. Vliet’s books include: It’s My Ovaries, Stupid!; Screaming To Be Heard: Hormonal Connections Women Suspect– And Doctors STILL Ignore; Women, Weight and Hormones; The Savvy Woman’s Guide to PCOS.Dr. Vliet is a seasoned expert commentator and a passionate fighter against government takeover of health care in the proposed Health Care “Reform” that seeks to eliminate or penalize private options. Dr. Vliet’s educational medical website is www.herplace.com. Doctor Vliet has been speaking to the healthcare reform issue on many National TV and Cable Networks, including Stuart Varney, Neil Cavuto, Fox & Friends, as well as, many major syndicated radio shows. For more information on healthcare reform, Dr. Vliet suggests two patient advocate Web sites on healthcare: www.JoinPatientsFirst.com, www.PatientsUnitedNow.com. 

Peter DeFazio, 12-term progressive incumbent in heavily Democratic Oregon, was supposed to have safe seat—until scientist Art Robinson put his life on hold to run for Congress and try to restore American freedom.

DeFazio refuses to debate his basic political principles or to defend his record in Congress, other than to boast of earmark projects he got for Oregon or to brag about the rare occasions on which he cast votes opposed to Democrat leadership. He trumpets the extra money he wangled for Oregon doctors, apparently the price of his vote, but won’t say how much other Americans will pay in higher premiums and taxes, or reduced access to medical care.

His campaign strategy is to attack his opponent Art Robinson. He evades one-on-one confrontation with his opponent, reasoned argument, or unscreened questions from his constituents. The four events at which he agreed to appear with Dr. Robinson were carefully choreographed to limit time severely, making full discussion of any issue impossible. Questions had to be screened and asked by the moderator, and questions not asked were destroyed (none of my three questions were asked).

From attending the two Oct 18 forums—at one I was behind an air wall with 300 Robinson supporters who were kept out—and looking at the smear websites, here is my take on DeFazio’s assertions and methodology.



AAPS signed on with 20 other groups to urge against “unneccessary rulemaking” for Dextromethorphan cough medicines.  Download PDF file of the letter.

The coalition letter reads:

Drug Safety and Risk Management Advisory Committee
Re: Advisory Hearing Regarding Dextromethorphan on September 14, 2010

Dear Committee Member,

We write on behalf of millions of taxpayers and concerned citizens represented by our organizations regarding a forthcoming hearing on cough medicines containing Dextromethorphan. The hearing could lead to an unnecessary rulemaking process that would require prescriptions for medications containing this ingredient. This would increase costs and limit accessibility for consumers and expand the regulatory regime to address a relatively narrow concern.

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By: Jane M. Orient, M.D.

Before passage, Democrats were urged to vote for ObamaCare as a smart political move. In time, they thought, people would come to love the new benefits. “Good policy is good politics,” Obama said.

Now, a lead Wall Street Journal editorial queries: “Who’s ObamaCare’s Daddy?” As people find out what’s in the bill, Families USA advises a new message: The bill isn’t perfect, but we’ll improve it. Forget about the extravagant claims of reducing medical costs and the federal deficit: “Keep claims small and credible.”

None of the left-wing groups that pushed for passage are doting on the baby or sending out pictures. Electioneering politicians aren’t bragging about their authorship of “historic” legislation.

At our county medical society, there’s a mood of impassive resignation. The society is making a deal with a business group to help doctors survive—and to help the society slow the loss of disenchanted members. There’s no applause for the AMA’s endorsement of the bill.

Small medical practices won’t be able to afford the crushing new “compliance” requirements, say the society’s leaders. They have 3 years to figure out what they are going to do. The alternative to closing or merging is, in this view, to outsource responsibility for studying the new rules, collecting the documentation, and filing reports. (Declaring independence from the system hasn’t occurred to them yet.)

Patients have no cause to celebrate either. Sure, more people will be covered—by Medicaid and by unemployment benefits. As employers look at the cost of “minimum essential coverage” or penalties such as $3,000 per employee if any worker qualifies for subsidies, there will be fewer hires and more pink slips. Especially around the thresholds of the 201st, 101st, or 51st employee, where new requirements based on “bigness” kick in.

Small businesses may have been excited about the 35% tax credits touted on a postcard sent at taxpayer expense. But if they did the math or used the National Federation for Independent Business internet calculator, they probably figured out that they didn’t qualify.

States might be glad that they too got the “Cornhusker Kickback” reportedly used to buy Sen. Ben Nelson’s vote. The federal government will foot the bill for the swollen Medicaid rolls—until 2016. Meanwhile, they’ll lose the premium taxes on people crowded out of private plans and onto Medicaid—taxes that now fund up to one-third of that program. They’ll also have new demands on already strained or broken budgets, such as the requirement to monitor insurance premium increases or to set up insurance exchanges.

Dr. Orient's annotated copy of ObamaCare.In reading the 906 pages of statutory language, in order to write an article entitled “ObamaCare: What’s in It?” for the fall 2010 issue of the Journal of American Physicians and Surgeons, I used colored sticky notes for the various features of the bill: taxes, regulations, punishments, favors to special-interest groups, and social engineering. There are no “patient protections” and nothing that makes care more affordable. There are only ways of shifting the increased costs to other people or taxpayers.

Features that most Americans will hate include billions of new tax reporting forms (including 1099s for the sandwich shop), more crowded emergency rooms, fewer available doctors, loss of medical privacy, more marriage penalties, and lots of new taxes—either because you are defined as “rich” or because you are paying the taxes that “rich” businesses such as medical device manufacturers pass along to you.

Even Rosemary’s Baby, of course, was pleasing to its real daddy. There are things in the bill that some people will like: federally funded abortions; lots of multiculturalism; national servitude for doctors; acceptance of death by dehydration or starvation; thousands of new jobs for IRS agents and bureaucrats; millions of unwilling new customers for managed-care schemes and federally certified computer systems; and grants for developers of medical cookbooks, ineffective smoking cessation aids, or politically correct “counseling” or “education” programs.

If ever an abortion of a misbegotten monster was warranted, to save the life of the mother (our country), this baby would qualify. It’s been conceived and implanted, but it has a lot of growing to do before it matures around 2014—in the course of which it will suck the economy dry while displacing the professionals and institutions devoted to caring for the sick. We need to starve it of funding, disown it, repeal it, enjoin it, and nullify it on the state and individual level. The ideas and their purveyors need to be expelled from the halls of Congress and the palaces of the executive branch, and the society that harbored them needs to be immunized by this experience against future schemes for a government takeover of medicine.

Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University of Arizona College of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943. Complete curriculum vitae posted at www.drjaneorient.com.

If the AMA had done its job of representing its constituents, the American people and Congress would have known what doctors really thought about ObamaCare before the final vote was taken. Instead, the “people and doctors of America have been betrayed by self-serving medical leaders,” states Adam Frederic Dorin, M.D., a San Diego anesthesiologist.

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By: Richard Amerling, MD

“You load sixteen tons, what do you get,
another day older and deeper in debt,
Saint Peter don’t you call me ’cause I can’t go,
I owe my soul to the company store”
 
—-“Sixteen Tons”    Merle Travis
 
According to Wikipedia, the “company store” in this classic country song refers to the “truck system” where employees are paid in substitute currency, known as “scrip.”  This limits employees’ ability to choose how to spend earnings, generally to the benefit of the employer.  In closed economic systems, such as existed in various mining towns, workers had little choice but to buy from the company store, which often led to significant indebtedness, limiting their ability to leave the system.  This created a form of indentured servitude, prompting legislation that made payment in other than legal tender illegal.  

During World War II, the government imposed wage and price controls.  In an effort to attract and retain workers, companies offered health insurance in lieu of wages.  These benefits were not taxable for either the employer or employee.  When the war ended and controls lifted (everywhere except in New York City, where rent controls persist to this day), the tax subsidy for employer-sponsored health insurance was retained.   This explains why the majority of working Americans buy health insurance at work, at the “company store.”  This accident of history underlies much of what has gone wrong with health care in America.  

Since insurance is “in kind” payment in lieu of wages, it sustains the illusion that “someone other than you” is paying for your medical care and creates an incentive to use the benefits.  Along with low-deductible, “first dollar” coverage, this clearly led to overutilization of health care services, which drove up both prices for services and insurance premiums.  Most people are unaware of how much their insurance costs.  It is probably between $10-20,000 per year.  This money would be added to your paycheck, taxable, if there was no insurance provided.  When your employer deducts money from your paycheck for premiums, what they are really doing is shifting wages into non-wage benefits.  Assuming you are healthy and don’t use much health care, this is a bad deal financially and leaves you poorer.  

Employers naturally want healthy and happy workers, but they have bottom line requirements that compel them to shop for inexpensive policies.  This created a market for health maintenance organizations (HMOs) with their gatekeepers and intensive micromanagement that doctors and patients find so distasteful.  Employers must limit options for their employees, who are stuck unless they change jobs or refuse to buy “company store insurance.”  In the latter case, they will pay in after-tax dollars for an outside insurance policy.   

Employees, or their families, with chronic health issues may be quite reluctant to leave a job with a health plan, particularly if they have relationships with hospitals and doctors in that plan.  There are undoubtedly millions of Americans who are trapped in jobs they no longer like simply because they are worried about the consequences of changing health plans, or going without.  These people have “sold their soul to the company store” and are, at least partially, enslaved. 

Imagine how transformed the landscape would be if individuals purchased their own health insurance (as we do for all other types of insurance).   As proposed by George W. Bush and others, this could be done immediately and painlessly by transferring the tax break on health insurance from the employer to the individual.   A competitive market for individual health insurance policies would spring up overnight.  The majority of consumers would likely prefer a high-deductible policy to cover against a significant illness, coupled with a Health Savings Account, from which routine care could be financed.  Groups could form to enhance purchasing power, and to cover those with significant pre-existing conditions.  

According to 2008 Census data, of 45.6 million uninsured, 32.1 million earned over $25,000 per year (including 9.1 million earning over $75,000).  Many of these people chose not to buy health insurance, seeing it as the bad deal it is.  Many would likely buy a catastrophic policy were one available.  Far from being unable to get care, they can freely choose any physician they like and pay cash.   In many ways they enjoy more freedom than the 200 million covered by private insurance and the 87.4 million covered by government insurance.   Too bad we will all soon be enslaved under ObamaCare, and will “owe our soul” to the federal government.

 Richard Amerling, MD, is a nephrologist practicing in New York City.  He is an Associate Professor of at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center.  Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981.  He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania.  He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).

Even Nancy Pelosi admitted to the unknown consequences of the bill when she said, ”we have to pass the bill so that you can find out what is in it.”

To help us (and Nancy) find out what is in ObamaCare, Sally Pipes, President and CEO of the Pacific Research Institute, read the greater than 2,000 pages of the legislation passed in March.  She published the findings in her new book, The Truth About ObamaCare.

AAPS Government Affairs Counsel Michael Ostrolenk, this past Wednesday, interviewed Ms. Pipes about her book as well as true free-market solutions that would re-empower patients to make their own health care decisions.

Listen to the interview at http://www.aapsonline.org/newsoftheday/001230 .

In addition to the audio interview, at the above link, you can watch a video clip of Ms. Pipes discussing these topics at the August 7th National Doctors Tea Party.

Dr. Orient's annotated copy of the PPACA aka "ObamaCare".

AAPS Executive Director, Jane Orient, M.D. also read the Patient Protection and Affordable Care Act and summarizes her findings in an upcoming article in the Journal of American Physicians and Surgeons.  Download the pre-publication version: www.jpands.org/vol15no3/orient.pdf .

Dr. Orient also made an appearance at the National Doctors Tea Party on August 7th.  Watch the video clip of her explaining the opposing priorities of private free-market medicine versus government-controlled health care at http://www.aapsonline.org/newsoftheday/001230 .

John Dennis is running to oust Speaker of the House, Nancy Pelosi in California's 8th Congressional District this November. 

He has promised that his first priority is to have ObamaCare repealed.

He also supports: 

• Making all out-of-pocket medical expenses tax deductible.
• Making insurance premiums paid by individuals tax deductible.
• Eliminating legal impediments that restrict companies from opening Health Savings Accounts for employees.
• Repealing government imposed requirements on what insurance companies must cover.
• Using the Commerce Clause of the Constitution, which allows the Federal government to make interstate commerce "regular," to repeal state laws preventing insurance companies from competing across state lines.

Read more about Mr. Dennis at www.johndennis2010.com.

By Richard Amerling, M.D.

Since our Imperial President installed Donald Berwick at the head of the Center for Medicare and Medicaid Services (CMS) in the dead of night before the July 4 weekend, bypassing even so much as a hearing, the American people know little about him. They have not been helped by the mainstream press, with a few exceptions.  Yet this man will have a profound effect on how health care is delivered in the years to come. What can we expect from him, and how can we prepare?

We’ve heard his anti-free market, pro-big government sound bites, his “love” for the British National Health Service and their central rationing board, the National Institute for Clinical Excellence (NICE). But what has he actually done that qualifies him for this position and why was the President so eager to grab him?

For one, Donald Berwick is already an accomplished bureaucrat.  He’s been toiling for years as CEO of the Institute for Healthcare Improvement (IHI; www .ihi.org).  Lawrence A. Hunter, Senior Fellow at the Institute for Policy Innovation and Chief Economist at the Free Enterprise Fund reports that Dr. Berwick’s annual  salary averaged $600,000, jumping to $2.36 million in 2008, a year the non-profit ran a >$600,000 deficit! Where was Kenneth Feinberg?

Dr. Hunter writes that IHI receives about $40 million yearly in grants, fees and consulting contracts from managed care companies, academic medical centers, hospitals and healthcare foundations, many of which are “already participating or seeking to influence boards and panels established by ObamaCare to cut Medicare spending, ration new technologies, and only pay doctors when they meet the government’s definition of quality care.” 

Available from the IHI website is a white paper entitled “Reducing Costs Through the Appropriate Use of Specialty Services.”  This document is a roadmap showing where Dr. Berwick and his ilk will be driving us. They begin with the claim that 30% of health costs ($700 billion) can be eliminated without reducing quality!  The source quoted for this claim is a paper presented at the National Quality Forum in 2008 that I will thoroughly deconstruct in a future Op-Ed. For now, let me state that while there certainly are cost savings to be had, the notion that a handful of geniuses could possibly bring this about without loss of quality is beyond arrogant—it’s delusional.

They state, “payment incentives such as fee-for-service are a strong driver of overutilization.”  Well, not exactly. Fee-for-service is what ensures the prompt availability of care, rather than long waiting lines. It is the third party payment system that leads to unrestrained consumer demand and overuse of services. Careful, your bias is showing! The authors decry variability in utilization of services and quote a paper by Atul Gawande, “The Cost Conundrum.” The idea that variations in care and use of services is somehow bad pervades the groupthink of the central planners. There is no evidence for this, just as there is no evidence that applying rigid standardized care improves hard patient outcomes.

How will standardized care be implemented?  One route will be the electronic health record (EHR).  They cite the example of HealthPartners in Minnesota who, in order to cut down on the use of high-tech imaging procedures “incorporated appropriateness criteria for radiological tests into the EMR as a reminder to primary care doctors.” 

There will also be a “primary focus on changing professional practice culture through the engagement of physicians in developing and implementing practice standards. The framework derives partly from known principles and methods of guideline or protocol development.” They suggest starting small with “selective, smaller scale efforts to reduce overuse,” as this will “prepare the local culture for broader changes in the future.”

There can no longer be any doubt that this is what the future holds should ObamaCare survive the dozens of legal challenges. The underhanded recess appointment of this devoted central planner confirms our grim predictions. There is also no question this approach will fail, and fail on a grand scale. There will be shortages, dislocations, more massive bureaucracies, huge cost overruns, and what may be an irreversible loss of quality. Along the way, thousands, if not millions of patients will be harmed.

The only way to prevent this scenario, barring regime change, is if enough patients and physicians abandon this sinking ship and create a true free market for healthcare. This is the safe route to deliver high quality care and control costs.

 Richard Amerling, MD, is a nephrologist practicing in New York City.  He is an Associate Professor of at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center.  Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981.  He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania.  He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).

By Alieta Eck, MD

In the recent AMNews, June 7, 2010, pp 6-7, we physicians were given talking points on how to tell our patients about ObamaCare.  It was so full of “happy-speak” that one must wonder if the AMA has paid lobbyists for the Administration.

A typical question might be, “What’s in it for me?”   We are to say “For many patients who don’t have coverage and can’t afford it, the government in 2014 will offer sliding scale credits to buy a plan… Employers also are going to be expected to step up to the plate, offering coverage or kicking in part of the premium for employees who sign up for plans through the insurance exchanges.”  

Of course, that is assuming that our patients still have jobs.  But we must not say that.

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