Obama, who can be thin-skinned when people disagree with him, was downright irritated when the early polls showed that a majority of Americans opposed his health care “reform” bill.  On April 1, he criticized the polls as premature, saying “So before we find out if people like health care reform, we should wait to see what happens when we actually put it into place.  Just a thought.”

The problem with his argument is that the more Americans find out what is actually in this monstrosity of a bill, the less they like it.  Polls conducted by Rasmussen Reports show that 55 percent of the public supported the repeal of ObamaCare on March 25, just two days after its passage.  Today, a half-year later, the number of those favoring repeal has grown to 61 percent.

I am not one to call the President a liar.  I have too much respect for the office held by giants like George Washington and Ronald Reagan for that.  But I do believe that much of what Obama has said about his own health care bill is simply not true.  He claimed in Maine that people could keep their own health insurance, in Maryland that people could keep their own doctors.  In Washington, DC, he promised that his plan would cut costs but would not lead to the rationing of care.  He has consistently claimed that it would not fund abortions, and that its “end-of-life visits” would not lead to euthanasia.

Six months later, all of these claims are being questioned by taxpayers who see people losing their health care plans and paying more for health insurance.  More and more Americans are realizing that they and their children will be stuck with the bill as healthcare costs rise, and that they will be paying for “family planning services” that include not just sterilizations and contraception, but abortions as well.
Obama has repeatedly reassured nervous Americans that “if you like your insurance plan, you will keep it.  No one will be able to take that away from you.  It hasn’t happened yet.  It won’t happen in the future.” (April 1, 2010)  In reality, millions of Americans will lose their health insurance in the coming years as a direct result of ObamaCare.

On September 21, 2010, the Centers for Medicare and Medicaid Services (CMS) announced 1.2 million seniors will be forced out of the Medicare Advantage or Medicare prescription drug plan that they currently enjoy next year.  Add to this the news that nHealth has dropped all its customers because of ObamaCare and is going out of business, and that the American National Insurance Company will not sell health insurance to early retirees, self-employed workers, and small businesses because of ObamaCare.  In fact, the worst blow of all may fall upon small businesses.  Regulations issued by the Obama administration may cause up to 80 percent of small businesses to lose their current plans.

You will also be paying more for your health insurance in years to come because of ObamaCare.  Obama continues to maintain that “This law will cut costs and make coverage more affordable for families and small businesses.” (June 22, 2010)  But the reality behind the rhetoric is that ObamaCare is causing health insurance prices to skyrocket.  The Wall Street Journal reported that ObamaCare is causing rates to increase up to 20 percent for some buyers.  In Connecticut, rates are increasing 18 percent for small businesses and 14.2 percent for the self-employed, early retirees, and others who buy their own coverage on October 1, 2010.

These increases are taking place not because of greed on the part of insurance companies, as Obama’s media minions like to claim, but because of the new mandates and regulations contained in ObamaCare, all of which cost real money to comply with.

The elderly will bear the brunt of Obama’s deceptions, such as his claim that “If you like your doctor, you can keep your doctor.” (June 8, 2010)  The reality is that doctors are already fleeing Medicare in droves. In Texas alone, more than 300 primary care physicians have stopped seeing seniors in the last two years. When ObamaCare cuts Medicare payments to doctors next year, even more doctors will bail out of a system that overworks and underpays them, leaving millions of seniors without a personal physician.

Costs are rising as well, flying in the face of Obama’s claim that “over time, costs will come down for families, businesses, and the federal government, reducing our deficit by more than $1 trillion over the next two decades.  That’s what this reform will do.” (April 1, 2010)  We now know that, according to President Obama’s own Center for Medicare and Medicaid Services (CMS), ObamaCare will increase health care spending by 6.3 percent annually and will cause health care to consume almost 20 percent of the our nation’s GDP.  In other words, ObamaCare will only pile more debt on the mountain of debt that Obama’s other forays into socialism have caused.

The easiest Obama claim to refute is his contention that ObamaCare would not fund abortions.  This is because he refuted it himself by issuing an executive order that purportedly forbade the funding of abortions through ObamaCare.

When I first learned of this particular ruse, I didn’t know whether to laugh or cry.  Because it is a ruse; albeit very clever one that many people, apparently including “pro-life” Democrats like Bart Stupak, failed to see through.

You see, if ObamaCare had not funded abortion in the first place, then his executive order would be unnecessary.  So the executive order (at http://www.whitehouse.gov/the-press-office/executive-order-patient-protection-and-affordable-care-acts-consistency-with-longst) constitutes evidence that, contra Obama, ObamaCare had funded abortion all along.

At the same time, however, since federal law always and everywhere trumps executive orders, Obama’s order is not worth the paper it is written on.  As a Harvard-trained lawyer, the President surely realizes that his executive order will not stand up to the most cursory of judicial reviews.  Obamacare will then be used as Obama, Reid and Pelosi intended, as a vehicle to promote and perform abortions.

It seems to me that our choice as Americans is simple:  Either we euthanize ObamaCare before it is too late, or it winds up euthanizing us.

It is time to pay an “end-of-life” visit to ObamaCare.

Essentially, where Medicare goes, insurers follow for the guidelines in covered services and baseline physician fee schedules for private payers as well as worker’s compensation and automobile insurance companies in most states, as well as Medicaid and Medicare itself.

What Pelosi has effectively done is saved the insurance companies who use the Medicare fee schedule millions of dollars of payouts to physicians on their claims–regardless if the patient is a Medicare patient.  I’m not seeing the insurance lobby out there right now, are you?  However, on the provider side, the doctor’s lobby groups are outraged at Pelosi’s failure and the damage this inaction will cause physicians–especially private–and force them to layoff employees to make up for the loss in reimbursements to cover their enormous monthly overhead costs.

Pelosi is completely ignorant of the doctor’s fee schedules and how their reimbursements are calculated.  In a multilayered approach and working with the Centers for Medicare and Medicaid Services (CMS), the AMA Resource-Based Relative Value Scale (RBRVS) is used and the AMA/Specialty Society Relative Value Scale Update Committee (RUC) makes annual recommendations regarding new and revised physician services to CMS and performs broad reviews of the RBRVS every five years.  These values have not been adjusted since the 21% fee schedule reduction took effect and for Pelosi to ignore the fact that the doc fix will actually cost doctors to see their patients because their fees will be reduced, but the cost of providing the services and the supplies needed have not gone down and in some cases, continue to rise.  Additionally, student loan payments have not been decreased by 21% for doctors, have they?

The only business segment to ultimately win is the insurance industry.

Real-world exit questions:  If you own a company and your revenue just got nicked by 21%, but your supplies and cost of services has remained the same, how long before you will have to layoff employees to cover your monthly costs?

Do people understand that private practice physicians take most, if not all, of their salaries on assignment?  Physicians must do this because of provider contracts and other variables, but their fees are not a guarantee of payment; claims can be denied in part or in full.  (Some lawyers take their fees on assignment, but it is their choice.)  And now, doctors are being used as political pawns by the Democrats.

Is it possible that the Democrats are attempting to push doctors into the union, say the SEIU?  Only those doctors who are in private practices, not employed by hospitals cannot unionize, so what’s next for them?

Nothing like having a bunch of bureaucrats who have no idea about healthcare, costs of providing services,  running a business, covering overhead, etc. in charge of your salary, covered services, and future.

Finally, this is clearly a Democrat problem, after all, “You won.”  And by that, Americans now understand that to mean that the Democrats are clearly the party of cry-babies, finger-pointers, and blame-shifters.  And job killers, because if your more than $800 billion stimulus and jobs bills actually provided jobs, we wouldn’t need unemployment extenders in current legislation.  Americans would actually be back to work, wouldn’t they, Nan?

Berwick is a leading Ivy League academic and technocrat – he’s graduated from Harvard not once, but three times – and is the founder of a Cambridge-based think-tank, the Institute for Health Care Improvement. Yet the job of running CMS is hardly the same as running a small think tank or talking in broad terms about the nature of health care – CMS is essentially the world’s second largest insurance company after the United Kingdom’s NHS, covering over 98 million people and overseeing roughly $800 billion annually in taxpayer-funded health care expenditures.

Berwick is a great fan of the NHS, and worked as a consultant on the project under Tony Blair. Berwick will have the opportunity to apply the ideas he gained through that experience with the power of the CMS position, which means that his nomination holds massive ramifications for Medicare and Medicaid recipients, hospitals and doctors and, under Obama’s law, all Americans.

Berwick: Health Care Must Redistribute Wealth

Key to understanding Berwick’s views on the NHS is a speech he gave as part of a presentation offered two years ago, in which he shared his thoughts on the NHS and health care generally. You can watch the full speech here. The full video shows several lines from Berwick that are notable. He decries private sector solutions to health care problems, dismissing the “invisible hand of the market” as an “unaccountable system.” He also states:

“I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country.”

And more disturbingly, in this clip:

“Any health care funding plan that is just equitable civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”

Berwick’s Views on Why the US Should Be More Like the UK

Robert Goldberg, vice president of the Center for Medicine in the Public Interest, writes on Berwick’s views expressed in 2008 at length in this piece at the American Spectator:

“Berwick complained the American health system runs in the ‘darkness of private enterprise,’ unlike Britain’s ‘politically accountable system.’ The NHS is ‘universal, accessible, excellent, and free at the point of care – a health system that is, at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just’; America’s health system is ‘toxic,’ ‘fragmented,’ because of its dependence on consumer choice. He told his UK audience: ‘I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.’”

But as Goldberg points out:

“It may not be joyous or just or configured correctly, but for nearly every disease, particularly cancer, stroke, and heart attacks, Americans live longer and healthier than the English because of better care.”

Indeed, the UK has a terrible record on heart attacks, cancer, and more. A recent piece in the Telegraph runs down the OECD numbers concerning Britain’s actual outcomes from the system Berwick supports so much:

“Britain also languishes near the bottom of the breast cancer league table, with a survival rate of 78.5 per cent. The OECD-wide average is 81.2 per cent. Heart attack victims in Britain are also more likely to die after entering hospital than in most other developed nations. Around 6.3 per cent of patients who have suffered a heart attack have passed away within 30 days of entering a British hospital – significantly higher than the 4.3 per cent average. The figures also show that British life expectancy is much lower than our nearest neighbours. Men in this country can expect to live to 79 years and six months, against 81 years in France. While the report’s authors identified some successes in British healthcare – we have among the best records in Europe for screening women for breast and cervical cancer – the survey indicates that Labour’s much-trumpeted NHS investment has failed to raise standards in key areas.”

The fact is that the UK system is designed for a very different population than ours, with a very different culture — one with far fewer guns, auto accidents, better diets, and fewer young people doing dangerous things. Yet America still has advantages in dealing with these key diseases. While there are many statistics to trumpet on this point, perhaps the best example is that American life expectancy at age 65 is actually higher than Britain.

Berwick: Best System is Ration-Based Single Payer

Berwick is not so much an ideologue as a true believer in governmental efficiency over the ability of the marketplace and the consumer to direct their health care. In a recent piece in Health Affairs, written along with two colleagues, Berwick details his position on the ideal nature of health care:

“If we could ever find the political nerve, we strongly suspect that financing and competitive dynamics such as the following, purveyed by governments and payers, would accelerate interest in [our policy ideal] and progress toward it: (1) global budget caps on total health care spending for designated populations, (2) measurement of and fixed accountability for the health status and health needs of designated populations, (3) improved standardized measures of care and per capita costs across sites and through time that are transparent, (4) changes in payment such that the financial gains from reduction of per capita costs are shared among those who pay for care and those who can and should invest in further improvements, and (5) changes in professional education accreditation to ensure that clinicians are capable of changing and improving their processes of care. With some risk, we note that the simplest way to establish many of these environmental conditions is a single-payer system, hiring integrators with prospective, global budgets to take care of the health needs of a defined population, without permission to exclude any member of the population.”

As the eloquent Avik Roy wrote recently, there are serious flaws in Berwick’s approach (emphasis mine):

“First off, as William Schambra observed in National Affairs, it assumes that politicians — and politics — play no role in forming health-care policy. Even if you believe that technocrats could better organize our health-care system, Berwick’s approach only works if the narrow interests of Congressmen, labor unions, general hospitals, the AARP, etc., have no influence on the writing of law. No one who watched Democrats make the Obamacare sausage can harbor any illusions on this score.

“Secondly, as Friedrich Hayek pointed out back in 1945, the command approach is doomed to fail because its commanders do not gain accurate information about what is happening on the ground. Technocrats may believe they can marshal statistics and analysis to optimize the health-care system, but they are not omniscient. Their analyses rely on too many assumptions and on unreliable data. This is why government programs always result in colossal amounts of waste, fraud, and abuse. On the other hand, a truly free market for health insurance could efficiently allocate health-care resources to those therapies and tests that patients and doctors most need.”

Yet Berwick is not particularly ideological in his endorsement: he simply believes that the single payer model is the most efficient, and the most easily managed, approach to health care. In large part, this is because he believes in government-directed rationing of care.

In an interview on Comparative Effectiveness Research, Berwick supported an agency which would rationing health care. He particularly focused on what he perceives as the benefits of the UK’s National Institute for Clinical Health and Excellence: As Dr. Berwick said:

“NICE is extremely effective and a conscientious, valuable, and — importantly — knowledge-building system [which has] developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn.”

The interviewer pointed out: “Critics of CER have said that it will lead to the rationing of health care.” To which Berwick replied: “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”

Here are just some of the horror stories from NICE over the past several years. Under Donald Berwick’s authority as the head of CMS, get ready to see stories like these in the pages of American papers in the years to come.

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The deliberate setup for the White House power grab is built into the each of the health care bills and, if they fail, little-known twin bills called “MedPAC Reform of 2009” are waiting in the wings.  The bills, S.B. 1110 and H.R. 2718, craftily amend the Social Security Act and transfer the Medicare guideline and rule setting processes, from the legislative branch to the executive branch.  These bills offer cover to one another in case one doesn’t pass the House or Senate, respectively.  Remember, Democrats need to gain executive branch authority by amending the Social Security Act over Medicare regulations and physician fee schedules to transform the health care system in a single-payer, socialized system.

More importantly, Medicare’s regulations and physician fee schedules are the keystone to developing payer systems and reimbursement models across the entire health care industry.  And where Medicare goes, insurers follow.

To underscore the far-reaching power, a bulk of the states already reference or utilize the Medicare guidelines and fee schedules in determining policy, coverage, and payment, which impacts certain state-specific plans, including, but not limited to, self-funded plans, automobile insurance payers, and state workers’ compensation funds and plans – affecting even Big Labor.   For the executive branch to have such authority over Medicare regulations with little oversight is alarming.  This raises further issues of the powerful impact these federal mandates could potentially have on the states in stripping them of their own management of their respective insurance industries.

Specifically, the language in the Reid bill intentionally places unlimited power directly in the hands of Health and Human Services (HHS) Secretary Kathleen Sebelius, including the ability to designate covered services, or rationing.  The Pelosi bill creates a Health Choices Commission and its “commissioner” is empowered to make the same decisions.  More alarming, both will have to take direction from the White House–and its unconfirmed czars–due to their executive branch affiliation.

In retrospect, Obama’s pick of Sebelius as HHS Secretary is obvious.  Aside from being a governor, Sebelius is the former Kansas insurance commissioner and has the ability to identify the strongest and weakest links–navigating her way quite expeditiously throughout the health care system.  And she’ll never disavow one of her first career choices — executive director and chief lobbyist for the Kansas Trial Lawyers Association.  That explains the blatant omission of tort reform, in addition to the fact that the trial lawyers are the biggest Democrat donors.

Another disturbing Obama appointee is health care czar Nancy Ann DeParle, who remains unconfirmed, and was the administrator of the Health Care Financing Administration (HCFA), now known as the Centers for Medicare and Medicaid Services.  In short, she “owns” Medicare.  And if you put Sebelius and DeParle together in a room for a few hours, you’ll get a formula for a single-payer government-run health care system – with Obama’s wish list met.

These designed appointees make sense of the intentions at hand to frame a universal or single-payer health care system.  Everything in this administration makes sense when you look at the overall agenda.  Even the branding makes sense.  The urgency, caring for the uninsured, taking advantage of the uninsurable, proclaiming it’s paid for,  packaging it as deficit-neutral, and amplifying that people are ‘dying’ in the streets.

The aforementioned MedPAC Reform of 2009 bills give the executive branch power it so dearly covets to devise the single-payer system.  Currently, MedPAC–the Medicare Payment and Advisory Committee (MedPAC)–is a Clinton-era independent Congressional agency established by the Balanced Budget Act of 1997 that advises the Congress on issues affecting the Medicare program, including payments to private health plans participating in Medicare and providers in Medicare’s traditional fee-for-service program.  MedPAC also analyzes access to, quality of, and cost of health care.

The MedPAC bill designer, progressive Senator John Rockefeller (D-WV), has strategically branded the need for the bill by calling Congress “inefficient” and “inconsistent” –and who wouldn’t agree with that?

Therefore, the MedPAC Reform bill creates a new MedPAC–the Medicare Payment and Access Commission–and gives the Obama White House and its advisors over-reaching control of several factors governing the economy of the health care system.  The new MedPAC, which is exempted from judicial review, would have the authority to rewrite physician fee schedules, redefine medical necessity, evaluate coverage of treatment options, rewrite beneficiary definitions and coverage, and redesign diagnostic definitions and coverage.

The new MedPAC’s mission would also be to inform new research in health services to adequately address deficiencies in the evidence. However, in reality, this would apparently cripple new treatments and technologies by overshadowing progressive research and treatment algorithms by apparently emphasizing the deficiencies, not the benefits, equaling a denial of care and arresting development of burgeoning technologies.

Rockefeller also confirms that the new MedPAC will evaluate and test new and innovative payment models for provider reimbursement.  The MedPAC reform is being packaged under the guise of efficiency; however, by maximizing the volume of care delivered at the lowest possible cost, it appears that the payment and utilization schedule is a mechanism to control the pressure that would build when the health care system is overloaded with millions of new patients.

Finally, Rockefeller highlights another intention of MedPAC, which is to expand the capacity to evaluate basic and health services research for reimbursement.  This is the pinnacle power grab because this gives the new MedPAC and the executive branch the power to ration or deny care and decide what treatment options are available or acceptable as a whole.

Senator Chuck Grassley (R-IA), ranking Republican on the Senate Finance Committee, commented, “As a congressional support agency, MedPAC’s mission is to advise Congress on Medicare payment issues.  If MedPAC were to become part of the executive branch as contemplated in the Rockefeller bill, then Congress would no longer have this support agency to provide technical support when making policy decisions.”  Senator Grassley also confirmed that he is not willing to abdicate congressional responsibilities for Medicare payment policymaking to a body that does not hold certificates of election.   He is correct that Congress wouldn’t have the support agency’s advice, but misses that it wouldn’t be Congress’s responsibility anymore—the policy decisions would be the responsibility of the new MedPAC—under the direction of the Obama White House.

What’s inherently disturbing is the fact that Rockefeller has been very outspoken in support of the public option and knows that this transfer of power must take place via the Social Security Act—in any form.  He even confirms that health care reform will not be successful, unless all authority is shifted to the executive branch.  He also rightly chooses his words–the “healthcare delivery system,” which is code for the public option.

Additionally, Rockefeller confirms the overall task at hand by stating, “Establishing MedPAC as an independent executive branch agency – which can only change through an act of Congress – is the cornerstone of improving our delivery system reform.  Health care reform will only be successful if we craft transformative changes.”  Transformative, as in a government-run health care system.

If there are any questions if the White House would flex its executive branch authority over an agency, just look the way of the EPA.  Congress stalled on cap and trade and Climategate has proven to be a problem, so the White House and EPA took matters into their own hands to keep moving on the agenda—to intentionally put regulations in place that further strangle American businesses, create unemployment, and further destabilize the economy.

Furthermore, with most of the Obama administration graduates of the Saul Alinsky school of thought, of course the main goal of all legislation and policies would be to support the overall intention of Alinsky, which is for the “have-nots on how to take it away.”

In any of these legislative scenarios–Pelosi, Reid or MedPAC bills–the White House gets the power it seeks–and needs–in order to accomplish the task at hand–a single payer, government-run health system.

These bills must be defeated; the power grab thwarted because after the Social Security Act is amended in any form these bills present and the rule changes take effect, it is not likely for the Act to be reopened and amended again.  The problem is Congress doesn’t even comprehend what’s at stake in either of the health care bills or MedPAC Reform–and you can’t stop something you don’t see.

-“Total national health expenditures under this bill would increase by an estimated 2.7 percent in 2019…”

 -“The additional demand for health services could be difficult to meet initially with existing health provider resources and could lead to price increases, cost-shifting, and/or changes in providers’ willingness to treat patients with low-reimbursement health coverage.”

-More than half of the expansion in coverage (18 million out of 34 million) would be from increased Medicaid coverage.

-12 million people would lose employer-sponsored coverage.

-The productivity adjustments to Medicare are “unrealistic” and providers “might end their participation” because the cuts would make serving Medicare beneficiaries unprofitable.

-Medicare Advantage enrollment would decrease by 64 percent (from a projected level of 13.2 million to 4.7 million under the proposal).

As of today, HHS still hadn’t published the analysis on their website, even though it was written by its own staff. We have a feeling it may never find a home there. So, we’ve brought it to you directly. Full financial analysis below.  

CMS OACT – Memo on Financial Impact of H R 3200 09-10-21 –