From the Associated Press:

Obama promised Medicare beneficiaries that he’d veto any legislation asking them to sacrifice without also raising taxes on upper-income earners. But he didn’t issue them a complete pass.

Instead, he’s proposing to raise a range of costs for future retirees, while mostly shielding Medicare’s 48 million current beneficiaries. Under the president’s plan, starting in 2017:

_Upper-income beneficiaries would pay higher monthly premiums for outpatient and prescription coverage. Eventually about a quarter of all Medicare beneficiaries would be hit with the higher income-related premiums that only a small share of seniors now pay.

_Newly signed-up beneficiaries would pay a penalty if they also purchase private insurance that covers all or most of Medicare’s copayments and deductibles. Administration officials say such insurance encourages over-treatment.

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I’m going to take the death panel end-of-life planning conundrum down one point at a time to make this very clear for Americans to understand what the Pelosi-led Democrats have done to your healthcare and their attempt to take cover under a Bush-era law–the Medicare Improvement for Patients and Providers Act of 2008.

The Hill reported that the Obama White House attempted to calm Americans’ fears of the dreaded death panels:

The Medicare policy will pay doctors for holding end-of-life-care discussions with patients, according to the Times. A similar provision was dropped from the new healthcare reform law after Republicans accused the administration of withholding care from the sick, elderly and disabled.

However, an administration spokesman said the regulation, which is less specific than the reform law’s draft language, is actually a continuation of a policy enacted under former President George W. Bush.

“The only thing new here is a regulation allowing the discussions … to happen in the context of the new annual wellness visit created by [healthcare reform],” Obama spokesman Reid Cherlin told The Wall Street Journal.

In 2003, Medicare added a consultation visit for seniors new to the program, according to the Journal. Another 2008 law, enacted under Bush, said the visit can include “end-of-life” planning discussions.

However, what The Hill’s Jason Millman forgot to mention in his article was that President Bush VETOED the 2008 bill and the Democrats, along with some “good-willed” Republicans OVERRODE Bush’s veto forcing him to sign the legislation into law.  The bill dealt with doctors’ reimbursements and more, but the Democrats slipped in the end-of-life planning by opening up the Social Security Act, which I have stated many times is dangerous. Once the act is changed, it is difficult to amend again and allows for tinkering with the Medicare fee schedule and covered services definitions and requirements

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Sound familiar? Most everyone has heard it time and time again. It’s the way many TV sales pitches end after seeming to give the viewing audience something for nothing.  It’s a sucker’s pitch. It usually works like this: you are offered the gadget of the moment for the bargain price (typically) of $19.95, and you get an additional gadget for free.  Then comes the addendum (very quickly and often in a whisper) “just pay separate processing and handling.” The fee is never disclosed, but it’s always there (typically $9.95 for each gadget, or another $19.90 for both which brings the total to $39.85 exclusive of shipping charges) proving there are no free lunches.  This deceitful advertising used by television pitchman works so well that its equivalent has become the new Obama-Pelosi-Reid pitch to disguise the true cost of their programs.

And while this may not be a precise analogy for the way things are done in Washington, it’s close enough.  “Just pay processing and handling” is our metaphor for the entire panoply of Washington speak that produces programs, the costs of which are often orders of magnitude more than originally represented.  We are, almost daily it seems, pitched free lunches or  “benefits” by our government.  And while the seemingly irreversible debt we are currently piling on our children and grandchildren is truly unprecedented in American history, this administration did not invent the government “free lunch” shell game; they’ve simply refined and extended it with complete abandon.  As Ronald Reagan so aptly warned, “The nine most terrifying words in the English language are I’m from the government and I’m here to help.”

Let’s count a few of the ways American consumers and taxpayers have been sold a bill of goods whereby the bill for the goods is, or will be, much higher than the assurance given in the Obama-Pelosi-Reid sales pitch.

Everyone can recall the “deficit neutral” healthcare reform bill.  It wasn’t going to add a dime to the deficit “now or in the future.”  Then, no sooner than you could transfer a bill into an Act (a law) the essential quarter-of-a-trillion dollar “doc fix,” which had been yanked from the original healthcare reform bill to make it “deficit neutral,” was, a short time later, enacted separately blowing the deficit neutral promise to smithereens — just pay separate processing and handling.

The Pelosi-Reid-led Congress established new high-risk pools in the new legislation and allocated $5 billion to take care of the chronically ill and uninsured until the government-controlled insurance exchanges, which are to be set up under the new law, are up and running in 2014.  But no sooner, it seems, was the legislation signed into law than the Chief Actuary for Medicare estimated that the tax-payer funded high-risk pools would run dry in 2011 or 2012, “resulting in substantial premium increases to sustain the program” — another new, hidden and unexpected cost compliments of Obamacare.  Just pay separate processing and handling.

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Aside from breaking her word to the AMA and physicians across the country, Democrat House Speaker Nancy Pelosi has effectively demolished doctor reimbursements for most of the healthcare industry.  The 21.2% Medicare fee schedule cut has taken effect, but what most do not realize is that the Medicare fee schedule is the gold standard for provider reimbursement fee schedules across the nation.

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.

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Democrat House Speaker Nancy Pelosi will not take up the Senate’s “doc fix” bill, which passed through the Senate on Friday.  A letter from Pelosi reaffirms her position and scolds Republicans for blocking the jobs portion of the bill:

“What is it that Republicans in the Senate and House don’t understand about the need for jobs in America? I see no reason to pass this inadequate bill until we see jobs legislation coming out of the Senate. House Democrats are saying to Republicans in the Senate: Show us the jobs!”

It’s humorous to hear Pelosi whine on this–if my memory is correct the Democrats control both Chambers and passed the $787 billion stimulus bill to create ” jobs, jobs, jobs.”  More than one year later, we now know that the “stimulus failed,” and a second $17 billion stimlus/jobs bill was passed–which somehow still is not enough.

So, we have more than $800 billion in stimulus spending “designed” to create jobs and now Pelosi has the audacity to blame the GOP after the two previous massive, generational-theft stimulus bills failed.  Are you kidding, Nan?

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Like a relentlessly advancing cancer, the news about the US fiscal deficit and the accumulated debt, which is its result, keeps getting worse.  Every week the press discloses some supposedly “new” information about either the federal budget, economic failure, projections of economic growth, the effects of the so-called “doc fix” (about which we have written several times), the sorry fiscal condition of state and municipal finances, or some further jobs stimulus proposal, all of which pile more costs on this nation that, if it were a private business, would be considered broke.

Before looking at the most recent spate of deficit and debt related news, let us start with the CBO’s updated March 2010 report which estimated that the cumulative effects of the Administration’s budget proposals would add $9.7 trillion to our current deficit of $14 trillion (an amount equal to approximately ninety percent of our annual GDP and clearly approaching the danger zone).  This amount does not include any spending for enacting climate legislation or the effect of rising interest rates to service our debt or spending for contingencies from unplanned events which will inevitably occur.

Moreover, it projects economic growth every year at four percent when we have had only two quarters of growth at four percent or higher in the past five years and, at least since 1982, have never had four consecutive years of growth as high as four percent per annum.  That overly optimistic CBO assumption if not realized will raise the deficit and the accumulated debt, perhaps by trillions of dollars.

In recent days we see once again the fantasy of the most recent budget the president presented.  After just a few months it is outdated.  Mr. Obama has just asked Congress for an additional $50 billion in aid to state governments.  It is uncontested that state and local governments are in terrible fiscal condition and, of course, they can’t print money to inflate away their accumulated debts.  Cumulative state shortfalls in 2009 and 2010 alone are approximately $310 billion and projections for 2011 and 2012 combined are for an additional $300 billion.

State governments have in the past few years either borrowed with abandon or resorted to accounting gimmickry to approach balancing their budgets.  They have consistently looked for new sources of tax revenue or raised taxes on existing sources, making a reality of Ronald Reagan’s statement about government: “if it moves, tax it.”

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While the “March Madness” that resulted in the passage of the Patient Protection and Affordability Care Act of 2010 would lead you to believe that STAT change was needed in our health care system, the on-going delay in the “fix” to the SGR (sustainable growth rate) formula for Medicare invokes images of a long waiting list for a rationed medical procedure.

Medicare, the federal government’s health care insurance plan for the elderly and disabled established in 1965, is largely funded from payroll taxes and FICA, and supplemented with premiums paid by its beneficiaries. It is administered by the Department of Health and Human Services via the Centers for Medicare and Medicaid Services (CMS), and is the place to look to see how our government will administer a health care system.

Since 1998, the SGR has been a component of the formula used to calculate physician payments for providing services to Medicare patients. It is based on the GDP and not on actual health care practice costs (which have been rising faster than the GDP.) The SGR produced steep cuts in physician compensation for services to Medicare patients, in hopes that by paying individual physicians less, overall health care cost would decrease.

Unfortunately, this approach has failed.

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Rationing Medicare will not require clandestine meetings in smoke filled rooms. Simply reduce physician reimbursement to below the cost of delivering quality care, and free market forces will take care of the rest.

Medicare has already begun the process of backdoor rationing. Facing overwhelming budget shortfalls, Medicare needs to trim its books. Washington found a clever solution: eliminate the billing code for “physician consults.”

As a hospital physician, I often admit Medicare patients with chest pain or shortness of breath. If my patient needs urgent help from a cardiologist, I call a colleague for assistance.

Until December 31, 2009 the cardiologist could charge a “physician consult” fee for getting out of bed, coming to the hospital, and evaluating a patient with a potentially life threatening problem. Medicare paid $195.76 for this middle-of-the-night work (the same rate as when done during the day).

By eliminating the “physician consult” billing code, Medicare now advises the specialist to charge for a “hospital admission.” For two more months, Medicare will pay $175.67 for this service. However, without a change in current law, the physician’s reimbursement for a “hospital admission” will drop to $141.63 on March 1. This is why the “Doc Fix” is so important for working physicians and their Medicare patients.

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The first game in a long series of Obamacare battles is complete and the liberals lost Game 1 by 13 votes.  The Senate voted against a procedural motion to debate the so-called “Doc Fix” bill Wednesday.  Just as Manny Ramirez of the Los Angeles Dodgers has taken a beating in the media for leaving Game 5 of the National League Championship Series early to take a shower and hitting a mere .250 for the series, Senator Harry Reid has taken a beating in the press for marching the Democrat Caucus into a losing vote in the first battle over Obamacare.

A bipartisan coalition of senators concerned about spending stopped Senators Reid from bringing “Doc Fix” to a vote with 13 Democrats siding with the entire Republican Caucus.  Democrat Senators Evan Bayh of Indiana, Robert Byrd of West Virginia, Kent Conrad and Byron Dorgan of North Dakota, Russ Feingold and Herb Kohl of Wisconsin, Claire McCaskill of Missouri, Bill Nelson of Florida, Jon Tester of Montana, Mark Warner and Jim Webb of Virgina, Ron Wyden of Oregon and Independent Democrat Senator Joe Lieberman of Connecticut all opposed the motion to start debate on the bill.

The strategy to pass the “Doc Fix” outside of Obamacare in an attempt to buy off doctors groups’ support for Obamacare was documented in the media.  The Hill reported earlier this week that “the White House and Democratic leaders are offering doctors a deal:  They’ll freeze cuts in Medicare payments to doctors in exchange for doctors’ support of healthcare reform.”  Clearly the majority of senators would not go along with this strategy because the $247 billion price tag for the bill was too high to buy Obamacare. 

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