Posted by Tina
This is in no way an exhaustive post on the subject of government intrusion into the healthcare system. Let’s call it an appetizer…with a big kick. It should give those of you who care about quality care reason to pause and do some research on your own.
First up, Mike Huckabee asks three doctors how government’s intrusion in healthcare, including the PPACA (Obamacare), has impacted their practice:
Legal challenges to Obamacare continue despite Supreme Court ruling:
The Case Against IPAB – One lawsuit, being pursued by the Goldwater Institute, is against the law’s Independent Payment Advisory Board (IPAB). IPAB is a board of 15 presidential appointees that has the authority to control Medicare spending through a variety of means such as determining physician reimbursement rates, dictating how states use federal Medicare dollars, appropriating money, imposing taxes, and determining what drugs, procedures, and tests are judged cost-effective.
Christina Sandefur, Attorney of the Scharf-Norton Center for Constitutional Litigation at the Goldwater Institute, is arguing that this board violates the constitution in two distinct ways.
First, the federal health care law prohibits IPAB from being repealed. Elected officials have only a small frame of time in 2017 to pursue repeal according to the text of the law, and they must attain a 3/5ths supermajority vote from all members of both houses of Congress.
According to Sandefur, “This ‘anti-repeal’ provision rises to the level of unconstitutional entrenchment. By preventing IPAB’s repeal, PPACA binds the hands of future Congresses, denying them their constitutional legislative powers.”
Violating Separation of Powers – The second constitutional violation, Sandefur says, is that IPAB violates the separation-of-powers doctrine.
“PPACA has delegated an unprecedented amount of legislative power to set Medicare policy to 15 unelected, unaccountable bureaucrats. IPAB’s so-called ‘proposals’ automatically become law, and its actions are not subject to judicial review. Thus, IPAB is ‘independent’ in the worst sense of the word: it is independent from administrative, legislative, and judicial review,” Sandefur said.
Grace Marie Turner of National Review looks at misstatements made by the President regarding Medicare under his signature legislation, Obamacare:
President Obama said during his weekly radio address today that he wanted to share “some actual facts” about “a lot of accusations and misinformation flying around” about Medicare.
Let’s look at the “facts” that he highlights in his address:
We’ve extended the life of Medicare by almost a decade.
He “extends the life of Medicare” by paying Medicare providers less and less every year to the point that 15 percent, and eventually 40 percent, of Medicare providers will either go bankrupt or stop seeing Medicare patients altogether, according to Medicare actuaries.
And I’ve proposed reforms that will save Medicare money by getting rid of wasteful spending in the health care system and reining in insurance companies — reforms that won’t touch your guaranteed Medicare benefits. Not by a single dime.
The Affordable Care Act assumes deep reductions in payments to doctors, hospitals, nursing homes, and Medicare Advantage program, totaling $716 billion over ten years. By paying providers less, the trust fund may last a bit longer, but it means seniors will have a harder and harder time finding a doctor to see them as they drop out of the program or stop taking new Medicare patients. The law may not explicitly cut benefits, but it certainly will impact access to care. What good is a Medicare card if you can’t find a doctor? That is precisely the problem that patients on Medicaid — the program for lower-income Americans — face today, forcing them to go to hospital emergency rooms for even routine care. Do seniors want that?
And they certainly don’t want the Independent Payment Advisory Board, the unelected, unaccountable board of 15 bureaucrats charged with keeping Medicare spending down. The main tool the IPAB will have is an ax to cut Medicare payments even further, which will reduce access to care even more.
Worse, the president’s health-care law harms tomorrow’s taxpayers by spending that $716 billion in alleged Medicare savings twice! It uses the money again to create a vast new entitlement program to provide generous taxpayer subsidies for health insurance through the new exchanges. (continues)
The defenders of Obamacare cannot dismiss or explain away the very real concerns that doctors, patients, lawyers, health care organizations, and employers continue to have not only about the PPACA but also about the unsustainibility of Medicare/Meidcaid and the financial impact that government intrusion has had in making healthcare expensive, intrusive, and unworkable.
America has been a leader in the world in healthcare. We can fix the problems and bring costs down if we stick to the principles that made our healthcare system sterling on in the first place.
Failing this, we will surely soon join other countries around the world with an expensive, restrictive, inadequate government system that still does not cover everyone..
Great find Tina. Dr. Vecchio’s claims turned out to be accurate if she refused to comply with ObamaCare mandates.
Thanks for validating our arguement presented in the other article.
Tina, quoting Heartland: “IPAB is a board of 15 presidential appointees that has the authority to control Medicare spending through a variety of means such as…determining what drugs, procedures, and tests are judged cost-effective.”
That’s a lie, as I have shown you literally dozens of times. The law prohibits the IPAB from making direct recommendations about access to benefits and care. That means they have no authority to make decisions regarding drugs or treatments.
There is a point to be made that lowering payments to doctors will hurt seniors’ access to care. But this was already a problem long before the law was passed, and I don’t see either side proposing a solution to it. Both sides have proposed about the same amount of cuts to Medicare, and some of that will include lowering payments to doctors.
Tina, how do you propose cutting Medicare without lowering payments to doctors?
Peggy: “Great find Tina. Dr. Vecchio’s claims turned out to be accurate if she refused to comply with ObamaCare mandates.”
No. You are once again conflating separate issues. Dr. Vecchio claimed that she would be arrested, fined, or put in jail simply for recommending mammograms to women under 50. This is not true, and neither you or Tina have provided any evidence that it is true.
Tina did cite an article showing that doctors may be arrested for receiving remuneration (bribes) for recommending certain services, but that has been the law for a long time. Apparently the PPACA does make this more easy to prosecute by saying that a doctor does not necessarily have to have criminal intent in order to commit a violation. I’m not sure if I agree with that part of the law. But it does nothing to validate Dr. Vecchio’s false claim that she is forbidden from recommending mammograms to her patients. All it shows is that she is forbidden from taking bribes in return.
Chris: “The law prohibits the IPAB from making direct recommendations about access to benefits and care.”
Doctors can respond better to Chris than can I and so once again…Dr. Rich:
http://covertrationingblog.com/healthcare-reform/what-does-the-ipab-tell-us-about-progressives
Read his award winning blog here:
http://covertrationingblog.com/
Read Dr. Rich’s bio here:
http://covertrationingblog.com/drrich
Dr Vecchio is INTIMIDATED against recommending mammograms…and that is THE CHICAGO WAY. We don’t do that S**t in America. Your thuggish party and its leader do and the doctors don’t want any part of it.
Tina, you and I could write until we are blue in the face in our attempts to get Chris to understand the health care mandates authority and its power over the health care professionals and our personal covered care. Since he has previously stated in other post he doesnt read anything by publishers or writers he doesnt agree with its a waste of our time and effort. Below are a couple of sample weve both furnished last week to prove my point.
Your new information is most disturbing. Knowing this outrages law now guarantees it can not be overturned by any future congress is beyond all limits of just how far the Progressives will go to guarantee they not only got what they wanted but to keep it and, therefore, us under its control forever. Our only hope is our next Congress will be able to overturn the law in its entirety or to at least defund it rendering it harmless.
Thanks for all your time, effort and valuable information. We really appreciate what you do.
Under the Patient Protection and Affordable Care Act (PPACA), a previously obscure government advisory body has acquired vast authority to decide which health care services Americans will have access to.
PPACA gives the USPSTFs recommendations the force of law, making them de facto mandates on which preventive services private health plans and public programs such as Medicare must pay for.
Under President Obamas health care plan, the United States Preventive Services Task Force now wields great power to decide which health services (like mammograms) doctors should provide, yet it has few checks on its sweeping authority.
You’re welcome Peggy.
It’s the unintended consequences (or the covertly intended consequences) that we as citizens must guard against by remaining vigilant. I appreciate all you do as well as I’m sure most of our readers do!
Tina: “Dr Vecchio is INTIMIDATED against recommending mammograms…”
She is? How?
Even if she is being “intimidated,” that does not justify her claims that she will be arrested and put in jail if she recommends mammograms. You still have no provided any evidence that this claim is true; instead, you cite articles that level completely different accusations against the law.
I ask again: How do you propose cutting Medicare without lowering payments to Medicare doctors?
On a related note, if the Romney/Ryan plan ends up lowering payments to Medicare doctors, will you refer to their plan as “rationing,” as you have with Obama’s?
She didn’t say she would be…she said she could be.
I have shown legal opinions that support her fears.
You disagree which is your right.
That’s all I have to say on the subject.
The proposed savings in Medicare under the Ryan proposal is achieved by introducing free market principles, including putting control back in the hands of patients. One change would be giving choice to those younger than 55 to remain in the current Medicare system or pick from a group of approved alternatives (This is what Congress has). A premium support check would be given to each participant that would cover a basic plan; those who want more coverage can pay for it out of pocket. The plan will also be means tested so that the wealthier pay more. Competition and individual choice will spur competition among insurers who will innovate and bring costs down to attract customers.
A good article on this is here:
http://americansforprosperity.org/legislativealerts/medicare-part-iii-congressman-ryans-medicare-plan/
The same group evaluates Obamacare here:
http://americansforprosperity.org/legislativealerts/medicare-part-ii-president-obamas-medicare-plan/
And the problems in the current Medicare program are discussed here:
http://americansforprosperity.org/legislativealerts/medicare-part-i-what-is-medicare/
Our readers can now make a comparison and decide for themselves why we need reform and what would be the better course.
“She didn’t say she would be…she said she could be.”
She uses “could” to refer to the possibility of being put in jail, but she uses “will” when she refers to being fined. Either way, she’s still wrong. The law does not make it illegal for her to recommend mammograms to women under 50. Let’s go through her statement again, because you still don’t seem to understand the claims she made:
“When I see a breast patient, when I do a mammogram, and I work her up, at the end of my workup, according to the government, I can only recommend a screening mammogram for women over 50 every other year until 74, and never again…”
This is false. The guidelines actually say that she CAN recommend mammograms to women under 50. From WebMD:
“What fundamentally changed in 2009 was that the USPSTF came out against routine screening mammography in women age 40-49. Instead, it stated that the decision to get routine screening mammograms before age 50 should be “an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”
It was widely reported, however, that the USPSTF was against screening entirely for women with an average risk of breast cancer between the ages of 40 to 49. That wasn’t the case, says Diana Petitti, MD, professor of biomedical informatics at Arizona State University and vice chair of the 2009 USPSTF committee.
The actual recommendation was not communicated well, according to Petitti. “The decision about the age to start being screened at 40, 42, 44, 48, should be one that was more individualized,” she says, rather than a woman’s 40th birthday triggering an automatic authorization slip from her doctor to get a mammogram.”
http://www.webmd.com/breast-cancer/features/starting-mammography-screening
And even if the guidelines were completely against mammograms for any woman under 50 (which would never happen), the law still wouldn’t do what Dr. Vecchio claims. As I have shown you by citing the law, the guidelines are simply used to set the MINIMUM standard of care that insurers must cover. It also explicitly says that insurers are allowed to cover things not recommended by the guidelines. How anyone can interpret that to mean doctors are banned from recommending anything beyond those guidelines remains a mystery to me. It doesn’t make sense.
Dr. Vecchio goes on to say:
“I will violate their guidelines every day, many times a day. As a result of that–as a result of my violations–I will be fined, I won’t be paid, and I could be put in jail. Put. In. Jail. I will not be practicing medicine when this law takes effect.”
I can only hope that last sentence is true, because nothing else she says is. There is no punishment for Vecchio violating the guidelines, because the law only makes them the minimum standard of care. She can still recommend mammograms to any woman she thinks needs them.
The American College of Physicians, which is the largest medical specialty organization in the U.S., put out a statement attempting to correct misinformation about the task force guidelines:
“Under the bills being considered by Congress, the USPSTF will have an important role in making evidence-based recommendations on preventive services that insurers will be required to cover, but the bills do not give the Task Force or the federal government itself any authority to put limitations on coverage, ration care, or require that insurers deny coverage. Specifically, the House and Senate bills would require health plans to cover preventive services based in large part on the evidence-based reviews by the USPSTF, but no limits are placed on health plans ability to offer additional preventive benefits, or in considering advice from sources other than the USPSTF in making such coverage determinations. Accordingly, patients will benefit by having a floor not a limit on essential preventive services that would be covered by all health insurers, usually with no out-of-pocket cost to them. Patients will also benefit from having independent research on the comparative effectiveness of different treatments, as proposed in the bills before Congress. The bills specifically prohibit use of comparative effectiveness research to limit coverage or deny care based on cost.
The controversy over the mammography guidelines illustrates the importance of communicating information on evidence-based reviews to the public in a way that facilitates an understanding of how such reviews are conducted and how they are intended to support, not supplant, individual decision-making by patients and their clinicians.
ACP urges Congress, the administration, and patient and physician advocacy groups to respect and support the importance of protecting evidence-based research by respected scientists and clinicians from being used to score political points that do not serve the publics interest.”
http://www.acponline.org/pressroom/pol_ebcr.htm
That was in 2009; Dr. Vecchio’s speech occurred this year. I guess she didn’t get the memo.
“I have shown legal opinions that support her fears.”
No, you haven’t. You’ve cited legal opinions dealing with completely different aspects of the law, none of which support Vecchio’s claims. The most you can say is that according to those opinions, the government might have the authority to ban mammograms for women under 50 at some point in the future. But that’s very far away from the claim Dr. Vecchio made. She said that right now, she cannot recommend mammograms to women under 50. That. Is. Not. True.
“You disagree which is your right.”
We are all entitled to our own opinions, Tina. We are not entitled to our own facts. Dr. Vecchio’s claims have no basis in fact. They are directly contradicted by the text of the PPACA, the text of the task force guidelines she cites, and by multiple respected medical organizations. They. Are. Not. True.
Why can’t you admit that? There’s no shame in doing so. There is a lot of shame in trying desperately to twist reality to fit a political bias, especially when it involves misinforming people about their medical options. The ACP warned against precisely this. For a doctor such as Jill Vecchio to abuse her power in such a way is negligent and wrong. She should be stripped of her medical license for lying to the public about their medical options.
Am I the only one here who cares about accuracy? About honesty? About the truth?
I’ll try to address more later.
Well, isn’t this interesting. Not only does the PPACA not restrict women under 50 from getting mammograms. It actually PAYS for women to have mammograms if they are 40 years old or older. Here’s a memo from Kathleen Sebelius, dated Oct. 5, 2012:
“The Affordable Care Act, signed into law earlier this year, makes breast cancer screening and coverage for treatment available and accessible by requiring health plans to cover preventive services and eliminate cost-sharing and by making health coverage more affordable and accessible for women.
If you or your family enrolled in a new health plan on or after September 23, 2010, that plan will be required to cover recommended preventive services without charging you a copayment or deductible. This includes annual screening mammograms for women starting at age 40.”
For those fuzzy on the timeline, this memo was issued months after the PPACA was passed.
Tina, Peggy, are you ready to admit that you and Dr. Vecchio were wrong, and that the law does not stop doctors from recommending mammograms to woman younger than 50?
The law will be anything the Secretary who is charged with saving money based on recommendations made by the panel of 15 decides it will be.
The doctor expressed concerns about what the law can mean to her practice…fear and loathing backed up by legal opinion regarding language in the law that gives the secretary and her unelected panel unprecedented power and authority.
The end.
Chris: “Here’s a memo from Kathleen Sebelius, dated Oct. 5, 2012:”
Isn’t today Aug. 29, 2012? How could Sebelius send out a memo dated Oct. 5, 2012? Want to clarify?
Sorry, Peggy. I meant to write 2010. If you read the memo, you will see that this is the date.
Do you see how Dr. Vecchio’s claims were wrong now? The health care law doesn’t stop her from recommending mammograms to women under 50. In fact, it actually PAYS for women to have mammograms if they are 40 and older. The law does the exact opposite of what Vecchio claims; rather than restricting access to mammograms, it expands it.
Tina: “The law will be anything the Secretary who is charged with saving money based on recommendations made by the panel of 15 decides it will be.
The doctor expressed concerns about what the law can mean to her practice…”
Good lord, have you ever seen anything more weasley? Why do you try to hide behind such vague generalizations? Dr. Vecchio did not just “express concerns.” She made a very specific claim. She said that under the law, she cannot recommend mammograms to women under 50 and over 75. That is not true. Even if you believe that the Secretary can arbitrarily change the law later, the fact remains that what Dr. Vecchio said was false.
Is there something physically stopping you from conceding this point?