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Sunday, April 25, 2010

Andrew Napolitano - Health Care Tyranny

Thursday, April 22, 2010

Nearly 4M to pay health insurance penalty by 2016

Nearly 4M to pay health insurance penalty by 2016

Stephen Ohlemacher
From Real Clear Politics

Nearly 4 million Americans will have to pay a penalty if they fail to get health insurance when that element of President Barack Obama's health care overhaul law kicks in, according to congressional projections released Thursday.

The penalties will average a little more than $1,000 apiece in 2016, the Congressional Budget Office said in a report.

The vast majority of people paying the fine will be middle class, which would violate Obama's 2008 campaign pledge not to raise taxes on individuals making less than $200,000 a year and couples making less than $250,000.

Republicans have criticized the penalties, even though the idea for a mandate was originally proposed by Republicans in the 1990s and is part of the Massachusetts health care plan signed into law by then Gov. Mitt Romney, a Republican, in 2006. Attorneys general in more than a dozen states are working to challenge the mandate in federal court as unconstitutional.

Democrats argue the mandate and the penalties are a necessary part of a massive overhaul designed to expand coverage to millions who now lack it. They point out that getting young, healthy Americans in the insurance pool will reduce costs for others.

Americans who don't get qualified health insurance will be required to pay penalties starting in 2014, unless they are exempt because of low income, religious beliefs, or because they are members of American Indian tribes. The penalties will be fully phased in by 2016.

About 21 million nonelderly residents will be uninsured in 2016, according to projections by the CBO and the Joint Committee on Taxation. Most of those people will be exempt from the penalties.

Under the new law, the penalties will be phased in starting in 2014. By 2016, those who must get insurance but don't will be fined $695 or 2.5 percent of their household income, whichever is greater.

After 2016, the penalties will be increased by annual cost-of-living adjustments. People will not be required to get coverage if the cheapest plan available costs more than 8 percent of their income.

The penalties will be collected by the Internal Revenue Service through tax returns. However, the IRS will not have the authority to bring criminal charges or file liens against those who don't pay.

About 3 million of those required to pay fines in 2016 will have incomes below $59,000 for individuals and $120,000 for families of four, according to the CBO projections. The other 900,000 people who must pay the fine will have higher incomes.
The government will collect about $4 billion a year in fines from 2017 through 2019, according to the report.

Would the Founders Love ObamaCare?

Would the Founders Love ObamaCare?

The left-wing critics are right: The rage is not about health care. They are also right that similar complaints about big government were heard during the New Deal and the Great Society, and the sky didn't fall.

But what if this time the sky is falling—on them.

What if after more than a century of growth in the national government, starting with the Progressive Era, the American people are starting to push back. Not just the tea partiers or the 13 state attorneys general seeking protection under the 10th Amendment and the Commerce Clause. But something bigger than that.

Daniel Henninger discusses the widespread anxiety over the size of government.
The Democratic left, its pundits and academics criticizing the legal challenges to ObamaCare seem to be arguing that their version of our political structure is too big to change.

That's not true. The American people can and do change the nation's collective mind on the ordering of our political system. The civil rights years of the 1960s is the most well-known modern example. (The idea that resistance to Mr. Obama's health plan is rooted in racist resentment of equal rights is beyond the pale, even by current standards of political punditry.)

Powerful political forces suddenly seem to be in motion across the U.S. What they have in common is anxiety over what government has become in the first decade of the 21st century.

The tea party movement is getting the most attention because it is the most vulnerable to the standard tool kit of mockery and ridicule. It is more difficult to mock the legitimacy of Scott Brown's overthrow of the Kennedy legacy, the election results in Virginia and New Jersey, an economic discomfort that is both generalized and specific to the disintegration of state and federal fiscs, and indeed the array of state attorneys general who filed a constitutional complaint against the new health-care law. What's going on may be getting past the reach of mere mockery.

Constitutional professors quoted in the press and across the Web explain that much about the federal government's modern authority is "settled" law. Even so, many of these legal commentators are quite close to arguing that the national government's economic and political powers are now limitless and unfettered. I wonder if Justice Kennedy believes that.

Or as David Kopel asked on the Volokh Conspiracy blog: "Is the tax power infinite?"

In a country that holds elections, that question is both legal and political. The political issue rumbling toward both the Supreme Court and the electorate is whether Washington's size and power has finally grown beyond the comfort zone of the American people. That is what lies beneath the chatter about federalism and the 10th Amendment.

Liberals will argue that government today is doing good. But government now is also unprecedentedly large and unprecedentedly expensive. Even if every challenge to ObamaCare loses in court, these anxieties will last and keep coming back to the same question: Does the Democratic left think the national government's powers are infinite?

No one in the Obama White House, asked that in public on Sunday morning, would simply say yes, no matter that the evidence of this government's actions the past year indicate they do. In his "Today Show" interview this week, Mr. Obama with his characteristic empathy acknowledged there are "folks who have legitimate concerns . . . that the federal government may be taking on too much."

My reading of the American public is that they have moved past "concerns." Somewhere inside the programmatic details of ObamaCare and the methods that the president, Speaker Pelosi and Sen. Reid used to pass it, something went terribly wrong. Just as something has gone terribly wrong inside the governments of states like California, New York, New Jersey, Michigan and Massachusetts.

The 10th Amendment tumult does not mean anyone is going to secede. It doesn't mean "nullification" is coming back. We are not going to refight the Civil War or the Voting Rights Act. Richard Russell isn't rising from his Georgia grave.

It means that the current edition of the Democratic Party has disconnected itself from the average American's sense of political modesty. The party's members and theorists now defend expanding government authority with the same arrogance that brought Progressive Era reforms down upon untethered industrial interests.

In such times, this country has an honored tradition of changing direction. That time may be arriving.

Faced with corporate writedowns in response to the reality of Congress's new health plan, an apoplectic Congressman Henry Waxman commanded his economic vassals to appear before him in Washington.

Faced with a challenge to his vision last week, President Obama laughingly replied to these people: "Go for it."

They will.

As to the condescension and sniffing left-wing elitism this opposition seems to bring forth from Manhattan media castles, one must say it does recall another, earlier ancient regime

Wednesday, April 21, 2010

The Truth About the Health Care Bill

A retired Constitutional lawyer has read the entire proposed healthcare bill.Share
Today at 4:20pm

The Truth About the Health Care Bill
A retired Constitutional lawyer has read the entire proposed healthcare bill.Share
Today at 4:20pm

The Truth About the Health Care Bills - Michael Connelly, Ret.
Constitutional Attorney
Well, I have done it! I have read the entire text of proposed House Bill
3200: The Affordable Health Care Choices Act of 2009. I studied it with
particular emphasis from my area of expertise, constitutional law. I was
frankly concerned that parts of the proposed law that were being discussed
might be unconstitutional. What I found was far worse than what I had heard
or expected.

To begin with, much of what has been said about the law and its implications
is in fact true, despite what the Democrats and the media are saying. The
law does provide for rationing of health care, particularly where senior
citizens and other classes of citizens are involved, free health care for
illegal immigrants, free abortion services, and probably forced
participation in abortions by members of the medical profession.

The Bill will also eventually force private insurance companies out of
business, and put everyone into a government run system. All decisions
about personal health care will ultimately be made by federal bureaucrats,
and most of them will not be health care professionals. Hospital
admissions, payments to physicians, and allocations of necessary medical
devices will be strictly controlled by the government.

However, as scary as all of that is, it just scratches the surface. In
fact, I have concluded that this legislation really has no intention of
providing affordable health care choices. Instead it is a convenient cover
for the most massive transfer of power to the Executive Branch of government
that has ever occurred, or even been contemplated If this law or a similar
one is adopted, major portions of the Constitution of the United States will
effectively have been destroyed.

The first thing to go will be the masterfully crafted balance of power
between the Executive, Legislative, and Judicial branches of the U.S.
Government. The Congress will be transferring to the Obama Administration
authority in a number of different areas over the lives of the American
people, and the businesses they own.

The irony is that the Congress doesn't have any authority to legislate in
most of those areas to begin with! I defy anyone to read the text of the
U.S. Constitution and find any authority granted to the members of Congress
to regulate health care.

This legislation also provides for access, by the appointees of the Obama
administration, of all of your personal healthcare -- a direct violation of
the specific provisions of the 4th Amendment to the Constitution
information, your personal financial information, and the information of
your employer, physician, and hospital. All of this is a protection against
unreasonable searches and seizures. You can also forget about the right to
privacy. That will have been legislated into oblivion regardless of what
the 3rd and 4th Amendments may provide...

If you decide not to have healthcare insurance, or if you have private
insurance that is not deemed acceptable to the Health Choices Administrator
appointed by Obama, there will be a tax imposed on you. It is called a tax
instead of a fine because of the intent to avoid application of the due
process clause of the 5th Amendment. However, that doesn't work because
since there is nothing in the law that allows you to contest or appeal the
imposition of the tax, it is definitely depriving someone of property
without the due process of law.

So, there are three of those pesky amendments that the far left hate so
much, out the original ten in the Bill of Rights, that are effectively
nullified by this law It doesn't stop there though.

The 9th Amendment that provides: The enumeration in the Constitution, of
certain rights, shall not be construed to deny or disparage others retained
by the people;

The 10th Amendment states: The powers not delegated to the United States by
the Constitution, nor prohibited by it to the States, are preserved to the
States respectively, or to the people. Under the provisions of this piece
of Congressional handiwork neither the people nor the states are going to
have any rights or powers at all in many areas that once were theirs to

I could write many more pages about this legislation, but I think you get
the idea. This is not about health care; it is about seizing power and
limiting rights... Article 6 of the Constitution requires the members of
both houses of Congress to "be bound by oath or affirmation to support the
Constitution." If I was a member of Congress I would not be able to vote for
this legislation or anything like it, without feeling I was violating that
sacred oath or affirmation. If I voted for it anyway, I would hope the
American people would hold me accountable.

For those who might doubt the nature of this threat, I suggest they consult
the source, the US Constitution, and Bill of Rights. There you can see
exactly what we are about to have taken from us.

Michael Connelly
Retired attorney,
Constitutional Law Instructor
Carrollton , Texas

Monday, April 19, 2010

ObamaCare will drive up costs, burden the healthy

NYT: ObamaCare will drive up costs, burden the healthy
Posted on April 18, 2010 by Ed Morrissey

From the Hot Air Blog

Perhaps the New York Times needs to change its well-known motto to All the News That’s Fit to Print … Eventually. In today’s edition, buried in its Regional section, comes an analysis of the health-insurance reforms imposed by the state of New York over fifteen years ago. Like ObamaCare, the state required insurance carriers to issue policies to people with pre-existing conditions as a means of making the industry more “fair” and imposed community pricing rather than risk-based premiums.

How did that work for New Yorkers?

About the way ObamaCare critics predicted:

New York’s insurance system has been a working laboratory for the core provision of the new federal health care law — insurance even for those who are already sick and facing huge medical bills — and an expensive lesson in unplanned consequences. Premiums for individual and small group policies have risen so high that state officials and patients’ advocates say that New York’s extensive insurance safety net for people like Ms. Welles is falling apart.

The problem stems in part from the state’s high medical costs and in part from its stringent requirements for insurance companies in the individual and small group market. In 1993, motivated by stories of suffering AIDS patients, the state became one of the first to require insurers to extend individual or small group coverage to anyone with pre-existing illnesses.

New York also became one of the few states that require insurers within each region of the state to charge the same rates for the same benefits, regardless of whether people are old or young, male or female, smokers or nonsmokers, high risk or low risk.

Healthy people, in effect, began to subsidize people who needed more health care. The healthier customers soon discovered that the high premiums were not worth it and dropped out of the plans. The pool of insured people shrank to the point where many of them had high health care needs. Without healthier people to spread the risk, their premiums skyrocketed, a phenomenon known in the trade as the “adverse selection death spiral.”

In fact, that death spiral has nearly wiped out the individual market insurance industry in New York. The state has the highest annual premiums for individual-market policies at over $6600 for single-beneficiary comprehensive plans and about double that for families. The employer-based market has fared better, but mainly because employers subsidize insurance and so keep healthy people in the plans.
ObamaCare supporters will argue that the federal insurance mandate will solve this problem, even though the mandate in Massachusetts hasn’t kept costs in line.

Interestingly, the New York Times also sounds skeptical:

The new federal health care law tries to avoid the death spiral by requiring everyone to have insurance and penalizing those who do not, as well as offering subsidies to low-income customers. But analysts say that provision could prove meaningless if the government does not vigorously enforce the penalties, as insurance companies fear, or if too many people decide it is cheaper to pay the penalty and opt out.

Under the federal law, those who refuse coverage will have to pay an annual penalty of $695 per person, up to $2,085 per family, or 2.5 percent of their household income, whichever is greater. The penalty will be phased in from 2014 to 2016.
It doesn’t take much to do the math here. If one has to pay $6600 per year for a comprehensive policy one doesn’t really need or pay $2500 on a salary of $100,000, which one will healthy, younger earners take? That assumes, of course, that the government will actually enforce the mandate, which Democrats insisted the ObamaCare bill couldn’t do.

The rebuttal to this will be that most young, healthy people earn much less and will get federal subsidies, but that still depends on them deciding whether to pay anything out of pocket at all for a comprehensive policy that clearly doesn’t suit them. That argument neglects the fact that the actual costs will still skyrocket, but that taxpayers will be on the hook for the subsidies, which will have to increase to match the premium hikes to remain effective. Instead of just having premiums based on rational risk assessments, we have the young and healthy subsidizing premiums for the older and less healthy, who then subsidize the younger and healthier through federal handouts. It’s an insane feedback loop.

If nothing else, this proves a couple of points that critics have made all along. The mandates are nothing more than a way to get the young to create a proxy welfare state by forcing them into a usurious insurance model. It does nothing to reduce actual costs, and in fact makes cost increases both more likely and more amplified.

Finally, this problem has unfolded in New York for years. The premium problem in individual markets — the very kind that ObamaCare requires — were well known to the New York Times. They had almost a year to report this during the health-care debate before a vote was taken. Instead, they report it almost a month after Congress passed the bill, and stuck it in the Regional section where national readers might have missed it. Shameful.

Sunday, April 18, 2010

Allen West Needs 1000 Patriots

Wednesday, April 14, 2010

Poll Finds Tea Party Anger Rooted in Issues of Class

Poll Finds Tea Party Anger Rooted in Issues of Class

Published: April 14, 2010

Tea party supporters are wealthier and more well-educated than the general public, tend to be Republican, white, male, and married, and their strong opposition to the Obama administration is more rooted in political ideology than anxiety about their personal economic situation, according to the latest New York Times/CBS News poll.

The 18 percent of Americans who identify themselves as Tea Party supporters look like Republicans in many ways, but they hold more conservative views on a range of issues and tend to be older than Republicans generally. They are also more likely than Republicans as a whole to describe themselves as “very conservative” and President Obama as “very liberal.”

And while most Republicans say they are “dissatisfied” with Washington, Tea Party supporters are more likely to classify themselves as “angry.”

Speculation and anecdotal evidence have often taken the place of concrete data about who supports the Tea Party movement, and the poll offers some surprising findings.
In some ways, Tea Party supporters look like the general public. For instance, despite their allusions to Revolutionary War-era tax protesters, most describe the amount they paid in taxes this year as “fair.” Most send their children to public schools, do not think Sarah Palin is qualified to be president, and, despite their push for smaller government, think that Social Security and Medicare are worth the cost. They are actually more likely than the general public to have returned their census forms, despite some conservative leaders urging a boycott.

Their fierce animosity toward Washington, and the president in particular, is rooted in deep pessimism about the direction of the country and the conviction that the policies of the Obama administration are disproportionately directed at helping the poor rather than the middle class or the rich.

The overwhelming majority of Tea Party supporters say Mr. Obama does not share the values most Americans live by, and that he does not understand the problems of people like themselves. More than half say the policies of the administration favor the poor, and 25 percent, compared with 11 percent of the general public, think that the administration favors blacks over whites. They are more likely than the general public, and Republicans, to say that too much has been made of the problems facing black people.

Asked what they are angry about, Tea Party supporters offered three main concerns: the recent health care overhaul, government spending, and a feeling that their opinions are not represented in Washington.

“The only way they will stop the spending is to have a revolt on their hands,” Elwin Thrasher, a 66-year-old semi-retired lawyer in Florida, said in an interview following the poll. “I’m sick and tired of them wasting money and doing what our founders never intended to be done with the federal government.”

They are far more pessimistic than Americans in general about the economy improving. More than 90 percent of Tea Party supporters think the country is headed in the wrong direction, compared with about 60 percent of the general public. About 6 in 10 say America’s best days are behind us when it comes to the availability of good jobs for American workers.

Nearly 9 in 10 disapprove of the job Mr. Obama is doing overall, and about the same percentage fault his handling on the specifics, too: health care, the economy, and the federal budget deficit. More than 8 in 10 hold an unfavorable view of him personally, and 92 percent believe he is moving the country toward socialism – an opinion shared by about half the general public. Tea Party supporters are also more likely than most Americans to believe, mistakenly, that the president has increased taxes for most Americans.

“I just feel he’s getting away from what America is,” said Kathy Mayhugh, 67, a retired medical transcriber in Jacksonville. “He’s a socialist. And to tell you the truth I think he’s a Muslim and trying to head us in that direction, I don’t care what he says. He’s been in office over a year and can’t find a church to go to. That doesn’t say much for him.”

The nationwide telephone poll was conducted April 5-12 with 1,580 adults. For the purposes of analysis, Tea Party supporters were oversampled, for a total of 881, and then weighted back to their proper proportion in the poll. The margin of sampling error is plus or minus three percentage points for both all adults and Tea Party supporters.

The Tea Party supporters are more likely than the general public to say their personal financial situation is good or very good. But like the general public, 55 percent are concerned that someone in their household will be out of a job in the next year. And more than two-thirds say the recession has been difficult or caused hardship and major life changes. Like most Americans, they think the most pressing problem facing the country today are the economy and jobs.

But while most Americans blame the Bush administration or Wall Street for the current state of the American economy, the greatest number of Tea Party supporters blamed Congress.

Still, while they overwhelmingly disapprove of Congress, 4 in 10 Tea Party supporters, like most Americans, approve of the job their own representative is doing.

They do not want a third party, and say they usually or almost always vote Republican. The percentage holding a favorable opinion of former president George W. Bush — at 57 percent — almost exactly matches the percentage in the general public that holds an unfavorable view.

Dee Close, a 47-year-old homemaker in Memphis, said she was worried about a “drift” in the country. “Over the last 3 or 4 years I’ve realized how immense that drift has been away from what made this country great,” she said. “I’m angry because I feel that those who are elected hijack the country once they are elected to positions of power.”

She blamed Americans for being apathetic. “Most people are not even aware of how gullible they are,” she said. “They’re not educated enough to know what’s going on.”
Yet while the Tea Party supporters are more conservative than Republicans on social issues, they do not want to focus on those issues: about 8 in 10 say that they are more concerned with economic issues.

When talking about the Tea Party movement, the largest number of respondents said that the goal should be reducing the size of government, more than cutting the budget deficit, or lowering taxes.

And nearly three quarters said they would prefer smaller government even if it means spending on domestic programs would be cut.

But in follow up interviews, people said did not want to cut Medicare or Social Security — the biggest domestic programs – suggesting instead a focus on “waste.”
“I do believe we are responsible for the widow and the orphan,” said Richard Gilbert, a 72 year old retired teacher. “But I think there is a welfare class that lives for having children and receiving payment from the government for having those children. They have no incentive to do any better because they have been conditioned into it.”

Others defended being on Social Security while fighting big government by saying they had paid into the system, so deserved the benefits.
Others could not explain the contradiction.

“I guess I want smaller government and my Social Security,” said Jodine White, 62, of Rocklin, Calif. “I didn’t look at it from the perspective of losing things I need. I think I’ve changed my mind.”

Support for repeal of health bill grows

Support for repeal of health bill grows
From Marketwatch Blog

Support for repeal of controversial health-care legislation is growing, according to the latest poll from Rasmussen Reports.

The tracking service said Monday that 58% of those surveyed are in favor of revoking the measures recently passed by the House and Senate designed to reform health care, with 50% of voters strongly favoring repeal. The 58% figure is up from the 54% of voters favoring repeal a week ago, which remained unchanged from the week before that.

Those strongly opposing repeal dropped by the same margin, down to 38% from the 42% posted a week ago, Rasmussen says.

Rasmussen says support for repeal is growing among Republicans, as 88% of that party’s members are against it, along with 54% of unaffiliated voters. On the other side, 61% of Democrats are opposed to repeal. Republican support grew by eight points while Democratic opposition declined by seven points.

Among likely voters in this latest survey, though, only 38% think it is likely that the health-care bill will be repealed, and 18% say it is not at all likely. And over the weekend, Rasmussen reported that President Barack Obama has received a bit of a boost in his approval ratings.

Those who strongly approve of Obama’s job performance as the nation’s chief executive has grown to 31%, and that metric has hovered in the 28% to 34% range since passage of health reform, Rasmussen says. Prior to that, Obama got a “strongly approve” rating from 22% to 27% of those surveyed.

Still, those who “strongly disapprove” of Obama’s job performance is higher, at 42%, Rasmussen says.

Russ Britt, Los Angeles bureau chief

Tuesday, April 13, 2010

Medical Schools Can't Keep Up

Medical Schools Can't Keep Up
As Ranks of Insured Expand, Nation Faces Shortage of 150,000 Doctors in 15 Years


First-year resident Dr. Rachel Seay, third from left, circumcises a newborn in George Washington University Hospital's delivery wing on March 12.
The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.

Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.

That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.
The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.
A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.

Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.

Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.

But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.

There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.

Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.
Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill.

"It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.
While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.

One provision in the law attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services.

Some efforts by educators are focused on boosting the number of primary-care doctors. The University of Arkansas for Medical Sciences anticipates the state will need 350 more primary-care doctors in the next five years. So it raised its class size by 24 students last year, beyond the 150 previous annual admissions.

In addition, the university opened a satellite medical campus in Fayetteville to give six third-year students additional clinical-training opportunities, said Richard Wheeler, executive associate dean for academic affairs. The school asks students to commit to entering rural medicine, and the school has 73 people in the program.

"We've tried to make sure the attitude of students going into primary care has changed," said Dr. Wheeler. "To make sure primary care is a respected specialty to go into."

Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine in New York, has 1,220 residency slots. Since the 1970s, Montefiore has encouraged residents to work a few days a week in community clinics in New York's Bronx borough, where about 64 Montefiore residents a year care for pregnant women, deliver children and provide vaccines. There has been a slight increase in the number of residents who ask to join the program, said Peter Selwyn, chairman of Montefiore's department of family and social medicine.

One is Justin Sanders, a 2007 graduate of the University of Vermont College of Medicine who is a second-year resident at Montefiore. In recent weeks, he has been caring for children he helped deliver. He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] fields are a lot sexier to students with high debt burdens."

Monday, April 12, 2010

Healthcare law to sock middle class with a $3.9 billion tax increase

The Hill: Healthcare law to sock middle class with a $3.9 billion tax increase
Posted in: Latest News by admin on April 12, 2010

From The Hill:

Taxpayers earning less than $200,000 a year will pay roughly $3.9 billion more in taxes — in 2019 alone — because of healthcare reform, according to the Joint Committee on Taxation, Congress’ official scorekeeper for legislation.

The new law raises $15.2 billion over 10 years by limiting the medical expense deduction, a provision widely used by taxpayers who either have a serious illness or are older.

Taxpayers can currently deduct medical expenses in excess of 7.5 percent of their adjusted gross income. Starting in 2013, most taxpayers will only be allowed to deducted expenses greater than 10 percent of AGI. Older taxpayers are hit by this threshold increase in 2017

Once the law is fully implemented in 2019, the JCT estimates the deduction limitation will affect 14.8 million taxpayers — 14.7 million of them will earn less than $200,000 a year. These taxpayers are single and joint filers, as well as heads of households.

“Loss of this deduction will mean higher taxes for 14.7 million individuals and families making under $200,000 a year in 2019,” Sen. Chuck Grassley (R-Iowa) told The Hill. “The new subsidy for health insurance would not be available to offset this tax increase for most of these households.”

The healthcare law contains tax breaks for individuals purchasing health insurance, but phase out for those making $88,000 a year.

Grassley is the ranking member on the tax-writing Senate Finance Committee and voted against the health reform bill.

Couples earning less than $250,000 will also nicked by the tax, but the exact number is unclear. The JCT lumps this income level in with those making at least $500,000. Joint Tax estimates that 58,000 taxpayers earning between $200,000 and $500,000 annually will pay $74 million more in taxes in 2019.

About 5,000 taxpayers earning over $500,000 a year will pay $43 million more in tax because of the limitation.

President Obama in his Saturday radio address said the healthcare law keeps his campaign pledge to not raise taxes on the middle class. On the trail he promised individuals earning less than $200,000 and joint filers earning less than $250,000 would not see a tax increase under his watch

Saturday, April 10, 2010

Hate speech, hypocrisy from AFL-CIO chief

Hate speech, hypocrisy from AFL-CIO chief

Obamacare’s Consequence

Obamacare’s Consequence
A tarnished presidency
BY Matthew Continetti
The Weekly Standard

April 5 - April 12, 2010, Vol. 15, No. 28
The liberal line is that President Obama has secured his place in history by signing into law the Patient Protection and Affordable Care Act of 2010. And secured it he has. Henceforth Obama will be remembered as the man who accelerated America’s mad dash toward bankruptcy. He will be remembered as the leader who promoted a culture of dependency. He will be remembered as the figure who sacrificed a dream of national unity upon the altar of big government liberalism. It’s true: Obama is now a president of consequence. And almost all of those consequences are bad.

The fiscal picture was bleak before Obama made it worse. Government debt is 60 percent of the gross domestic product and climbing. The deficit is projected to remain above 4 percent of GDP for the next decade. The week before the president signed his health care reform into law, Moody’s warned that America’s AAA bond rating may be downgraded. The day before the signing ceremony, the nation learned that Warren Buffett is a safer investment than U.S. treasuries. One needn’t look across the Atlantic, where a penniless Greece is a supplicant to the IMF, to see our future. Look to California, where the economy is crippled by high taxes, high spending, and burdensome debt.

President Obama is an intelligent man. He knew there was no way a massive entitlement could get through Congress when spending, deficit, and debt are major issues. So he claimed that health care reform would help ameliorate America’s fiscal problem, not exacerbate it. And for support he had the Congressional Budget Office (CBO), which found that, under a certain set of conditions—spending cuts, Medicare cuts, new taxes—health care reform would not only pay for itself but would reduce the deficit.

But what happens under real world conditions? What happens when the Medicare cuts and the excise tax disappear and the subsidies are more generous than expected? When Representative Paul Ryan of Wisconsin asked the CBO these questions, he was told the deficit would increase by a considerable margin. Which outcome is more likely: a Congress that cuts services, imposes taxes on favored constituencies, and refrains from spending? Or a Congress that goes instead on a fact-finding mission to Djibouti while making promises it cannot keep?

But balancing the books was never Obama’s primary goal. Equality was. For decades, liberals have decried America’s patchwork system of health insurance and have sought to provide coverage for all. But rather than deregulate health markets and provide consumers with the tools they need to spur competition, reduce prices, and promote innovation, liberals chose another path. They chose to increase regulation and make government the intermediary between taxpayer dollars and the insurance companies. Through the individual mandate, the Democrats have ordered every adult American to purchase a consumer product. And if an American cannot afford that product, government will subsidize him, thereby directing public money to private profit.

How long before the Democrats figure out that it would be cheaper for government to eliminate the middleman and become the insurer of first resort? Perhaps sooner than you think. (Some already have.) A portent is the student loan industry. Last week Congress, after years of subsidizing loans originating in private banks, decreed that all loans would now originate directly from the federal government. A narrow partisan majority effected the drastic policy change. This is the process by which markets shrink, choice is curtailed, and government dependency grows. It’s become commonplace.

What is most striking is the impact of health care on Obama’s presidency. Liberals are already touting his legislative victory as the catalyst for a domestic and foreign policy rebound. To the contrary: Obama is enfeebled. Health care reform has helped turn large swaths of independents against him. It has nullified the chance for bipartisan cooperation in this Congress. It has exposed him as weak: Despite 39 speeches on the topic, despite a huge investment of political capital, the health bill passed by a margin of five votes. Thirty-two Democrats defected. The public opposed this law.

Gone is the charismatic young man who told the 2004 Democratic National Convention in Boston that there was no Blue America and no Red America, only the United States of America. All that remains is a partisan liberal Democrat whose health care policy bulldozed public opinion, enraged the electorate, poisoned the Congress, and set into motion a sequence of events the outcome of which cannot be foreseen.

This tarnished White House complains incessantly about the crises it inherited from its predecessor. Crises? You ain’t seen nothing yet.

—Matthew Continetti

Wednesday, April 7, 2010

Is Health Care a Right?

by Walter E. Williams


Most politicians, and probably most Americans, see health care as a right. Thus, whether a person has the means to pay for medical services or not, he is nonetheless entitled to them. Let's ask ourselves a few questions about this vision.

Say a person, let's call him Harry, suffers from diabetes and he has no means to pay a laboratory for blood work, a doctor for treatment and a pharmacy for medication. Does Harry have a right to XYZ lab's and Dr. Jones' services and a prescription from a pharmacist? And, if those services are not provided without charge, should Harry be able to call for criminal sanctions against those persons for violating his rights to health care?

You say, "Williams, that would come very close to slavery if one person had the right to force someone to serve him without pay." You're right. Suppose instead of Harry being able to force a lab, doctor and pharmacy to provide services without pay, Congress uses its taxing power to take a couple of hundred dollars out of the paycheck of some American to give to Harry so that he could pay the lab, doctor and pharmacist. Would there be any difference in principle, namely forcibly using one person to serve the purposes of another? There would be one important strategic difference, that of concealment. Most Americans, I would hope, would be offended by the notion of directly and visibly forcing one person to serve the purposes of another. Congress' use of the tax system to invisibly accomplish the same end is more palatable to the average American.

True rights, such as those in our Constitution, or those considered to be natural or human rights, exist simultaneously among people. That means exercise of a right by one person does not diminish those held by another. In other words, my rights to speech or travel impose no obligations on another except those of non-interference. If we apply ideas behind rights to health care to my rights to speech or travel, my free speech rights would require government-imposed obligations on others to provide me with an auditorium, television studio or radio station. My right to travel freely would require government-imposed obligations on others to provide me with airfare and hotel accommodations.

For Congress to guarantee a right to health care, or any other good or service, whether a person can afford it or not, it must diminish someone else's rights, namely their rights to their earnings. The reason is that Congress has no resources of its very own. Moreover, there is no Santa Claus, Easter Bunny or Tooth Fairy giving them those resources. The fact that government has no resources of its very own forces one to recognize that in order for government to give one American citizen a dollar, it must first, through intimidation, threats and coercion, confiscate that dollar from some other American. If one person has a right to something he did not earn, of necessity it requires that another person not have a right to something that he did earn.

To argue that people have a right that imposes obligations on another is an absurd concept. A better term for new-fangled rights to health care, decent housing and food is wishes. If we called them wishes, I would be in agreement with most other Americans for I, too, wish that everyone had adequate health care, decent housing and nutritious meals. However, if we called them human wishes, instead of human rights, there would be confusion and cognitive dissonance. The average American would cringe at the thought of government punishing one person because he refused to be pressed into making someone else's wish come true.

None of my argument is to argue against charity. Reaching into one's own pockets to assist his fellow man in need is praiseworthy and laudable. Reaching into someone else's pockets to do so is despicable and deserves condemnation.

Dr. Williams serves on the faculty of George Mason University as John M. Olin Distinguished Professor of Economics and is the author of More Liberty Means Less Government: Our Founders Knew This Well

This Just In: America No Longer 'Free' Country

This Just In: America No Longer 'Free' Country
David Knowles Writer

(April 6) -- How free is "mostly free"?

The Heritage Foundation, a self-described conservative think tank that espouses a free-market, small-government ideology, today released its annual Index of Economic Freedom World Rankings. And by its metrics, America's status has dropped from "free" to "mostly free."

Ranking countries throughout the world in 10 categories, the index concludes that the United States is now the eighth most economically free nation, down two spots from last year. Hong Kong ranked No. 1, while North Korea, which was categorized as "repressed," took the bottom rung.

Only seven countries actually rated as "free" on the index, which was released in conjunction with The Wall Street Journal (owned by conservative media mogul Rupert Murdoch, owner of News Corp.).

The largest factor in the Heritage Foundation's demotion of the U.S. is the rise in government spending, especially under the Obama administration.

"The national government's role in the economy, already expanding under President George W. Bush, has grown sharply under the administration of President Barack Obama, who took office in January of 2009," the report read. "Economic growth, which collapsed in 2008, had resumed by the second half of 2009, but legislative proposals for large and expensive new government programs on health care and energy use (climate change) have increased prospects for significant economic disruptions and raised concerns about the long-term health of the economy."

Beating out the United States in terms of economic freedom were, in descending order: Hong Kong, Singapore, Australia, New Zealand, Ireland, Switzerland and Canada.

Organized Medicine Split Over Healthcare Reform Along Specialty Lines

Robert Lowes
From Medscape

April 7, 2010 — The enactment of landmark healthcare reform last month shone a spotlight on deep divisions not only within Congress and the American public but also within organized medicine.

Where medical societies stood on the legislation largely hinged on the answer to the question "What's in it for me?" And the answer to that question depended on whether a given society represented surgical specialists or primary care physicians.

At first glance, the split may not be so apparent. The American Medical Association (AMA), often called "the house of medicine" because it purports to represent all physicians in all specialties, had given qualified support to the legislation. Its stance was a new leaf for an organization that had staunchly opposed major healthcare reform initiatives — think Medicare — going back for decades.

Other major medical societies that applauded the passage of reform legislation with varying degrees of enthusiasm include the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Cardiology, the American Psychiatric Association, and the American Osteopathic Association. By and large, these groups praised the law for extending insurance coverage to 32 million more Americans over 10 years and imposing pro-patient regulations on private insurers, who will no longer be able to deny someone a policy on the basis of preexisting conditions.

"We see this as a good platform for providing people with quality, affordable healthcare," American Academy of Family Physicians President Lori Heim, MD, told Medscape Medical News.

However, the primary care hue of most of these pro-reform groups is telling. Surgeons, by and large, had urged the House to vote down the healthcare legislation that it ultimately approved on March 21. A coalition of 23 medical societies representing 240,000 surgeons and anesthesiologists sent a letter to House Speaker Nancy Pelosi (D-CA) shortly before the vote, stating that the bill failed to build a solid foundation for reform. Signatories included the American College of Surgeons, the American Congress of Obstetricians and Gynecologists, the American Association of Orthopaedic Surgeons, and the American Urological Association.

Some of the major discontents of this coalition were shared by the AMA and other societies that had rallied behind the legislation. The absence of a repeal of the notorious sustainable growth rate formula, which led to a 21.2% Medicare pay cut on April 1, ranked high on the list, as did the creation of an Independent Payment Advisory Board for Medicare that critics consider unaccountable for its decisions. Other gripes were the lack of any major tort reform, such as caps on pain-and-suffering damages in malpractice cases, and penalties for physicians who do not participate in Medicare's Physician Quality Reporting Initiative.

Although the AMA and its allies vowed to work with Congress to correct these sins of omission and commission, the surgical societies concluded that the cons of healthcare reform outweighed the pros, and lobbied against the legislation.

Bonus for Primary Care Physicians, But Not for Most Surgeons

Medical societies representing primary care physicians tended to support healthcare reform more than their surgical counterparts because they stood to gain more from it, experts say.

"There were many things to help primary care physicians, and not very many things to help surgeons," said Kristen Hedstrom, assistant director of legislative affairs for the American College of Surgeons. It is not as if surgeons didn't want to give an economic break to beleaguered internists, family physicians, and pediatricians, Hedstrom explained. Surgeons just wanted a break for themselves as well.

For one thing, the new law attempts to expand a short-handed primary care workforce, which will be further strained by millions of newly insured patients. It pumps more money into scholarships and loan repayment programs for medical students headed into primary care fields, increases the number of residency-training slots for them, and provides economic incentives to practice in underserved areas.

In addition to those carrots, there is a 10% Medicare bonus for primary care physicians and general surgeons in medically underserved areas from 2011 to 2015. However, there is no 10% bonus for an orthopaedic surgeon in suburban Chicago or a urologist in Seattle. Likewise, general internists, pediatricians, and family physicians will see their Medicaid reimbursement rise to Medicare levels in 2013 and 2014 for evaluation and management services and vaccine administration.

"That's a very significant increase," Princeton University healthcare economist Uwe Reinhardt, PhD, told Medscape Medical News. "This bill is friendly to primary care physicians, who have always felt underpaid."

Surgeons Stand to Face Pay Cuts in the Long Term

Other reimbursement advantages accruing to primary care physicians are more subtle than a mere pay hike, said Paul Ginsburg, PhD, president of the Center for Studying Health System Change. The reform law, for example, promotes the medical-home practice model in which a primary care physician receives extra money for coordinating a patient's care.

Another new reimbursement model in the law is the accountable care organization (ACO). The Medicare Payment Advisory Commission defines an ACO as an alliance of primary care and specialist physicians and at least 1 hospital that assumes joint responsibility for meeting performance measures for quality and cost. The new law allows ACOs to share in any cost savings they achieved in treating Medicare patients. Again, a key idea here is coordinated care.

In an ACO, said Dr. Ginsburg, "primary care physicians probably see themselves as becoming a more critical part of the delivery system." As such, they would reprise the central role they played in the heyday of managed care in the early to mid-1990s, "which really enhanced the income of primary care doctors," Dr. Ginsburg said. And by effectively managing chronic diseases like diabetes and hypertension, he said, ACOs can reduce hospitalizations and surgeries, which bodes ill for surgeon income.

To be sure, the new healthcare reform law gives some consideration to what surgeons earn. It's written so that the Medicare bonus for primary care physicians will not be funded by trimming pay for other specialties. However, in the long-term, the handwriting on the wall is reduced reimbursement for surgeons, noted Dr. Reinhardt.
"They know ultimately that their fees will be cut," he said.

The conflicting positions that primary care and surgical societies took on healthcare reform reflect a long-standing rift over these kind of reimbursement issues, said cardiologist Thomas Sullivan, MD, a former president of the Massachusetts Medical Society.

"It's an old battle between procedurally oriented and cognitively oriented physicians, and it's heating up, partly because the government recognizes there's a major shortage of primary care physicians," said Dr. Sullivan. "Surgeons are afraid that primary care will be promoted at their expense."

State Medical Societies Parted Ways Over Reform Legislation

The division in organized medicine over healthcare reform also expressed itself on a state level for reasons that went beyond specialty squabbles. Some state medical societies such as those in Minnesota, Pennsylvania, Massachusetts, and California took a cue from the AMA and hailed the bill's passage as a good first step, or progress, despite its shortcomings.

"It is difficult for the Pennsylvania Medical Society to speak either glowingly or disparaging of the health system reform package," society president James Goodyear, MD, stated in a press release.
Mario Motta, MD, president of the Massachusetts Medical Society, was a bit more positive.

"Even though the bill is far from perfect, our country is much better off with the legislation than without it," Dr. Motta said.

In contrast, at least 10 state medical societies — those in Alabama, Delaware, Florida, Georgia, Kansas, New Jersey, Oklahoma, South Carolina, Tennessee, and Texas — went on record as opposing the bill. The reasons are well summarized in a statement from William Fleming III, MD, the president of the Texas Medical Association.

"[Congress] passed a bill that does nothing to fix glaring problems in our current healthcare system," stated Dr. Fleming. "Instead, it saddles Texans with higher costs, higher taxes, more red tape and more bureaucracy. We believe the bill's unaffordable health system reforms, piled on top of a crumbling Medicare foundation, will create even more dire consequences for all."

Whether a state was politically red or blue appeared to have some bearing on which way its medical society went. President Barack Obama carried California, Massachusetts, Minnesota, and Pennsylvania in 2008, for example, and the medical societies in those blue states also leaned toward the healthcare reform law. Medical societies that came out against "Obamacare" tended to be in states won by Sen. John McCain (R-AZ). Texas and Georgia were prime red examples. However, organized medicine in the blue states of Florida, New Jersey, and Delaware broke this political pattern by siding with reform opponents.

To Dr. Sullivan, how state medical societies lined up on this historic reordering of the healthcare system reflected the inherent diversity in the profession.
"We're like the rest of the United States, and Congress," he said.

Tuesday, April 6, 2010

Obama's bait-and-switch campaign

Obama's bait-and-switch campaign
By: Norm Coleman
April 6, 2010 05:00 AM EDT

One telling moment in the 18-month health care debate was at the White House summit. Sen. John McCain (R-Ariz.) reminded President Barack Obama of his campaign promises to "bring us together" on health care.

"We're not campaigning anymore," the president said. "The election is over." The next question should have been, "Does that mean your campaign promises are null and void?"

Enough time has passed, and enough actions have been seen, to conclude that Obama ran as one kind of president but is governing as a very different one.

What the American people want is the kind of president Obama sold them: a post-partisan consensus builder.

They are justifiably angry at the massive bait-and-switch on health care reform, the most important public policy debate in our lifetime. Obama has violated their trust, which is especially devastating with the long list of challenges we need unity for to tackle, like jobs, energy and the deficit.

Health care is an emotional issue for everyone. In my years in government, I learned that the deeper an issue, the more carefully leaders have to listen — and the greater the need for consensus building rather than using raw political power.

Obama promised to expand health care coverage by 32 million people and add not one dime to the deficit. He promised Americans who wanted to keep their coverage that the government would leave it alone.

He promised the bill would help the economy and grow jobs when millions of unemployed Americans are looking for hope.

He promised not to add to states' debts.

But those promises won't come true.

The law will not pay for itself. In a New York Times op-ed piece, former Congressional Budget Office head and American Action Forum President Douglas Holtz-Eakin estimated it could put the country about $560 billion in the hole.

The law could cost jobs, hurt economic growth and hamper innovation. Verizon, AT&T, Caterpillar, John Deere, 3M and other companies have filed SEC reports saying that this bill will cost them a combined $10 billion.

Beacon Hill Institute, the fiscally conservative economic research group of Boston's Suffolk University, estimates 700,000 jobs will be lost, as small and medium-sized businesses try to provide health care for their employees.

The law does not allow seniors to keep the insurance they have. By 2019, 4.8 million seniors will be squeezed out of Medicare Advantage.

The law does not help states with the high cost of health care. It makes the states' budget situations worse. By 2014, states will be required to pay 50 percent of the administrative costs that come with expanding Medicaid.

This law will not let the middle class keep its plans. The CBO projects that by 2016, the basic plan, covering only 70 percent of a family's medical expenses, will cost $14,100 a year. Families making $88,000 or more won't qualify for the government subsidies.

This means a family making $100,000 could spend as much as one-fifth of annual income to keep private insurance.

Everybody understands that the status quo on health care was not acceptable.

This issue cried out for a bipartisan approach. We should have worked together and done things differently.

In fact, Obama promised during the campaign that he would do things differently — with change we could all believe in.

The American people believed that he would change how Washington does business — that he would seek consensus, that he would genuinely listen to the other side, find the best ideas and move forward in such a way as to unify the country.

But he didn't. Instead, he decided to jam legislation down the throats of the American people. Poll after poll shows that a majority of the people do not support this law.

They don't like the cost. They don't like what they believe will be its impact on their personal health insurance.

Most of all, they don't like the process. They don't like the backroom deals. They don't like the arm-twisting. They don't like the exercise of raw power that shows that the politicians are not listening to them.

And it is not just on health care. On issue after issue, Obama campaigned one way and is governing in a different way.

He said he would fight waste, but he signed a pork-filled stimulus bill. He said he would cut taxes on the middle class, but they face tax increases with health care reform. He said he would be Israel's strongest supporter, but we all now know that isn't true.

He said he would unify the country. But the country is more polarized than ever.

The president took great pride in signing this health care law. But that won't help him with the American people.

He is not living up to his promises. This law does not live up to its promise.

We can do better. The president is right: We aren't campaigning anymore.

But it is obvious that Obama the campaigner was more compelling than Obama the president — who looks to be a rather conventional liberal politician.

Norm Coleman, who served as a Republican senator from Minnesota, is chief executive officer of the American Action Network.

The Separation of Health and State

From the WSJ, April 6, 2010

What happens when all medical decisions are political.

Now that U.S. health care has been annexed by Washington, every medical question will soon become a political question too, and the British elections are foreshadowing what that will mean in practice. Over the weekend, David Cameron and the Conservatives promised that if they win in May they'll devote £1 billion to ensuring that National Health Service patients have access to cutting-edge cancer treatments.

The Tories say the £200 million annual fund will pay for drugs that have been prohibited or controlled by Britain's rationing bureaucracies, and give physicians more latitude in deciding which drugs to prescribe, especially for rare cancers and orphan diseases. Cancer survival rates in Britain lag behind the rest of Europe, and especially the U.S., but the Tory proposal is, believe it or not, controversial.
The Labour government says the plan is unaffordable. Meanwhile, "It's wrong to recommend the use of treatments where the additional benefit is uncertain," Andrew Dillon told the Guardian. "This is misleading for patients and wastes scarce NHS resources."

Sir Andrew leads the National Institute for Health and Clinical Excellence, or NICE, the body that makes hard-and-fast decisions about which patients will benefit from which treatments, and which lives are cost-effective to save or improve amid a tight budget. Recent NICE rejections include the bone-marrow drug Vidaza, multicancer drug Avastin, and Tyverb for breast cancer. Sutent, a breakthrough treatment for kidney cancer, was only approved after a campaign by doctors, against NICE's supposedly better judgment.

One of ObamaCare's core promises is that American technocrats will also use medical evidence to control health spending, but the British experience neatly illustrates the inevitable outcome. In the medical journal Lancet Oncology in 2008, researchers produced the first direct world-wide comparison of five-year survival rates for breast, colorectal and prostate cancers. The U.S. had the highest survival rate for breast cancer at 83.9% and prostate cancer at 91.9%—compared to the U.K.'s respective 69.7% and 51.1%.

While the data are from the 1990s, and British outcomes have since improved somewhat, the authors conclude that "Most of the wide global range in survival is probably attributable to differences in access to diagnostic and treatment services." In other words, advanced tests and drug treatments result in better outcomes.

That kind of innovative health care is costly, and the inescapable logic of a health system dominated by government is that it always ends up with some version of NICE. Scarcity forces choices, which have long been especially severe in Britain where austerity medicine is the norm. Mr. Cameron deserves credit for trying to ameliorate the worst excesses of a system that pits the terminally ill against, say, strep throat.

The open-ended style of American care has the problem of rapidly growing costs, but as the British spectacle shows it is extremely difficult to reverse a command medical economy once it is entrenched, even when the results are morally appalling. The far better option is to extricate politics and give patients more control, which starts by rolling back ObamaCare.

Monday, April 5, 2010

Bush Deficit vs Obama Deficit: Obama Budget Insane? » Right Pundits

Bush Deficit vs Obama Deficit: Obama Budget Insane? » Right Pundits Dennis Guthrie Letter to Nancy Pelosi Dennis Guthrie Letter to Nancy Pelosi

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The Process of Passing Health Bill Shameful

The Process of Passing Health Bill Shameful
By Jon Barela
Republican Candidate for Congress

To hear Rep. Martin Heinrich tell the story, as he did in an op-ed for the Albuquerque Journal last week, the majority of New Mexicans and Americans who disagree with the recently-passed 2,500 page health care bill are simply scared of change. He's not giving his constituents just credit, is he?

While I respect Mr. Heinrich and his office, I have a fundamentally different point of view of how to reform health care and reject such a "government knows best" attitude. The bill will increase the cost and decrease the quality of health care in the United States, and it was passed using a thoroughly non-transparent process by representatives who appear to be woefully out of touch with our greatest needs and concerns.

This health care legislation, with a price tag between $940 billion and $2.5 trillion, reflects the misguided priorities that are dominating Washington today. The bill contains a whopping $569 billion in job-killing tax increases and creates a new marriage penalty with new income and investment taxes. It cuts Medicare by approximately $500 billion, a significant portion coming from the Medicare Advantage program.

Worse yet, this bill will lead to a massive bureaucratic expansion that will require the IRS to hire more than 16,000 additional employees just to enforce all the new taxes and penalties in the plan. If it concerns you that the IRS will now be in the thick of personal health care decisions, you are certainly in good company.

Sadly, during the last year, more than 2.5 million American jobs were lost — nearly 7,600 jobs per day — while politicians in Congress spent their time trying to ram through this unpopular piece of legislation. Americans have been quite clear that creating jobs, reducing the national debt and cutting wasteful spending are their top priorities, yet this legislation levies large tax increases on job-creators, raises insurance premiums for American families and heaps greater debt onto the shoulders of our children. When all the spending is done and the bill fully implemented, 23 million people still will be uninsured in 2019.

Just as importantly, the process used by Nancy Pelosi and Harry Reid to pass this bill did not represent American democracy well. It wasn't bipartisan, it wasn't inclusive, it wasn't honest and it wasn't transparent. Instead, it was reckless, distorted and thoroughly undemocratic, and it's no wonder Americans are feeling ignored, angry and shunned.

They pulled out every legislative trick and scheme in the book, with the unfortunate highlight being their consideration of the so-called "Slaughter Solution," where representatives considered trying to pass the bill without actually having to vote for it. Nothing projects courage, confidence, or reassurance quite like that.

Combined with the closed-door, back-room meetings, where sweetheart deals were struck with taxpayer money, along with the efforts to shut down debate and exclude dissenting viewpoints, there is no amount of perfume that Martin Heinrich can spray on this odorous process to mask its stench.Even Pelosi stated, "We have to pass the bill so that you can find out what is in it."

Unlike those who have served the 1st Congressional District in the past, I am convinced that Martin Heinrich lacks the independence necessary to represent New Mexico families well. At every turn, he supported the policy prescriptions of Speaker Pelosi, proving himself to be at the left fringe of his own party by so vocally supporting a robust "public option" that was completely out of the mainstream, was rejected by most of his Democrat colleagues in Washington, and would have further dismantled our free enterprise system.

There is a better way to offer high quality, affordable health care in America, and it begins by discussing proposals that could win bipartisan approval, as well as the support of states, small businesses, and American families. Among other things, these include allowing for the sale of health insurance across state lines, encouraging small businesses to pool together to compete for lower insurance rates for their workers, significant tort reform to reduce the waste that is generated by junk lawsuits and defensive medical practices, and providing tax credits to individuals to use in health savings accounts.

New Mexicans and Americans are not ignorant about what has unfolded in Congress over the past year. They are not scared or confused by what is or is not in this bill, as Martin Heinrich suggests. Instead, they are rightfully concerned that their voices and thoughts were never heard or appreciated, and a bill was passed over their strong objections through a process that was devious and shameful.

It's time for a heavy dose of accountability in Washington.

KING: 100 percent repeal of Obamacare

KING: 100 percent repeal of Obamacare

Nothing less can prevent American decline

By Rep. Steve King

President Obama, speaking at a rally in Iowa City on March 25, challenged opponents of Obamacare who have vowed repeal. To repeal advocates, the President said, "Go for it."

Before the first light of dawn on the morning after this Pelosi Congress sent Obamacare to the President's desk, I started the process to repeal.My decision to take this fight to and through the next election and probably through the presidential election in 2012 was not a knee jerk response to a legislative defeat.It is a commitment to the Constitution, fiscal responsibility, real health care reform and American Liberty.

President Obama, Speaker Pelosi and Majority Leader Reid - the troika that controls America today - have long had designs to shove America into the abyss of socialism. Their philosophy, political power and cynical effort to expand the dependency class all lined up to make Obamacare the law of the land. The highest price every generation of Americans will pay is not measured in dollars but in lost liberty.

America is a unique nation with unmatched vitality. The rights and liberties which transformed the "Dream" into the reality of American Exceptionalism are written on our hearts. We have a vitality that is unmatched because we have skimmed the cream of the crop off every donor civilization.

Millions have flocked to America because of the promise of liberty. They have joined natural born Americans to form the most vigorous culture on the planet. Every preceding generation has had the freedom to succeed and the freedom to fail.

Obamacare is a reversal of the formula that has produced the world's unchallenged greatest nation. For these reasons, 100 percent of Obamacare must be repealed.
With the massive costs of Obamacare, we cannot hope to pay our debts in our lifetimes or our children's. Under Obamacare, costs will go up and quality will go down. Under Obamacare, we must go all the way to the Supreme Court to reestablish the Constitution as a pact limiting the reach of the federal government.

However, all of the aforementioned will not crush our national spirit like the oppressive weight of mandated dependency. Obamacare takes away the American right to manage our own lives.

The rights to "life, liberty and pursuit of happiness" are prioritized rights. No one has the right to kill in the name of liberty just as no one has the right to take your liberty in pursuit of their happiness. Obamacare is a "taking" of our liberty.

We the People understand this intuitively and reject this injustice which will, if not repealed, bring about the American decline. We cannot "hide the decline" or "manage the decline." We must decline the decline by repealing 100 percent of Obamacare.

Every provision of Obamacare must be repealed - not selective parts of it. Not by preserving a short list of less egregious components. Obamacare must be ripped out completely, lock, stock and barrel - root and branch - no vestige left behind - not a DNA particle of Obamacare retained.

The toxic stew of Obamacare would taint every effort to reform and give the next generation of leftist politicians their talking points for another assault on our liberty. Republicans will either stand unanimously together for 100 percent repeal, as we did against the bill, or our ranks will be split and our effort defeated.
The voracious appetite of the leftists to consume American Liberty has spontaneously created a new class of activists whom I define as the "constitutional conservatives." They are the 9-12 Project groups, all the Tea Party groups, and the organizations who join in their efforts.

Constitutional conservatives are emerging as the new majority makers and will not support a partial repeal. They stood in the streets, town halls and capitols of our states and nation to "Kill the bill."

No one demonstrated to "kill the most egregious aspects" or "preserve the least egregious aspects" of Obamacare. This is an all or nothing fight from this point forward. Either we will be unified, energized and resolute for 100 percent repeal or we will be divided and deservedly conquered by Obama, Pelosi and Reid.

This is a life or death struggle for the soul of America. We are the redoubt of Western Civilization. It is our charge to set the standard for the world.

From an upstart nation formed on the profound belief that all men are "endowed by their Creator with certain unalienable Rights" we have, over the past century assumed "among the Powers of the Earth," the responsibility of sole superpower. We have defeated our enemies and saved Western civilization for the world.

We are not a nation created to mimic mediocrity. Our charge is to take this nation upwards to a new level of liberty and prosperity built upon the pillars of american exceptionalism.

Congressman Steve King is on the House Judiciary Committee and represents Iowa's Fifth Congressional District.


By Jeremy

Blog: Common Sense Capitalism

In the few short weeks since the passage of the Obama Healthcare Bill, corporations have had to disclose that they will take earnings losses as a result of tax credit reversals under previous healthcare laws. Well, the Obama Administration sounded off to suggest that these write-downs were a vast CEO conspiracy to make a political point, even going as far as calling the write-downs “BS.”

I find it very humorous that these companies are actually following SEC and government regulations to disclose any knowledge of changes in earnings and are being called manipulators by the very people who defend the regulations. What else is there for these companies to do?

Now that we’ve got that “BS” out of the way, let’s focus on the losses these corporations are taking on ObamaCare.

AT&T has announced that ObamaCare will cost it $1 billion.

Caterpillar says ObamaCare will cost $100 million in the first year alone.

John Deere announced ObamaCare will cost them $150 million.
3M ($90 million), AK Steel ($31 million), and Valero Energy ($20 million) announced their ObamaCare costs.

Honeywell announced ObamaCare will cost its company $100 million.

Verizon released an email to employees advising them of an increase in healthcare costs.

Boeing ($150 mil), Prudential ($100 mil), ITW ($22 mil), Goodrich ($10 mil),

Allegheny Tech ($8 mil) have each announced their ObamaCare costs.

So what does this mean for jobs? I believe that each job created costs about $100,000 in salary, taxes, and benefits costs. So, how much are these write-downs when it comes to jobs?

If we take the above (and include Verizon as 0 since we don’t have an estimate yet), we get a total of $1,781,000,000 ($1.781 billion) in write-downs. Divided by the $100,000 in per job costs, we get 17,810 jobs.

While these are non-cash write-downs, they still exemplify real losses in earnings that have to be reported to the investment community. So, if you own stocks, mutual funds, a 401k, a Roth IRA, or any other type of public equity investment, your portfolio could take a hit when earnings of companies are released (especially if real ObamaCare losses are higher than estimates). This includes the above companies and any companies who decide to wait until they announce earnings to disclose ObamaCare related costs.

The above company’s disclosures of ObamaCare related costs immediately as opposed to an earnings announcement should have a short-term effect on the markets. However, if ObamaCare costs continue to be disclosed several months down the road, the market and your portfolio could suffer.

Keep an eye on our new page entitled “ObamaCare Costs” to keep up to date on ObamaCare related costs and the number of jobs those earnings are translated into. Please use our Facebook fan page to disclose any new ObamaCare costs.

Sunday, April 4, 2010

Spring forecast: Incivility with a chance of rage

From Politico
By: David Catanese
April 4, 2010 06:12 PM EDT

MANCHESTER, N.H. – If the experience of this state’s two Democratic House members is any indication, the raw emotion and mistrust emanating from last summer’s congressional town halls never really went away.

Instead, the unrest simmered over the ensuing months only to return to a boil when Rep. Carol Shea-Porter and Rep. Paul Hodes, who is running for U.S. Senate, returned home to meet with their constituents here during the first week of the Easter recess.

Their public events provided a bracing reminder to Democrats that the political pivot from health care to economic and financial issues is going to be much more arduous than they expected.

At a senior center in Manchester Wednesday, one woman turned away when Hodes offered his outstretched hand for an introduction.

"I don't want to shake your hand. You voted for health care, so just go," snapped Carmen Guimond, as she refocused on her lunch of roast beef and mashed potatoes and waved him on.

When Hodes decided to stay at the table and launch a defense of what's considered to be one of the more popular provisions of the law — closing the "donut hole," a gap in prescription drug coverage for Medicare recipients — she challenged whether he had read the entire bill and dismissed his explanation.

"Two hundred and forty dollars in the first year. That's all it is," she said, referring to the initial subsidy. "That's not much."

"And over time, by 2020, it closes the donut hole," Hodes explained.

"We'll all be dead by then," she deadpanned.

While the new landmark health care reform law is driving much of the hostility, in a handful of events here in the week after passage, voters expressed profound cynicism and suspicion not just about the legislation, but about Washington, government and virtually everything that came out of their legislators’ mouths.

A man who did not want to be identified said he pulled Hodes aside at the Manchester event to ask him why he wasn’t wearing a wedding ring. The congressman told him he’s allergic to gold. His constituent remained skeptical.

“It’s a satisfactory answer, but I don’t know if it’s true,” the man said afterward, citing “all the improprieties out there” as the reason he inquired.

For her part, at back-to-back town hall meetings in Bedford and Merrimack, Shea-Porter faced consistent boos, heckles and catcalls after almost every point she rattled off in defense of her vote.

Despite an effort to accommodate questions from the raucous crowds with a ticketed lottery system and a two-minute time limit for speakers, the congresswoman got little credit from the audience. If anything, it gave her opponents fresh ammunition.

"Why can't we ask a question?" yelled one man, objecting to a format that randomly selected numbers out of a tub of tickets to choose questioners.

"Are you a princess or a representative?" chastised another woman.

Yet another man was miffed that he received a form letter from her office in response to six specific questions he sent to her by mail.

"I expect a reply. I heard a position statement that did not answer any of my questions," complained Ben Niles of Merrimack.

Shea-Porter had her defenders too, and they were uncowed. When one heckler mentions polling against health care reform, he was greeted with, “That’s Sarah Palin’s death panel lies!”

Another supporter of the congresswoman responded to a comment with, "What, are you employed by some insurance company? Shut up!"

The raw emotion expressed at the public events—on both sides—left both Shea-Porter and Hodes seemingly resigned to the fact that that act of defending, or heralding, their health care vote will continue to occupy much of their time for the near future.

Hodes said he’s happy to answer the questions and is convinced that the majority of voters don’t have their heels dug in against the bill.

"If two out of twelve people have their minds fixed, that's about the ratio that I would expect. I think now that we have a bill and we're able to talk about what's in it and we're able to give people some very clear information about what's in it,” Hodes told POLITICO.

"Over these next few months, you're going to see growing acceptance of the legislation, growing appreciation for what the legislation does and an open mindedness to the benefits that the legislation will bring," he added.

Kathy Sullivan, a former state Democratic Party chair, said a groundswell of cynicism is to be expected when most of the attention and media coverage thus far has focused on a convoluted process and the colorful opposition.

“All we knew was that this behemoth was coming and that it was going to cost a fortune, and there were a lot of people upset about it. It wasn’t until the bill passed that you started seeing stories about what the bill actually did,” she said. “Cover kids on their parents plans until 26? Excellent! Takes away the companies power to deny pre-existing conditions? Great. Where is the communist stuff, and where is the stuff about the death panels now? It doesn’t exist.”

One question, though, is whether the unseemly horse-trading that to many voters seemed to characterize the process has tainted the final product—and voters’ trust of Congress.

When Shea-Porter referred the health care legislation at one event as a bipartisan effort and noted 200 amendments by Republicans, several in the audience jeered, "What a joke! You have got to be kidding me!"

When she said there was growing support for the legislation, even within her congressional district, a heckler taunted her, yelling, "How are your polls doing, Carol?" Another shouted, "That's a lie! That's a Pelosi line!"

Her statement that "the bill is paid for" led to a hearty round of laughs that made it seem like she had delivered a joke.

Of the 12 questioners who got a chance to speak inside the Bedford High School cafeteria, nine made it clear they flatly opposed the new law. Shea-Porter acknowledged there was strong opposition.

"We are in a swing district. It's split down the middle. This district really is a divided district on this issue," she said at Merrimack Middle School, adding that her support for health care expansion shouldn't have been a surprise to anyone who followed her 2006 campaign.

When she told the crowd the obvious -- that they had the chance to oust her in seven months -- the notion prompted claps and a promise from one man who thundered, "And we will."

New health care law: What does it mean for you?

By Elizabeth Simpson
The Virginian-Pilot
© April 4, 2010

Jane Prinz has been known to split her prescription pills in half just to afford her medications, so she has paid close attention to the national debate over health care.
Will the new law signed by President Barack Obama last month help the 41-year-old Virginia Beach woman?

She's still not sure. Pills aren't the only thing hard to divide.
"It's hard to divide the actual facts from all the rhetoric," said Prinz, who has a neurological disorder.

It's a view shared by many.

There are numerous unanswered questions as the 2,000-plus pages of law get transformed into even more pages of regulation. The region's patients, doctors and hospitals await the details and consequences, both good and bad.

Roughly 1 million Virginians are uninsured. According to the Virginia Health Care Foundation, it's expected that under the new law about one-third will be newly eligible for Medicaid, the shared federal and state insurance for the poor and disabled. An additional 17 percent of the state's uninsured fall between ages 18 and 24, and they could be added to their parents' insurance. And 700,000 are expected to qualify for insurance subsidies, according to the Commonwealth Institute for Fiscal Analysis.

The law will have consequences for the insured as well, and Prinz falls into two critical categories.

She's a member of a Medicare Advantage plan, an insurance program that the new law targets for cuts. That's a move that some insurance experts say will either reduce benefits or increase premiums with the privately managed plans.

Prinz also is in a category of people that the law is expected to help: Medicare recipients who fall into the so-called "doughnut hole." That's a gap in prescription drug coverage that begins when about $2,800 is spent on drugs.
Prinz hit the doughnut hole last year in March, and she's bumping up against it this year as well.

The new law would provide a $250 rebate this year and give her discounts on name-brand drugs beginning in 2011. The gap will start closing next year, a process that will be complete in 2020.

"It's a start, but it's a weak start," Prinz said. "What am I supposed to do for the next 10 years?"

Because Virginia's current eligibility for Medicaid is one of the most restrictive in the country, the state is expected to pick up more new Medicaid patients - 350,000, by one estimate - than many states. Childless, non-elderly adults in Virginia will be eligible for the first time in 2014.

The gateway for the newly insured will be family-practice doctors, many of whom are already swamped.

"This will unveil the shortage of primary-care physicians," said Dr. Christine Matson, chairwoman of family and community medicine at Eastern Virginia Medical School.

Doctor reimbursements for Medicaid patients are less than those for private insurance and Medicare, the federal insurance for the elderly and some disabled people. The health care law will increase Medicaid reimbursements in 2013 and 2014 to bring them in line with Medicare.

Still, many doctors limit their acceptance of that government insurance, too.
Dr. Cynthia Romero, a family-practice doctor in Virginia Beach, said some of her new Medicare patients tell her it took months to find a doctor who would accept their insurance. "I think we'll be bombarded by the volume of new patients looking for care," she said.

Dr. Daniel Carey, president of the Medical Society of Virginia, said the General Assembly made cuts to the Medicaid reimbursement rates in the most recent budget, and that's expected to reduce the number of doctors willing to accept new Medicaid patients.

He said the new law failed to address what doctors see as a flawed Medicare and Medicaid reimbursement formula. As long as doctors and hospitals lose money on patients with those types of insurance, it will be tough to expand the primary care network.

And health care providers are concerned that state legislators will continue turning to Medicaid to seek cuts during budget shortfalls.

"We are holding our breath," said Howard Kern, Sentara Healthcare's president and chief operating officer.

On the positive side, more insured patients mean people will address health issues sooner, reducing costly emergency-room visits and hospital stays. Medicare will also provide free annual wellness visits and prevention plans under the law.
"The most important thing is it moves us toward the idea that all citizens should have access to health care," said Matson, of EVMS. "It's been embarrassing and tragic not to have had that in place."

Meghan McNamara

Meghan McNamara, 23, of Norfolk hopes the law will help young adults such as herself. She is uninsured because she is working on a short-term basis for an immigration reform organization. The job ends in a few months and doesn't have health insurance.

Within six months, the new law will require new insurance policies to permit adult children to stay on their parents' policies until they are 26.
The years McNamara has spent uninsured have been costly. Last year she spent $4,000 out-of-pocket for testing and removal of some pre-cancerous cells in her cervix.
"I'm still paying that off," she said.

Randy Lassiter

Randy Lassiter, 80, also of Norfolk, is worried that his insurance plan may be subject to change of the negative sort. He describes his Medicare Advantage plan through Optima as "the best thing since sliced bread."
"I'm very concerned it will affect people like me," he said. "I'm concerned it will diminish some of my current coverage."

He's one of 159,150 people in Virginia who have enrolled in Medicare Advantage plans. That's about 14 percent of all Medicare beneficiaries in the state, a rate lower than the national average of about 25 percent.

Michael M. Dudley, president of Optima Health, said it's too soon to know the exact impact of the law on Optima's Medicare Advantage plan. "We will have to stay on our toes as the regulations are written," he said. "We can study the law, but we don't know its implications until regulations are written."

He supports more people having access to insurance but worries the penalties for people who don't buy insurance are not high enough to keep them from for going a policy. The law calls for an annual tax penalty by 2016 of up to $695.
His concern is that people will pay the penalty instead of buying insurance while they are well. But when they're sick, they'll buy health insurance.

"Without those people in the pool," Dudley said, "the practical impact will be the premiums will go up instead of down."

Jim Dahling

Jim Dahling, president and CEO of Children's Hospital of The King's Daughters, said the law holds many positives for that hospital's patients. Insurance companies would no longer be allowed to deny coverage to children with pre-existing conditions or place annual or lifetime limits on coverage.

But for the hospital, the law also has some potential for harm. CHKD qualifies for "disproportionate share hospital payments," which go to hospitals with large percentages of Medicaid and charity patients.

The law reduces those payments, because it's expected that hospitals will have more insured patients and fewer charity cases. However, 99 percent of CHKD's patient base is already insured, so the hospital doesn't stand to gain as much as other hospitals in newly insured patients.

A challenge for hospitals that serve larger adult populations will be connecting patients who turn to emergency rooms for care with new "medical homes," said Kern, of Sentara.

It's a process that won't happen overnight.

Dr. Carl Wentzel

Dr. Carl Wentzel, emergency department medical director at Bon Secours Health Center at Harbour View, said a robust primary care network will be crucial. He said in Massachusetts, which enacted a universal type of health insurance in 2006, emergency department visits initially increased after the law went into effect because people couldn't find primary care doctors.

Community health clinics have long served as an access point for such people, and the law increases their funding by $11 billion. The centers, which accept a mix of uninsured, government-insured and private-pay, expect an upswing in patients.
EVMS' Matson said the law includes some incentives for medical students to choose primary care, which could provide relief down the road. She worries, though, that people will be frustrated if they don't see positive change right away.

"It's been such an emotional issue that the first unintended consequence that comes along will make people think the whole bill is bad," she said.

The phased-in nature of the law also could cause confusion. Cathy Revell, executive director of Chesapeake Care Inc., worries that donations to free clinics - which treat the uninsured - will dry up because people will think everyone's covered now.
The center has 750 people on a waiting list for treatment, and it will be years before new insurance options open for them.

"It's a wonderful start," Revell said. "But it's not an immediate solution."

Friday, April 2, 2010

Florida Doc Tells Obama Voters to Go Away

Katie Drummond Contributor
AOL News

April 2) -- A doctor in Mount Dora, Fla., has posted a sign on his clinic door that instructs patients who "voted for Obama" to go elsewhere for their medical care.

Dr. Jack Cassell, a urologist in the town of 11,500 people, is a registered Republican who opposes health care reform. The typewritten sign, which he posted earlier this week, reads, "If you voted for Obama, seek urological care elsewhere," and goes on to state that "changes to your health care begin right now, not in four years."

"I'm not turning anybody away -- that would be unethical," Cassell, 56, told the Orlando Sentinel. "But if they read the sign and turn the other way, so be it."

One of Cassell's patients told a friend, Estella Chatman, about the sign. Chatman's daughter then snapped a photo and sent it to Rep. Alan Grayson, an Orlando Democrat who staunchly supported his party's efforts at health care overhaul.

The friend, Chatman said, "is going to find another doctor."

It's illegal for doctors to turn away patients based on factors like race, gender, religion or disability. Political preference, however, isn't specifically protected by civil rights law.

Allen's likely pushing the limit, but not doing anything illegal, according to William Allen, a professor of bioethics at the University of Florida's College of Medicine.

By not directly inquiring about the political stance of his patients, he's "trying to hold onto the nub of his ethical obligation," Allen told the Sentinel. "But this is pushing the limit."

The sign isn't the only indication of Cassell's disdain for new health legislation. The doctor provides leaflets on health reform, along with a sign stating, "This is what the morons in Washington have done to your health care. Take one, read it and vote out anyone who voted for it."

Cassell and his wife, Leslie, have a long history in the area where the doctor practices. She's a Republican Party candidate for the county commissioner's office. He's been a urologist in Mount Dora for more than 20 years and was also chief of surgery at a nearby hospital.

And if you're a pro health reform patient who'd still like an appointment? Cassell says he'll treat anyone. But, he admits, he'd really rather not.

"I can at least make a point," he said.

Rep. Grayson, for one, thinks a doctor's office is the wrong place to make a political stand.

"I think it's disgusting," he said. "I know that most people go into health care because they want to help sick people. They don't have some political agenda. I think it's outrageous that someone would try to press his political agenda."

"I think the sore losers are out in force."