Posts
Sunday, January 1, 2012
Dr. Truth Hurts on "Why we must repeal Obamacare"
http://actualgrit.wordpress.com/2011/12/31/dr-truth-hurts-why-we-must-repeal-obamacare/
Monday, December 26, 2011
Doctors Say Obamacare Is No Remedy for U.S. Health Woes
From Forbes Online, 12/26/11
America’s doctors have conducted a full examination of the president’s health reform law — and their diagnosis of its effects on our healthcare system isn’t good.
Nearly two-thirds of doctors expect the quality of care in this country to decline, according to a new survey from consulting giant Deloitte. Just 27 percent think that the law will lower costs. And nearly seven of every 10 doctors believe that medicine is no longer attractive to America’s “best and brightest.”
Few people know more about our healthcare system than doctors working on the frontlines. Policymakers should pay heed to their indictment of Obamacare and revisit the disastrous law.
President Obama promised that his reform package would begin to stymie the out-of-control growth in the cost of American health care. He pledged $2,500 in health insurance savings for the typical American family.
But doctors don’t buy it. Only one quarter feel that Obamacare will reduce health insurance costs for consumers. Nine out of ten posit that insurers will raise premiums for employers and individuals.
They have good reason to doubt Obamacare’s cost-cutting potential. Healthcare spending is expected to reach $2.7 trillion this year — or about $1 of every $6 spent in our economy. By 2020, health spending will account for a full fifth of America’s GDP.
That increase is in large part thanks to Obamacare. Instead of relieving high insurance premiums, the nonpartisan Congressional Budget Office estimates that American families in the non-group market will see their premiums rise $2,100.
They’re already trending higher. According to the Kaiser Family Foundation, average family premiums in 2011 topped $15,000 — a 9 percent increase from 2010. Prior to Obamacare’s passage — from 2009 to 2010 — premiums went up just 3 percent.
In April 2010, Richard Foster, the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS), concluded that American spending on health care through 2019 would be $311 billion higher than if the law had never passed.
Even with all that additional money flowing through the system, doctors don’t think that the quality of care will improve. Half of all doctors believe that access to care will diminish because of hospital closures prompted by health reform.
Further, nearly 70 percent of doctors believe that long wait times will plague emergency rooms. A full 83 percent of physicians foresee increased wait times for primary care appointments.
That’s in large part because Obamacare is expected to extend government-subsidized insurance coverage to many folks — even as the supply of providers remains relatively constant.
The United States already faces a shortage of primary-care doctors. Medical schools today produce one such physician for every two our country needs. By 2019, the American Academy of Family Physicians warns that the United States will be short 40,000 doctors.
Expanding insurance coverage to millions more Americans won’t do much good if they can’t get doctor’s appointments. Physicians believe that their ability to provide quality care will be further strained by the law’s attempt to change the way they’re paid — from a fee-for-service basis to a vaguely defined system of paying doctors based on patient health and outcomes.
Nine out of ten physicians fear they will receive inadequate payments and endure higher administrative costs. Fewer than a quarter of doctors expect their paperwork requirements to ease up. Time spent wading though paperwork is also time no longer available for actually practicing medicine.
American doctors’ negative view of Obamacare is telling. Proponents of the law may claim that their griping is misplaced, but as Paul Keckley, Ph.D., the lead author of the report explains, “Understanding the view of the physician is fundamental to any attempt to change the health care model.”
In other words, if physicians aren’t on board with Obamacare, it won’t work. A law that hinders the practice of medicine, obstructs access to care, and costs Americans more is clearly not the right remedy for what ails us.
Sally C. Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her next book — The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare (Regnery) — will be released in January 2012.
America’s doctors have conducted a full examination of the president’s health reform law — and their diagnosis of its effects on our healthcare system isn’t good.
Nearly two-thirds of doctors expect the quality of care in this country to decline, according to a new survey from consulting giant Deloitte. Just 27 percent think that the law will lower costs. And nearly seven of every 10 doctors believe that medicine is no longer attractive to America’s “best and brightest.”
Few people know more about our healthcare system than doctors working on the frontlines. Policymakers should pay heed to their indictment of Obamacare and revisit the disastrous law.
President Obama promised that his reform package would begin to stymie the out-of-control growth in the cost of American health care. He pledged $2,500 in health insurance savings for the typical American family.
But doctors don’t buy it. Only one quarter feel that Obamacare will reduce health insurance costs for consumers. Nine out of ten posit that insurers will raise premiums for employers and individuals.
They have good reason to doubt Obamacare’s cost-cutting potential. Healthcare spending is expected to reach $2.7 trillion this year — or about $1 of every $6 spent in our economy. By 2020, health spending will account for a full fifth of America’s GDP.
That increase is in large part thanks to Obamacare. Instead of relieving high insurance premiums, the nonpartisan Congressional Budget Office estimates that American families in the non-group market will see their premiums rise $2,100.
They’re already trending higher. According to the Kaiser Family Foundation, average family premiums in 2011 topped $15,000 — a 9 percent increase from 2010. Prior to Obamacare’s passage — from 2009 to 2010 — premiums went up just 3 percent.
In April 2010, Richard Foster, the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS), concluded that American spending on health care through 2019 would be $311 billion higher than if the law had never passed.
Even with all that additional money flowing through the system, doctors don’t think that the quality of care will improve. Half of all doctors believe that access to care will diminish because of hospital closures prompted by health reform.
Further, nearly 70 percent of doctors believe that long wait times will plague emergency rooms. A full 83 percent of physicians foresee increased wait times for primary care appointments.
That’s in large part because Obamacare is expected to extend government-subsidized insurance coverage to many folks — even as the supply of providers remains relatively constant.
The United States already faces a shortage of primary-care doctors. Medical schools today produce one such physician for every two our country needs. By 2019, the American Academy of Family Physicians warns that the United States will be short 40,000 doctors.
Expanding insurance coverage to millions more Americans won’t do much good if they can’t get doctor’s appointments. Physicians believe that their ability to provide quality care will be further strained by the law’s attempt to change the way they’re paid — from a fee-for-service basis to a vaguely defined system of paying doctors based on patient health and outcomes.
Nine out of ten physicians fear they will receive inadequate payments and endure higher administrative costs. Fewer than a quarter of doctors expect their paperwork requirements to ease up. Time spent wading though paperwork is also time no longer available for actually practicing medicine.
American doctors’ negative view of Obamacare is telling. Proponents of the law may claim that their griping is misplaced, but as Paul Keckley, Ph.D., the lead author of the report explains, “Understanding the view of the physician is fundamental to any attempt to change the health care model.”
In other words, if physicians aren’t on board with Obamacare, it won’t work. A law that hinders the practice of medicine, obstructs access to care, and costs Americans more is clearly not the right remedy for what ails us.
Sally C. Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her next book — The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare (Regnery) — will be released in January 2012.
Sunday, December 25, 2011
Can we really afford Obamacare?
Since Massachusetts instituted Romneycare, the cost, per patient, of healthcare has risen steadily to over $9400.00 per person compared to a national average of about $6800.00. Now, it doesn't take a rocket scientist, a doctor, or an healthcare economist to figure out that when you mandate everyone to have insurance, the incentive for personal responsibility is lost and people will seek and demand more as well as more expensive high tech care of which most is not needed.
Sadly, most people will read this and just shrug...
Share and repost if you believe we cannot afford Obamacare!
Sadly, most people will read this and just shrug...
Share and repost if you believe we cannot afford Obamacare!
CDC issues new alert for new R1P1 Virus
*****URGENT*****
The CDC has released an urgent advisory to physicians and other healthcare providers warning about a cluster of small epidemics of a serious viral infection that has traditionally been a virus with relatively low virulence and with small, but characteristic spikes every 4 years or so.
Scientists from the CDC are calling this virus the R1P1 virus which is a politico virus that is similar to the polio virus in that it primarily infects the nervous system. Unlike the polio virus which primarily affects the peripheral nerves, the politico virus causes widespread damage in the brain manifested as chronic encephalopathy.
Infection with this virus causes a very characteristic syndrome characterized by a sudden and permanent loss of ability to engage in higher cognitive functioning or reasoning and patients affected are characteristically delusional and paranoid and engage in curious behavior including echolalia (the repetition of words or phrases by a patient of words addressed to him), obsessive rumination (repetitive regurgitation of inane phrases ), persistent dwelling in conspiratorial and paranoid thinking, and an obsessive and compulsive need to a-paul-ogize to radical Islam for American neo-nazi-fascism and intervention. The clinical syndrome is often referred to as pauli-encephalopathy and commonly called Ronpaulitis. It is very similar to another chronic brain-wasting disease (Mad Cow Disease) caused by a slow-virus and because of this similarity is often called “Mad Paul Disease”.
Researchers from the CDC are concerned about the increased incidence and virulence of this otherwise relatively harmless virus that in past years has infected relatively few people (less than 2-3%). The RP viruses are relatively common viruses and arise from a family of viruses called the "cult viruses", included in this family are the BO (B. Obamagotcha) virus, the DK (D. Koreshiae) and the JJ (J. Jonesensei) virus. Researchers at the CDC say they are not sure if it is a mutation in the virus from a R1P2 virus which is the most common variety to a new R1P1 virus, or if instead it is a relative decrease in host defenses brought on by concurrent infection of a similar virus called the BO virus. One researcher believes that the evidence supports a mutation rather than a general decrease in immunity in the population because of areas of sporadic epidemics in the US, such as Iowa, New Mexico, and Texas. While there is no cure for these viruses, researchers do say that they are preventable by engaging in common sense behaviors such as
thinking and avoiding certain books (The Revolution: A Manifesto, End The Fed, etc), documentaries (Conspiracy Theory with Jesse Ventura), or movies such as George Orwell’s 1984 or JFK and the Manchurian Candidate. While, most people have a robust and natural defense against the negative and irrational cerebral influences of this genre of work, it is thought that exposure and infection to the R1N1 virus renders this natural defense weak or even non-existent.
Doctors at the CDC claim they are working on a vaccine for this virus, but do not expect to see a vaccine come to market until after November of 2012 at the soonest and caution that it may take several more decades before a cure or vaccine are found.
Doctors, healthcare workers, and the general public are asked to contact their local health departments and/or the CDC if they have become exposed to the virus or know of anyone that has. Since there is no cure, this would be strictly for demographic and research purposes. (From Neuter's Medical News Service)
The CDC has released an urgent advisory to physicians and other healthcare providers warning about a cluster of small epidemics of a serious viral infection that has traditionally been a virus with relatively low virulence and with small, but characteristic spikes every 4 years or so.
Scientists from the CDC are calling this virus the R1P1 virus which is a politico virus that is similar to the polio virus in that it primarily infects the nervous system. Unlike the polio virus which primarily affects the peripheral nerves, the politico virus causes widespread damage in the brain manifested as chronic encephalopathy.
Infection with this virus causes a very characteristic syndrome characterized by a sudden and permanent loss of ability to engage in higher cognitive functioning or reasoning and patients affected are characteristically delusional and paranoid and engage in curious behavior including echolalia (the repetition of words or phrases by a patient of words addressed to him), obsessive rumination (repetitive regurgitation of inane phrases ), persistent dwelling in conspiratorial and paranoid thinking, and an obsessive and compulsive need to a-paul-ogize to radical Islam for American neo-nazi-fascism and intervention. The clinical syndrome is often referred to as pauli-encephalopathy and commonly called Ronpaulitis. It is very similar to another chronic brain-wasting disease (Mad Cow Disease) caused by a slow-virus and because of this similarity is often called “Mad Paul Disease”.
Researchers from the CDC are concerned about the increased incidence and virulence of this otherwise relatively harmless virus that in past years has infected relatively few people (less than 2-3%). The RP viruses are relatively common viruses and arise from a family of viruses called the "cult viruses", included in this family are the BO (B. Obamagotcha) virus, the DK (D. Koreshiae) and the JJ (J. Jonesensei) virus. Researchers at the CDC say they are not sure if it is a mutation in the virus from a R1P2 virus which is the most common variety to a new R1P1 virus, or if instead it is a relative decrease in host defenses brought on by concurrent infection of a similar virus called the BO virus. One researcher believes that the evidence supports a mutation rather than a general decrease in immunity in the population because of areas of sporadic epidemics in the US, such as Iowa, New Mexico, and Texas. While there is no cure for these viruses, researchers do say that they are preventable by engaging in common sense behaviors such as
thinking and avoiding certain books (The Revolution: A Manifesto, End The Fed, etc), documentaries (Conspiracy Theory with Jesse Ventura), or movies such as George Orwell’s 1984 or JFK and the Manchurian Candidate. While, most people have a robust and natural defense against the negative and irrational cerebral influences of this genre of work, it is thought that exposure and infection to the R1N1 virus renders this natural defense weak or even non-existent.
Doctors at the CDC claim they are working on a vaccine for this virus, but do not expect to see a vaccine come to market until after November of 2012 at the soonest and caution that it may take several more decades before a cure or vaccine are found.
Doctors, healthcare workers, and the general public are asked to contact their local health departments and/or the CDC if they have become exposed to the virus or know of anyone that has. Since there is no cure, this would be strictly for demographic and research purposes. (From Neuter's Medical News Service)
Iowa Kool-Aid and How to Form a Cult
I was surprised to see the results of the Fox News Poll showing Ron Paul leading in who the pollsters thought would win the Iowa caucus vote. While, I consider myself a conservative and lean more towards libertarianism, I am nonetheless, quite frankly concerned about the possibility of Ron Paul winning the primaries and--God forbid--possibly becoming president of the United States. My concern comes as a fellow physician who believes that Dr. Paul suffers from a real psychological disorder characterized by megalomania, narcissism, delusional thinking, paranoia, antisocial characteristics, and (abnormal) feelings of persecution. Now, I am not a psychiatrist, but I did minor in psychology as an undergraduate and most physicians have been educated in the behavioral sciences and have been trained to diagnose common psychiatric disorders. Furthermore, it is estimated that the incidence of Narcissistic Personality Disorder occurs 34 times more often in medical doctors than in the general population.
Over the last several weeks, I have been studying Dr. Paul as well as his followers through his television appearances, his letters (and Newsletters), social media, and video clips from You-tube and have noted a very disturbing pattern of Dr. Paul showing all of the psycopathological characteristics of a genuine "cult leader" and his followers showing all of the characteristics of a cult.
I have studied cults and their leaders and have outlined the "five basic
rules" of being a cult leader. I have also indicated the psychopathology associated with cult leaders as they form their cults:
The number one rule of a cult leader is to polish and cultivate a persona that you--and only you--have been chosen, anointed, or have achieved spiritual, political, or intellectual enlightenment above all others. This shows features of megalomania, delusions of grandeur, as well as narcissism.
1. Dr. Paul has tried to cultivate this persona for over 30 years as the “outsider” and enlightened one within the “Washington establishment”.
2. Dr. Paul has publicly stated that while he believes in term limits, they do not apply to him because (paraphrasing) “there is no one good enough to bring in to replace him”.
3. In 2010, Dr. Paul commented to his wife that he would run for President in 2012 “if things were happening so quickly and fast in our country and we were in a crisis period…and needed somebody…with the knowledge he as, he would do it”.
4. Dr. Paul presents in interviews as haughty and stern and seems to be lecturing rather than engaging in conversation.
The next rule is to appeal to the disconnected, disenchanted, and disaffected in society who are often intellectually, politically, and emotionally immature (i.e., younger people)and convince them that while you have been “chosen” (or more likely self-selected) you are (almost) human just like them and can empathize with their disenchantment and discontent. This shows more tendencies of narcissism and ego-feeding by someone who sees them self as inherently better than others, but with a need to surround one’s self with those less fortunate or less “enlightened”—a “savior complex”, if you will. Often times, the empathy and compassion shown to the acolytes is not genuine (which is a feature of antisocial personality) and is only used for the ulterior motive of personal gain in sex, money, or power (or sense of superiority) or combination thereof.
1. Dr. Paul has always had a relatively small number of fanatical followers who have mostly been drawn from younger people in society. He routinely targets schools,
colleges, and other events where younger people tend to be.
2. His “populist” message today resonates with many, besides young people as social, geopolitical, and economic turmoil are perceived to be worsening and more and more people become disenfranchised, disenchanted, and discontent.
3. Dr. Paul’s ploy of not accepting Medicare payment for his Medicare services or a congressional pension—while on the surface seem like noble gestures—are really means to portray himself as “one of us” and morally higher than his colleagues.
The third step is through indoctrination, coercion, repetition, and/or isolation to exercise mind control over your flock of followers by relieving them of their ability to think rationally (usually by not allowing them to test your theories or have access to “the outside”)—but not emotionally—while simultaneously convincing them that your ideas—while plausible (but generally at the far fringes of mainstream thought) are the “light and the truth”. This shows more elements of antisocial ego-building in that the leader is now getting others to surrender their will and rational thought against deep seated norms of the self and/or society while they align their thinking towards that of the leader.
Furthermore, this shows the disordered or delusional thinking of the leader who generally has delusional thinking of the world and how it operates and he or she is the only one with the power to fix it.
1.Dr. Paul plays on the emotions of his followers by carefully crafting plausible—and easy to understand-- (but highly improbable and at the fringes of mainstream thought)scenarios out of complex geopolitical, political, social and economic issues
that are at “top of mind” of our society and that tug at some of our most basic
interests (individual freedom, economic freedom, nationalism, sanctity of life,
torture, and war) and evoke very basic human responses such as fear, anxiety,
anger, disgust, and etc.
2. Dr. Paul’s views on national defense, monetary policy, isolationism, and constitutionalism are considered by most to be outside of the mainstream of rational political, social, and governmental philosophy.
3. Dr. Paul has consistently repeated his messages over 30 years and as noted above, tends to target younger followers who are easier to indoctrinate.
The fourth rule is to proselytize not only your “enlightened philosophy or beliefs, but also to spread forth the word that while you and your followers are “the enlightened or chosen ones”, there will be naysayers and those that will persecute you and the movement. This clearly shows the elements of paranoia and persecution by the non-believers.
1. Dr. Paul and his followers are very defensive when challenged on the issues and their beliefs. Instead of engaging in earnest discourse, they tend to attack and accuse the “non-believer” as persecuting them for their beliefs or of being ignorant and unenlightened in their philosophy.
2. Dr. Paul and his followers display a common paranoia and decry a “conspiracy” of the right, the political elite, and the left against them and their “lofty ideas that will save America”.
3. Dr. Paul has consistently offered the explanation that others are simply “out to get him” by taking “tongue-in-cheek comments out of context” and things that were written in his newsletters (but purportedly not authorized or written by him).
4. Dr. Paul comes off as defensive and angry when challenged in interviews and becomes condescending.
The fifth and last rule is to convince your followers that it is only through blind faith and rigid adherence to your philosophy—no matter how foreign it may be to self or to society—that that blind adherence or “loyalty” is the only path to salvation, redemption, or the reparation of the “perceived” ills of society. This is more antisocial ego-building and the tightening of control over the flock.
1. Dr. Paul and his followers play the same monotonous drum beat about “smaller government”, defense of our borders,monetary reform and fiscal responsibility, “stop the wars”, and national isolationism over and over again like a Gregorian chant and mantra in a blind and stubborn adherence to their fringe philosophy that is the only path to saving America despite practical, rational, philosophical, and real world
evidence against and “common sense” opposition to their “zany” ideas, Messianic
messages, and Utopian philosophies.
Some authors would add another step which is to construct a “doomsday scenario” for your followers, such as “the end of the world, World War III, or economic collapse as the great incentive to motivate the followers to adhere to and spread your
teachings. This, again, would show delusional thinking as well as narcissistic thinking, especially if the leader and his or her followers will be the only ones saved from the impending calamity.
1. Of course we are all aware of the “doomsday” prophecies of Dr. Paul considering our economy and its impending collapse with hyperinflation if we don’t get rid of the Fed.
After considering this, and seeing Dr. Paul’s rise in the Iowa polls, it makes me
wonder what they are doing out there in Iowa. It seems to me that maybe they are mixing a little Ron Paul Kool-Aid with some fermented corn!
Over the last several weeks, I have been studying Dr. Paul as well as his followers through his television appearances, his letters (and Newsletters), social media, and video clips from You-tube and have noted a very disturbing pattern of Dr. Paul showing all of the psycopathological characteristics of a genuine "cult leader" and his followers showing all of the characteristics of a cult.
I have studied cults and their leaders and have outlined the "five basic
rules" of being a cult leader. I have also indicated the psychopathology associated with cult leaders as they form their cults:
The number one rule of a cult leader is to polish and cultivate a persona that you--and only you--have been chosen, anointed, or have achieved spiritual, political, or intellectual enlightenment above all others. This shows features of megalomania, delusions of grandeur, as well as narcissism.
1. Dr. Paul has tried to cultivate this persona for over 30 years as the “outsider” and enlightened one within the “Washington establishment”.
2. Dr. Paul has publicly stated that while he believes in term limits, they do not apply to him because (paraphrasing) “there is no one good enough to bring in to replace him”.
3. In 2010, Dr. Paul commented to his wife that he would run for President in 2012 “if things were happening so quickly and fast in our country and we were in a crisis period…and needed somebody…with the knowledge he as, he would do it”.
4. Dr. Paul presents in interviews as haughty and stern and seems to be lecturing rather than engaging in conversation.
The next rule is to appeal to the disconnected, disenchanted, and disaffected in society who are often intellectually, politically, and emotionally immature (i.e., younger people)and convince them that while you have been “chosen” (or more likely self-selected) you are (almost) human just like them and can empathize with their disenchantment and discontent. This shows more tendencies of narcissism and ego-feeding by someone who sees them self as inherently better than others, but with a need to surround one’s self with those less fortunate or less “enlightened”—a “savior complex”, if you will. Often times, the empathy and compassion shown to the acolytes is not genuine (which is a feature of antisocial personality) and is only used for the ulterior motive of personal gain in sex, money, or power (or sense of superiority) or combination thereof.
1. Dr. Paul has always had a relatively small number of fanatical followers who have mostly been drawn from younger people in society. He routinely targets schools,
colleges, and other events where younger people tend to be.
2. His “populist” message today resonates with many, besides young people as social, geopolitical, and economic turmoil are perceived to be worsening and more and more people become disenfranchised, disenchanted, and discontent.
3. Dr. Paul’s ploy of not accepting Medicare payment for his Medicare services or a congressional pension—while on the surface seem like noble gestures—are really means to portray himself as “one of us” and morally higher than his colleagues.
The third step is through indoctrination, coercion, repetition, and/or isolation to exercise mind control over your flock of followers by relieving them of their ability to think rationally (usually by not allowing them to test your theories or have access to “the outside”)—but not emotionally—while simultaneously convincing them that your ideas—while plausible (but generally at the far fringes of mainstream thought) are the “light and the truth”. This shows more elements of antisocial ego-building in that the leader is now getting others to surrender their will and rational thought against deep seated norms of the self and/or society while they align their thinking towards that of the leader.
Furthermore, this shows the disordered or delusional thinking of the leader who generally has delusional thinking of the world and how it operates and he or she is the only one with the power to fix it.
1.Dr. Paul plays on the emotions of his followers by carefully crafting plausible—and easy to understand-- (but highly improbable and at the fringes of mainstream thought)scenarios out of complex geopolitical, political, social and economic issues
that are at “top of mind” of our society and that tug at some of our most basic
interests (individual freedom, economic freedom, nationalism, sanctity of life,
torture, and war) and evoke very basic human responses such as fear, anxiety,
anger, disgust, and etc.
2. Dr. Paul’s views on national defense, monetary policy, isolationism, and constitutionalism are considered by most to be outside of the mainstream of rational political, social, and governmental philosophy.
3. Dr. Paul has consistently repeated his messages over 30 years and as noted above, tends to target younger followers who are easier to indoctrinate.
The fourth rule is to proselytize not only your “enlightened philosophy or beliefs, but also to spread forth the word that while you and your followers are “the enlightened or chosen ones”, there will be naysayers and those that will persecute you and the movement. This clearly shows the elements of paranoia and persecution by the non-believers.
1. Dr. Paul and his followers are very defensive when challenged on the issues and their beliefs. Instead of engaging in earnest discourse, they tend to attack and accuse the “non-believer” as persecuting them for their beliefs or of being ignorant and unenlightened in their philosophy.
2. Dr. Paul and his followers display a common paranoia and decry a “conspiracy” of the right, the political elite, and the left against them and their “lofty ideas that will save America”.
3. Dr. Paul has consistently offered the explanation that others are simply “out to get him” by taking “tongue-in-cheek comments out of context” and things that were written in his newsletters (but purportedly not authorized or written by him).
4. Dr. Paul comes off as defensive and angry when challenged in interviews and becomes condescending.
The fifth and last rule is to convince your followers that it is only through blind faith and rigid adherence to your philosophy—no matter how foreign it may be to self or to society—that that blind adherence or “loyalty” is the only path to salvation, redemption, or the reparation of the “perceived” ills of society. This is more antisocial ego-building and the tightening of control over the flock.
1. Dr. Paul and his followers play the same monotonous drum beat about “smaller government”, defense of our borders,monetary reform and fiscal responsibility, “stop the wars”, and national isolationism over and over again like a Gregorian chant and mantra in a blind and stubborn adherence to their fringe philosophy that is the only path to saving America despite practical, rational, philosophical, and real world
evidence against and “common sense” opposition to their “zany” ideas, Messianic
messages, and Utopian philosophies.
Some authors would add another step which is to construct a “doomsday scenario” for your followers, such as “the end of the world, World War III, or economic collapse as the great incentive to motivate the followers to adhere to and spread your
teachings. This, again, would show delusional thinking as well as narcissistic thinking, especially if the leader and his or her followers will be the only ones saved from the impending calamity.
1. Of course we are all aware of the “doomsday” prophecies of Dr. Paul considering our economy and its impending collapse with hyperinflation if we don’t get rid of the Fed.
After considering this, and seeing Dr. Paul’s rise in the Iowa polls, it makes me
wonder what they are doing out there in Iowa. It seems to me that maybe they are mixing a little Ron Paul Kool-Aid with some fermented corn!
Saturday, December 17, 2011
"Arm chair economists" vs MD/MBA and Expert in Healthcare Economics
I have read with amusement the letters to the editor in today’s (12/17/2011) Albuquerque Journal criticizing Dr. J. Deane Waldman’s recent editorial regarding out of control health care costs and the government’s role in regulating and/or contributing to those costs. It is interesting that all three letters published were all critical of Dr. Waldman’s analysis with no counter opposing view(s) supporting his analysis. I don’t know if that means there were no letters to support Dr. Waldman or if the Journal simply chose not to include any letters that supported his views.
Regardless if there was any supportive letters sent to the editor, it is both interesting and amusing to see three non-medical (and assuming, non-health care economics) professionals—unless one counts “45 years experience as a health care advocate” as qualifying as a health care professional—trying to rebut the thoughtful analysis of not only a practicing physician who has practiced for more than 2 decades within our “sick system”,but is also an MBA who is a published author and expert in healthcare economics and reform.
It is obvious from the reading of all three letters that the basis of their rebuttal is not based on any real facts or data from scholarly journals in medicine or economics, but rather simply on personal political ideology and opinion. All three letter writers obviously espouse a more liberal “more government is better” philosophy towards healthcare—vis-à-vis “Obamacare”-- and two of the letter writers ignominiously attempt to discredit Dr. Waldman’s analysis as merely the musings or political ranting of just another ill-informed or unenlightened “conservative”.
Regarding the first letter by Mr. Richard Valdez, he somehow manages to shift the argument that more government regulation is more or less cost efficient based on the merits—or lack of—of governmental bureaucratic efficiency , instead arguing for the benefits of more government regulation in healthcare in order to improve patient safety. In other words, he is trying to compare apples to apples, but using oranges as an example. On top of that,he insinuates that Dr. Waldman just magically pulls his data (of 40% of healthcare expenditures not going to pay for direct patient care) out of the air if not from a “conservative think tank” while offering his own simple statistic from the CDC and Institute of Medicine (which by the way is a liberal think tank) of “100,000 to 135,000 deaths annually due to doctor and/or hospital error”. Now, did I miss something? I thought we were discussing money and bureaucratic efficiency/inefficiency here and not the number of potentially preventable patient deaths per year attributable to medical errors. What does one have to do with the other? I’m deeply sorry that he has lost two sons, but his argument that more government spending or regulations would have saved them may or may not be true, but have absolutely nothing to do with the argument that the government can or cannot be more efficient in managing healthcare!
Regardless if there was any supportive letters sent to the editor, it is both interesting and amusing to see three non-medical (and assuming, non-health care economics) professionals—unless one counts “45 years experience as a health care advocate” as qualifying as a health care professional—trying to rebut the thoughtful analysis of not only a practicing physician who has practiced for more than 2 decades within our “sick system”,but is also an MBA who is a published author and expert in healthcare economics and reform.
It is obvious from the reading of all three letters that the basis of their rebuttal is not based on any real facts or data from scholarly journals in medicine or economics, but rather simply on personal political ideology and opinion. All three letter writers obviously espouse a more liberal “more government is better” philosophy towards healthcare—vis-à-vis “Obamacare”-- and two of the letter writers ignominiously attempt to discredit Dr. Waldman’s analysis as merely the musings or political ranting of just another ill-informed or unenlightened “conservative”.
Regarding the first letter by Mr. Richard Valdez, he somehow manages to shift the argument that more government regulation is more or less cost efficient based on the merits—or lack of—of governmental bureaucratic efficiency , instead arguing for the benefits of more government regulation in healthcare in order to improve patient safety. In other words, he is trying to compare apples to apples, but using oranges as an example. On top of that,he insinuates that Dr. Waldman just magically pulls his data (of 40% of healthcare expenditures not going to pay for direct patient care) out of the air if not from a “conservative think tank” while offering his own simple statistic from the CDC and Institute of Medicine (which by the way is a liberal think tank) of “100,000 to 135,000 deaths annually due to doctor and/or hospital error”. Now, did I miss something? I thought we were discussing money and bureaucratic efficiency/inefficiency here and not the number of potentially preventable patient deaths per year attributable to medical errors. What does one have to do with the other? I’m deeply sorry that he has lost two sons, but his argument that more government spending or regulations would have saved them may or may not be true, but have absolutely nothing to do with the argument that the government can or cannot be more efficient in managing healthcare!
While this letter is meant to offer a critique of the letters criticizing Dr. Waldman’s analysis and not a separate analysis of how we can best prevent medical errors in healthcare or what the government’s best role is in preventing medical errors, I do want to point out—using Mr. Valdez’ own statistics—how easy it is to pick and choose random statistics disingenuously to support one side or another of an argument. While Mr. Valdez correctly contends that there are anywhere from 100,000 to 135,000 (actual range is 85,000 to 195,000)deaths annually attributable to doctor and/or hospital errors, he conveniently fails to indicate that number one, these are classified as “potentially preventable deaths” and number two, that these potentially preventable deaths represent an extremely small fraction (0.00005%--using the higher number of 200,000) of the nearly 1 billion (995 million) doctors visits, outpatient clinic visits, ER visits, and hospitalizations (CDC data) seen each year!
You don’t have to be a "Black Belt” in Six Sigma --an extremely rigorous business ideal advocating for near perfection or 99.99966% error free processes—to see that in medicine, we get pretty damn close! Now as a physician and a father-- and a healthcare consumer-- I understand that we are talking about human lives here and not the manufacturing of ball bearings and that even 1 preventable death due to medical error is tragic and regrettable, but from the dawn of civilization, we have never been, currently are not, and never will be perfect in medicine or in any other human endeavor!
Mr. Raymond Schall and Mr. Byers both just simply spout standard democratic party line demagoguery in their justification for and defense of “Obamacare” and increased government involvement in one of the most personal aspects of our lives without providing any real or objective data or logic to buttress their criticism of Dr. Waldmam’s analysis. Mr. Schall tries to
also pick and choose some “statistics” to bolster his support of “Obamacare” by citing that the “Health and Human Services recently released their long awaited rules requiring insurance companies to spend at least 80 to 85 percent of their revenue on actual patient care. What he failed to mention is that in the United States, most private insurance companies spend about 6 to 11percent of revenues on “administrative costs” and 89 to 94% on “patient care costs” (multiple sources). He also did not mention that from at least 2000 to 2010, Medicare consistently has spent 19 to 31% more on true “administrative costs” than private insurance companies. He also tries to tout the benefits of “Obamacare” by stating that “more than 100,000” New Mexicans have “received free preventative health care” and “more than 18,000 students have received primary and behavioral healthcare” because of “Obamacare”.
Now Mr. Schall obviously has never heard of or does not believe in the 1st principle of economics which basically states “there is no such thing as a free lunch”. He uses the word “free” as if “the free market tooth fairy”—to borrow a trite little phrase from Mr. Byers (the 3rd letter writer)—suddenly dropped the money into the government coffers to pay for the “free care”! Excuse me, but just because the patients received “free” or discounted health care doesn’t at all mean that it was “free”—somebody(you and I—and not the tooth fairy) in the form of increased taxes and or both increased premiums has to pay for that “free health care”! Beyond that, the medical providers providing the “free care” do so at a deeply discounted government mandated rate that often is below the amount required to sustain a viable practice!
Finally, Mr. Doug Byer’s letter is nothing more than old and tired progressive-socialist and “new” OWS dogma lamenting the evils of capitalism and free markets thinly—as well as feebly--disguised as an attempt in intellectual discourse.
I conclude my critique of the letters to the editor with some rather interesting “statistics” to ponder:
1. There are approximately 1800 pages each in both Harrison’s textbook of Medicine and the American College of Surgeons textbook of Surgery which could be considered the "bibles” of Western Medicine and Surgery and which represent the collection of
at least 3000 years of medical and surgical science and knowledge. This compares to 1000 pages in the Patient Protection and Affordable Act (aka “Obamacare”), 670 pages in the HIPPA regulations, and over 132, 000 pages of Medicare rules and regulations collected over the last few decades (this does not include the various state and local rules and regulations regarding the practice of medicine in States and local localities)!
2. There are approximately 650,000 practicing physicians and surgeons in the United States and it is estimated that for every physician, there is 2 to 5 or (1.2 to 3.25 million) “non-medical administrative” workers (most of them Federal and State employees) per doctor “administering healthcare”!
3. The Medicare Trustees have projected that Medicare (which administers to approximately 30.5 million Americans) will be bankrupt by 2024 at current spending projections and somehow we want to expand that government bureaucratic behemoth to cover 10 times that much? This is what a “real” doctor in health care economics has to say about that:
“Contrary to the claims of public plan advocates, moving millions of
Americans from private insurance to a Medicare-like program will result in
program administrative costs that are higher per person and higher, not lower,
for the nation as a whole.”
Robert A. Book, Ph.D., is Senior Research Fellow in Health Economics in the Center
for Data Analysis at The Heritage Foundation
Sincerely,
John R. Vigil, MD
Dr. Vigil has a blog titled “What’s Wrong With American Healthcare Today;
The Musings of a Working Doc” and has been a practicing physician and surgeon for over 20 years. His interests in medicine are healthcare economics, improving healthcare delivery, and history of medicine and surgery. He has completed 1 year towards his Master’s degree in Business Administration at the Anderson School of Management, University of New Mexico.
Wednesday, August 31, 2011
Opiates and Pain Management; Pandora's Box
Opiates and Pain Management: Pandora’s Box
Today is National Overdose Awareness Day and an appropriate time to discuss the terrible epidemic of opiate addiction that we are seeing, not only in our community, but nationally as well. The statistics are staggering as according to SAMHSA (Substance Abuse and Mental Health Services Administration) there were 1.9 million prescription opiate addicts and another 600,000 or more heroin addicts in 2009 and the numbers are increasing. Accidental overdose has overtaken car accidents as the number one killer of young people 18 to 44 who are not only in their prime of life, but also the primary producers in our economy and society. It is estimated that overall, 24 million people in the US have an addiction and only about 1-2% are receiving treatment for their addiction.
I could easily write an entire paper on the staggering cost of addiction, not only in loss of human lives but also in economic costs to this country; however this paper is about the people affected by this horrible epidemic and not about statistics. There have been a number of stories and citizen comments recently in our news and newspapers about young people tragically dying of heroin overdose and doctors over-prescribing narcotic medication. This paper is written to try to bring some insight to the community of the scope of this problem, how we got there, and some possible solutions.
Sometime in the middle of the last decade, several national and international organizations, including the WHO (World Health Organization) drafted and adopted a Patient’s Bill of Rights that dealt specifically with pain management. Specifically and amongst other things, it stated that all patients “have a right to proper, respectful, informed, and non-discriminatory pain management and care”. Prior to this shift change in medicine, opiates had more or less been reserved to manage chronic pain only for patients with advanced cancers or other end-stage painful conditions. Apart from these patients, the only other use for opiates was generally for the short term treatment of severe acute pain postoperatively or for severe acute trauma. Following the lead of the national and international organizations, most state medical boards and societies adopted the Pain Patient’s Bill of Rights and Pandora’s Box was opened.
Since then, millions of patients have been treated and are being treated with opiate pain medication for a variety of conditions including headaches, chronic back pain, arthritis, fibromyalgia, and just about any other disorder that causes pain. While the overwhelming majority of these patients are being treated for legitimate pain by well-meaning, well trained, and legitimate physicians and are not abusing their medication or addicted, many of them do become addicted and/or dependent and a few obtain their medication illegitimately, by ruse or illegally. Unfortunately, there have been—and remain--more than a few unscrupulous and unethical doctors who have been more than happy to provide some of the latter “patients” with prescriptions for narcotic medication.
The opening of Pandora’s Box has produced a schizophrenic medical community with doctors under pressure to respect and adhere to the “Patient Bill of Rights” by providing legitimate patients with adequate and compassionate pain management on the one hand while feeling threatened or intimidated by the DEA and other law enforcement agencies if they chose to treat such patients. Another problem arises when all physicians know and understand that while the majority (more than 80%) of patients treated with opiate pain management will never develop an abuse problem or addiction, about 10% will ultimately develop an addiction with its attendant negative consequences—including risk of accidental overdose-- on those patient’s lives. Unfortunately for us, patients do not carry a sign with them that warn us that a particular patient will become addicted. Furthermore, since pain is a subjective and individual experience and is modified by emotional, physical, and psychological states, it is impossible for any physician to be 100% certain 100% of the time, who is legitimately seeking pain management and who is not.
By some of the reports in the news as well as some of the citizen’s comments, it would appear that there is a perception that most physicians are just “willy nilly” handing out prescriptions for opiates to just anyone who requests them without consideration of the consequences. As I have mentioned earlier and which have been documented in news stories across the country, I acknowledge that there are unethical and unscrupulous physicians who are prescribing for profit, but like the minority of legitimate patients who become addicted and cause problems to themselves and society, they are in the vast minority! In fact, statistics from SAMHSA indicate that in most communities, most “illegitimate” prescriptions are coming from only 1 or 2 doctors. Most doctors take their responsibility to their profession and society seriously and understand the risks of prescribing opiate medication. We also understand that the majority of people prescribed such medication will also be responsible and never develop a problem with it and we are constantly weighing the risks versus the benefits of prescribing such medication to each and every patient. It is inevitable that some of us will be duped by some “patients” and it is also inevitable that some legitimate patients will develop an addiction and that is the risk we take while Pandora’s Box is open.
Another common misperception is that many teenagers and young people are becoming addicted to opiates obtained from doctors. There are very few indications to treat a young person with opiate medication and most physicians are hesitant to prescribe these medications to teens and young people except in cases of moderate to severe pain from orthopedic or operative trauma. Statistics from SAMSHA and from my personal experience as an addiction specialist, most teens and young people (55%) report that they are getting their opiates right from home (friends or family), 17% report getting them from one doctor, and the rest from the street. Of those that reported obtaining their medication from friends or family, 80% of the friends or family members reported getting their medication from only one doctor.
So what can we do about Pandora’s Box? According to legend, once it was open, there was no way of closing it and I do not believe that there is any way of closing our modern day version of the box. However, the one thing that remained in the box was hope and it with hope that we can possibly change things at a variety of levels including personally, professionally, and legislatively to effect positive change in our communities and society at large to combat this insidious and horrible epidemic that is claiming the lives of our youngest and most productive individuals. Every time one of our young people dies from an overdose, it robs us all and our society of a “what if”—what if that person was going to be the next doctor to cure cancer or addiction, a great actress or actor, singer or athlete, or the next CEO of a great company, or even the next President.
While I do not profess to have all of the answers to this complex and vexing problem, I do have some suggestions, some of which will undoubtedly bring much scorn and criticism upon me from colleagues and others. I will outline these suggestions from a personal to professional to a legislative order.
Personally, as individuals we must all become aware of this insidious epidemic and must educate ourselves—and our children-- about the risks and dangers of opiate addiction when given these medications, even for short term use. As parents, we must educate ourselves to the signs and symptoms of addiction so that we may intervene early and decisively should we suspect our children or loved ones of developing a problem or experimenting with opiates. If we are obtaining and using opiate medication we must take measures to safeguard our medication and keep them out of the reach of children and inquiring minds. We can become advocates in our schools and our communities, becoming involved in groups and organizations, such as the Heroin Action Committee, that spread the word about this problem. Lastly, we must learn and understand that addiction is a disease and should be treated like a disease without the stigmatization that surrounds it and which stands as a barrier to many of those who would otherwise seek treatment.
At a professional level, we must take our heads out of the sand and acknowledge the epidemic of opiate addiction that the opening of Pandora’s Box has caused. We must keep up to date on the standards of care for the treatment of chronic pain and we must also keep up to date on the advances that are being made in the non-opiate management of chronic pain as well as the advancements being made in addiction medicine. We too, must divest ourselves of the cloaks of superiority and ignorance and recognize addiction for the disease that it is and not the old stereotypes we might still believe. We must accept our part in this epidemic and be more diligent about truly doing risk analysis every single time we write a narcotic prescription, including opiates, benzodiazepines, and medication for ADD. We must recognize our educational and training limitations and refer those patients requiring complex psychological and concomitant pain management to appropriate specialists. It is our house where Pandora’s Box came from and we must clean our house or others will clean it for us and ultimately, the patients and society will suffer.
At a legislative level, which must occur at both the state and federal levels, there are several things that can be done. First of all, hydrocodone and tramadol should be made scheduled II narcotics and all scheduled II narcotics should be controlled and prescribed only by appropriate specialists or physicians who have demonstrated interest, experience, and proficiency through conferences, courses, and continuing medical education in pain management—as well as addiction-- to their respective state medical boards or licensing agencies. It is interesting that I must demonstrate proficiency to apply for a license to prescribe Suboxone which treats addiction, but I have no restrictions whatsoever to write for all the drugs that cause addiction! For those specialists that may often treat acute severe pain, such as surgeons, orthopedic surgeons, or ER/Urgent Care physicians, strict limits should be made with respect to amounts written for and duration of treatment for all scheduled II drugs. All states should be mandated to have a reporting mechanism through the pharmacy boards where all physicians should be mandated to access and report to before prescribing scheduled II medication. On a broader level, we must enact legislation that shifts the emphasis from punishment to prevention and treatment for those that struggle with addiction. We should encourage and expand dramatically the number of doctors and midlevel providers who wish to provide outpatient opiate addiction treatment with Suboxone. As a society, we too must understand that addiction is a neurobiological disease manifested by abnormal behavior, not abnormal people voluntarily engaging in harmful and bad behavior!
Pandora’s Box may be open, but by coming together as citizens, professionals, and policy makers, we can perhaps reopen the box and bring hope to our communities and to society.
John R. Vigil, MD
Today is National Overdose Awareness Day and an appropriate time to discuss the terrible epidemic of opiate addiction that we are seeing, not only in our community, but nationally as well. The statistics are staggering as according to SAMHSA (Substance Abuse and Mental Health Services Administration) there were 1.9 million prescription opiate addicts and another 600,000 or more heroin addicts in 2009 and the numbers are increasing. Accidental overdose has overtaken car accidents as the number one killer of young people 18 to 44 who are not only in their prime of life, but also the primary producers in our economy and society. It is estimated that overall, 24 million people in the US have an addiction and only about 1-2% are receiving treatment for their addiction.
I could easily write an entire paper on the staggering cost of addiction, not only in loss of human lives but also in economic costs to this country; however this paper is about the people affected by this horrible epidemic and not about statistics. There have been a number of stories and citizen comments recently in our news and newspapers about young people tragically dying of heroin overdose and doctors over-prescribing narcotic medication. This paper is written to try to bring some insight to the community of the scope of this problem, how we got there, and some possible solutions.
Sometime in the middle of the last decade, several national and international organizations, including the WHO (World Health Organization) drafted and adopted a Patient’s Bill of Rights that dealt specifically with pain management. Specifically and amongst other things, it stated that all patients “have a right to proper, respectful, informed, and non-discriminatory pain management and care”. Prior to this shift change in medicine, opiates had more or less been reserved to manage chronic pain only for patients with advanced cancers or other end-stage painful conditions. Apart from these patients, the only other use for opiates was generally for the short term treatment of severe acute pain postoperatively or for severe acute trauma. Following the lead of the national and international organizations, most state medical boards and societies adopted the Pain Patient’s Bill of Rights and Pandora’s Box was opened.
Since then, millions of patients have been treated and are being treated with opiate pain medication for a variety of conditions including headaches, chronic back pain, arthritis, fibromyalgia, and just about any other disorder that causes pain. While the overwhelming majority of these patients are being treated for legitimate pain by well-meaning, well trained, and legitimate physicians and are not abusing their medication or addicted, many of them do become addicted and/or dependent and a few obtain their medication illegitimately, by ruse or illegally. Unfortunately, there have been—and remain--more than a few unscrupulous and unethical doctors who have been more than happy to provide some of the latter “patients” with prescriptions for narcotic medication.
The opening of Pandora’s Box has produced a schizophrenic medical community with doctors under pressure to respect and adhere to the “Patient Bill of Rights” by providing legitimate patients with adequate and compassionate pain management on the one hand while feeling threatened or intimidated by the DEA and other law enforcement agencies if they chose to treat such patients. Another problem arises when all physicians know and understand that while the majority (more than 80%) of patients treated with opiate pain management will never develop an abuse problem or addiction, about 10% will ultimately develop an addiction with its attendant negative consequences—including risk of accidental overdose-- on those patient’s lives. Unfortunately for us, patients do not carry a sign with them that warn us that a particular patient will become addicted. Furthermore, since pain is a subjective and individual experience and is modified by emotional, physical, and psychological states, it is impossible for any physician to be 100% certain 100% of the time, who is legitimately seeking pain management and who is not.
By some of the reports in the news as well as some of the citizen’s comments, it would appear that there is a perception that most physicians are just “willy nilly” handing out prescriptions for opiates to just anyone who requests them without consideration of the consequences. As I have mentioned earlier and which have been documented in news stories across the country, I acknowledge that there are unethical and unscrupulous physicians who are prescribing for profit, but like the minority of legitimate patients who become addicted and cause problems to themselves and society, they are in the vast minority! In fact, statistics from SAMHSA indicate that in most communities, most “illegitimate” prescriptions are coming from only 1 or 2 doctors. Most doctors take their responsibility to their profession and society seriously and understand the risks of prescribing opiate medication. We also understand that the majority of people prescribed such medication will also be responsible and never develop a problem with it and we are constantly weighing the risks versus the benefits of prescribing such medication to each and every patient. It is inevitable that some of us will be duped by some “patients” and it is also inevitable that some legitimate patients will develop an addiction and that is the risk we take while Pandora’s Box is open.
Another common misperception is that many teenagers and young people are becoming addicted to opiates obtained from doctors. There are very few indications to treat a young person with opiate medication and most physicians are hesitant to prescribe these medications to teens and young people except in cases of moderate to severe pain from orthopedic or operative trauma. Statistics from SAMSHA and from my personal experience as an addiction specialist, most teens and young people (55%) report that they are getting their opiates right from home (friends or family), 17% report getting them from one doctor, and the rest from the street. Of those that reported obtaining their medication from friends or family, 80% of the friends or family members reported getting their medication from only one doctor.
So what can we do about Pandora’s Box? According to legend, once it was open, there was no way of closing it and I do not believe that there is any way of closing our modern day version of the box. However, the one thing that remained in the box was hope and it with hope that we can possibly change things at a variety of levels including personally, professionally, and legislatively to effect positive change in our communities and society at large to combat this insidious and horrible epidemic that is claiming the lives of our youngest and most productive individuals. Every time one of our young people dies from an overdose, it robs us all and our society of a “what if”—what if that person was going to be the next doctor to cure cancer or addiction, a great actress or actor, singer or athlete, or the next CEO of a great company, or even the next President.
While I do not profess to have all of the answers to this complex and vexing problem, I do have some suggestions, some of which will undoubtedly bring much scorn and criticism upon me from colleagues and others. I will outline these suggestions from a personal to professional to a legislative order.
Personally, as individuals we must all become aware of this insidious epidemic and must educate ourselves—and our children-- about the risks and dangers of opiate addiction when given these medications, even for short term use. As parents, we must educate ourselves to the signs and symptoms of addiction so that we may intervene early and decisively should we suspect our children or loved ones of developing a problem or experimenting with opiates. If we are obtaining and using opiate medication we must take measures to safeguard our medication and keep them out of the reach of children and inquiring minds. We can become advocates in our schools and our communities, becoming involved in groups and organizations, such as the Heroin Action Committee, that spread the word about this problem. Lastly, we must learn and understand that addiction is a disease and should be treated like a disease without the stigmatization that surrounds it and which stands as a barrier to many of those who would otherwise seek treatment.
At a professional level, we must take our heads out of the sand and acknowledge the epidemic of opiate addiction that the opening of Pandora’s Box has caused. We must keep up to date on the standards of care for the treatment of chronic pain and we must also keep up to date on the advances that are being made in the non-opiate management of chronic pain as well as the advancements being made in addiction medicine. We too, must divest ourselves of the cloaks of superiority and ignorance and recognize addiction for the disease that it is and not the old stereotypes we might still believe. We must accept our part in this epidemic and be more diligent about truly doing risk analysis every single time we write a narcotic prescription, including opiates, benzodiazepines, and medication for ADD. We must recognize our educational and training limitations and refer those patients requiring complex psychological and concomitant pain management to appropriate specialists. It is our house where Pandora’s Box came from and we must clean our house or others will clean it for us and ultimately, the patients and society will suffer.
At a legislative level, which must occur at both the state and federal levels, there are several things that can be done. First of all, hydrocodone and tramadol should be made scheduled II narcotics and all scheduled II narcotics should be controlled and prescribed only by appropriate specialists or physicians who have demonstrated interest, experience, and proficiency through conferences, courses, and continuing medical education in pain management—as well as addiction-- to their respective state medical boards or licensing agencies. It is interesting that I must demonstrate proficiency to apply for a license to prescribe Suboxone which treats addiction, but I have no restrictions whatsoever to write for all the drugs that cause addiction! For those specialists that may often treat acute severe pain, such as surgeons, orthopedic surgeons, or ER/Urgent Care physicians, strict limits should be made with respect to amounts written for and duration of treatment for all scheduled II drugs. All states should be mandated to have a reporting mechanism through the pharmacy boards where all physicians should be mandated to access and report to before prescribing scheduled II medication. On a broader level, we must enact legislation that shifts the emphasis from punishment to prevention and treatment for those that struggle with addiction. We should encourage and expand dramatically the number of doctors and midlevel providers who wish to provide outpatient opiate addiction treatment with Suboxone. As a society, we too must understand that addiction is a neurobiological disease manifested by abnormal behavior, not abnormal people voluntarily engaging in harmful and bad behavior!
Pandora’s Box may be open, but by coming together as citizens, professionals, and policy makers, we can perhaps reopen the box and bring hope to our communities and to society.
John R. Vigil, MD
Saturday, February 26, 2011
Why Healthcare Cannot Be a Right--In a Free Society
There is a proposed constitutional amendment in our state (New Mexico) to recognize Healthcare as a basic human right. Dr. Bruce Trigg, a local physician and colleague wrote an editorial in our local newspaper titled "Make Healthcare a Right For All". The following is my response:
I have read my esteemed colleague’s (Dr. Bruce Trigg) editorial today (2/25/11), titled “Make Health Care a Right for All.” While I have the utmost respect for Dr. Trigg, I must answer with the counter argument that health care is not a right-- in a free society.
This nation was founded on the principle of “self evident truths” that each of us as individuals are born equal (not that we should share in all equally) and “endowed’” with “certain unalienable rights”, including the right to “life, liberty, and the pursuit of happiness”. Nowhere did our founding fathers mention “health care” or “good health” as a right, neither in our Declaration of Independence nor in our constitution or its Bill of Rights.
Now some would argue that in 18th and early 19th century America, “Health Care” was nothing to brag about and certainly, nothing to pursue as a fundamental right for all citizens. Others would argue that it was simply an oversight that the founding fathers did not include our health as a fundamental right. I would counter the first of those arguments by asserting that many Americans would travel back to Europe for their “health care” which had to be extraordinarily expensive and inconvenient and yet, there was no clamoring to have the fledgling American government, or rather, its citizens pay for such care. As far as the second argument goes, it is incredulous and inconceivable to consider that considering the collective wisdom of our founders who included Benjamin Rush and other physicians, they would have overlooked something as important as a basic and fundamental human right.
I believe that it was with foresight from our founding fathers that “health care” as a right was purposely excluded as a basic and fundamental right. Unlike, our current politicians, our forefathers were well read and versed in history, philosophy, law, economics, and theology and understood the dangers of the government picking and choosing certain rights arbitrarily and compelling the citizenry to pay for such rights. They understood human nature and man’s natural tendency to want and desire what others have and he doesn’t have and they understood how that very human nature could be exploited by politicians and tyrants for political expediency and political power by providing those things as “rights”.
They recognized that man could conjure up an endless list of needs and desires and rationalize any one of them or all of them as being indispensable as basic human rights. Yet, they carefully selected only three basic “unalienable rights” or “natural rights”, none of which another man could provide to another nor could be compelled to pay for or provide to another. These rights are negative rights in that the right is not in the power or the purview of the government (or fellow citizens) to provide such rights, but rather places in the government the power and responsibility to protect such rights from being taken away from us. The government nor our fellow citizens cannot give us or ensure us life, liberty, the pursuit of happiness-- or good health!
Our government may only protect our rights from such things being taken from us and it is our individual responsibility to respect the rights of others and not take such rights from each other, but nowhere in our constitution is it stated or expressed that our government must provide us with anything or compels us to provide our neighbors with anything! They understood that to compel us to provide for the needs and wants of our neighbors would be antithetical to the very principles this country was founded on and for which we fought a war of independence for: That no man should be in servitude to a tyrant, a tyrannical government, or to each other and that no man should be beholding to or dependent on another man or government for his life, liberty, or pursuit of happiness!
Now some would argue that the Bill of Rights and subsequent amendments to the Constitution is where we derive our positive rights from, or those rights that by “social contract”, obligate us or our government to provide us with certain “rights” pertaining to our “general welfare”, yet the first ten amendments, or the “Bill of Rights” were added to further delineate—and limit—the power of the government with respect to both protecting our natural rights of life, liberty, the pursuit of happiness and the right to attain and own private property as well as to define and specify certain liberties, such as the freedom of speech, the freedom to keep and bear arms, and etc. Again, nothing in the Bill of Rights or subsequent amendments explicitly or implicitly allows for or compels the government to provide the citizenry with a minimum standard of welfare or for the citizens to provide for the general welfare of each other for to do so erodes our individual freedoms and places us in the servitude of our government and/or our fellow citizens.
Dr. Trigg in his essay asks “why can’t we guarantee that everyone has medical care on the same basis that we provide police and fire protection and universal free education”? The answer is that the provision of police and fire protection are governmental institutions specifically created and empowered solely to protect our natural and property rights. They cannot provide us with any material needs or desires nor can they deny us or take away from us our property, our lives, or our freedom. With respect to providing “universal free education”, nowhere in the Constitution is it mandated that we all be provided free education. Education from K to 12 is compulsory by state statutes and certainly is not “free” in that we all pay taxes to fund our public education. Access to higher education is protected by law, again, as a negative right only, in that no one, including the government can prevent us access to education—as long as we have the means and money to pay for it!
So far, I have made the argument that our Founding Fathers and Framers of our Constitution purposely excluded “health care” and an endless list of similar human needs and wants as positive rights based solely on a moralistic philosophy that to compel the government or the citizenry to provide for such rights would create the hypocritical and antithetical situation of protecting our freedoms and pursuit of happiness while at the same time placing us into involuntary servitude to our government and/or our fellow citizens. Although I believe that such moralistic and enlightened thinking was behind the decisions of our Founders as they framed and penned our Constitution, I also believe there were more practical considerations as well that influenced their thinking.
Besides being great moral thinkers and products of “the enlightenment”, our Founders were also businessmen and pragmatists and understood that the provision of most goods, needs, wants, and services—including health care—to the citizenry was best, most fairly, and most efficiently accomplished through the time-honored system of free markets. They understood from Adam Smith that free markets are the engines that drive democratic economies and the most efficient way to provide scarce resources to the greatest number. They also understood (unlike modern politicians) that the “invisible hand” of the free markets worked best unfettered and unrestrained by the “heavy hand” of oppressive government, burdensome bureaucratic regulations, onerous taxes, or union extortion.
Dr. Trigg is correct in asserting that a substantial number of our population already receives “[free] medical care either provided directly by the government (VA, Military, Indian Health Service, etc) or paid for by the government (UNM, Medicaid, Medicare, etc)”; however, he fails to mention that, for the most part, care in those systems, is grossly inefficient, very costly, and burdened by layers and layers of costly and onerous government bureaucracy and would best be provided by independent and competing practices in a free market system!
Dr. Trigg states that the proposed state amendment making health care a human right “paraphrases the words of the late Cardinal Joseph Bernardin” who has called since the 1990s for our government to recognize healthcare as a human right which government must “take responsibility” for. That is an interesting proposition from a religious spokesman from a religion that from medieval times has assumed the responsibility of providing access to healthcare and healthcare directly, through charity and charitable hospitals to millions and millions of sick souls! The Catholic Church and other religions have plenty of assets and money, if they believe healthcare is a right, then let them bear the burden of responsibility of providing it! I’m sure that religious leaders would no more appreciate government fiat compelling them to assume the responsibility of providing healthcare to each and every citizen anymore than any free man or woman wishes to be compelled to assume such responsibility!
I am not arguing that access to healthcare is not a right and I do not believe that our Founders believed that access was not a right; they correctly believed that “healthcare” in and of itself is a service and best provided through the marketplace. Every American has access to healthcare right now and our government has enacted statutes to prevent anyone or any government entity from barring us from such access to healthcare and that is the extent of government involvement that our sage Founders purposely wrote into the Constitution. Unfortunately, from Roosevelt, to Obama, modern day politicians have completely disregarded the thought and intent of our great Founders and have transformed an “age of enlightenment” to an “age of entitlement”.
Now before, I am accused and nailed to the cross as an uncaring and self-serving capitalist or hate-monger, it should be known that I have started a free-clinic for migrant workers in Ohio in 1995 that still operates today and I open my clinic as a free clinic in the South Valley to uninsured and underinsured people every 1st and 3rd Sunday of the month. I also have never turned a patient away from any of my clinics because of their inability to pay and every day I provide free or discounted care. As a physician, I took an oath of voluntary servitude to my fellow man, but, as an American, I must resist any call from my government or otherwise well-meaning citizens for my indentured servitude to them, for I am a free man in a free and democratic society!
John R. Vigil, MD
I have read my esteemed colleague’s (Dr. Bruce Trigg) editorial today (2/25/11), titled “Make Health Care a Right for All.” While I have the utmost respect for Dr. Trigg, I must answer with the counter argument that health care is not a right-- in a free society.
This nation was founded on the principle of “self evident truths” that each of us as individuals are born equal (not that we should share in all equally) and “endowed’” with “certain unalienable rights”, including the right to “life, liberty, and the pursuit of happiness”. Nowhere did our founding fathers mention “health care” or “good health” as a right, neither in our Declaration of Independence nor in our constitution or its Bill of Rights.
Now some would argue that in 18th and early 19th century America, “Health Care” was nothing to brag about and certainly, nothing to pursue as a fundamental right for all citizens. Others would argue that it was simply an oversight that the founding fathers did not include our health as a fundamental right. I would counter the first of those arguments by asserting that many Americans would travel back to Europe for their “health care” which had to be extraordinarily expensive and inconvenient and yet, there was no clamoring to have the fledgling American government, or rather, its citizens pay for such care. As far as the second argument goes, it is incredulous and inconceivable to consider that considering the collective wisdom of our founders who included Benjamin Rush and other physicians, they would have overlooked something as important as a basic and fundamental human right.
I believe that it was with foresight from our founding fathers that “health care” as a right was purposely excluded as a basic and fundamental right. Unlike, our current politicians, our forefathers were well read and versed in history, philosophy, law, economics, and theology and understood the dangers of the government picking and choosing certain rights arbitrarily and compelling the citizenry to pay for such rights. They understood human nature and man’s natural tendency to want and desire what others have and he doesn’t have and they understood how that very human nature could be exploited by politicians and tyrants for political expediency and political power by providing those things as “rights”.
They recognized that man could conjure up an endless list of needs and desires and rationalize any one of them or all of them as being indispensable as basic human rights. Yet, they carefully selected only three basic “unalienable rights” or “natural rights”, none of which another man could provide to another nor could be compelled to pay for or provide to another. These rights are negative rights in that the right is not in the power or the purview of the government (or fellow citizens) to provide such rights, but rather places in the government the power and responsibility to protect such rights from being taken away from us. The government nor our fellow citizens cannot give us or ensure us life, liberty, the pursuit of happiness-- or good health!
Our government may only protect our rights from such things being taken from us and it is our individual responsibility to respect the rights of others and not take such rights from each other, but nowhere in our constitution is it stated or expressed that our government must provide us with anything or compels us to provide our neighbors with anything! They understood that to compel us to provide for the needs and wants of our neighbors would be antithetical to the very principles this country was founded on and for which we fought a war of independence for: That no man should be in servitude to a tyrant, a tyrannical government, or to each other and that no man should be beholding to or dependent on another man or government for his life, liberty, or pursuit of happiness!
Now some would argue that the Bill of Rights and subsequent amendments to the Constitution is where we derive our positive rights from, or those rights that by “social contract”, obligate us or our government to provide us with certain “rights” pertaining to our “general welfare”, yet the first ten amendments, or the “Bill of Rights” were added to further delineate—and limit—the power of the government with respect to both protecting our natural rights of life, liberty, the pursuit of happiness and the right to attain and own private property as well as to define and specify certain liberties, such as the freedom of speech, the freedom to keep and bear arms, and etc. Again, nothing in the Bill of Rights or subsequent amendments explicitly or implicitly allows for or compels the government to provide the citizenry with a minimum standard of welfare or for the citizens to provide for the general welfare of each other for to do so erodes our individual freedoms and places us in the servitude of our government and/or our fellow citizens.
Dr. Trigg in his essay asks “why can’t we guarantee that everyone has medical care on the same basis that we provide police and fire protection and universal free education”? The answer is that the provision of police and fire protection are governmental institutions specifically created and empowered solely to protect our natural and property rights. They cannot provide us with any material needs or desires nor can they deny us or take away from us our property, our lives, or our freedom. With respect to providing “universal free education”, nowhere in the Constitution is it mandated that we all be provided free education. Education from K to 12 is compulsory by state statutes and certainly is not “free” in that we all pay taxes to fund our public education. Access to higher education is protected by law, again, as a negative right only, in that no one, including the government can prevent us access to education—as long as we have the means and money to pay for it!
So far, I have made the argument that our Founding Fathers and Framers of our Constitution purposely excluded “health care” and an endless list of similar human needs and wants as positive rights based solely on a moralistic philosophy that to compel the government or the citizenry to provide for such rights would create the hypocritical and antithetical situation of protecting our freedoms and pursuit of happiness while at the same time placing us into involuntary servitude to our government and/or our fellow citizens. Although I believe that such moralistic and enlightened thinking was behind the decisions of our Founders as they framed and penned our Constitution, I also believe there were more practical considerations as well that influenced their thinking.
Besides being great moral thinkers and products of “the enlightenment”, our Founders were also businessmen and pragmatists and understood that the provision of most goods, needs, wants, and services—including health care—to the citizenry was best, most fairly, and most efficiently accomplished through the time-honored system of free markets. They understood from Adam Smith that free markets are the engines that drive democratic economies and the most efficient way to provide scarce resources to the greatest number. They also understood (unlike modern politicians) that the “invisible hand” of the free markets worked best unfettered and unrestrained by the “heavy hand” of oppressive government, burdensome bureaucratic regulations, onerous taxes, or union extortion.
Dr. Trigg is correct in asserting that a substantial number of our population already receives “[free] medical care either provided directly by the government (VA, Military, Indian Health Service, etc) or paid for by the government (UNM, Medicaid, Medicare, etc)”; however, he fails to mention that, for the most part, care in those systems, is grossly inefficient, very costly, and burdened by layers and layers of costly and onerous government bureaucracy and would best be provided by independent and competing practices in a free market system!
Dr. Trigg states that the proposed state amendment making health care a human right “paraphrases the words of the late Cardinal Joseph Bernardin” who has called since the 1990s for our government to recognize healthcare as a human right which government must “take responsibility” for. That is an interesting proposition from a religious spokesman from a religion that from medieval times has assumed the responsibility of providing access to healthcare and healthcare directly, through charity and charitable hospitals to millions and millions of sick souls! The Catholic Church and other religions have plenty of assets and money, if they believe healthcare is a right, then let them bear the burden of responsibility of providing it! I’m sure that religious leaders would no more appreciate government fiat compelling them to assume the responsibility of providing healthcare to each and every citizen anymore than any free man or woman wishes to be compelled to assume such responsibility!
I am not arguing that access to healthcare is not a right and I do not believe that our Founders believed that access was not a right; they correctly believed that “healthcare” in and of itself is a service and best provided through the marketplace. Every American has access to healthcare right now and our government has enacted statutes to prevent anyone or any government entity from barring us from such access to healthcare and that is the extent of government involvement that our sage Founders purposely wrote into the Constitution. Unfortunately, from Roosevelt, to Obama, modern day politicians have completely disregarded the thought and intent of our great Founders and have transformed an “age of enlightenment” to an “age of entitlement”.
Now before, I am accused and nailed to the cross as an uncaring and self-serving capitalist or hate-monger, it should be known that I have started a free-clinic for migrant workers in Ohio in 1995 that still operates today and I open my clinic as a free clinic in the South Valley to uninsured and underinsured people every 1st and 3rd Sunday of the month. I also have never turned a patient away from any of my clinics because of their inability to pay and every day I provide free or discounted care. As a physician, I took an oath of voluntary servitude to my fellow man, but, as an American, I must resist any call from my government or otherwise well-meaning citizens for my indentured servitude to them, for I am a free man in a free and democratic society!
John R. Vigil, MD
Sunday, April 25, 2010
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.
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 RESISTANCE TO OBAMACARE IS ABOUT A LOT MORE THAN THE 10TH AMENDMENT.
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
THE RESISTANCE TO OBAMACARE IS ABOUT A LOT MORE THAN THE 10TH AMENDMENT.
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
control.
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
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
control.
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.
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
Friday, April 16, 2010
Wednesday, April 14, 2010
Poll Finds Tea Party Anger Rooted in Issues of Class
Poll Finds Tea Party Anger Rooted in Issues of Class
By KATE ZERNIKE and MEGAN THEE-BRENAN
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.”
By KATE ZERNIKE and MEGAN THEE-BRENAN
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
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
By SUZANNE SATALINE And SHIRLEY S. WANG
From WSJ.com
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."
As Ranks of Insured Expand, Nation Faces Shortage of 150,000 Doctors in 15 Years
By SUZANNE SATALINE And SHIRLEY S. WANG
From WSJ.com
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
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
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