Defund Obamacare

September 19, 2013

There are a lot of political careers in the balance as the argument about defunding ObamaCare proceeds. To average Americans, this positioning of the Republican Party means little to nothing. However, there is still an excellent reason to push for defunding ObamaCare – it sends a message to politicians that they are being watched – that we, the American People, are paying attention, and we know that this “trainwreck” of a law is not in our best interests.

Already, the surge of Public opinion on this issue has changed the landscape, and the House will now almost certainly vote to defund. If we continue to push, we may even get a few Democratic votes, and a new conversation might start to emerge about what path we truly want to follow in our quest for better health care.

So, I urge you to sign into

http://www.dontfundobamacare.com

and SIGN THE PETITION – even if you don’t particularly like the Senators behind this, this gives us a shot at getting a better system out of our Congress down the road.

Of course defunding does not solve our health care problems – we still need to modify our health care delivery system to make it more responsive and accessible. But a vote to defund is a good first step because ObamaCare itself makes health care less responsive and less accessible than the system we already have!

This is something most people did not realize in the run up to the vote on this bill. Many people were reluctant to believe their Government would actually reduce health care access for most Americans for the illusion of “fairness.” The real shame of all this is that now the Congressional Budget Office estimates that, even after implementation, ObamaCare will still leave 30 million folks uninsured for at least the next ten years! This is a true lose-lose proposition – your health care will be degraded, AND hardly anyone will be helped! A recent independent study shows that ObamaCare vs. no ObamaCare makes a difference of less than two million more folks insured. Whatever happened to the coverage of 40 million uninsured that we were promised?

Honestly, there are any number of ways to do better than this at far less disruption and cost – any group of savvy professionals could propose a better plan – one that would not destroy jobs and hiring, or discourage Doctors from staying in practice.

Oh, and about the Administration’s noise that it would be wrong to defund a program that was “duly passed” into Law, please remember that when Scott Brown was elected in Massachusetts, Mr. Obama lost his 60 vote majority in the Senate. In fact, a very, very, Democratic Massachusetts expressly elected Brown precisely to vote against ObamaCare.

This meant that Congress could not amend the bill to make the Senate and House versions match because it would fail a Senate vote. So the Administration did something that was totally unprecedented. They “passed” this Leviathan bill that will impact all our lives using “reconciliation” – a procedure that allows a 51-vote majority to prevail in order to avoid funding lapses for WELL-ESTABLISHED programs that have already passed Congressional muster. This procedure had never been used for such a new and vast program. In fact, if you look hard, you might find video of Mr. Obama himself saying that health care reform can only be passed with 60 votes. Actually my old link of this video has suspiciously been scrubbed from the net, but I have found the audio of it here (I guess I better archive it)

Therefore, I do not recognize this law as having been “duly passed.” I view it as having been forced on the American People using unscrupulous methods. Anything we can legally do to rid ourselves of this nightmare is legitimate and just.

Again, I urge you to sign into

http://www.dontfundobamacare.com

And sign the petition.

Thanks for reading and good luck to us all.

The Sceptic

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ObamaCare Attempts to Repair Image on Children’s Health

July 14, 2013

June 2013 was a disastrous month for ObamaCare with bad press at every turn. In early June, a study was published indicating that if all states “opt in” to ObamaCare, the number of uninsured individuals would still be 29.8 million. The bad news? – If all states “opt out” the number is projected as only 31 million! In other words, the net effect of trillions in spending may be only an additional 1.2 million insured! By the way, this 30 million uninsured level is echoed by a February 2013 CBO (Congressional Budget Office) study that shows a level rate of 30 million uninsured through 2023! Whatever happened to the campaign promises to insure 40 million folks?

The bad news continued with GAO (General Accountability Office) reports indicating that the exchange systems and other aspects of ObamaCare were well behind schedule and could not meet their target dates. This failure to meet milestones has played a role in the July 2013 announcement of a one year delay in implementation.

Perhaps, though, the worst ObamaCare nightmare was the Sarah Murnaghan story. A 10-year old Pennsylvania girl with cystic fibrosis was denied access to adult donors under existing guidelines which set a lower age limit of 12. Secretary Sebelius said that she could not intervene and stay the guidelines, issuing her now-famous quote: “Someone lives, someone dies.” The girl’s parents appealed this decision and the District Court issued a temporary injunction that set aside the guideline and instructed Secretary Sebelius to grant Sarah Murnaghan access to the donor network. While Secretary Sebelius argued that adults could die as a result of this decision, part of the thinking expressed in Court was the one-dimensionality of the criteria for children’s access to adult organs – based solely on age and not considering the urgency of the medical circumstances or any other factor. In fact, children under 12 are about three times as likely to die waiting for a lung transplant as are their over-12 counterparts.

Subsequently, Ms. Murnaghan received the transplant and is still alive and recovering at this point. The same may not be true for ObamaCare, which suffered a fall in popularity as a result of the above bad publicity. Gallup reported a seven point swing in unfavorability from 45% last fall to 52% in June.

In view of wavering support and low enrollment, the Obama administration and its political wing are struggling to create a favorable impression of ObamaCare using advertisements, and seeking the endorsement of celebrities and athletes. Organizing for Action (An official Obama organization) has issued a new ad showing how ObamaCare has helped a little girl who needed open heart surgery, and who, in time, could have bumped up against a ‘lifetime cap” on benefits. I had trouble playing this video at neutral sites – being informed there was no access because it was “private.” I did eventually find it at

http://www.barackobama.com/health-care/

Actually, this is a rehash of the Zoe Lihn story used to great emotional effect at the Democratic Convention last year. She may just be the only child in the U.S. to actually be helped by ObamaCare, and so she is being trotted out again as a prop in this campaign to garner favorable public opinion.

But the issue is far wider than anecdotal evidence regarding one little girl from Pennsylvania or her counterbalance in Spinland. Let’s take a look at how a centrally planned, rationally conceived health care scheme would apportion scarce health care resources to all children, as well as all adults, based on age. This graph was published in the Lancet by Dr. Ezekiel Emanuel, an Obama health care advisor who helped frame ObamaCare, and represents his logical, ideal apportionment of scarce health care resources (click to enlarge):

Target Allocation of Health Care Resources by Age

Target Allocation of Health Care Resources by Age

Note that to the far right, at age 60 and older, the probability of receiving care is about one-fourth that of an individual between 20 and 30. Dr. Emanuel argued that these seniors had already had “complete lives” and intervention was not as important as for a younger person.

Note that to the far left, at age 10 and younger, the probability of receiving care ranges from about one-half to one-tenth that of an individual 20 to 30 years old. This is explained by Dr. Emanuel as reflecting the fact that society has not invested as much (for education etc.) in such children as it has in young adults, and therefore it is not cost effective to spend large sums to save them. This category is the one in which Sarah Murnaghan found herself, and therefore it is not surprising that the rules created by the transplant network limits her access to about one-third of that for older patients. In fact, to quiet the news crisis, Secretary Sebelius asked the board to review their criteria, and that review so far has changed nothing, nor will it in the future, unless Public opinion can be converted to political leverage.

As for the little girl in the Obama commercial who is receiving large expenditures of resources for her cardiac condition at age 1, I can only think that she may be the temporary beneficiary of the need to sell this program to a still-doubting Public. Once ObamaCare becomes a firmly ensconced, monolithic, and unrepealable health care machine, I would expect the bureaucrats to revert to form and greatly rein in expenditures for such a young person to be more in line with the one-tenth of young adult level. After all, their ideal health care resource curve calls for that, and, as Secretary Sebelius pointed out, she can’t make exceptions to these rules and guidelines.

By the way, the image of the Murnaghans pleading for their daughter’s life fulfils exactly my prediction that under this new arbitrary system, the citizens will find themselves on their knees, begging for health care for themselves and their loved ones. Evidently, it will take actual Court orders to obtain such mercy. Unbelievable! In a system that boasts that it exists “for the people,” I don’t think this is the proper relationship between the government and the governed. Do you?

the Sceptic

Tax on Health Care Premiums

May 13, 2013

As you may know, starting in 2018, ObamaCare will tax insurance policies that are deemed “Cadillac” plans. It will do so by taxing “excess” premiums – i.e. premiums that are in excess of the Federally mandated level. The tax rate will be up to 40%.

For example, the limit for an individual policy in 2018 will be $10,200 in premiums payed. Let’s say an employer pays 2/3 of the employee’s coverage and the total premium payed is $18,000 – 12K by the employer and 6K by the employee. The tax on the employer will be $720 (40% of the “excess” premium of $1,800).

The problem is that the rise in premiums has been reported as from 18 to 50 percent so far – only one year into implementation. If this were to continue year over year, premiums could rise a whopping 200% to 500% by the time 2018 rolls around! This means that individual plans that are now valued at about $2500 could exceed the “Cadillac” limit before we even start levying the taxes in 2018! The number of affected individuals and families could be staggering.

To avoid a catastrophe, Congress may need to change these limits, but this doesn’t help ObamaCare’s solvency and doesn’t address the underlying issue – ObamaCare seeks to control Federal expenditures, such as those for Medicare and Medicaid, but does little to control actual costs. Since premiums reflect costs (especially under the ObamaCare scheme), they will continue to rise above the “Cadillac” limits wherever they may be set.

At a more basic level, why is there a judgment that a certain amount of insurance is “excess,” or “Cadillac?” Why wouldn’t our Government want an employer to obtain the best possible coverage for its employees? In a rational world, wouldn’t it make sense to have a tax break for part of the cost of health insurance rather than a tax penalty? Wouldn’t this encourage people to get coverage more effectively than a toothless “mandate?”

The problem is the word “rational.” We are dealing not with just health care, but with ideology. Those who framed the ACA sincerely believe that there is only so much health care to go around, and that you should not get more than your “fair share.” “Fair share” may eventually be expanded to your lifetime – as in “You have already received your fair share of health care, and we are not going to provide you with any more.” In effect this is the ‘complete lives’ theory advanced by many Government controlled health care advocates, including Mr. Obama’s advisor Dr. Ezekiel Emanuel.

Buckle your seat belts folks, we’re in for a bumpy ride.

The Skeptic

ObamaCare Cuts Billions from Medicare Advantage; Cuts Hidden Until After Election

October 25, 2012

Update – Nov 25, 2012 – The original purpose of this blog – to build a consensus for real health reform and to repeal/repave the technocratic tarpit called ObamaCare – is now no longer feasible because Mr. Obama has been reelected.  There will be no repeal. But there is still work to do.  The purpose now shifts to deleting  or defunding bad parts of ObamaCare, providing rational arguments in support of States not establishing “exchanges,”  and alerting patients about the problems they will face in getting appropriate care under this impersonal, one-size-fits-all system.

Anyone watching the 2012 vice presidential debate would have seen Mr. Biden denying the planned cuts to Medicare Advantage, and pointing to the program’s current high enrollment rates as his evidence.

This is, to use the Vice President’s Jurassic era jargon, just a bunch of “malarkey.”

Medicare Advantage has a big target on it’s back – it is singled out as an object of true loathing by Government-mandated health care supporters because it entrenches private insurers within the Government programs, and will make it harder to eventually go to a single-payer system (which, after all, is their goal).  Medicare Advantage also provides just too much coverage to its enrollees to suit Government health care advocates, who want to provide minimal health care to seniors so we can redistribute more resources to other, poorer, younger demographic groups.

Therefore, ObamaCare is scheduled to gradually slash Medicare Advantage by as much as $300 billion over the next 10 years! This is about 40% of the total of $716 billion in Medicare cuts that will be used to offset the costs of other portions of ObamaCare (as described in this Investor’s Business Daily article.) The problem is that this program is very popular among seniors, especially those in the so-called “Swing States,” with ever more people wanting to enroll, as our brilliant Vice President has noted.  With the first round of cuts looming before the 2012 election, the Administration faced a potential backlash from senior voters in those States.  What to do?

The Obama Administration solution was to use another provision of the Affordable Care Act (ACA)  to simply hide these cuts.  The ACA gives ‘the Secretary’  (of DHHS) discretionary power to utilize funds set aside for experimental “demonstration projects,” without Congressional approval.  Secretary Sebelius is currently pumping these funds into the Medicare Advantage program in the form of “quality bonus payments”  in order to offset the current round of cuts.  In effect, the Obama Administration is using funds intended for other purposes as a “slush fund” to hide the cuts to Medicare Advantage from prospective voters until after the election!

The amount of offset reported by the General Accountability Office (GAO) for 2012 is $8.35 billion – more than has been spent on all the “normal” projects and studies over the last 17 years!  And the really smelly part of this taxpayer-funded temporary bailout of Medicare Advantage is its purely political purpose.  It is as though taxpayers were forced to support the Obama campaign to the tune of $8 billion just so Old Joe Biden could could blather on and mislead voters by insisting the program had not been cut and was healthier than ever.  You can read more about this disgraceful deception in the excellent Forbe’s story.

The real shame of all this political theater and vilification of Medicare Advantage as a “subsidy” for “rich insurance companies”, is the unrecognized effectiveness of this program in serving its subscribers. Studies show that Medicare Advantage patients spend fewer days in the hospital and have lower hospital readmission rates than their regular Medicare counterparts. Supposedly, with its Public face, ObamaCare seeks to control such cost factors.

Nevertheless, after the election, a second Obama Administration will quietly turn off the phony “quality bonus” subsidy spigot and proceed with the scheduled cuts, because this isn’t really about cutting costs, or providing quality care. It’s about reducing Government expenditures on groups seen as too well-off, or not worth the “investment.”  The only way ObamaCare can rein in its incredibly underestimated expenses, is to restrict access to health care by those that need and use it most – the elderly. I will have more to say about this policy in the very near future when I tell you about the Independent Medicare Advisory Board, and its agenda to slash Medicare expenditures and force the rationing of care, and about the new punishments for hospitals who readmit Medicare patients.

We need to get rid of truth-challenged political hacks like Joe Biden and have a real investigation into the malfeasance and corruption of this Administration, and the extent to which public funds have been diverted to shabby partisan uses.

But mostly we need to come up with a true health care reform plan that doesn’t punish patients for being sick, and doesn’t punish doctors for helping them.  The present Administration clearly isn’t up to the task.

The Sceptic

Scarlett Johannson Promotes Romney Cancer Screening Scare, but Ignores ObamaCare Decrease in Screening Mammograms

October 16, 2012

Ms. Johannson, who has been known to  personally e-correspond with President Obama for several years,  is featured in a recent pro-Obama ad where she declares that Mitt Romney wants to end “cancer screening” for women.

Ironically,  on June 26, 2012, a Mayo Clinic study  reported a decrease in screening mammograms which resulted from a ruling by an obscure panel of “experts” empowered by … you guessed it – ObamaCare!   In November, 2009, this panel decided that mammography screening, for women between 40 and 49 years of age did not need to be covered.  This decision, reached without a single oncologist or breast cancer expert on the panel, was widely criticized by many groups of true experts, including the American College of Radiology (ACR) , the American College of Obstetrics and Gynecology,(ACOG), etc.

Despite amendments offered by Senator Barbara Mikulski and Senator David Vitter to fix this bureaucratic mess, the Mayo Clinic study indicates that mammography rates have fallen by 6% as a result of the confusion caused among patients and doctors by this disastrous decision.  This means that 54,000 fewer women in this age group have had mammograms in 2010.

Does Ms. Johannson care that it is the policies of her hero, Mr. Obama, that are responsible for this proven decrease in breast cancer screening?  It seems not.  She would rather blame Mitt Romney for hypothetical decreases in screening that have not yet occurred, and, which, in fact, will never occur.

Folks, pay attention to the details.  It is section 2713 of ObamaCare, not Mitt Romney, that will be responsible for the unnecessary breast cancer deaths that are virtually  guaranteed by the November, 2009 United States Preventive Services Task Force (USPSTF) decision regarding mammography.  For more information on this read my comprehensive post on the impact of ObamaCare on mammography

Learn to be skeptical of the self-serving, self-righteous story lines offered by these political shills – despite their ability to convey emotion, they care little for you or yours.

The Skeptic

ObamaCare and Mammography – the Real ‘War on Women?’

October 7, 2012

Update – November 3, 2012 – The board responsible for the 2009 decision to deny mammograms to women between 40 and 49 years old has continued its ‘war on women’ by classifying various screening tests and procedures as not covered by ObamaCare.  The USPSTF would now deny women access to chlamydia testing, HPV testing, cervical cancer screening( for women over 65), and digital mammography screening.  Denial of digital mammography screening shows how cost-driven ObamaCare is since it is better at detecting aggressive cancers and produces significantly lower doses of x-rays than regular film mammograms thus reducing the risk of causing cancer with the screening.  The only reason to deny it is cost.  Read more about these denials of access in this New York Post article: ObamaCare v. Women

I have posted this info before, but in a very long entry located here. This version focuses on the June 26, 2012 pre-release of a Mayo Clinic study showing how a bad decision by an ObamaCare panel has lowered mammography testing rates for women between 40 and 49 years of age.

In November, 2009, an obscure panel of experts, the United States Preventive Services Task Force (USPSTF) classified mammography for women between 40 and 49 years of age as a “Class C” procedure.  Unfortunately, this panel was empowered by Sec. 2713 of the Affordable Care Act (ObamaCare) to determine what would and would not be covered by insurers.  The “Class C” rating meant that women between 40 and 49 years of age would not have insurance coverage for this procedure.

This decision was roundly criticized by all reputable medical authorities connected to this issue, including American College of Radiology (ACR), American College of Obstetrics and Gynecology (ACOG) and, recently, the American Medical Association (AMA).  Basically, these groups all pointed out that there has been a decrease in mortality of 40% since regular mammography screening has been implemented.

The issue was so disturbing to legislators who wanted to support ObamaCare but were astounded by this decision, that they hastily passed an amendment to provide adequate breast cancer screening for all women, including those in the disputed age group.  Unfortunately, this has not deterred supporters of centrally-planned health care from staunchly defending the indefensible USPSTF decision.  Their arguments that  mammography is not cost-effective, that the USPSTF was correct in their determination (despite the fact that not a single oncologist sat on the panel making this decision), and that we need to spend less in this area anyway, are all aimed at covering up the fact that this Government panel was wrong – DEAD wrong!

Now, as we feared,  we have some hard evidence that these establishment “experts” have succeeded in confusing doctors and patients, and may have done serious damage to Public Health.  The Mayo Clinic, suspecting that all the confusion caused by the USPSTF decision and subsequent defense of that decision by “experts” may have depressed mammography rates among women between 40 and 49, decided to review the data.

Sure enough, the preliminary results of the Mayo study, released on June 26, 2012, indicate that mammography rates have indeed declined by about 6% in this age group subsequent to the USPSTF decision.  This amounts to about 54,000 fewer mammograms per year in this age group despite the ObamaCare amendment that was supposed to ensure their access to this procedure, and despite the DHHS quiet reversion to the previous (2002) USPSTF guidelines,  which allow coverage of mammograms for women over 40.   An undetermined number of these currently untested women will die unneccessarily as a result of the confusion caused by the USPSTF decision.  You can read an article about this study at HealthDay –  http://consumer.healthday.com/Article.asp?AID=666143

What has happened is that basically doctors are confused by the 2009  USPSTF decision, the USPSTF refusal to retract, and now the defense of that decision by various  “experts.”   Doctors are under a mistaken impression that USPSTF actually knows something about breast cancer, and they are also confused into thinking that perhaps they will be breaking some rule, or will not receive compensation if they prescribe this procedure for women between 40 and 49 years of age.

This is really unfortunate, and hopefully the recent ACR, ACOG and AMA definitive statements in support of annual mammograms, will “shore up” these doctors to where they are able to represent their patients’ best interests.

In the meantime, we should all learn a valuable lesson from this as to how impersonal, and basically dishonest, health care will become when it is run by bureaucrats who are primarily interested in withholding resources that might be spent on “Patient A,” so that those resources can be better used on the much more worthy “Patient B,” as determined by their infallible methodology.  Infallible, until someone takes a hard look at it to see it for the sham that it is.

This is the real “War on Women” being waged in doctor’s offices every day by ObamaCare and it’s flunkies.  It makes Ms. Fluke’s highly choreographed charges regarding contraception costs look trivial because the consequences of not getting a mammogram may well be death.

Tell your friends about these hypocrites and how we need to get rid of them for our own health and safety.

The Sceptic

ObamaCare and Mammography – October 2013 Update – Bad News and Good News

July 23, 2012

Note :  This is a popular, but long post.  If you just want to know whether ObamaCare allows mammograms for women over 40, the answer is “Yes,” for now, provided your Doctor agrees.  I urge you to talk to your Doctor soon about this – it may save your life.  This post tells the story of how women’s access to mammography has been saved by staring down a disastrous ObamaCare decision… a decision that, despite being discredited by experts, has still resulted in 54,000 fewer mammograms per year among women between 40 and 49 years of age!  My source?  No less than the Mayo Clinic – you can read about their study here http://www.mayoclinic.org/news2012- orst/6958.html  or here (a survivor’s report on the Mayo study) http://noboobsaboutit.org/treatment/6556/

_______________________________________

In November, 2009, an obscure Government-appointed panel, the USPSTF (United States Preventive Services Task Force), did what it had been doing for many years – it evaluated a diagnostic procedure and classified it.  The unusual aspect of this decision, was that this time a new bill, the Affordable Care Act (ACA), also referred to as “ObamaCare,” would, upon enactment, specifically give this USPSTF decision the force of law in determining insurance coverage for all Americans.

The procedure evaluated by USPSTF was mammography for the detection of breast cancer.  In its decision, the USPSTF now classified a mammogram as a “Class C” procedure for any woman between 40 and 49 years of age.  Under section 2713 of the ACA,  only Class A and Class B procedures were required to be covered by public or private insurance.  A “Class C” rating meant that insurers could legally “co-pay” mammograms out of reach for hundreds of thousands of women.   With this one bureaucratic ruling, the USPSTF had provided a frightening glimpse of just how ObamaCare could empower and transform an obscure panel of experts effectively into a “death panel.”

How much death?  Senator Barbara Mikulski estimated the toll at 40% of women in this age group who have breast cancer, reflecting the overall reduction in mortality since regular mammograms became common practice.  A more modest estimate by the Health Resources and Services Administration (HRSA)  is that mammography, by itself, is responsible for about a 10% reduction in mortality from breast cancer.  Since the number of women 40-49 currently getting mammograms is estimated at around 800,000, this would still amount to potentially hundreds of dead women per year, every year!

Update – October 2013: These previous estimates of mortality due to lack of screening may be underestimates.  In a new study “…71 percent of the (breast cancer) deaths were among women who had never had a mammogram or it had been more than two years since their last screening. The study found half the deaths were women younger than 50 …” This study has caused a new furor amongst the mammogram “deniers” because it indicates a higher death rate among younger women who were not screened than was previously suspected. You can read about this study in a recent Chicago Tribune story (click here). 

Inside the beltway, panicky lawmakers were blindsided by this double system failure because most hadn’t even read section 2713, or heard of the USPSTF! This was a double system failure because firstly, too much authority was concentrated in one small, isolated group that has no specific expertise in the area being classified, and because, secondly, there were no downstream safeguards built into the system to monitor impacts and overturn a bad decision.

Many tried to portray this major system failure as a minor bureaucratic glitch that had no impact. On television, Secretary Sebelius tried to whitewash the problem saying that the USPSTF decision would not change policy (later on, she would discover that DHHS was already bound to this decision!) In December, 2009,  in an effort to reassure shaky  ObamaCare supporters, Senator Mikulski proposed an amendment to void the USPSTF ruling, and guarantee that women would receive all necessary health procedures.

Although it passed, this amendment did nothing to change the bureaucratic paradigm and reasoning employed by the USPSTF, or their unchecked authority under the ACA.  The amended wording of section 2713, voiding the USPSTF decision, is vague, referring only to decisions reached “in or around November 2009,”  thus avoiding any admission that any mistake had been made.   Also, the amendment validates the sole authority of the USPSTF to set these criteria, merely reinstating by default the most recent previous USPSTF decision from 2002.  Any lessons learned? Evidently not.

Unfortunately, this time-specific voiding leaves open the possibility that USPSTF could revisit mammography in the future, and, once again, restrict women’s access to this procedure in a new decision.  Because no systematic safeguards have been added, such as a requirement to show equivalence to recommendations from other recognized expert groups (such as ACOG, ACR etc.), or a requirement to forge consensus recommendations with such groups. or a requirement for true experts to sit on the USPSTF panel, or a requirement to maintain vigilance over outcomes after issuing a new guideline, etc. etc.  it is quite likely that a future USPSTF panel would  reach the same disastrous conclusion as that reached in November, 2009, with the same disastrous results!  Only the next time, politicians may not be so eager to “fix” a bad decision. By then, the ACA will be firmly in place, and totally unpopular anyway, so there will probably be no fevered rush to try to get public opinion in favor of  the program like there was at the end of 2009.

Please understand, the USPSTF has never admitted any mistake in their analysis or conclusion regarding mammography, despite the Mikulski Amendment and attendant outrage.  Early on, the American College of Radiology (ACR) called on USPSTF to rescind their decision.  They never have.  Incredibly, many true believers and Government health care advocates still defend the USPSTF methodology and conclusion on this issue!  Today, you can go on the internet and find these “expert” apologists claiming that mammography is ineffective, too costly, and even dangerous.

One academically prestigious site I visited, gleefully proclaimed that mammograms were no longer the gold standard and could, in fact,  increase the risk of cancer in women under 50.  The induced cancer rate for digital mammography was estimated at 1 in 100,000.  However, the risk of not testing is estimated by some HMOs as one death  per 2000 mammograms not performed.  I’ll do the math for you – the risk of getting cancer from a mammogram may be about 50 times less than  the risk of undetected cancer due to not getting a mammogram!

These advocates of Government health care are counting on you not knowing this, and there are hordes of them out there.  Please pay attention to this folks – this is the hallmark of Government-mandated health care – the Bureaucracy has never, ever, ever made a mistake.  If ObamaCare persists, all such failures of the system will be denied and/or covered up by the expertocracy.

What is the motivation for all this deception and misuse of science, when reliable information of the real value of mammograms is readily available right at the Health Resources and Services Administration (HRSA) website and many, many other sources?  The late Dr. Bernadine Healy (former head of NIH) shed some light on the possible motivation for these mammography “deniers” in her excellent commentary on the USPSTF guideline.  Dr. Healy wrote that the USPSTF diminished mammography screening program of 2009 would accomplish “…roughly 80 percent of the survival benefits of the intensive program in exchange for an estimated 50 percent of the costs.”  So, basically, ObamaCare was prepared to sacrifice about one in five survivors for the sake of saving money (actually redistributing it to other patients deemed more worthy).  I believe mammography “deniers” are trying to confuse the Public so they will not reach Dr. Healy’s grim dollars and cents conclusion.  After all, if they can convince you that mammography is ineffective,  then you will think that no survivors will be lost if we don’t provide mammograms.

The “Bad News” (very bad indeed) is that the bureaucracy’s failure to rescind the USPSTF decision and come out forcefully, and quickly, in favor of annual mammograms, may already have affected Public Health, perhaps even costing lives.  The Mayo Clinic believed that the USPSTF decision, and the confusion it caused among doctors and patients, could have depressed mammography rates among women between 40 and 49, and so they performed a study.  Sure enough, the preliminary results of the Mayo study, released on June 26, 2012, indicate that mammography rates have indeed declined by about 6% in this age group subsequent to the USPSTF decision.  This amounts to about 54,000 fewer mammograms per year in this age group, despite the ObamaCare amendment that was supposed to ensure access.  You can read about the Mayo Clinic study here  http://www.mayoclinic.org/news2012-rst/6958.html or  http://noboobsaboutit.org/treatment/6556/

Further update – October 2013: Another study has found a decline in mammography rates among older women. This study was reported by Dr. David Levin at a meeting of the Radiological Society of North America. Using Medicare data, Dr. Levin found a decline in mammograms of over 4% in 2010 – the year after the USPSTF guideline was issued. The data seems compelling because, in the four previous years, a consistent increase of about 1% per year was observed. The 4% decline effectively wipes out all the previous progress and puts the mammography rate back at 2005 levels. You can read about this study in this Ob.gyn.news story (click here).

So an outlier position, taken by a task force of contract bureaucrats who are not experts in this field, has still managed to reach out, long after having been discredited, and put a large number of women at risk.  Some of these women will die unneccessarily as a result of the confusion caused by this decision.  Is this the real “War on Women,” soon to be the “War on Patients?”  Is this the shape of ObamaCare to come- endless bureaucratic decsions made in ivory towers having devastating consequences on patients’ lives out there in the real world?  Decisions that are difficult to overturn and which are endlessly defended by entrenched bureaucrats and their fans?  After 100 years of trying to fix ObamaCare, will we wind up with a system that isn’t nearly as good as what we originally had, but which is tremendously more expensive?

Because of the Government refusal to take responsibilty and admit to what was a truly disastrous failure, we have had to look to official pronouncements by various independent medical organizations to counteract the damage caused by USPSTF.  Hopefully, if enough organizations with enough credentials contradict the USPSTF decision, mammography rates will return to normal, and the USPSTF will be unwilling to face the firestorm of criticism that would result if they imposed further restrictions on mammograms.

The first good news came in March 2010, when Senator David Vitter, and others in Congress, complained to the Department of Health and Human Services (DHHS) that their website still posted the 2009 Guidelines, causing confusion to doctors and patients.   The problem was that the ACA was not yet in effect, therefore amended section 2713 was not yet applicable, and the 2009 USPSTF decision was not yet voided!  Roused out of her “this won’t affect policy” denial, Secretary Sebelius tasked DHHS to develop and publish its rationale for departing from the new USPSTF guideline. In September 2010, DHHS finally, formally adopted the National Cancer Institute (NCI) guidelines and the previous USPSTF guidelines from 2002. This reversion to the old guidelines means that, currently, until further notice, women over forty are covered for a mammogram if their physicians approve of the  procedure.  

Sensing the precarious state of  mammography coverage, the “real” experts began to weigh in.   In 2011, the American College of Obstetrics and Gynecology (ACOG), in a position endorsed by the American College of Radiology (ACR), contradicted the USPSTF decision, and issued a recommendation for annual mammograms after age 40.  Additional good news has continued in 2012 with the American Medical Association (AMA) formal policy announcement of June 19, 2012, that women over the age of 40 should receive annual mammograms, if agreed to by their doctors.  This strong position was accompanied by a statement urging insurers to factor in annual mammograms for women 40-49 into their coverage.  Smackdown, USPSTF!! AMA goes over the heads of the bureaucrats and directly tells insurers to ignore USPSTF and pay up! The AMA policy statement was endorsed by the ACR, and other imaging groups.

According to Dr. Van Moore, a radiologist who testified to the AMA delegates, the 2009 USPSTF  decision to not cover mammograms for women less than 50 years old was reached in a bureaucratic vacuum. “None of the recognized experts in the field were contacted, to the best of our knowledge,”  Van Moore stated.

Unfortunately, that policy is exactly intentional.  The USPSTF intentionally had no oncologists on the panel reaching this decision! The thinking of many true believers in Government health care is that specialists cannot be trusted to impartially rule on areas in which they are experts.  Since the principal  goal of ObamaCare is to rein in Government expenditures, specialists are an enemy because A) they tend to favor using health care resources for their own specialty and B) they tend to favor expensive interventions  (procedures and tests aimed at root causes) rather than palliative and relatively cheap “pill medicine.” So, unless drastic changes are made, the USPSTF will continue to avoid including appropriate specialists on any panel classifying a preventive procedure.

This bureaucratic monster is still on the prowl, make no mistake.  In the last year, USPSTF has ruled that routine PSA screening to detect prostate cancer in men, should not be covered.  So far, Secretary Sebelius has done nothing to soften this decision.

In 2012, the USPSTF has also continued its ‘war on women’ by classifying various screening tests and procedures as not covered by ObamaCare.  The USPSTF would now deny women access to chlamydia testing, HPV testing, cervical cancer screening( for women over 65), and digital mammography screening.  Denial of digital mammography screening shows how cost-driven ObamaCare is since digital mammograms are more effective at detecting agressive cancers and produce significantly lower doses of x-rays than film mammograms thus reducing the risk of causing cancer with the screening.  The only reason to not cover digital mammography is cost.  Read more about these denials of women’s access to routine procedures in this New York Post article: ObamaCare v. Women

I have been warning folks about the rationing structure built into ObamaCare long before the Democratic Party coined the term “War on Women,”  but incredibly, the Public seems to have forgotten (or never understood in the first place) the nightmare scenario ObamaCare created regarding women’s access to mammograms.   We seem to be in denial of the possibility that our Government might purposely seek to deny access to health care resources for millions of Americans in order to reallocate those resources to more “worthy” uses under some grand bureaucratic scheme. This denial carries great risks for our society as we move forward toward the future.  Unless we learn from this example, I fear we are doomed to many more bureaucratic health care disasters, because they are effectively hardwired into the ObamaCare patchwork of arbitrary boards and rules.

Senator Mikulski, Senator Vitter, ACOG, ACR, and now the AMA deserve our thanks because they have saved the lives of thousands of women, but the underlying problem still remains – it is the wrong-headed notion that isolated, task-focused, Government expertocracies are wiser than a dynamic, interconnected medical community that is based on centuries of science, and custom, and ethics.

Unfortunately, this notion undergirds all of ObamaCare, and is written into many sections besides section 2713.   It is a monster that is only waiting for another ill-informed decision by USPSTF, or some other bureaucratic entity, to spring off the page and into your doctor’s office!  And there will be no Senator there with you in the office to nullify the decision – you will face this monster alone…

The only effective way to stop this monster is to proactively repeal ObamaCare and replace it with something centered around patients and doctors – NOT BUREAUCRATS!!!

the Sceptic

ObamaCare Cuts Billions from Medicare Advantage; Cuts Hidden Until After Election

April 3, 2012

Anyone watching the 2012 vice presidential debate would have seen Mr. Biden denying the planned cuts to Medicare Advantage, and pointing to the program’s current high enrollment rates as his evidence.

This is, to use the Vice President’s Jurassic era jargon, just a bunch of “malarkey.”

Medicare Advantage has a big target on it’s back – it is singled out as an object of true loathing by Government-mandated health care supporters because it entrenches private insurers within the Government programs, and will make it harder to eventually go to a single-payer system (which, after all, is their goal).  Medicare Advantage also provides just too much coverage to its enrollees to suit Government health care advocates, who want to provide minimal health care to seniors so we can redistribute more resources to other, poorer, younger demographic groups.

Therefore, ObamaCare is scheduled to gradually slash Medicare Advantage by as much as $300 billion over the next 10 years! This is about 40% of the total of $716 billion in Medicare cuts that will be used to offset the costs of other portions of ObamaCare (as described in this Investor’s Business Daily article.) The problem is that this program is very popular among seniors, especially those in the so-called “Swing States,” with ever more people wanting to enroll, as our brilliant Vice President has noted.  With the first round of cuts looming before the 2012 election, the Administration faced a potential backlash from senior voters in those States.  What to do?

The Obama Administration solution was to use another provision of the Affordable Care Act (ACA)  to simply hide these cuts.  The ACA gives ‘the Secretary’  (of DHHS) discretionary power to utilize funds set aside for experimental “demonstration projects,” without Congressional approval.  Secretary Sebelius is currently pumping these funds into the Medicare Advantage program in the form of “quality bonus payments”  in order to offset the current round of cuts.  In effect, the Obama Administration is using funds intended for other purposes as a “slush fund” to hide the cuts to Medicare Advantage from prospective voters until after the election!

The amount of offset reported by the General Accountability Office (GAO) for 2012 is $8.35 billion – more than has been spent on all the “normal” projects and studies over the last 17 years!  And the really smelly part of this taxpayer-funded temporary bailout of Medicare Advantage is its purely political purpose.  It is as though taxpayers were forced to support the Obama campaign to the tune of $8 billion just so Old Joe Biden could could blather on and mislead voters by insisting the program had not been cut and was healthier than ever.  You can read more about this disgraceful deception in the excellent Forbe’s story.

The real shame of all this political theater and vilification of Medicare Advantage as a “subsidy” for “rich insurance companies”, is the unrecognized effectiveness of this program in serving its subscribers. Studies show that Medicare Advantage patients spend fewer days in the hospital and have lower hospital readmission rates than their regular Medicare counterparts. Supposedly, with its Public face, ObamaCare seeks to control such cost factors.

Nevertheless, after the election, a second Obama Administration will quietly turn off the phony “quality bonus” subsidy spigot and proceed with the scheduled cuts, because this isn’t really about cutting costs, or providing quality care. It’s about reducing Government expenditures on groups seen as too well-off, or not worth the “investment.”  The only way ObamaCare can rein in its incredibly underestimated expenses, is to restrict access to health care by those that need and use it most – the elderly. I will have more to say about this policy in the very near future when I tell you about the Independent Medicare Advisory Board, and its agenda to slash Medicare expenditures and force the rationing of care, and about the new punishments for hospitals who readmit Medicare patients.

We need to get rid of truth-challenged political hacks like Joe Biden and have a real investigation into the malfeasance and corruption of this Administration, and the extent to which public funds have been diverted to shabby partisan uses.

But mostly we need to come up with a true health care reform plan that doesn’t punish patients for being sick, and doesn’t punish doctors for helping them.  The present Administration clearly isn’t up to the task.

The Sceptic

ObamaCare Reduces Access to Diagnostic Imaging Services

February 18, 2012

Advanced diagnostic imaging tools such as MRIs and CT scans have long been posterized as high tech villains responsible for the growth in medical costs.  There has always been the implication that they are somehow luxury items that are being prescribed unnecessarily to make money for imaging centers and physicians.  In fact, they have been identified as a major contributor to observed increases in life expectancy in the U.S.

Nevertheless, ObamaCare attempts to harshly rein in Medicare expenditures associated with advanced diagnostic imaging.  One control method is simply to increase the assumed rate of use of these expensive machines from currently assumed levels.  Plugging this arbitrary increase into the Medicare payment formula results in a lower Medicare payment per service to the imaging center.  Basically, the high capital cost of the machines is being distributed over a larger assumed patient pool so the payment per patient is reduced.

Of course, if the assumed utilization rate is incorrect, the imaging center may not recoup the cost of the machine.  In fact, the CBO identified this as the major downside of this proposal in its December 2008 analysis, noting that this could discourage centers in rural and suburban areas from acquiring advanced imaging equipment. This could result in a shortage of equipment and delays in diagnosis for seniors living in these areas.

A second control measure is the institution of a “prior authorization” policy.  Basically, the Government will hire Radiation Benefit Managers (RBMs) to evaluate all imaging requests before they are performed in order to weed out those considered “unnecessary.” The criteria the Government RBMs would use in making their evaluations would be formulated by HHS.  The argument for this control measure is very telling – the proponents argued basically that, after all, RBMs are used by private insurance companies.

The same private insurance companies that we were told were evil and greedy?  So now we have an evil, greedy, Government making these decisions!  And unlike any private insurance company, I see no provision in ObamaCare for making an appeal when a “prior authorization” request for diagnostic imaging is denied.

Also telling is the CBO observation that insurance company experience with instituting “prior authorization” shows that expenditure growth rates are only cut in the beginning of implementation, and resume their upward trend later.  Basically, it appears that, initially, doctors are on a learning curve as to how to submit the requests for imaging services, and so many requests are denied.  Do you really think it is appropriate for your Government to embrace reduced expenditures that it knows are rooted in the complexities of the “prior authorization” system and which will result in the denial of access to diagnostic tools for many patients during that learning curve period?

So where does all this stand at the present time?  A February 14, 2012, article in Molecular Imaging Magazine indicates that HHS has gone forward to implement these cost control measures.  You can read it here http://www.molecularimaging.net/index.php?option=com_articles&view=article&id=31966

This article indicates that diagnostic imaging spending/services have been cut back to 2004 levels, and that we can expect a lapse in life expectancy as a result.

Of course, the concept that the ObamaCare bureaucracy could evaluate “prior authorization” requests for diagnostic imaging in a timely manner is ludicrous. Therefore, even the fewer procedures that are eventually approved will be performed later than they should be, resulting in even higher mortality.

I’d like to ask former Speaker Pelosi whether she is now getting a clearer picture of ” ..what’s in the bill” …

Because we certainly are!

the Sceptic

ObamaCare Stifles Competition Among Insurers

February 13, 2012

 

ObamaCare forbids competition between insurance providers on any basis other than price of the policy – the premium.

Here’s the story.  Let’s say the minimum coverage established by the HHS Secretary (currently Kathleen Sebelius) does not include knee replacements for anyone older than 70.  Insurer A abides by this and does not cover this service.  Insurer B decides to cover knee replacements for old folks, but, as a result, the premium must be $7.50 per month higher than Insurer A’s premium.

Under ObamaCare, if Insurer B tries to explain the price differential by promoting their policy as better for knee replacements than Insurer A’s policy, they can be fined, or banned from the exchange, or go to jail!

What is the purpose of this seemingly unreasonable rule? The original reason given was to reduce overhead in insurance advertising costs and increase percent of revenues spent on payouts, but the real reason is – Uniformity.  Basically, if insurers can’t promote what makes their coverage better than others, this greatly reduces the incentive for any “Insurer B” to offer any features other than those required in the Government minimum plan.  ObamaCare’s goal is that no insurer will volunteer to provide knee replacements to individuals that the Government has determined are not worth this procedure.

Dirty little secret – the folks behind ObamaCare believe that insurance companies have been far too generous in their coverage and need to be reined in to reduce overall expenditures on health care.  They need to adhere to the Government guideline because the Government knows what is best for everyone – no exceptions.

No exceptions, that is for the “99%.” Of course, insurance will still be available for any condition from non-exchange, custom insurance policies -i.e.  those intended and priced for the “1%.”  So the rich will still have good insurance and get specialized care etc.  Aren’t you relieved?

Do you folks know this stuff?  Didn’t anyone tell you about this before this mess got enacted?  Did you just blow off all critics of ObamaCare because you believed the media story arc that criticism of ObamaCare was just hatred directed toward Mr. Obama?

Stick with me, and maybe I can help you to see what we critics see coming … before it’s too late to stop it.

the Sceptic


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