OBAMACARE IN THE NEWS

July 6th, 2010 Press Release

click and read:
"How the AMA and Local Medical Societies Failed to Serve Their Constituents" (Dorin, Sept. '10)
(with accompanying press release)

Kudos to Doctor Giurgiu, delegate to the California Medical Association (CMA), and member of the Solo and Small Group Practice Forum, who submitted a 'resolution' to the CMA based on the eloquent position paper below.
Dan Giurgiu, MD, FACS  ( Fall '10 )
Enlightened physicians, whether liberal, conservative, progressive, or libertarian realize that The Patient Protection and Affordable Health Care Act (The Act), known as “Health Care Reform” or “ObamaCare,” threatens the medical profession, the nation’s economic security, and our individual freedom.    
 The Act Does Not Protect Patients     
 Patients trust their doctors with their lives.   The Act separates patients from their personal physicians by creating a de-personalized, centrally planned health system made up of countless new governmental entities and their for-profit partners.  
 Rather than always doingwhat is best for individual patients, physician functionaries of this bureaucracy will work together as a team to ration medical care for the financial benefit of the collective common good. 
 Presidential committees such as IPAB (Independent Payment Advisory Board) and CER (Council for Comparative Clinical Effectiveness Research) have unprecedented statutory power to decide what patients “need.”  CER, modeled after NICE (Britain’s mammoth National Institute of Clinical Effectiveness), is developing “evidence based” guidelines that are more than advisory.  Physicians are expected to provide “authorized” care in accordance with these unscientific, dogmatic “quality” protocols and will only be able to make limited medical decisions for their own patients.  In order to judge and reward physician compliance, government agents and their private subcontractors have access to confidential medical records. 
 Just as beleaguered British physicians are already expected to comply with cost-containment guidelines based on “Quality Adjusted Life Years” (QALYs), America’s physicians will be compelled to withhold care from their own patients – with or without the patient’s knowledge.  
 For example, NICE authorizes treatment of one eye in patients afflicted with a blinding disease called macular degeneration.  NICE acknowledges that “loss of normal binocular vision can result in a reduction in quality of life” and understands that there is “considerable anxiety and depression associated with allowing an affected eye to deteriorate without treatment.” However, only one good eye is needed to avert blindness, which makes treatment of the second eye uneconomical.  A British physician, who may be penalized even if he treats a second diseased eye free of charge, has incentives to conceal such disease from his patient.    
 Dr. Donald Berwick, the new Medicare chief, stated:
“The social budget is limited.  … The decision is not whether or not we will ration care – the decision is whether we will ration with our eyes open. … NICE  has developed very good … models for the evaluation of medical treatments ...”   
 United States government employees propose various rationing methods including a "complete lives system":
"When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated. ... Consideration of the importance of complete lives supports modifying the youngest-first principle by prioritizing adolescents and young adults over infants. Adolescents have received substantial education and parental care, investments that will be wasted without a complete life.  Infants, by contrast, have not yet received these investments. ...” (http://www.ncpa.org/pdfs/PIIS0140673609601379.pdf)
 The Act is a direct assault on all physicians’ professional autonomy.  In a free economy, market forces determine common sense solutions to distribution of goods and services, and honest men and women do not condone heavy-handed rules that ration medical care by erecting unnecessary roadblocks to treatment such as “pre-authorization” approvals.  Instead, the unique contract based on trust that creates the confidential doctor/patient relationship must be honored and protected.  
 The Act is Not Affordable   
 Reasonable people understand that we are recklessly saddling our children and grandchildren with an exploding $120 trilliondebt that includes an unsustainable $33.5 trillion projected Medicare shortfall.
 Enough money is already being spent to pay for all of the medical care that Americans need.  There are ample resources, but not enough transparency or accountability.
 The Act bleeds more red ink. The Chief Actuary for Medicare (the Centers for Medicare & Medicaid Services) expects national health spending to increase another $311 billion/year under The Act.  Although the Medicare Board of Trustees and Dr. Berwick apologize for The Act’s shortcomings by vaguely claiming “savings,” the former Secretary of Health and Human Services is correct: these “savings” are an “illusion.”
 Currently, anyone who cannot or will not pay their bill receives unlimited free medical care at any emergency room.  The government unilaterally grants itself half-off discounts when paying the bills for Medicare and Medicaid enrollees.  Everyone else subsidizes these underpayments because indentured physicians (who are forced to give both charity care and discounts or face stiff criminal penalties) typically have to charge privately insured patients extra in order to stay in business.  To make matters worse, con artists game pre-paid health plans by charging exorbitant premiums or billing third parties excessively for unnecessary services.  Many consumers feel cheated by the process.  
 Instead of explaining everything to the American people, who are responsible and fair by nature, a few politicians hid the football, perpetuated the status quo (quantity, not quality), and underfunded an all-you-can-eat smorgasbord of health care.  
 The Act dictates that every state vastly broaden its Medicaid eligibility standards to accommodate upwards of 50 percent more people – but does not fund the additional burden on local governments.  Taxpayers of the State of California must spend billions of dollars to administer this mandatory expansion of MediCal (our state’s Medicaid) and must buy MediCal for many of California’s 8.4 million uninsured residents. 
 The Act also fails to fund the tens of billions of dollars Congress reluctantly will still have to approve every year to patch Medicare’s underpayments to physicians caused by SGR, an automatic formula that offsets higher costs with lower fees.  In addition, draconian cost-containment measures reduce Medicare’s payments to physicians another 30% over the next 3 years, which will put an estimated 15% of physicians out of business and make it harder for everyone, not just Medicare and Medicaid recipients, to find a doctor. 
 The Act Is a Trojan Horse
 The IRS’s power is expanded.  Everyone must buy insurance or pay a 2.5% yearly income tax or $695 fine, whichever is greater.  Families who sell their homes face a new 3.8% tax.  The IRS will track and tax purchases whose aggregated cost exceeds $600 a year (e.g. postage stamps).  Instead of creating jobs, such burdens bankrupt hard-working individuals, including physicians, most of whom run small businesses. 
 The Act uses the sick as human shields to raise taxes in order to finance bigger government.  This is why 21 states have already joined a lawsuit alleging:
“The Act represents an unprecedented encroachment on the liberty of Individuals … by mandating that all citizens and legal residents of the United States have qualifying healthcare coverage or pay a tax penalty. ... By imposing such a mandate, the Act exceeds the powers of the United States under Article I of the Constitution and violates the Tenth Amendment to the Constitution.”   
 The Act anoints winners: some HMOs (rebranded “ACOs” or accountable care organizations), insurance companies, third-party data miners, and vendors to managed care and government such as the AMA (American Medical Association).   Some physicians may better their situation by joining the massive new bureaucracy, butThe Act irreparably harms the private health care sector and incrementally forces citizens into a governmental health care system.  While the middle class suffers, the more privileged political class and other interested stakeholders will thrive in this bewilderingly complex plan that irresponsibly promises the impossible and expects some physicians to betray their own patients.
 Yet, The Act still does not achieve the altruistic dream of universal health care.   In "The Cancer Ward," Alexander Solzhenitsyn contrasts "universal, free, public health service" to "private medical practice":
“The doctors don't work without pay. It's just that the patient doesn't pay them; they're paid out of the public budget. The public budget comes from these same patients. Treatment isn't free, it's just depersonalized.”  
 Most Americans fundamentally do not believe in the Act and do not think it can be fixed.  At its heart, the Act foolishly protects job-based insurance: workers who get sick often lose both their jobs and insurance.  The unemployed still do not have access to reasonably-priced private medical insurance.
We stand at a pivotal moment in our nation's history.  Millions of Californians including thousands of physicians believe that it is unethical for a few politicians to hold the medical profession hostage and mortgage our country’s future in order to promote utopia.  CMA must stand with the majority of Americans - our patients - who believe The Act must be repealed.  
 Traditional American values based on free enterprise and individual liberty and responsibility must prevail.  All citizens should be allowed to make decisions regarding their health in consultation with their physician without intrusion by third parties.  Thoughtful leaders understand that we must de-fund, repeal, and replace this unrealistic, expensive command-and-control take-over of much more than medicine.  Now is the time to reject this invasion of privacy and get America back on track financially. 

Physicians Against Obamacare 2010