Hey, GOP - how about a kiss first next time?

Hey, GOP - next time, you could at least kiss us first.

In January of 2011, I posted an article written by Adam Love, the North Carolina State Coordinator for Campaign for Liberty entitled, “Obamacare: Symbolic Gestures are NOT Enough”. Adam’s post gave a voice to thousands of healthcare workers that cautiously placed their votes for GOP candidates that vowed to repeal the Patient Protection and Affordable Care Act (a.k.a. Obamacare). Like it or not, all we had to go on was a campaign promise. I am holding on to hope that we will continue to be watchful and keep their elected officials on task.

The House of Representatives voted to repeal the PPACA. The vote passed with a solid majority. The bill went to the Senate and was subsequently ignored. I have called, emailed, faxed, and otherwise made efforts to drive my elected officials crazy. One of my Senators never returns my calls or correspondence – no real surprise. She hasn’t had time for children of lesser gods such as myself since the day she was elected. A friendly young gentleman at my other Senator’s office has assured me they are doing “their best” to try to push the legislation forward.

I appreciate the lip service. But I’m not seeing any results here, hoss.

Instead, I’m watching in horror as family practice doctors are drowning in “Patient-Centered Medical Home” paperwork and tasks as simple as ordering medications for patients with cancer require several additional pages of codes and justification – with a disclaimer printed at the top: “…in compliance with the Patient Protection and Affordable Care Act”. Insurance premiums are skyrocketing as major insurance companies prepare to collect windfall profits once the insurance mandates finally take effect. All this is happening while Congress – and Americans in general – are unusually silent about it.

As most of the mainstream GOP is shrugging their shoulders in an “Oh, well, we tried” gesture, now even “Tea Party Favorites” are deciding that the healthcare battle isn’t worth their time. On May 8th, The Hill released an article about Representative Allen West (R-FL), a known Tea Party “favorite”, who has decided that the one option we have left – defunding key parts of the Patient Protection and Affordable Care Act – was not worth his vote. He “believes there are bigger funding issues to be focusing on right now”. (The full article can be found at http://thehill.com/homenews/house/159813-tea-party-favorite-breaks-with-gop-on-healthcare-repeal )

Apparently Representative West has learned quickly the classic Congressional stance: priorities of the constituents that got you elected are only important if they match your own personal priorities or the priorities of the people that are padding your pockets. Hopefully the Tea Party that got him into office will show their appreciation for his inattention to campaign promises at the ballot box when he runs for re-election.

In the meantime, big GOP names are lining up to challenge Barack Obama in 2012 for the Office of the Presidency. I expected Mitt Romney to throw his name in the hat. But of all ways to get into the race, he has decided to give a speech on...healthcare?

Today, the Wall Street Journal released an article about Romney’s announcement of his speech this coming Thursday:

“Former Massachusetts Gov. Mitt Romney will seek to blunt a major criticism Republican primary voters harbor against him by delivering a health-care speech in Michigan on Thursday that lays out a plan to replace the new national health-care law with other, more targeted changes.”

(The Wall Street Journal article can be found at: http://blogs.wsj.com/washwire/2011/05/10/romney-to-deliver-health-care-speech-thursday/?mod=WSJBlog&utm_source=twitterfeed&utm_medium=twitter )

Nice...since his first healthcare law was such a resounding hit.

I have an idea for you, Mr. Romney. How about talking with healthcare workers and patients that are already starting to hit brick walls with the PPACA – and people that have to purchase their own health insurance that are reeling at the skyrocketing premiums they are having to pay in anticipation of ObamaCare rolling out mandates – and see what they have to say about government being involved in healthcare? And here’s a more novel concept: how about calling out the rest of your party about sticking to their campaign promises and not giving up the second it looks like it might require just a little bit of a fight?

Because right now, GOP, all I’m seeing is a party of turncoats that said all the right words to get into office and gave nothing more than one token vote – and a ton of lip-service – to the campaign promise that got you elected.

Happy birthday, Obamacare.

Yesterday was the "official" birthday of Obamacare. The healthcare cluster law is a not-so-healthy one year old now, and becoming more of a problem child with every passing month. In honor of the Obamacare's first birthday, I for one skipped the gym, ate cinnamon rolls from Ikea and skipped the gym. Take that, Washington.

To further commemorate this infamous day, I'd like to share an editorial post that speaks to the true implications of allowing this beast of a law to survive even one year. This post is from The Wall Street Journal: "ObamaCare and Carey's Heart", by Ron Johnson. You can also find this article here on the Wall Street Journal Website.


Today is the first anniversary of the greatest single assault on our freedom in my lifetime: the signing of ObamaCare. As we consider what this law may do to our country, I can't help but reflect on a medical miracle made possible by the American health-care system. It's one that holds special meaning for me.

Some years ago, a little girl was born with a serious heart defect: Her aorta and pulmonary artery were reversed. Without immediate intervention, she would not have survived.

The infant was rushed to another hospital where a surgeon performed a procedure at 1 a.m. that saved her life. Eight months later, when her heart was the size of a small plum, an incredibly dedicated and skilled team of medical professionals surgically reconstructed it. Twenty-seven years later, the young woman is now a nurse in a neonatal intensive care unit where she is studying to become a nurse practitioner.

She wasn't saved by a bureaucrat, and no government mandate forced her parents to purchase the coverage that saved her. Instead, her care was provided under a run-of-the-mill plan available to every employee of an Oshkosh, Wis., plastics plant.

If you haven't guessed, this story touches my heart because the girl is my daughter, Carey. And my wife and I are incredibly thankful that we had the freedom to seek out the most advanced surgical technique. The procedure that saved her, and has given her a chance at a full life, was available because America has a free-market system that has advanced medicine at a phenomenal pace.

I don't even want to think what might have happened if she had been born at a time and place where government defined the limits for most insurance policies and set precedents on what would be covered. Would the life-saving procedures that saved her have been deemed cost-effective by policy makers deciding where to spend increasingly scarce tax dollars?

Carey's story sounds like a miracle, but America has always been a place where medical miracles happen. Since 1970, American doctors have won more Nobel Prizes for Medicine than all other countries combined. According to McKinsey and Co., thousands of foreigners come to the United States every year for medical care they cannot get at home—due to rationing or because it is simply not provided. And cutting-edge drugs to treat serious illnesses are more widely available in the U.S. than abroad.

Take cancer as one example. Compared to the U.S., breast cancer mortality is 9% higher in Canada (according to the government statistics of each country), 52% higher in Germany and 88% higher in the United Kingdom (according to studies published in Lancet Oncology). Prostate cancer mortality is 604% higher in Britain.

Those in need of timely care from specialists are better off in the U.S. Drawing on several peer-reviewed studies, Dr. Scott Atlas of the Stanford University Medical Center notes that patients who need knee and hip replacement, cataract surgery, and radiation treatment wait months longer in the United Kingdom and Canada than in the United States.

The plain truth is that the American system is better at rewarding innovation and responding to consumer needs. But the history of government-led care is there for all to see. Are we doomed to repeat it?

For the first time in U.S. history, a personal inaction (not purchasing something, in this case, a health- insurance plan) will be deemed unlawful. The person not committing this act (or is it committing an inaction?) will be subject to a fine. Or is it now, as the government contends, a tax? I'm confused.

This is precisely what Nancy Pelosi, Harry Reid and President Obama wanted. The Patient Protection and Affordable Care Act was sprung on an unsuspecting public with barely enough time for anyone to read it. Remember Speaker Pelosi's famous line? "We have to pass the bill so that you can find out what is in it." Unbelievable.

I am convinced that ObamaCare was designed to lead to a government takeover of our entire health-care system, which is one-sixth of our economy. As I traveled around Wisconsin in the last year, I asked thousands of people a simple question: "Do you think the federal government has the capability of running one-sixth of our economy?" Only two people ever raised their hands.

Our health-care system has problems that must be addressed. But ObamaCare will make those problems much worse. Instead of increasing consumer choice, it narrows it. Instead of encouraging innovation, it stifles creativity. Instead of expanding access to care, it will ration it. And instead of allowing competition to help bring down costs, it increases spending and puts our health-care system on a path to ruin.

The defects with the president's health law are so serious and widespread that the administration has already granted over 1,000 waivers to protect businesses, labor unions and other organizations from its most onerous provisions. We need to recognize that the finest health-care system in the world is at risk—and repeal ObamaCare before it's too late.

Mr. Johnson, a Republican, is a senator from Wisconsin.

Constitutionality, Presumptions, and Blatant Arrogance

Nothing helps a good workout like watching C-Span.

Yesterday, I was able to enjoy a lively debate from my elliptical trainer as Senator Mitch McConnell (R-KY) and Senator Dick Durbin (D-IL) grilled a panel of constitutional lawyers with questions about the constitutionality of the healthcare law today at a Judiciary Committee hearing. It didn’t take long for my heart rate to get to a good peak when I saw the exchange between these clowns.

Here are some highlights I found from this debate:

“The judge in that case, Roger Vinson, ruled the individual mandate -- which requires everyone to buy insurance by 2014 or else pay a penalty -- exceeds Congress' authority under the Commerce Clause of the Constitution, which regulates interstate commerce. He ruled the entire law "void" because the individual mandate provision can't be separated out from the rest of the law.

Vinson agreed with the states involved in the lawsuit that the government cannot force individuals to participate in the stream of commerce, in this case, the health insurance market, nor can it penalize those for inactivity, i.e. not buying health insurance.

Walter Dellinger, professor emeritus of law at Duke University, and Charles Fried, law professor at Harvard Law School -- two of the lawyers on Wednesday's five-attorney panel -- agreed with that stance. Sooner or later, they said, everyone will have to get medical treatment, and when they do, if they lack insurance, the costs will be passed on to others.

Not so, argued panelist Michael Carvin, a partner at the Washington law firm Jones Day.

"Sitting at home and staying out of the insurance marketplace is not commerce," said Carvin. "The decision to sit at home doesn't effect Insurance Company A's ability to contract with Citizen B."

They were joined by John Kroger, the Oregon attorney general, who said the individual mandate is constitutional, and Randy Barnett, a law professor at Georgetown University, who said it is not.

In his opening statement, Sen. Charles Grassley (R-Iowa) said that if the individual mandate is found to be constitutional, then Congress could force Americans to buy any good or service.

...Another common argument in the debate is that the healthcare reform law marks the first time that Congress has used its power to mandate that citizens purchase something on the private market.

Fried said that isn't true and pointed to an century-old case law, Jacobson v. Massachusetts In 1905, the Massachusetts government mandated that all citizens get a smallpox vaccination or else pay a $5 fine -- a hefty sum in those days. The Supreme Court sided with the state of Massachusetts.

But Carvin said that case is about the states having the authority to pass laws to promote health and welfare, and would be out of the scope of the Commerce Clause. A more apt comparison to the individual mandate, he said, would be like Congress passing a law requiring everyone to take vitamins.” (1)

“Majority Whip Dick Durbin, D-Ill., vowed that repeal "will not go forward."
Durbin called a Judiciary Committee hearing on the law's constitutionality, which a federal judge in Florida struck down Monday.

"Many who argue the Affordable Care Act is unconstitutional are the same people who condemn judicial activism," he said. "They are pushing the Supreme Court to strike down this law because they could not defeat it in Congress and they are losing the argument in the court of public opinion."

During debate Wednesday, Sen. John McCain, R-Ariz., dismissed the Congressional Budget Office's estimate that repeal would increase the deficit by $230 billion as "garbage in, garbage out," The Hill reported.

He said the CBO failed to account for rising reimbursements to Medicare physicians, which he said was estimated to cost $208 billion over 10 years. He also predicted a long-term care insurance program would eventually have to be funded by the government.

The National Retail Federation endorsed repeal Wednesday.

Requirements for employers to provide health coverage or pay penalties, to take effect in 2014, are "deterring job growth today at the expense of tomorrow's economy," said NRF leader David French.” (2)

I watched as attorneys pontificated back and forth, each with their own agendas and theories about why they thought their opinion was best. What struck me with the most horror was a senator by the name of Richard Blumenthal (D-Conn.). In summary, here is what I understood from Senator Blumenthal: Since the law was passed by a “coequal” Congress, and since Congress knows best what is constitutional and what is not constitutional, then there should be no question here. If Congress passed it, we should presume that the law is constitutional. Why bother wasting the Supreme Court’s time when Congress knows best, right?

Working in the medical field, there are many shades of gray, as there seem to be in the field of law. Apparently there is one screaming difference: in the medical field, we are obligated to do the right thing. The right thing ethically, the right thing legally, but more than anything, we do the right thing by our patients. The autonomy and freedom of our patients to make decisions about their well-being is a patient right that is held in the highest regard by the medical profession.

That is called liberty.

Senator Blumenthal apparently expects the medical field to bend over and hand that autonomy to the federal government as they decide what is the right thing to do for our patients.

No, sir. Not on my watch.

The “coequal” Congress was far from coequal – it was a heavily biased Congress in both houses that was brought into office by an ingenius marketing campaign by an otherwise no-name senator that learned how to campaign on smoke and mirrors. And even with a filibuster-proof majority, they still had to fight to push through legislation that was a slap in the face to the Constitution – while Americans rallied against this legislation on the lawns of the nations’ capitol.

While pushing through the legislation, Americans were patronizingly told, “Well, if you have a better idea, we’d love to hear it.”

So we gave our ideas and were ignored.

Some of the panel attorneys yesterday gushed over the wonderful thing that the healthcare law is – constitutionality be damned. I am still baffled over their line of thinking. What kind of a wonderful thing is it when you require United States citizens to purchase health insurance – but not allow competition among insurance companies, so for all practical purposes people have less than a handful of options to choose from – and then threaten fines and possible jail time for violations? Moreover, impose the same restrictions on employers who are already struggling to stay afloat and keep people at work in an economy that has yet to come out of the toilet, no matter what the esteemed President says?

Sure it’s a wonderful thing. If you’re an executive for one of those private insurance companies who claimed the biggest financial victory in history when the healthcare law passed. The one group of people that advocates for this healthcare law love to vilify is the exact group of people that will stand to make an insane profit when this law is in full effect. Nice work, Congress.

I would also like to address another issue that has been handed to me a hundred times if it’s been handed to me once. In every debate that I have participated in about the individual mandate, without fail, someone barks, “Well, the government makes us buy car insurance. What’s the difference?”

You can choose not to have a car. We weren’t given a choice as to whether or not we have a pulse. You can choose to ride a bike, walk, or use public transportation if you don’t want to purchase car insurance. And if you do choose to purchase it, you have the benefit of a competitive market that makes the cost more affordable. There is no choice in the healthcare mandate. There is no provision to protect Americans from costs that have already begun to skyrocket as salivating insurance executives prepare to pad their wallets with windfall profits.

I have been watching the efforts to repeal this healthcare disaster over the past weeks with a great deal of trepidation. I fear that this may be nothing more than lip service from the Republican party, and now that the bill has failed in the Senate, we will hear an “Oh, well, we tried.”

No, actually, you didn’t.

Until the Republicans in Congress pursue repeal of the healthcare law with as much persistence as the President had when he shoved this legislation through with no regard for the opinion of the American people – until Republicans in Congress put as much blood, sweat and tears as everyday Americans put into fighting this law over the past two years - only then can they say with any level of sincerity that they really tried.

Keep your campaign promise, GOP. We voted you into office because of that promise. We will vote you out if you don’t remain true to it.



REFERENCES:

(1) Medical News: Senate Panel Probes ACA’s Constitutionality http://www.medpagetoday.com/Washington-Watch/Reform/24664

(2) UPI.com: Senate debate on healthcare bill heats up: http://www.upi.com/Top_News/US/2011/02/02/Senate-debate-on-healthcare-bill-heats-up/UPI-39941296639060/

Political Math

Thanks to Matthew Ridenhour, leader of the Charlotte Tea Party for sharing this.

An interesting take on what we have to look forward to with our new healthcare reform legislation:

Obamacare: Symbolic Gestures Are NOT Enough

Special thanks to guest blogger Adam Love for this great post!


On Wednesday, the House of Representatives will hold a vote to repeal ObamaCare.

While it's nice that House Republicans are keeping their promise to hold a vote to repeal this socialized medicine scheme, the reality is that with Harry Reid in control of the Senate and Barack Obama in the White House, a full repeal is just not possible.

Given this political reality, no member of Congress is staring at the end of their career by voting for repeal.

Some liberty activists are afraid Republicans are trying to get away with an "Oh well, we tried" vote they know is going nowhere in order to wash their hands of their campaign trail, pro-liberty rhetoric.

This harkens back to the Bush Era, when Republicans would pay lip service to liberty issues while voting to massively expand the size and scope of government.

That's why it's vital you contact your Representative, especially if they are a Republican, and send a clear message that you will not tolerate empty gestures as a substitute for meaningful action.

You see, spending bills must originate in the House, so the newly elected Republican majority holds powerful cards. House Republicans can vote to defund programs and agencies tasked with implementing ObamaCare.

Contact Rep. Sue Myrick by phone at (202) 225-1976 and insist Congress take real action against ObamaCare by voting to defund this freedom-stealing legislation and rollback any regulation that restricts health freedom.

Let your Representative know you haven't stopped paying attention now that the election is over, and that the wave that swept them into office can just as easily sweep them out should they not do everything in their power to restore fiscal sanity and our lost freedom by defunding ObamaCare and eliminating intrusive regulations.

So please, contact Rep. Sue Myrick by phone at (202) 225-1976 and send a clear message that, while voting to repeal ObamaCare is a good start, you will not forgive or forget should this Congress not take meaningful action to defund ObamaCare and eliminate big government regulations that restrict our health freedom.

"Lady Liberty's Pat-Down", by Matthew Ridenhour

This post was written by Matthew Ridenhour, guest blogger for The Scarlet Stethoscope. Matthew Ridenhour serves in the United States Marine Corps Reserves. He is also an executive board member of the Mecklenburg County Young Republicans and the founder and leader of the Charlotte Tea Party.

My heartfelt thanks to Matthew for allowing me to share this.

"A man's country is not a certain area of land, of mountains, rivers, and woods, but it is a principle; and patriotism is loyalty to that principle." - George William Curtis

This month I have gone on two trips by car; one taking me south through Atlanta, across Alabama, and up to Memphis, and the other north through Virginia, to Harrisburg, PA. During these two trips through ten states, I have seen much of what my girlfriend called "the heart of America". From the rolling farmlands of Pennsylvania to the land of the Delta Blues, from Talladega Superspeedway to Gettysburg, Antietam, and Shenandoah; I consider myself fortunate for being able to drive through some of the most noted historical locations in our nation. There is something about watching an Amish buggy bounce down the road which seems to put things in perspective, especially in this time of fearful flying, wars, and cultural degeneration. Sunday afternoon I drove eight hours from Harrisburg, PA back to Charlotte, and I would do it again in a heartbeat. If you have never driven up I-81, I highly encourage you to do so. Grab your spouse or friend and take off for a weekend, and discover a little Americana along the way.

So what is America/Americana, anyways? Is it a place? For example, my home...I know where that is. I know the walls, the doors, the messy refrigerator, pictures on the wall-I know what "home" is. No, I do not think that America is a place. Oh, sure, it has borders, land area and such, but borders move and topography changes. Is it the Constitution or our rights and freedoms? Certainly those help define us as a people, but any nation could adopt our Constitution and grant their people the same rights and liberties. Would that make them "American"? No, it would not. How about people? Yes, people are certainly America. A people stitched together with the threads of history; bound to each other through community, shared freedoms, and a sense of "us". You and I are America. Much like the idea of true freedom, it lies within us, regardless of our surroundings.

What saddens me is that over the years, through apologetic, revisionist history, segregated communities, and stifled freedoms, we have lost a lot of the handiwork that made us American. Sometimes I feel like we are the cheap, synthetic imitation of America. Yes, we believe in free market economics, but not in times of economic trepidation (in that case, bail ‘em out). Yes, we believe in free speech, but only if it's PC (and not conservative talk, either, lest we pull your website or take you off the air). We believe in the right to bear arms, but not those arms or those arms (in fact, we'd appreciate it if you'd just stick to a .22 rifle and plink some tin cans). I fear we have satiated ourselves eating a McDonalds burger, not knowing that we could have a Del Frisco's ribeye instead. We did not get here overnight; it was not the actions of a single President, nor administration. It was not one terrorist attack, nor one stock market bubble. It was a constant erosion of America because we were apathetic. We were in a hurry. We were under attack. We were fearful. And so we wrote a blank check to the government and said, "Please take this responsibility. Make this easier. Make everything the way it used to be." But there is no going back, and there is no going home again.

"He who would trade liberty for some temporary security, deserves neither liberty nor security." - Benjamin Franklin

Reactions to the new TSA policies are an interesting barometer of the perspectives of Americans. There seem to be two main camps: "This is a dangerous world, and whatever the government needs to do to keep us safe is okay", and, "Don't touch my junk". I understand the former, but I am a believer in the latter. I understand why people are willing to submit to virtual strip searches and invasive pat-downs. They have become conditioned to: 1) not resist authority 2) believe that it's all in the name of "safety". You see, you can get away with a lot in America in the name of safety and security. Just look at hand sanitizer sales, food recalls, child safety features and a host of other actions we take and devices we use all in the name of safety and security. It is as if we are afraid of life itself. What a lot of people do not understand are the long-term effects of allowing the TSA such broad powers. First they scan and grope at the airports, then subways and mass transit. After all, it's all in the name of your security, Citizen. But then there is always the threat of car bombs, so tighter restrictions are made for car ownership and road travel. Think it will not/cannot happen? History is filled with examples: Germany, Italy, Russia, Ireland...and those are just from the last century. So while I understand people's desire to fly safely, I am concerned about the ramifications of trading a little temporary security for some of our essential liberty. It is a lot easier to draw the line in the sand now, rather than later, when we have to provide papers just to travel along the interstate. Now, I do not think that there is a conclave of old men, shrouded in black robes, wishing to control Americans; however I absolutely believe there are people in government so fearful of another attack, a financial meltdown, or unknown threats that they are willing to do anything to feel protected. They are no different than most Americans-except that they write the laws and set the policies.

"An agreeable village, in a damned rebellious country." - Lord Cornwallis

Americans have long had a history of resistance to oppression and authoritarian rule; it is in our blood, our history, it is a part of that fabric which binds Americans. We are seeing more of that resistance today. We must take our stands at every opportunity, even at the expense of our own time or resources. It may take longer to "opt-out", but we must. It may take time to write emails to members of the Senate against Senate Bill 510, but we must. Every policy, every bill, every action must be scrutinized, tested, and if necessary, resisted. Because we as Americans-the very keepers of America-are the only ones who will. If the Great Experiment fails, it will be because we allowed it to. We can never go back to 1999, but we can ensure that we do not go forward to 1984. Not on our watch.

As we hustle and bustle over the next few days with Thanksgiving, family, football, and black Friday shopping, let us think for a moment about our families, our genealogies, and our own stories. The events of the past, and of our lives, have shaped us and molded us to be exactly where we are right now. We live in a troubling time, filled with uncertainty and doubt. Yet you and I are here now, for a purpose, and that is empowering. You are needed right now. Lady Liberty and your countrymen are calling on you to keep America; keep it free, keep it healthy, keep it a beacon of equality, justice, and liberty. Keep it, and you will earn the eternal thanks of a nation.

Happy Thanksgiving.

Face to Face Encounters and Other Conundrums.

The House Energy and Commerce Committee Republicans posted the healthcare law implementation timeline a few months back. I sifted through the 53 pages of fine print to try to get an idea of when we would really start to see some impact (in other words, begin to feel the pain) from the healthcare law.

What I found most entertaining was the first part of the document…the disclaimer:

“This document represents the best efforts of the Energy and Commerce Committee Republican staff to describe the substantive provisions and effective dates of the legislation. Because of the lack of clarity, internal inconsistencies, and ambiguity in the text, many provisions will inevitably be subject to dispute or alternative interpretations.”

...You can’t say we weren’t warned.

One thing that went into place this year was the “Face to Face Encounter”…a provision that sounds really nice on paper. The punch line is that a physician, physician assistant, nurse practitioner or clinical nurse specialist must have a face-to-face encounter with a patient to certify eligibility for home healthcare services, durable medical equipment, and the most recent addition, hospice services. It is justified “in order to reduce waste, fraud and abuse”. And it’s a very good idea…on paper. But when you look at it from the perspective of home healthcare and hospice providers, it gets slippery. What is interesting about this is that in order for a patient to be certified for home healthcare services under Medicare, they must be “homebound”. The guidelines are pretty stringent…so if a patient already qualifies for home health care, one can assume that it takes some level of hardship for the patient to be able to go to the doctor. With the current shortage of healthcare providers at the practitioner level (physicians, nurse practitioners, physician assistants and clinical nurse specialists), you’ll be hard pressed to find one that is willing to do a house call. Durable medical equipment? Well…maybe that is more realistic, on some levels. If the equipment is something like a walker, a cane, something that allows the patient to be more mobile, then a face-to-face encounter is reasonable, and quite honestly should be expected. But what about that patient that is confined to their home and bedbound?

And the most jaw-dropping part of this: the hospice provision. In order for someone to qualify for hospice care, they must have a prognosis of six months or less. There is not as stringent a “homebound” requirement as there is for standard home healthcare services because in truth, people with a life-limiting illness are likely already homebound, or close to being that way. Certification periods for the hospice Medicare benefit are in 60 or 90 day increments – meaning that a new order that certifies eligibility must be done every 60 or 90 days, depending on how long the patient has been under hospice care. In many cases, it is very difficult for this patient population to get to the doctor’s office.

Hospice organizations are starting to foot the expense of putting nurse practitioners and physicians on staff (versus working with independent primary care physicians or specialists). This way, they will be able to make home visits for this special patient population to maintain compliance with this regulation…in a time where Medicare and Medicaid is already slashing reimbursement. It is well known throughout this healthcare field that the cost of Medicare and Medicaid fines is far beyond the cost of putting these providers on staff…even though both totals may put many smaller hospice organizations in the red. I’ll be posting an entry in the coming weeks about how Medicare reimbursement to hospice organizations works…just in case you weren’t outraged enough.

Some other interesting items I found on the healthcare law implementation timeline:

“Medicare: Sets Medicare payment for bone-density tests at 70 percent of the 2006 reimbursement rates in 2010 and 2011, subject to conversion and geographic adjustment factors. (Sec. 3111)”

“Medicare: Removes all funds ($22.2 billion) from the Secretary’s Medicare Improvement Fund. (Sec. 3112)”…and…
[April 1, 2010] “Medicare: Start date for the Secretary to reduce the annual inflation update to Medicare payments for inpatient acute hospitals, inpatient rehabilitation facilities and long-term care hospitals by 0.25 percentage points for fiscal year 2010. (Sec 3401)”

BUT…

“Medicare: Extends through FY 2012 funding for beneficiary outreach and education activities related to low-income programs with an additional $45 million for such activities. (Sec. 3306)”

Oh. So that’s where that money is going. But just in case they don’t get quite enough money from those cuts, there’s always this provision:

“Medicare: Permits the Secretary to periodically identify physician services as potentially misvalued, and make appropriate adjustments to the relative values of such services under the Medicare Physician Fee Schedule. (Sec. 3134)”

Members of Indian tribes are seeing some incredible benefits from this healthcare law – already in effect for 2010. Not sure why these benefits were not extended to all American citizens…rather curious…but I’m not sure if that is something we are allowed to question anymore (sic). In any case, there is a wonderful breakdown of those government-provided benefits that are already in place on pages 5-20 of the timeline…the link to the PDF of the timeline is listed under “References”.

That's just a small preview of what is already in place, courtesy of our new government healthcare law. More to come on other provisions that will be coming into effect as we near 2011…

REFERENCES

PDF version of House Energy and Commerce Republicans timeline for HR 3590 as Revised by HR 4872: http://republicans.energycommerce.house.gov/Media/file/News/042110_Health_Law_Timeline.pdf