I wish I had a helmet like that.
07 November 2009
06 November 2009
The death of irony
A man protesting the purported government takeover of healthcare at the Capitol yesterday suffered an apparent cardiac arrest. He was resuscitated by government-employed medical personnel.
More ominously, a man standing just beyond the TV cameras apparently suffered a heart attack 20 minutes after event began. Medical personnel from the Capitol physician's office -- an entity that could, quite accurately, be labeled government-run health care -- rushed over, attaching electrodes to his chest and giving him oxygen and an IV drip.
This turned into an unwanted visual for the speakers, as a D.C. ambulance and firetruck, lights flashing, pulled in just behind the lawmakers. A path was made through the media section, and the patient, attended to by about 10 government medical personnel, was being wheeled away on a stretcher just as House Minority Leader John Boehner (R-Ohio) stepped to the microphone. "Join us in defeating Pelosi care!" he exhorted. A few members stole a glance at the stretcher. Boehner may have been distracted as well. He told the crowd he would read from the Constitution, then read the "we hold these truths" bit from the Declaration of Independence.
Awwkwaaard.
05 November 2009
04 November 2009
Leaving on t a jet plane
I've got a lot to say these days, but I've been working 12-hour days and now I'm off to Denver for a whirlwind visit. Our ER is rolling out a new EMR and we are visiting some sites that have successful implementations. Sorry Luke, but I'll only be in town 24 hours. Maybe next time.
My flight tomorrow is at 5:45 AM. Ugh. I didn't even know airplanes could fly at that hour -- I thought the air was too dense for them or some such. Gah.
Hopefully I'll have more time to blog next week.
This is bad, very bad
Healthcare provision seeks to embrace prayer treatments -- latimes.com
Well, as Kevin Drum says, "It's true that not everything that seems like a slippery slope really is one, but this really is one. If it passes, can you imagine how this would play out among the Colorado Springs set within a few years? The mind reels." Yeah, every religious group out there will be in looking for their piece of the prayer-healing pie. The good news? Nancy Pelosi stripped a similar provision out of the House bill, based on concerns it wasn't constitutional. Good for her. Let's hope she sticks to her guns on that point in conference committee.
Sheesh.
Reporting from Washington - Backed by some of the most powerful members of the Senate, a little-noticed provision in the healthcare overhaul bill would require insurers to consider covering Christian Science prayer treatments as medical expenses.
The provision was inserted by Sen. Orrin G. Hatch (R-Utah) with the support of Democratic Sens. John F. Kerry and the late Edward M. Kennedy, both of Massachusetts, home to the headquarters of the Church of Christ, Scientist.
The measure would put Christian Science prayer treatments -- which substitute for or supplement medical treatments -- on the same footing as clinical medicine. While not mentioning the church by name, it would prohibit discrimination against "religious and spiritual healthcare."
Well, as Kevin Drum says, "It's true that not everything that seems like a slippery slope really is one, but this really is one. If it passes, can you imagine how this would play out among the Colorado Springs set within a few years? The mind reels." Yeah, every religious group out there will be in looking for their piece of the prayer-healing pie. The good news? Nancy Pelosi stripped a similar provision out of the House bill, based on concerns it wasn't constitutional. Good for her. Let's hope she sticks to her guns on that point in conference committee.
Sheesh.
03 November 2009
Responsible Governing is Hard
As has been noted on this blog, the new House health care reform bill does not contain a fix for the Sustainable Growth Rate problem. To recap, the SGR is a formula enacted as a part of the 1997 Medicare reforms which was intended to ensure that spending on physician services did not grow faster than GDP. Unfortunately, the number of medicare beneficiaries did increase, as did their age and complexity, and the SGR quickly mandated progressively deep cuts in physician reimbursement. Each year, Congress averted or mitigated those cuts, kicking the can down the road to next year. When the spending cuts have been averted, generally they have been deficit financed -- no effort was made to find any offset or increased revenue to pay for the physician reimbursement fix. As a result of a decade's worth of inaction, in 2010, physicians face a potential 21% cut in reimbursement.
It's important to note that when the CBO calculates the long-term deficit, it is obligated to assume that Congress will allow the cuts to go through as scheduled, even though that has never happened and politically is incredibly unlikely to come to pass. So the current deficit projections are something of an elaborate fiction, including the expiration of tax cuts which will never expire and spending cuts which will never be allowed to take place. The White House Budget Office has more discretion; the Bush administration used to do the same thing with regard to deficit projections, pretending the deficit was smaller than it really was; Obama's Budget Office did away with these tricks, assumed that the cuts would be blocked, and gave a more honest, larger projection of the federal deficit.
The initial plan was just to repeal the SGR, and that was part of HR 3200, the initial House health reform bill, and a key point in securing the support of the AMA. The problem with that was that there was political pressure to keep the cost of health care reform under $100 Billion per year, a somewhat arbitrary but symbolically important figure, and the cost of repealing the SGR problem amounts to $250 Billion over ten years, or $25 Billion per year. So it was dropped from the final bills, and Congress is planning on addressing the SGR in a separate piece of legislation.
Enter HR 3961, The Medicare Physician Payment Reform Act of 2009. According to its summary[PDF]:
So, let me get this straight, in the very same bill, indeed in the very same paragraph of your press release, you are going to:
a) Champion the fiscally conservative Pay-as-you-go principal that you are encoding into law, and
b) Define $250 Billion in previously-unaccounted-for spending as "not new" and allow it to accrue to the deficit.
Wow. That's chutzpah, on the Bushian level. It's also criminally reckless and dishonest.
I feel some sympathy for these guys -- they're facing withering criticism over $90 Billion in new annual spending for health care (while a $680 Billion defense appropriation passes with barely a peep), and they are desperate to find cover to minimize the apparent costs. It even makes sense to split the SGR fix off into another vehicle, since it's not truly part of the health insurance & delivery reforms proposed -- it's a repair for a mistake Congress made in 1997. I also understand that if they were to honestly account for the cost, it might well sink the whole effort. But geez, try a little subtlety! If you're going to lie to us, at least make the deception plausible. Better yet, don't even try to look responsible, just kick the can down another 12 months (like the Senate apparently plans to) and come up with a fiscally responsible fix then. (The risk of that, I assume, would be to lose the support of the AMA for the health reform in general.)
The take-home here is that there is generally little to no political advantage in fiscally responsible policy-making, and there is significant downside risk. It's true of all parties, to some degree, and it's painful to see the Democrats falling into the same short-sighted trap which has created the huge general budget crisis that we are facing in the coming years.
It's important to note that when the CBO calculates the long-term deficit, it is obligated to assume that Congress will allow the cuts to go through as scheduled, even though that has never happened and politically is incredibly unlikely to come to pass. So the current deficit projections are something of an elaborate fiction, including the expiration of tax cuts which will never expire and spending cuts which will never be allowed to take place. The White House Budget Office has more discretion; the Bush administration used to do the same thing with regard to deficit projections, pretending the deficit was smaller than it really was; Obama's Budget Office did away with these tricks, assumed that the cuts would be blocked, and gave a more honest, larger projection of the federal deficit.
The initial plan was just to repeal the SGR, and that was part of HR 3200, the initial House health reform bill, and a key point in securing the support of the AMA. The problem with that was that there was political pressure to keep the cost of health care reform under $100 Billion per year, a somewhat arbitrary but symbolically important figure, and the cost of repealing the SGR problem amounts to $250 Billion over ten years, or $25 Billion per year. So it was dropped from the final bills, and Congress is planning on addressing the SGR in a separate piece of legislation.
Enter HR 3961, The Medicare Physician Payment Reform Act of 2009. According to its summary[PDF]:
[This] legislation will repeal a 21 percent fee reduction scheduled for January 2010 and replace it with a stable system that ends the cycle of threats of ever-larger fee cuts followed by short-term patches. Permanent reform of physician payments in Medicare will guarantee that Medicare beneficiaries continue to enjoy the excellent access to care that they do today. It will also follow the President’s lead by ending a budget gimmick that artificially reduces the deficit by assuming physician payments will be cut by 40 percent over the next several years even though Congress has consistently intervened to prevent those cuts from occurring.Sounds great, right? And even better, they're being fiscally responsible, making statutory the "Pay-Go" principle:
The Medicare Physician Payment Reform legislation will be considered in the House under a procedure which will add the text of H.R. 2920, the Statutory PAYGO Act of 2009, as passed by the House on July 22nd before being sent to the Senate. The “pay as you go” principle of budget discipline requires Congress to find a way to pay for any new spending, outside of an economic crisis.Wow. These Democrats in Congress are the most responsible, principled, courageous lawmakers ever. So, let's read on and see where they found the money to offset the SGR fix. A new tax on soda pop? Cuts to the F-22 program? I can't wait to find out!
A previous Congress established the policy for paying Medicare doctors, so the update for 2010 is not a new policy to be paid for. The Statutory PAYGO Act would apply this principle to all new tax and spending policies, and would allow Congress to exclude the impact of continuing policies currently in place, including Medicare payments to physicians. The Medicare Physician Payment Reform Act would not increase total payments to physicians above what they are today and therefore, would not be subject to the paygo requirement.Oh.
So, let me get this straight, in the very same bill, indeed in the very same paragraph of your press release, you are going to:
a) Champion the fiscally conservative Pay-as-you-go principal that you are encoding into law, and
b) Define $250 Billion in previously-unaccounted-for spending as "not new" and allow it to accrue to the deficit.
Wow. That's chutzpah, on the Bushian level. It's also criminally reckless and dishonest.
I feel some sympathy for these guys -- they're facing withering criticism over $90 Billion in new annual spending for health care (while a $680 Billion defense appropriation passes with barely a peep), and they are desperate to find cover to minimize the apparent costs. It even makes sense to split the SGR fix off into another vehicle, since it's not truly part of the health insurance & delivery reforms proposed -- it's a repair for a mistake Congress made in 1997. I also understand that if they were to honestly account for the cost, it might well sink the whole effort. But geez, try a little subtlety! If you're going to lie to us, at least make the deception plausible. Better yet, don't even try to look responsible, just kick the can down another 12 months (like the Senate apparently plans to) and come up with a fiscally responsible fix then. (The risk of that, I assume, would be to lose the support of the AMA for the health reform in general.)
The take-home here is that there is generally little to no political advantage in fiscally responsible policy-making, and there is significant downside risk. It's true of all parties, to some degree, and it's painful to see the Democrats falling into the same short-sighted trap which has created the huge general budget crisis that we are facing in the coming years.
31 October 2009
30 October 2009
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