Wayne County Medical Society of Southeast Michigan

February 22, 2010

Editor's Column: The Guy Is Right
In My Opinion: Whatever Happened To Health Care Reform?
EVENT: Our Story: Trailblazers Of The Next Generation
AMA Letter Urges Congress To Fix SGR
Physicians Have Until March 17 To Choose Medicare Participation Status
GOP Plans To Attend Health Summit As Obama Calls For Compromise
Public Option Gains Steam
Obama's Health Plan Melds House, Senate Bills

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Editor's Column: The Guy Is Right

By JOSEPH WEISS, MD
The guy who said, “I don’t want government touching my Medicare,” had a point.

In August 2009, I had Medicare Advantage Plan, Option C, at a cost of $196/ month. In November, the federal government “touched” the plan and put an end to Option C. I was left with Option B, which provides less Physical Therapy and higher co-pay on office visits and prescriptions than Option C and costs me $248/month. Next year, the government “touch” will likely lead to a further decrease in coverage and an increase in cost that will exceed $300/month.

The man who said, “I don’t want government touching my Medicare,” was stating what any reasonable person covered by Medicare might feel. For those of us under the program it was, and remains today, a marvelous bargain. The rational view is that any change to our Medicare is likely for the worse and those of us already covered by the current plan should oppose it: any change, even if it is called reform, is really tampering with our program.

Unfortunately, when the guy said those words he didn’t know that the Medicare Modernization Act of 2003 mandated the federal government to: “pay as you go.” That means any money to pay physicians more or to reward new technology had to mean other physicians and established therapies got paid less. The other alternative was that Medicare recipients help foot the bill. All the above is happening in 2010. To help pay for ever increasing claims, the Medicare program eliminated subsidies to Medicare Advantage Option C and increased a recipient’s monthly premium for Option B. The same Medicare Modernization Act logic will cause a yearly repeat of higher premiums for less care for the foreseeable future.

What the man who said: “Don’t touch my Medicare,” didn’t realize was that no reform does not mean we will maintain the status quo. No reform means we will continue to travel down the path of higher premiums, larger deductibles and more co-pays to provide less and less care. We need reform now to stop this cycle that is like a plague upon a beleaguered city.

The failure of Washington to reach health reform agreement does not mean physicians can leave their advocacy posts and return to usual pursuits, just the opposite. Both as individuals and through our medical societies we must work for change. Furthermore, we should place our concerns regarding the SGR (Sustainable Growth Rate) on a lower priority than in the past. We need to concentrate on rescuing the reform measures presently wandering unattended through the halls of Congress. Otherwise, we will appear as just another party forwarding our own financial interests.

The guy who said, “I don’t want government touching my Medicare,” spoke in error. If, knowing better, we do nothing to right that mistaken statement, the scorn and ridicule heaped on him, belongs on us.

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In My Opinion: Whatever Happened To Health Care Reform?

By SUSAN ADELMAN, MD
It has been my experience that when you really believe in something it is easy to explain. The converse is also true: when you either do not believe something or do not understand it, your explanations get longer and more abstruse.

Let me stipulate that the reason why health care reform keeps going down is that the American public does not support a one-payer system.

The reason why President Clinton and now President Obama have not been able to explain their health care plans to the public is because both of them actually wanted a one-payer system, but both recognized that such a system did not have the support of a majority of the public. As a result, they both sought to disguise their real goal by proposing something other than what they really wanted. No wonder they could never explain their proposed system in a simple and compelling way.

Why does the public not believe in a one-payer system? After watching the process of Washington’s attempts to enact such a system, they do not trust this same government to implement it in such a way that it will properly provide them with health care.

A one-payer health care system appears likely to be clean, attractive and just. So does Communism. Do not get me wrong, I am not equating the two. I am just saying that the social justice of both has long been very appealing. The problems come in the implementation.

And that is what the public knows instinctively.

So, if we ever want to enact health care reform in the United States. We need to drop the doctrinaire approach, drop the one-payer system proposals, drop the ulterior motives and concentrate on the relatively obvious reforms of the private health care system about which we already have a national consensus.

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EVENT: Our Story: Trailblazers Of The Next Generation

The Annual Black History Month Program

Date: Friday, February 26, 2010
Location: McGregor Memorial Conference Center
495 Ferry Mall
Detroit, MI 48202
Time: 6:00pm-8:30pm
Cost: $10 (Free for WSU BMA members, WSU BLSA members, and WSU Alumni)
Dinner and Dessert will be served to those who have previously RSVPed
Come join guest speaker Dr. Cheryl Gibson-Fountain, the Paul Robeson Chorale, and the Black Medical Association acknowledge the accomplishments of African Americans from the past, present and future.
For more information about this event, please contact Monique Bowles at 734 274-0775 or mbowles@med.wayne.edu.

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AMA Letter Urges Congress To Fix SGR

Last week, the AMA sent the attached letter to all Senators and Representatives stressing the urgency of repealing the sustainable growth rate (SGR) formula. The letter points out that less than a week remains before the postponed 21 percent Medicare physician payment cut scheduled for 2010 takes effect. It also expresses the AMA’s opposition to further short-term fixes that make future cuts steeper and the budgetary impact of permanent reform more expensive.

All members of the Federation are urged to ask their members to share this message with their legislators. The AMA grassroots hotline is available for physicians to use to contact Congress, at 1-800-833-6354.

The Honorable Harry Reid
Majority Leader
United States Senate
522 Hart Senate Office Building
Washington, DC 20510

Dear Senator Reid:
On behalf of the physician and medical student members of the American Medical Association, I am writing to stress the urgency of addressing the flawed Medicare physician payment system and to call on Congress to take prompt action on a permanent solution to a problem that annually threatens the foundation of the American health care system.

Only a week remains before the most recent short-term Medicare physician payment freeze expires and a 21 percent payment cut takes effect, yet the pathway for addressing the underlying problem remains a mystery. Medicare payment for care provided to our nation’s seniors, and for military families who are covered by TRICARE, has been stagnant for almost a decade. Only in the last year have rates returned to 2001 levels. In the face of the rising cost of caring for Medicare beneficiaries and military families, this situation is untenable for physician practices, the majority of which are small businesses.

We understand the tremendous fiscal challenges our nation faces. However, Congress must step back and recognize that the enormous deficit in the Medicare physician payment system is one of its own creation. Despite claims that the costs of previous short-term “fixes” were offset, any casual observer knows that to be false. Scheduled cuts were merely delayed, and then further compounded by the continued operation of the sustainable growth rate (SGR) formula. Each year Congress fails to address the underlying cause of the problem, the deficit grows even larger; the cost of future fixes and the size of future cuts explodes. If Congress had fixed this problem in 2005, when physicians faced a cut of about 3.3 percent, the cost of permanent reform would have been $49 billion. Now, Medicare projects a 21 percent cut for this year and the price tag of reform has skyrocketed to $210 billion.

Kicking the can down the road with yet another short-term action magnifies the problem and makes it very difficult for physicians to continue caring for seniors and military families. Medicare beneficiaries and their physicians deserve better treatment than having to worry if this is the year or the month or the week that Congressional inaction will allow the Medicare

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Physicians Have Until March 17 To Choose Medicare Participation Status

Physicians have until March 17 to change their Medicare participation or nonparticipation status for this year, meaning that doctors who have not already changed their status still can do so and those who made a change can still retract it, according the AMA.

Because the decision would be retroactive, those who switch from “nonparticipation” to “participation” would have to refund any balance billing collected from their patients between Jan. 1 and their new decision date.

To help ensure that physicians are making informed decisions about their contractual relationships with the Medicare program, the AMA has developed a document that explains the current situation with respect to Medicare payment updates for 2010 and the various participation options that are available to physicians. The purpose of the document is to ensure that physicians are fully aware of the Medicare participation options they have, and the AMA does not advise or recommend any one of the three options described there.

Visit http://www.ama-assn.org/ama1/pub/upload/mm/399/med-par-options.pdf to view the document.

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GOP Plans To Attend Summit As Obama Calls For Compromise

President Barack Obama warned during the weekend that both Republicans and Democrats should be careful not to turn this week's health care summit into "political theater" but to work to find "common ground" on the issues, The Washington Post reports. "The Thursday event, scheduled to be televised live on C-SPAN, could prove a pivotal moment in the year-long effort to overhaul the health-care system. … While the parties agree broadly that the health-care system is broken, they have found little consensus on more detailed questions, such as how best to provide insurance to people who don't have access to affordable coverage through an employer. Obama's plan is expected to provide subsidies to people who can't afford coverage, incentives for businesses to offer insurance and expanded Medicaid coverage for the poor" (Murray and Shear, 2/21).

Politico: "And yet Obama is unveiling a health care bill just days before the six-hour summit that wouldn't require a single GOP vote, with plans to short-circuit the Senate rules and push it through without Republicans if necessary. That's left some Republicans angrily questioning whether the summit is a sham and even Democrats uncertain and noncommittal." Democrats are using the summit as a way to get Republicans to talk and "to debunk many of the GOP's talking points about their bill by walking viewers through shortfalls in the Republicans' own legislation; for example, the House GOP bill covers about 3 million uninsured Americans while the Democrats' bills would cover more than 31 million" (O'Connor, 2/22).

The Los Angeles Times reports that GOP senators, who were publicly questioning their summit attendance, have decided to participate despite reservations — "but the chamber's GOP leader is far from resigned to the Democrats' idea of cooperation on the hot-button issue." Senate Republican Leader Mitch McConnell said Sunday that Democrats were still acting "arrogant" in not tossing out reforms that have passed before and starting over. "Asked if the Republicans would slow down the consideration of health reform, McConnell said there were 'a variety of different options available'" (Parsons, 2/21).

Roll Call: "House Republican Conference Chairman Mike Pence (Ind.), who was not invited to attend the meeting with President Barack Obama at Blair House on Thursday, said on NBC's 'Meet the Press' that Democrats should scrap the House and Senate bills and use the summit to start over. … 'But what we can't help but feel like here is that the Democrats spell summit S-E-T-U-P and all this is going to be just some media event used as a preamble to shove through Obama care 2.0. We aren't going to have any of it'" (Kucinich, 2/21).

The Washington Times: "But with the White House expected to release a plan it hopes Democrats can support and Republicans firmly opposed to any of the Democrats' proposals, few health policy experts or lawmakers expect the summit to lead to policy compromises. … Republicans have steadfastly opposed a large comprehensive bill and prefer a step-by-step approach that includes proposals such as tort reform and allowing insurers to sell across state lines. They have several small-scale bills" (Haberkorn, 2/22).

Fox News on McConnell's comments on using budget reconciliation to pass reform and the summit: "'You know, we've witnessed the "Cornhusker kickback," the "Louisiana purchase," "the Gatorade," the special deal for Florida. Now they are suggesting they might use a device which has never been used the for this kind of major systemic reform. We know it would be — the only thing bipartisan about it would be the opposition to it,' he said" (2/21).

Los Angeles Times, in a news analysis: Obama "is struggling with the consequences of one of his most important early decisions: letting Congress take the lead in designing his signature policy proposal.

... That's one reason Obama has called a healthcare summit this week — to try to renew the debate on more pristine terms. Even if nothing comes of the talks, they are designed to spotlight on national television precisely the bipartisan, high-minded debate that Congress' year-long process was not. … Critics fault Obama and Congress for taking so long with the task, pointing to the standard set by President Lyndon B. Johnson, when such landmark measures as Medicare and the Voting Rights Act were passed seven months into 1965. … At the healthcare summit Thursday, Democrats hope to neutralize complaints that the process so far has been too partisan and secretive. But hardly anyone in Washington expects major decisions or compromises to be made on camera" (Hook, 2/22).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

This information was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.

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Public Option Gains Steam

The public option is gaining steam again, while a new study on the "Cadillac tax" suggests it would fall equally on union and non-union health plans.

"The recess week ended up providing liberal activists and their allies on Capitol Hill with a surprise opportunity to breath life into the proposal to create a government-run health insurance plan – a proposal that had been declared all-but-dead two months ago," The Hill reports. "Ironically, it's a shift that would have been unthinkable before Sen. Scott Brown (R-Mass.) won the late Sen. Edward Kennedy's (D-Mass.) seat in a special election last month." Without the crucial 60th vote to overcome a Republican filibuster, Democrats are turning to reconciliation, which requires only 51 votes and may give liberals an opportunity to insert the public option again.

"Over the course of three days, 18 Democratic senators signed on to Sen. Michael Bennet's (D-Colo.) Wednesday letter to Majority Leader Harry Reid (D-Nev.), requesting a floor vote on the public option should the upper chamber consider a healthcare reconciliation bill. ... Even Reid appears to be on board." His office issued a statement Friday indicating Reid would "bring the public option to the Senate floor." In addition, the "Obama administration appears to be ready to give it a go. 'If it's part of the decision of the Senate leadership to move forward, absolutely,' Health and Human Services Secretary Kathleen Sebelius said on MSNBC Thursday" (Young, 2/20).

Meanwhile, a new analysis studies another hot-buttom reform issue -- the so-called "Cadillac tax" and finds that "the conventional wisdom about the tax [on high-cost insurance plans] is wrong: The tax would actually fall equally on nonunion plans," The Washington Post reports. "At least 80 percent of the workers whose plans would be subject to the tax in 2019 would be in nonunion jobs, according to the analysis by Ken Jacobs of the University of California at Berkeley Labor Center and William H. Dow, a professor of health economics at Berkeley who was a member of President George W. Bush's Council of Economic Advisers. This impact is roughly in line with the overall breakdown of nonunion vs. union workers with employer-provided plans. And it would be true under both the version of the tax passed by the Senate and a more labor-friendly one the White House agreed to last month" (MacGillis, 2/22).

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Obama's Health Plan Melds House, Senate Bills

The proposal President Barack Obama will bring to his (Feb. 25) health “summit” with congressional leaders contains many of the ideas from the bills already passed by the Democratic House and Senate, including a mandate that individuals buy insurance and a promise to "end discrimination" from pre-existing conditions.

White House Web site: www.whitehouse.gov

In advance of the release, news organizations covered one aspect of the plan, a regulatory crackdown on insurers' rate hikes.

The New York Times: "Mr. Obama is seizing on outrage over recent premium increases of up to 39 percent announced by Anthem Blue Cross of California …" (Herszenhorn and Pear, 2/21).

The Wall Street Journal: "The [House and Senate] Democratic health bills already envision some role for the government to control premium costs, through new exchanges where individuals and small businesses could buy insurance. One version would prevent any insurer that raised rates beyond a level that the government deemed unfair from selling policies in the exchange. Private insurance companies are now regulated by the states, which review proposed rate increases. Under the Obama proposal, the federal Department of Health and Human Services would gain the power to review and block premium increases" (Meckler, 2/22).

Obama's plan would "set up a panel of experts" – including doctors, economists and other stakeholders – "charged with evaluating the healthcare market each year and determining what would constitute a reasonable rate increase," the Los Angeles Times reports. "Under the president's plan, rate increases outside the reasonable boundaries established by the board could be overruled by the [HHS] secretary, who would also have the power to require the insurer to revise its proposed rate changes or to order rebates for customers who overpaid" (Parsons, 2/22).

Politico: "White House officials have already begun urging Republicans to post their bills online as well – a clever tactic by the White House, because Republicans ideas for reform were spread across several pieces of legislation, or fell far short of the Democrats' goal of insuring 31 million uninsured Americans. The main House Republican proposal, for instance, would only cover 3 million more Americans" (Brown, 2/21).

The Washington Post reports that, before the full plan was released, a spokesman for the House Republican leader John Boehner said, "At first glance, this seems to be an admission from the Obama administration that their massive government takeover of health care will, despite their promises, increase health care premiums for millions of Americans," since it suggests that insurers' rates would need to be actively controlled, even with reforms in place (Shear and Balz, 2/22).

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