Tag Archives: Medicare

Obama regimes secret doctor survey – not so secret.

From the NYT

Aren't these the guys Obama wanted on his side? photo from Politico.com

Obama invited all these doctors to the White House, dressed them in taxpayer funded lab coats, schmoozed them and courted them to get their much needed endorsement for his Health Care plan and now he’s stealthily stabbing them in the back.

Is this what they had in mind when they went to the Rose Garden? I have to wonder if they understood how the government under Obama can and will reach it’s tentacles into their lives and livelihoods.

According to government documents obtained from Obama administration officials, the mystery shoppers will call medical practices and ask if doctors are accepting new patients and, if so, how long the wait would be. The government is eager to know whether doctors give different answers to callers depending on whether they have public insurance, like Medicaid, or private insurance, like Blue Cross and Blue Shield.

But of course, none of this information will be used against any particular doctor:

In response to the drumbeat of criticism, a federal health official said doctors did not need to worry because the data would be kept confidential. “Reports will present aggregate data, and individuals will not be identified,” said the official, who requested anonymity to discuss the plan before its final approval by the White House.

And these doctors are really supposed to believe this nonsense?

If this doesn’t reek of intimidation, nothing does.  And I see nowhere in the story that the reporter called the AMA to get their opinion on this. I also have to wonder how the decisions were made regarding what states to target with these “mystery shopper” calls:

[...] administration officials said, a federal contractor will call the offices of 4,185 doctors — 465 in each of nine states: Florida, Hawaii, Massachusetts, Minnesota, New Mexico, North Carolina, Tennessee, Texas and West Virginia. The doctors will include pediatricians and obstetrician-gynecologists. [In addition to family practice physicans and internal medicine doctors.]

What I find most troubling about this is that these nearly 4200 doctors will be called at least twice to determine if the doctor has different standards of care for private insurance patients versus government insured patients. But 11% of these doctors will be called a third time and this time the caller will identify himself as a govenment employee and will ask whether the doctors accept private insurance, Medicaid or Medicare, and whether they take “self-pay patients.” The study will note any discrepancies between those answers and the ones given to mystery shoppers.

Tell me again that these results will not be used against a physician – tell me again that this information will be kept confidential. Tell me again how Obama wants the support of America’s doctors, most of whom do not belong to the AMA, by the way.

 


Quote of the day – Ann Coulter

Democrats don’t resent “the rich” on behalf of the poor. They resent the rich on behalf of the government.

Read her column Human Events


More scary ObamaCare we never knew about comes to light

I believe that it only came to light yesterday because it only occurred to the regime’s collective mind over the weekend, after Rep. Ryan released his plan. This brilliant idea isn’t in the actual ObamCare bill.

In his speech yesterday, which was a poor attempt to rebut Rep. Paul Ryan’s much touted Path to Prosperity, Obama disclosed a new plan to the American people:

Fifteen members will serve on the Independent Payment Advisory Board [IPAD - dontcha love these government acronyms?], all appointed by the President and confirmed by the Senate. If per capita costs grow by more than GDP plus 0.5%, this board would get more power, including an automatic budget sequester to enforce its rulings. So 15 sages sitting in a room with the power of the purse will evidently find ways to control Medicare spending that no one has ever thought of before and that supposedly won’t harm seniors’ care, even as the largest cohort of the baby boom generation retires and starts to collect benefits. The Wall Street Journal

These are 15 UNELECTED “sages” who will be able to spend or not spend money, which  up  until now has been the job of Congress.

Let’s forego the obvious, that this is a stupid idea, and look at it as though it will really happen.

15 guys are appointed by the president to make these health decisions. When this president is gone, in 4 or 8  years and a new president comes in, a whole new bunch of wise men will be appointed.  Where’s the continuity in that? We are dealing with human beings who are making subjective decisions. It’s like musical chairs. They leave and new guys come take their place and all things will change again with every new butt that sits down.

It’s ridiculous. And it can be dangerous to the citizens. Imagine the malevolent chair sitters that might be appointed – guys who really don’t revere the Constitution or our republic, like for instance some of the czar’s that Obama has already appointed.

Obviously, this regime could not have thought this through. These people are supposed to be smart then I and I can see how stupid and unworkable, not to mention unfair, this idea is.

Seriously. Think about this. If you can’t see how unworkable, subjective and just plain goofy this whole idea is, then I’m a Chinese astronaut.


The democrat party REALLY is the party of communists

With Wasserman-Schultz (love that hyphenated last name, don’t you?) appointed chairPERSON of the DNC, it’s out in the open now that the democrat party is really the party of communists.  And with this appointment, the demise of the DNC is all but assured – or at least I’m praying so.

My God- watch Ryan’s response at about 2:00. It’s priceless:

Someone at HotAir commented that this exchange looked like a couple facing a divorce judge! LOL He obviously cannot stand her – along with many of the rest of us.

Her appointment really is the best thing that could happen to the RNC, unless they had appointed Sheila Jackson Lee (“when America planted the flag on Mars”) or Maxine Waters (“watch out or we will nationalize — er ummm- er — oil companies”).

And you’ll love this at the end when Debbie claims that the term “ObamaCare” is a disparaging tag:

It is time the DNC came out of the closet and admitted they really are communists and stop trying to fool the American voter.


Couple of facts from Karl Rove to confound your goofy liberal friends

from Karl Rove in todays WSJ

Mr. Obama and his people also mischaracterize where most stimulus dollars go. Their constant prattle about “shovel ready projects” is an attempt to leave the impression that most goes to bricks and mortar. Not true: Only 3.3% of the $814 billion stimulus went to the Federal Highway Administration for highway and bridge projects.

The administration’s misleading statements and obfuscations aren’t limited to the economy. On health care, for example, Mr. Obama continues saying that (a) health-care reform will reduce costs and the deficit, (b) no one who wants to keep existing coverage will lose it, and (c) the law’s cuts in Medicare won’t threaten any senior’s health care. These assertions are laughable.

The president’s habit of exaggeration and misstatement has infected other Democrats. Speaker Nancy Pelosi, for example, routinely talks about how the recently passed “Stimulus II” spending bill protected the jobs of police and firemen.

But it didn’t.

Stimulus II consisted of two parts: $10 billion for education and $16 billion for Medicaid. States can’t spend Medicaid money for anything but Medicaid, and they can only spend the education money on education, i.e., they can’t shuffle state funds around. Language allowing Stimulus II dollars to pay for police and firemen didn’t make it out of the Senate. Yet Democratic leaders persist in saying that their latest stimulus has helped keep police and firefighters on the job. The claim is flatly untrue.


Just give ‘em a pill? I can’t even do that anymore.

Agents of the Drug Enforcement Administration have been pushing harder to investigate cases of nursing-home staff giving powerful medications to patients without a doctor’s prescription. But if that sounds all well and good, some say it’s just the nub of a more-complicated situation.

Trade groups for nursing homes and hospice-care facilities say “patients have been left to ‘languish in pain’ while nursing homes and pharmacies try to find ways to comply with DEA regulations requiring physicians, in most cases, to write prescriptions,” the WSJ reports this morning. The industry groups are pushing for a change in the law and the issue will be taken up at a Senate hearing today.

The DEA has been ramping up efforts to fight prescription-drug abuse, which some experts say may surpass the abuse of illegal drugs, the article says. In nursing-home cases, DEA has been acting out of concern for patients, according to a letter to lawmakers in December from an assistant attorney general in the Justice Department, of which the DEA is part.

But the industry groups say long-term facilities can’t afford doctors to write every prescription. “DEA’s reliance on hard copy prescriptions and failure to acknowledge the role of nursing in long-term care and hospice place additional burdens on prescribers, pharmacists and nurses and can substantially delay and in some cases, impede access to appropriate pain medication,” industry backers said in a brief quoted by the WSJ.

Wall Street Journal

Well, Mr.TheOne, I can’t even do that anymore for my patients.

This is one of the newest and biggest dilemmas we face at work. We have many residents and patients who suffer from chronic pain due to numerous different disorders and diseases.  We are now hindered from alleviating their pain and suffering because of these new DEA regulations. The DEA is lying when they say that they are “acting out of concern for patients.” If that were true, they would not be putting this monsterous barrier up between us (the caregivers and physicians) and the suffering patient.

There is no rampant prescription drug abuse in nursing homes. Again, another lie. There are numerous checks and regulations already in place to prevent this.

What they are talking about is nurse’s either stealing drugs from patients or prescribing drugs without a doctor’s order. Yes, nurses do steal drugs. But in all my years as a nurse (this  year marks my 30th anniversary) I have only known of 2 nurses who did this. They were caught and punished.

No one, I repeat, no one writes orders for narcotics without express permission from a doctor. Anyone who does this will be without a job and likely, without a nursing license. But gone are the days when a VO (verbal order) or TO (telephone order) is accepted. I could call a doctor, explain the patient’s situation and  write an order for something. Then I would fax the order to our house pharmacy. The doctor comes in once a week and signs all his TO’s.

But no more.

Now someone has to go to the doctor’s office, have the doctor write a hard script (just like you’d get in the doctor’s office) which has to be taken or faxed to the pharmacy to be filled.  In our case, which I’m sure is not much different from other long term care facilities, the medications only arrive once a day – after 7pm. And no deliveries on weekends. These patients can go over 24 hours (or more if it’s a weekend) in pain, without medication. The only thing I can give a patient is Tylenol and not even Extra Strength Tylenol. For that I need a doctor’s order.

We have a locked emergency narcotic box that has almost anything the a doct0r would order: Lortab, Vicodin, Dilaudid, Percocet, etc. But we can no longer use it. I don’t know why the pharmacy doesn’t take it home because we cannot use it. Even with a hard script, we cannot use it. That hard script has to go through a pharmacy. We can’t use it in-house.

I’m caring for a patient right now who has terminal esophageal and mouth cancer, with a trach.  He can’t talk and communicates with pen and paper. He has a gastrostomy tube that he is fed and gets all his medications through. He is on Roxanol (liquid Morphine) every 2 hours. Roxanol comes in 30cc bottles or 1 oz. He gets 1cc every 2 hours. Do the math: he will be out of Roxanol in about 2 days. I ran out on Friday night.

Now, I can blame someone (other nurses) for not realizing that he would be out of his Roxanol and then not getting it ordered. But the real problem is that I cannot get him anymore morphine and that’s the problem I deal with – it does him or I no good to blame others. All I want to do is give the guy his medication.

How do I control the pain these people are suffering when I no longer have the tools to do so, when the DEA has taken away my ability to do my job? These are bureaucrats who look at paper: reports and summaries and have no contact with the real world and real patients who are making rules that simply do not and will not work.

And on the flip side of this: if a patient does not get his medication, the state will site US for neglect and abuse. And on the flip side of the flip side, it’s getting harder and harder to get doctors to sign on at nursing homes due to the Obama Medicare cuts. Things will not get better, thanks to TheOne’s medical Utopia.


How a bill becomes law – nothing like Schoolhouse Rock

This is an incredible read. It’s disgusting and disheartening to find out the real deals and arm twisting, bullying and threats that went on last week to pull this horrible bill across the finish line. And if nothing illustrates the Alinsky rule – the ends justify the means, at any cost – this behavior by OUR elected officials does. We elected these liars, cowards and crooks. These people have no business in the hallowed halls of our Founders. There should be investigations and impeachments over these atrocious activities.

For me, this is all beyond belief. How can these people look in their mirrors every day? How could they have ever put their dirty hands on a Bible and committed to uphold the Constitution? There is no longer any question in my mind that every single one of these people have to go in November. There is no redemption for them as the descendants of our Founding Fathers. They have sullied their offices and the memory of the great men who provided them with the greatest nation on the face of the earth.

I am enraged.

Inside the Pelosi Sausage Factory

Last week Republican Rep. Mike Pence posted on his Facebook site that famous Schoolhouse Rock video titled “How a Bill Becomes a Law.” It’s clearly time for a remake.

Never before has the average American been treated to such a live-action view of the sordid politics necessary to push a deeply flawed bill to completion. It was dirty deals, open threats, broken promises and disregard for democracy that pulled ObamaCare to this point, and yesterday the same machinations pushed it across the finish line.

You could see it all coming a week ago, when New York Rep. Louise Slaughter let leak a breathtaking strategy whereby the House would not actually vote on the unpopular Senate bill. The House would instead vote on a “reconciliation” fix to that bill, and in the process “deem” the underlying legislation—with its Cornhusker kickbacks and Louisiana purchases—passed.

The Slaughter Solution was both blunt admission and warning. House Speaker Nancy Pelosi did not have 216 votes to pass the Senate bill, there never was going to be majority “support” for it, but they’d pass it anyway. The final days were a simple death watch, to see how the votes would be bought, bribed or bullied, and how many congressional rules gamed, to get the win.

President Obama flew to Pennsylvania (home to five wavering House Democrats), Missouri (three wavering), Ohio (eight), and Virginia (four) to hold rallies with small, supportive crowds. In four days, Mr. Obama held 64 meetings or calls with congressmen. The goal was to let undecideds know that the president had them in his crosshairs, that he still had pull with the base, and he’d use it against them. By Saturday the tactic had yielded yes votes from at least half the previously undecided members of those states.

As for those who needed more persuasion: California Rep. Jim Costa bragged publicly that during his meeting in the Oval Office, he’d demanded the administration increase water to his Central Valley district. On Tuesday, Interior pushed up its announcement, giving the Central Valley farmers 25% of water supplies, rather than the expected 5% allocation. Mr. Costa, who denies there was a quid pro quo, on Saturday said he’d flip to a yes.

Florida Rep. Suzanne Kosmas (whose district is home to the Kennedy Space Center) admitted that in her own Thursday meeting with the president, she’d brought up the need for more NASA funding. On Friday she flipped to a yes. So watch the NASA budget.

Democrats inserted a new provision providing $100 million in extra Medicaid money for Tennessee. Retiring Tennessee Rep. Bart Gordon flipped to a yes vote on Thursday.

Outside heavies were enlisted to warn potential no votes that unions and other Democrats would run them out of Congress. Al Lawson, a Tallahassee liberal challenging Blue Dog Florida Rep. Allen Boyd in a primary, made Mr. Boyd’s previous no vote the centerpiece of his criticism. The SEIU threatened to yank financial support for New York’s Michael McMahon. The liberal Working Families Party said it would deny him a ballot line. Obama deputy campaign manager Steve Hildebrand vowed to challenge South Dakota Rep. Stephanie Herseth Sandlin if she voted no. New York’s Scott Murphy was targeted as a part of a $1.3 million union-financed ad campaign to pressure him to flip. Moveon.Org spent another $36,000 on ads in his district and promised a primary. Messrs. Boyd and Murphy caved on Friday.

All the while Mrs. Pelosi was desperately working to provide cover with a Congressional Budget Office score that would claim the bill “saved” money. To do it, Democrats threw in a further $66 billion in Medicare cuts and another $50 billion in taxes. Huzzah! In the day following the CBO score, about a half-dozen Democrats who had spent the past months complaining the bill already had too many taxes and Medicare cuts now said they were voting to reduce the deficit.

Even with all this, by Friday Mrs. Pelosi was dealing with a new problem: The rule changes and deals winning her votes were losing her votes, too. The public backlash against “deem and pass” gave several wary Democrats—such as Massachusetts’s Stephen Lynch and California’s Dennis Cardoza—a new excuse to vote no.

Mrs. Pelosi jettisoned deem and pass. Once-solid Democrat yes votes wanted their own concessions. Oregon’s Pete DeFazio threatened to lead a revolt unless changes were made to Medicare payments to benefit his state. On Saturday Mrs. Pelosi cut a deal to give 17 states additional Medicare money.

By the weekend, all the pressure and threats and bribes had left the speaker three to five votes short. Her remaining roadblock was those pro-life members who’d boxed themselves in on abortion, saying they would vote against the Senate bill unless it barred public funding of abortion. Mrs. Pelosi’s first instinct was to go around this bloc, getting the votes elsewhere. She couldn’t.

Into Saturday night, Michigan’s Bart Stupak and Mrs. Pelosi wrangled over options. The stalemate? Any change that gave Mr. Stupak what he wanted in law would lose votes from pro-choice members. The solution? Remove it from Congress altogether, having the president instead sign a meaningless executive order affirming that no public money should go to pay for abortions.

The order won’t change the Senate legal language—as pro-choice Democrats publicly crowed within minutes of the Stupak deal. Executive orders can be changed or eliminated on a whim. Pro-life groups condemned the order as the vote-getting ruse it was. Nevertheless, Mr. Stupak and several of his colleagues voted yes, paving the way to Mrs. Pelosi’s final vote tally of 219.

Even in these waning minutes, Senate Democrats were playing their own games. Republicans announced they had found language in the House reconciliation bill that could doom this entire “fix” in the Senate. Since many House Democrats only agreed to vote for the Senate bill on promises that the sidecar reconciliation would pass, this was potentially a last-minute killer.

Senate Democrats handled it by deliberately refusing to meet with Republicans and the Senate parliamentarian to get a ruling, lest it be unfavorable and lose House votes. The dodge was a clear dereliction of duty, but Democrats figure the Senate parliamentarian won’t dare derail this process after ObamaCare passes. They are probably right.

So there you have it, folks: “How a Bill Becomes a Law,” at least in Obama-Pelosi land. Perhaps the most remarkable Democratic accomplishment this week was to make the process of passing ObamaCare as politically toxic as the bill itself.

President Obama was elected by millions of Americans attracted to his promise to change Washington politics. These were voters furious with earmarks, insider deals and a lack of transparency. They were the many Americans who, even before this week, held Congress in historic low esteem. They’ll remember this spectacle come November.

Ms. Strassel writes the Journal’s weekly Potomac Watch column from Washington. The Wall Street Journal


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