URIBE: Obamacare prevents quality care – Washington Times


URIBE: Obamacare prevents quality care – Washington Times.

Government meddling driving doctors from medicine

By Dr. Constance Uribe

Americans are so focused on the availability of health care provided by the Affordable Care Act that they completely overlook the quality of care they might receive. Government interference, intrusive mandates and cumbersome regulations are making it impossible to continue providing high-quality care.

Physicians across the nation have been planning for the worst, and an exodus of more than 100,000 doctors is expected by 2020. I will be closing the doors of my office in December after 32 years in surgical practice.

Patients will be lucky to see a physician because fewer will be available. The government does not recognize the term “physician” anymore. A fully trained doctor of medicine or doctor of osteopathic medicine who completed a residency and became board-certified will be rare because the lesser-trained licensed health care provider will be the norm.

Since the 1980s, my career has been riddled with regulations created by a government bent on controlling every aspect of patients’ lives. The coup de grace was delivered by the Affordable Care Act, but the blindfold was placed by President George W. Bush.

By executive order, Mr. Bush in 2004 created the position of national coordinator for health information technology. This allowed for the establishment of a health information technology storehouse. Funding for this came from President Obama’s American Recovery and Reinvestment Act of 2009.

To insure buy-in from all health care providers, the government had to create meaningful incentives, the first of these being marginal payback for compliance. What started out as voluntary soon became mandatory. While physicians may have received partial reimbursements from the government to equip their offices with the computer systems, these did not come close to meeting the costs of implementation.

Mandates meant as meaningful incentives are quickly turning into penalties. Physicians see deductions on already-lowered Medicare payments because of failure to use e-prescribing. They are threatened with further deductions if they do not have electronic medical records in place by 2014.

The practicing physician is buried in more mandates, more regulations and more penalties. As entry of patient data into the computer becomes more burdensome, it does not take long to discover that the system has been designed for auditing purposes, not for charting purposes.

Not only are health records no longer protected within the walls of a medical office, but physicians are complaining about the time consumption, computer errors and false sense of security created as a scheme rather than a service. One physician wrote on a blog, “It adds an hour of work to my day and makes my office notes sound like they were written by an imbecile.”

From the patient’s viewpoint, the physician has turned his attention to clicking computer keys with eyes glued to the screen. Data entry now takes priority over quality time.

The Affordable Care Act will finish driving the wedge between the doctor and the patient and put an end to a once-sacred relationship. Not only will the current mandates remain in place, but physicians will be inundated with the new insurance exchange identification numbers, authorizations, codes and denials.

My office staff puts the patient’s interest first and tries to follow Medicare guidelines, yet we have problems getting insurance carriers to cover routine procedures without writing letters and making myriad phone calls. With my upcoming retirement comes the relief of no longer screaming four-letter words into the phone at uneducated bureaucrats and medical directors committed to pigeonholing people and withholding care.

The health information technology storehouse gives the government more ammunition to track physicians, enforce new evidence-based standards and grade physicians accordingly. The grading, called “pay for performance,” will be another way for the government to cut costs under the guise of improving health care.

If the health care provider fails in a certain category such as infection rate or mortality rate, his reimbursement will be affected. With this type of incentive for physicians, high-risk patients will have difficulty finding access to quality care. The art of medicine is becoming the trade of medicine.

The health information technology storehouse and the Affordable Care will rip total control of patient care from the hands of physicians. Anyone who believes differently is as delusional as the congressional leaders who passed the legislation in the first place. Then again, no one bothered to read it.

Dr. Constance Uribe is a general surgeon and author of “The Health Care Provider’s Guide to Facing the Malpractice Deposition” (CRC Press, 1999).


CBO report shows Obamacare’s ballooning costs | Campaign 2012 | Washington Examiner

CBO report shows Obamacare’s ballooning costs | Campaign 2012 | Washington Examiner.

byPhilip Klein Senior Editorial Writer

A new report from the Congressional Budget Office provides us with fresh insight into how much worse President Obama’s national health care law made our nation’s spending crisis.

When Democrats were reverse-engineering the health care law to meet Obama’s pledge that it would cost “around $900 billion,” one of the accounting tricks they used was to delay the enactment of the major spending provisions until 2014, to make the legislation appear cheaper over the CBO’s 10-year budget window (which at the time ran from 2010 through 2019). Today, the CBO released its updated budget and economic outlook that includes three additional years. Though the report doesn’t isolate the cost of Obamacare, it contains countless examples of how the law will put pressure on the budget.

As demonstrated by this chart, overall, spending on federal health care programs will more than double, from $847 billion, or 5.5 percent of GDP, in 2012, to $1.8 trillion, or 7.3 percent of GDP, by 2022. Notice the spike starting in 2014, when Obamacare’s major spending provisions are scheduled to take effect.

It’s true that a combination of health care inflation and the retirement of baby boomers would have driven up spending over the next decade no matter what. But Obamacare (formally known as the Patient Protection and Affordable Care Act) still made things worse.

Some highlights from the CBO:

— Obamacare’s expansion of Medicaid eligibility will make the program far more costly: “Spending for the program will climb again in 2013 and will shoot up rapidly in 2014, 2015, and 2016 as a result of provisions in the Affordable Care Act. By 2022, under current law, federal outlays for Medicaid are expected to total $605 billion, more than twice the 2012 amount; spending will equal about 2.5 percent of GDP, compared with 1.7 percent this year.”

— Obamacare’s insurance exchanges and additional provisions will drive up the costs of other health care programs: “In addition to Medicare and Medicaid, the federal government operates other programs through which it subsidizes the provision of health care…Provisions in the Affordable Care Act will significantly increase the scope and scale of such benefits in the coming decade. In CBO’s baseline projections, federal spending for mandatory health care programs other than Medicare and Medicaid rises from $26 billion this year to $161 billion in 2022.” In the decade from 2013 to 2022, the cost of the exchanges alone will total $645 billion.

—   Obamacare will help make the Medicare prescription drug benefit more expensive: “(F)ederal spending per beneficiary for Part D will double, largely because of a combination of rising drug costs and the more generous benefits enacted in the Affordable Care Act.”

— The CLASS Act, which was responsible for half of the deficit reduction in Obamacare at the time of passage, will no longer produce revenue because it was suspended: “In its August 2011 baseline projections, the agency anticipated that the CLASS program would begin collecting premiums in fiscal year 2012 and that net receipts from the program between 2012 and 2021 would total $76 billion. In the absence of that program, the government will not receive that income.”

Defenders of Obamacare’s finances will argue that the legislation ends up reducing the deficit due to a combination of Medicare cuts and tax increases Yet as I noted last week, even if those policies go into effect as planned, nearly all the money raised will be used to pay for the new Obamacare entitlements rather than deficit reduction. Today’s CBO report reinforces the fact that Obamacare dramatically drives up spending and adds to our long-term debt obligations.

Opinion: Delay health law’s implementation – Douglas Holtz-Eakin and James C. Capretta – POLITICO.com

Opinion: Delay health law’s implementation – Douglas Holtz-Eakin and James C. Capretta – POLITICO.com.

Obamacare is not ready for prime time.

Though the Patient Protection and Affordable Care Act was passed in March 2010, most of its key provisions don’t start until January 2014. That is when “exchanges” are supposed to begin offering insurance policies with income-tested premium subsidies and substantially different insurance regulations.

So Congress has the opportunity to improve the budget outlook and improve health policy by just delaying the act’s implementation.

Why? As the recent demise of the CLASS Act, or Community Living Assistance Services and Supports Act, makes clear, much of the Affordable Care Act was slapped together with insufficient due diligence to make sure it could actually work.

The law is now on shifting legal and political ground. Many of its rules are unworkable, and implementation is well behind schedule. Even where it seems feasible, evidence is growing that the substantial infrastructure — notably the exchanges and related insurance subsidies — won’t be ready by 2014.

Meanwhile, serious legal challenges are pending. There also remain significant political disagreements over the merits of many provisions — likely to be debated extensively during the 2012 presidential campaign.

In this environment, it makes sense to clarify the future of health policy. Delaying the Affordable Care Act for two to four years would permit exactly that.

When it passed, the act’s health provisions were expected to reduce the federal budget deficit by $124 billion over 10 years, according the Congressional Budget Office. Within that total are numerous spending increases, spending cuts, tax increases and tax reductions. The provisions with the most significant budgetary consequences are: first, expanded eligibility for the Medicaid program; second, premium credits payable to households with incomes between 133 percent and 400 percent of the federal poverty line, which are enrolled in health insurance plans offered in the state exchanges; third, targeted cuts in spending in the Medicare and Medicaid programs; and fourth, new tax hikes on insurance premiums, drug manufacturers and upper-income households.

There are multiple ways to construct a freeze or delay of the act, with targeted exceptions to achieve any desired budgetary goal. For example, the main features of the state-based exchanges, along with the insurance rules that are to go into effect at that time, could be delayed for two, three or four years.

In addition, the main tax increases and other spending provisions could be delayed in a similar manner — with targeted exceptions on a few spending reductions to ensure that the act’s delay is scored by the CBO as deficit reduction.

To gain an idea of the opportunity facing Congress, our recent research estimated the effect of delaying the entire state exchange structure. We looked at postponing the premium credits, the insurance rules that become effective with the exchanges, the Medicaid eligibility expansion, the medical-loss ratio requirement that became effective in 2011, the cuts in Medicare spending (with some exceptions, like the hospital readmission payment adjustment) and all the tax increases contained in the Affordable Care Act (except the high-cost insurance tax that does not become effective until 2018 anyway, and the tax adjustment in the biofuels tax credit program).

What are the budgetary implications? In every case, the 10-year savings would be significant: $176 billion from a two-year delay, increasing to $308 billion from a four-year delay.

Looking at it another way, the savings over four years would be about a third of the deficit reduction goal that the Joint Select Committee on Deficit Reduction must achieve (not counting net interest savings) to avoid across-the-board spending cuts starting in January 2013.

The federal budget is already buckling under the weight of existing entitlement promises. The health care act would pile on top of these unaffordable commitments an additional $1 trillion in costs over the coming decade.

Congress and President Barack Obama agreed this summer that widening deficits and growing debt threaten our economic future, and something must be done to get our nation’s fiscal house in order. A good start would be to agree to delay initiating the new spending in the Affordable Care Act so that a broader and more stable bipartisan consensus can be built around fiscally sustainable entitlement and tax policy.

Douglas Holtz-Eakin served as a director of the Congressional Budget Office from 2003 to 2005. He is now president of the American Action Forum. James C. Capretta is a fellow at the Ethics and Public Policy Center and a former associate director at the White House Office of Management and Budget.

Where Are All the New Jobs? – John C. Goodman – Townhall Conservative

Where Are All the New Jobs? – John C. Goodman – Townhall Conservative.

Why aren’t employers hiring more workers? Why are so many people seeking work unable to find anything other than part-time positions or temporary employment? And that’s when they can find a job at all.

In short, what’s causing the continuing stagnation of the U.S. economy?

Former Sen. Phil Gramm observed in the Wall Street Journal the other day that we’ve had recessions before. But at this point in the cycle we should be roaring back. Had we followed the pattern of the previous 10 recessions, almost 12 million more people would be employed right now, producing additional goods and services worth more than $8,000 for every household in America.

So what gives?

Job Creators Alliance (JCA) is an alliance of business leaders who are focused on this very issue. These are employers who are in the trenches, facing the economy’s woes day in and day out. Two of them told Fox Morning News last week that the reasons for slow job growth boil down to basic common sense. (Fair disclosure: my wife Jeanette is the director of the organization.)

Think of it this way. When an employer hires a full-time worker, the employer thinks of the relationship as long term. During an initial training and learning period, the employer probably pays out more in wages and benefits than the company gets back in production. But over a longer period, the hope is to turn that around and make a profit.

When employers hire new employees, then, they are making a gamble. They are betting that over time, the economics of the relationship will pan out.

The problem in the current economy is that hiring new workers and committing to new production has become extremely risky. As the JCA folks explain, an employer who hires workers today has no idea what the company’s future labor costs will be. Or its building and facility costs. Or its cost of capital. Or its taxes.

What’s causing all this uncertainty? You guessed it. Nobody knows what is going to happen in Washington, D.C.

Take the cost of labor. The Affordable Care Act (what some people call ObamaCare) is designed to force employers to provide full-time employees with comprehensive health insurance in less than three years. While the goal may be admirable, the consequences are not. Although no one knows how much this extra burden will cost, estimates are that the required family coverage will reach $15,000 a year or more — the equivalent of an additional $6 an hour minimum wage.

Employers could decide to drop their health insurance altogether; and if they do so they must pay a fine of $2,000 per employee per year. Yet if a lot of employers do this (and apparently a lot of them are thinking about it), don’t you think the federal government will respond by making the fine a lot higher?

Then there is the National Labor Relations Board (NLRB). After the aircraft maker Boeing spent $1 billion building a new plant and hiring 1,000 workers in South Carolina, the agency brought a halt to the whole thing, calling it an unfair labor practice. Boeing’s sin? South Carolina is a right-to-work state. The company should have built the plant in Seattle, where it would be required to use union labor.

There is more bad news. The NLRB is considering rule changes that would make it much easier to unionize workers. Would you like to see employers across the country facing the same kind of turmoil state governments are now facing in dealing with public sector unions? Most employers don’t relish that idea either.

Under the Obama presidency, the NLRB has made a radical change of direction. Some would say it is much more pro-labor, but this is a misnomer. What the agency is dedicated to is not labor, but making labor more costly.

As for capital investments such as new buildings and new equipment, here again there is considerable regulatory uncertainty. It should come as no surprise that the Obama administration is overly friendly to environmental groups who see carbon dioxide emissions as pollution. Yet every act of production emits carbon dioxide. You even emit it when you exhale.

As for the cost of financial capital, what is going to happen is anybody’s guess. When the Bush tax cuts finally do expire, the tax on capital gains will increase by a third and the tax on dividends will more than double. The administration has made no secret that it would like to accelerate these tax increases and make them even higher.

Bottom line: even if there were no Republican opposition in Washington, we would be in trouble. The Obama administration is profoundly anti-labor. It thinks it is pro-labor, of course. But that is because it is so naïve about economics that it doesn’t understand that when you make hiring more costly there will be less hiring.

But there are Republicans in Washington, and (ironically) their presence in some ways adds to uncertainty. While the two parties are battling, who knows what the outcome will be? No one can.

So the best strategy from a business perspective is to sit on cash, delay the employment of labor and capital and wait to see what happens next.