From that blog post on Obama’s #TemperTantrum:
” However, only one of our beaches is staffed with lifeguards under normal circumstances anyway, and when the Park closes on holidays, beaches are not barricaded, nor are citations issued to beach-goers. It should also be noted, interestingly, that according to VI Coastal Zone Management Act Section 903 (b) (6), all Virgin Islands beaches are public, from the high tide mark down to the water line…”
There have never been barricades (#Barrycades ) before, but there are under #HarryReidsShutdown?
Here’s what’s happening on St. John, US Virgin Islands due to Obama’s temper tantrum. This in spite of the fact that there are few restrooms and lifeguards, normally. (I think 2 of the beaches have lifeguards.) Those mooring balls are spots for boats to tie up – they are self-serve and people put their money ($15 a night) in a drop box on the honor system.
Originally posted on JUST BEaching.:
St John, USVI, hotbed of #shutdown protest?
So it would seem, however unlikely.
Our fair island is about 70% National Park land. Our tourism industry depends largely on operations and concessions inside the park – everything from taxi tours to boat charters, from snorkeling trips to beach weddings. Visitors come from near and far, both domestic and abroad, to sit on some of the most beautiful beaches in the world. Most of all, people visit for a chance to breathe, relax, and let the rest of the world fall away for a little while.
With the help of AFSCME national and the AFL-CIO’s Washington D.C. Metro Council, the unions created the “Federal Worker’s Guide to Shutdown D.C.,” which gives the status of major points of interest.
The furloughed workers will be in green and blue union t-shirts on the Constitution Avenue side of the Natural History Museum from 10 a.m. until noon on Wednesday. If the shutdown is long and the effort is successful, they may add volunteers at other museums.
Furloughed workers will be carrying signs.
How do they justify the extra people to close the WATER around Padre Island?
“Technically, they can’t even fish in park waters, we’ll have rangers on patrol to make sure that people know the waters as well as the land that’s under are jurisdiction is closed,” he added.
Think you own your business? Not if you contract with the Federal government!
The Arizona State highway through the Grand Canyon, along with all the private businesses (hotels, restaurants, gift shops, art galleries and even the historic Grand Canyon Railroad train from Williams, Arizona) that are not dependent on money from the Federal government, are arbitrarily “Shutdown” by the Obama Administration.
GRAND CANYON NATIONAL PARK, Ariz. (AP) – The state highway that runs through the Grand Canyon is closing Thursday morning after visitors disregarded the park closure.
Residents of Grand Canyon Village still can access State Route 64.
The Grand Canyon was forced to turn away visitors after the federal government shut down.
The highway had been open to through traffic, but visitors were pulling off the road and removing barricades from overlooks to get a glimpse of the canyon.
Park spokeswoman Maureen Oltrogge says motorists also were turning around on blind corners, tour buses were parking on the roadside and visitors were darting in front of ongoing traffic.
She says the highway closure is to ensure safety and protect resources. She says anyone caught in restricted areas could receive a citation or be arrested.
The people relying on Medicare, Medicaid and Social Security didn’t fail. They (we) were sold a tax scheme (sound familiar, Justice Roberts?) that claimed to be insurance and pension plans.
If you’ve ever scoffed at the rumors that the Federal government might confiscate your retirement savings, it’s time to reconsider. And you don’t have to look to the actions of Greece, Ireland, Poland or Cyprus to do so.
I recently read a radical extension of past theories for a Nationalized health care solution to the costs of Medicare and Medicaid for the elderly: Since many elderly citizens receive more out of Medicare, Medicaid and Social Security than they paid in, and so many eventually rely on Medicaid to pay their bills, it was suggested that our government “nationalize” all Nursing Homes and Assisted Living businesses and confiscate of Senior citizen’s assets. The Feds could then expand the Veterans Administration system in order to provide housing and medical care until death.
Isn’t the entire purpose of any insurance a bet that the insured will someday need more than he pays into the fund? Couldn’t the claim be made that many Social Security beneficiaries often receive more money over their lifetimes than they paid into the funds?
Since the Federal government got into the health care business with Medicare, Congress has done everything possible to ensure that Seniors are dependent on what we now know are failures. Everyone who becomes “Medicare eligible” - turns 65 years old – faces penalties for not signing up with Medicare. Janet Reno threatened Federal charges and prosecution for any Medicare-eligible senior who dared to pay for their own health care with their own money or entered into “private contracts” with their own doctors. Their doctors faced the penalties that go with “opting out” of Medicare. For anyone planning ahead, Congress wrote laws severely limiting Health Savings Accounts.
In the meantime, Federal (and State) government(s) failed to put money aside for the future of the people who were
paying taxes that could have gone into genuine savings or the purchase of real insurance. Private insurance and pension funds acting the same way would have been shut down and the officers imprisoned for doing the same thing.
Under the “tax” of the ACA, everyone will be forced by law – and the IRS, Federal lawyers, guns and prisons – to buy “insurance” (in reality, pre-paid health care). Since the scheme is rigged to benefit the government-run exchanges, that’s how most will buy their “insurance” – or pay their tax.
When the “Affordable Care” scheme proves to be as false as Medicare and Social Security, what next? Where to stop with “nationalization” and confiscation of property? 401K’s? Private pensions? The family home and Mama’s jewelry?
Edited to clean up punctuation, order of ideas – BBN
Representative Louie Gohmert (Republican from my old home in East Texas) leads the way: refuse ObamaCare subsidy if you can afford it.
“House Republicans have voted for and sent the Senate two different bills, because we have been offering compromises, even to the extent of compromising with ourselves because Senate Democrats and the President have refused to negotiate at all. They have made clear that they will negotiate with Russians and Iranians, but will not negotiate with Americans.”
Harry Reid is sauntering toward a Federal gov’t shutdown at midnight, tonight.
Even though the House passed a compromise Continuing Resolution (no longer defunding Obamacare, simply delaying it) just after midnight yesterday (Sunday) morning, Harry refused to allow the Senate to gather until 2PM, DC time, today (Monday).
Then, he made his motion to table the House CR. The motion passed along strict Party lines, 54-36. Then . . . might as well wait for it . . . he announced “debate” until 4PM, DC time.
“But in some situations, you may see a redefinition of what ‘start’ means.” (Wall Street Journal quoting Obamacare consultant.)
President Obama and Democrats everywhere should be grateful to the Republicans for saving them from a huge embarrassment. Instead, the Dems continue to dig in, escalating their claims to have won a mandate on ObamaCare in 2012, in spite of the fact that the Republicans won enough seats in the House of Representatives to secure a strong majority.
House Republicans passed a new Continuing Resolution that compromises on Obamacare, by changing from refusing funding altogether to setting up a one year delay. Included in the Bill is a measure that would ensure that our military is paid in the event of a shutdown. The Bill also repeals the 2.3% tax on medical devices and the mandate that business owners with religious objections buy insurance that includes controversial “free” contraception.
The Wall Street Journal, in addition to reporting the redefinition of “start,” outlines the many ways that the Federal and State exchanges are not ready to launch Obamacare on October 1:
In the District [of Columbia], people who use the online marketplace will not immediately learn if they are eligible for Medicaid or for subsidies.
In Oregon, people will not initially be able to enroll in an insurance plan on the Web site.
In Vermont, the marketplace will not be ready to accept online premium payments until November.
In California, it could take a month for an insurer to receive the application of someone who applies for coverage on the exchange on Oct. 1.
. . . But as the launch nears, more delays are occurring. On Thursday, the administration announced a delay in the online shopping system for small businesses and confirmed that the Spanish-language site for signing up for coverage will be delayed until mid-October. Earlier in the week, officials said Medicaid applications will not be electronically transferred from the federally run exchange to states until November.
The (oxymoronic) “Center for Reproductive Rights” and other abortionists have filed suit to prevent two of the provisions of Texas’ new requirements on doctors who perform abortions – not on the management or owners of the abortion facilities. The new law becomes effective October 29, 2013 and was passed by the Legislature and signed by the Governor.
From the on-line, liberal Texas Tribune:
The next stage in abortion rights advocates’ efforts to block implementation of strict new regulations on the procedure in Texas began on Friday, as the Center for Reproductive Rights, the American Civil Liberties Union and a group of abortion providers across the state filed a lawsuit in federal court.
Everyone in Texas politics has been waiting for the lawsuit(s) challenging this summer’s hotly debated legislation. Surprisingly, the abortionists aren’t asking the Courts to stop the prohibition on elective abortions after 5 months or on the requirement that abortion facilities meet requirements for Ambulatory Surgical Centers. Instead, only two parts are challenged and both are requirements on the State-licensed doctors, not on the facilities.
The dispute is over the requirement that doctors personally hand the pills for medical abortions to their patients, rather than delegating the dispensing to a nurse or med tech or sending the woman home to take the pill. Doctors must also have privileges at a hospital within 30 miles of the office or facility where they perform abortions, so that they are able to admit their patients and care for any complications that might arise from the abortions they perform.
The agreement that doctors sign with the company that makes Mifeprex (also known as RU486 or mifepristone) was reaffirmed a year ago by the FDA. By signing the contract with the manufacturer, the doctors pledge that they will dispense the pills themselves. State law now requires them to keep their word.
As to the requirement that the doctors performing surgical and medical abortions maintain hospital privileges: It’s standard of care to expect doctors to care for complications of any intervention they perform – whether it’s setting a broken bone, cleaning an abcess or performing some outpatient surgery such as removing a mole or ingrown toenail. To fail to provide timely follow-up and/or call coverage for after-hours care is abandonment. Why should it be different for Doctors intervening to perform an abortion? When I delivered babies, those of us who were on call for Obstetrics had to be able to physically show up at the hospital (and patients’ bedside) within 30 minutes in order to maintain hospital privileges. My Family Medicine privileges (without OB) required me to be able to respond (if not appear at the hospital) within a certain time. (I can’t remember the specifics, but believe it was similar.)
We’ll see if the Austin-area federal judges think it’s appropriate for the State to regulate the physicians we license. I’m especially looking forward to hearing why the State is “unconstitutional” by holding physicians to a contract they’ve already signed.
I love what Senator Ted Cruz is doing to fight ObamaCare and the Democrats, and totally agree with his stated goal, but strongly dislike one aspect of how he’s doing it.
Unfortunately, Senator Cruz – who was absolutely correct and exactly on target 99% of the time in his 20+ hour stand in the Senate on Tuesday and Wednesday – leads his crowd in attacking fellow conservative Republicans who support the House Bill that would fully fund the Federal government except for ObamaCare. This, in spite of the fact that Cruz has said that the fight against ObamaCare is “multistaged,” praised the Bill and House Republicans for their action and even joined in Wednesday’s unanimous Senate vote to consider the Bill in the Senate.
Most people either love or hate Ted Cruz, his agenda and his Senate tactics. There doesn’t seem to be any room for distinction between the Senator, his politics, and his actions. John McCain called him a “wacko bird.” Harry Reid called Cruz an “anarchist” – along with everyone in the Tea Party. Even Dorothy Rabinowitz, of the Wall Street Journal editorial board, went overboard contrasting Cruz and Senator Mike Lee with the “sane” wing of the Republican party. Bloggers and editors, as well as politicians focus more on Cruz’ “self regard,” his certainty that he’s right and everyone else is wrong and his lack of humility, than on the fight to stem the tide of Federal overspending and government interference in our lives. (See Wednesday’s Senate floor rants of Harry Reid And Dick Durbin, with the classic propaganda technique – or possibly, classic psychological projection – of accusing your opponent of doing the worst thing that you’re doing.)
At the same time, Cruz’ supporters have gone out of their way to call any of the Republicans who didn’t “#StandWithTed,” “traitors” and “RINO’s.” They make no distinction between McCain (who is a “RINO” in my opinion), and Texas’ Senior Senator, John Cornyn, promising to “primary” the latter in 2014.
I urge Senator Cruz and all conservatives to work to build up, not tear down. Do not join the Dems in emotional attacks and accusations. Most of all, don’t turn this into a 3-sided fight between the Dems, the Republicans, and the other Republicans.
Edited to add link to article on John Cornyn. BBN
If you only read the headlines and first paragraphs of – or the inflamed comments on – the media coverage of the debate over the Federal budget, you might believe that Republican leaders in the Senate are caving to the Democrats on funding Obamacare. In fact, Senators Mitch McConnell and John Cornyn and Senate Republicans recognize and support the House Continuing Resolution which fully funds the Federal government while defunding Obamacare.
There aren’t just two sides to the story. In fact, the media reports obscure that there are three factions: Harry Reid’s Dems, Republicans who support for the House continuing resolution, and In fact, there are three factions: Harry Reid’s Dems, the Republicans who are garnering support for the House continuing resolution, and the Republican efforts led by Senator Ted Cruz to block even the House Bill by filibuster. Hopefully, Senator Cruz will acknowledge that the House CR makes his filibuster unnecessary.
The House Continuing Resolution is a good Bill, allowing the continuation of the Federal government into December. It’s true that the whole budget debate will continue — but wouldn’t it any way?
“. . . graduate from high school, keep your first job for over 1 year, get married and stay married.”
Common sense, right? Okay, it’s not as easy as 1-2-3, and association doesn’t equal causation, but who would argue, right?
“Politifact Texas” would. The Politifact.com website claims to fact check political news and news makers’ comments, and has a Texas Edition. In my opinion, they tend to hit such comments from the Left of center. In this case, they seem to go out of their way to prove Texas Rail Road Commissioner Barry Smitherman wrong, but – even by stressing the importance of the economy in the equation – they prove him right.
Take a few steps, Barry Smitherman said, and you won’t live in poverty. Smitherman, seeking the 2014 Republican nomination for Texas attorney general, put his point this way in prepared remarks for an Aug. 26, 2013, appearance before the Texas Alliance for Life: “Several years ago, the Economist magazine published a piece which said that you only have to do three things to guarantee that you will live above the poverty line—graduate from high school, keep your first job for over 1 year, get married and stay married.”
The rest of the article traces the history of the publications that make the claims to which Commissioner Smitherman refers.
Bookmark this page: “Choosing Wisely: Lists.”
Whether you are seeing your doctor for a cold, a routine physical or a “new patient visit,” or when you suspect that he’s offering you the
famous notorious “blue pill or red pill,” how do you as a layman know whether a medical test or procedure is needed? Will it lead to a treatment decision or just more tests? Does it help? Or does it actually cause harm?
Or politically, will ObamaCare cost cuts and rationing deny you a procedure, test, or treatment that would be helpful?
The American Board of Internal Medicine Foundation asked the various physician sub-specialty organizations in the US to list tests, treatments and procedures that don’t help or might actually hurt patients. The lists are published on the “Choosing Wisely” website.
Remember, there’s a difference between screening tests that look for something you might have, and diagnostic tests to explain a symptom from your history or chief complaint, a finding on an exam or to determine whether a treatment is working or harming. And there’s certainly a difference between starting a treatment, doing a procedure or ordering a test that leads to more risk than the disease or condition we’re treating just because . . . of money, out-of-date knowledge, or patient desire. Or because we can.
Whatever health care problem or concern you have, take a look at the list from the medical specialty for the pertinent body part or organ system. Which tests and procedure do you need, and which have you had that are on these lists?
I don’t quite agree with all the items on all the lists. After all, patient care is not a recipe from a given cookbook – and besides, patients’ bodies can’t read the books to follow the recipes.
Let’s talk! Ask me questions and/or let me translate the jargon.
Nothing in the world is free, but we’re being told that a lot of expensive health care will be, thanks to ObamaCare. Why would anyone think that this time, government interference will result in anything different?
The savings talked about in this article aren’t an option for anyone eligible for Medicare, because few doctors and virtually no surgical facilities are willing to take their cash since any “provider” who enters into these cash-pay contracts must “opt out” of Medicare for two years.
Jeffrey Singer writes about the benefits of self-pay medicine and the hazards of involving a third party in the Wall Street Journal:
This process taught us a few things. First, most people these days don’t have health “insurance.” They have prepaid health plans. They pay premiums to take advantage of a pre-negotiated fee schedule arranged for and administered by a third party. My patient, on the other hand, had insurance.
Second, even with the markdown for upfront “cash-pay” patients, none of the providers was losing money on my patient. Otherwise they wouldn’t have agreed to the prices. With the third-party payer taken out of the picture, we got a better idea of the market prices for the services. It is the third-party payment system that interferes with true price competition, so “market clearing prices” can’t develop.
Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care.
When my patient returned for his post-op visit we discussed the experience. It was clear to both of us that the only way to make health care more affordable is to diminish the role of third-party payers. Let consumers and providers interact through market forces to drive down prices and drive up quality, like we do when we buy groceries, clothing, cars, computers, etc. Drop the focus on prepaid health plans and return to the days of real health insurance—that covers major, unforeseen events, leaving the everyday expenses to the consumer—just like auto and homeowners’ insurance.
A little history: Before I went to Medical school, my husband and I felt lucky to have major medical insurance, to cover hospital bills and some procedures. We paid cash for office visits – less than we pay for co-pays now. My first childbirth wasn’t covered by insurance, but we paid less than $1000, including the hospital and the $300 to the doc. Twenty years ago, I received $1100 (Medicaid) to $1800 (Insurance) for pregnancy and delivery Obstetrical care and the hospital charged about the same. Today, the total is $20,000 or more. (In Texas, 55% of those babies are paid for by you, the taxpayer, through Medicaid.)
While some people think our National problems began back when employers first started offering insurance, at least that was insurance and medical costs remained fairly stable until the late 1960′s. The real problems began when Medicare allowed Congress to collect taxes with a promise of a (hospital, Part A) safety net for those over 65, but spent all the money by “loaning” it to the general budget. From the beginning, Medicare inflated costs by encouraging doctors to raise their fees 10% a year. Private health care costs followed or leaped ahead.
Less than 10 years later, the Democrat Congress invented HMO’s in a failed attempt to control costs – but they still didn’t stop spending Medicare and Social Security dollars. A few years later, there was the very mistaken attempt to limit training to cut the numbers of doctors. The Hill-Burton Act, Stark laws, HIPPA, and on and on, further increased the actual costs, the hassle factors, and government ownership of medical care, while promising more by adding outpatient and drug coverage. Bill Clinton’s Attorney General Janet Reno not only armed Donna Shalala’s Health and Human Services Inspectors, she threatened to prosecute Medicare-eligible patients for contracting private pay agreements with their doctors. She and Shalala held “fraud rallies” in football stadiums with the Director of the FBI, to teach Medicare patients how to turn in their doctors for fraud.
If there is to be a government “solution” (short of getting out of the way), future laws should support innovations like “Direct Primary Care” combined with patient-owned major medical *insurance,* rather than pre-paid health care. For those who truly need help, give tax credits similar to the child credit or even the earned income credit.
Just in case you thought we were exaggerating:
The missed deadlines have pushed the government’s decision on whether information technology security is up to snuff to exactly one day before that crucial date, the Department of Health and Human Services’ inspector general said in a report.
As a result, experts say, the exchanges might open with security flaws or, possibly but less likely, be delayed.
When people try to enroll in health insurance starting on October 1 for insurance plans taking effect in 2014, their identity, income and other information they furnish with their application will be funneled through a federal “data hub.”
The hub is like a traffic circle for data. It does not itself store information, but instead has digital spokes connecting to the Internal Revenue Service and other agencies that will allow it to verify information people provide. Opponents of Obamacare have repeatedly raised concerns that sensitive personal information could be stolen.
Hat Tip to Congressman Michael Burgess and today’s “TMA Member Physician’s Daily”
From the Greg Abbott Campaign website:
Communications Director Matt Hirsch speaks with Dr. Beverly Nuckols on location at The Texas Mailhouse in Austin about the negative impact ObamaCare is having on small businesses and the health care industry, while U.S. Secretary of Health and Human Services tries to sell an unworkable, expensive healthcare takeover in Texas.
(I’m a doctor, not an audio/visual expert. And I certainly can’t afford one. Since I can’t get the podcast to embed, so please go to the site. While you’re there, volunteer, donate, help out!)
From the USAToday, August 8, 2013:
When California announced that individual premiums in its health insurance exchange could be 29% lower than expected, President Obama cheered. When Indiana announced premiums might be 72% higher than before, state officials predicted doom. So who is right? Are health insurance premiums going up or down?
We don’t know, at least in part, because both sides are playing with the numbers. To be sure, natural variation exists in how state insurance markets will be affected, but consumers should also be aware of how premium comparisons are twisted to reach predetermined results. Here are five ways they have been slanted: . . .
read more via ObamaCare’s effects difficult to measure: Column.
Edited 8-9-13 – Changed the title and post to make it more clear that this is from the USAToday, not my own writing. BBN
Peggy Fikac once again proves that she’s not a reporter, and most certainly not anything like a fair and balanced media representative.
From the Houston Chronicle’s coverage of events in Austin, today:
“Obamacare is the wrong prescription for American health care, and I will never stop fighting against it,” Abbott said, joined by small business people and a doctor who also oppose the law at a company, the Texas Mailhouse.
One reason that Abbott gave for fighting the law came in response to a doctor who asked him from the audience about what Texas could do to keep the federal law from interfering with doctors’ judgment about the best way to treat their patients.
“You’re raising one of the more challenging components of Obamacare, and a hidden component in a way, and that is government is stepping in between the doctor-patient relationship and trying to tell you what you can and cannot do, interfering with both your conscience and your medical oath to take care of your patient,” said Abbott, who is campaigning to succeed Gov. Rick Perry.
That is similar to arguments raised against tighter abortion restrictions approved in special session, including a ban on the procedure at 20 weeks, along with stricter regulations on clinics and abortion-inducing drugs.
I am that doctor from the audience. Ms. Fikac is correct that I voiced concern over the Federal interference between the patient and the doctor. She’s flat wrong about Texas regulation of medicine by bring abortionists up to standards being equivalent to the
I prefaced the question by noting that it is the State of Texas that properly regulates Texas Doctors and medicine. At the State level, patients and doctors have more influence on our elected officials and the people they appoint to write regulations and enforce the law than we do on the Federal level.
I also noted that because of the increasing interference over the years by Medicare, I am concerned about the reach that this new set of regulations will have, including ever-invasive micro-reporting of patient’s private medical conditions. (I named the upcoming move to the ICD-10, which will be a nightmare, requiring doctors to make distinctions between medical conditions, out to five (5) decimal places.
As bad as the bureaucracy of the Office of the Inspector General for the Federal Health and Human Services and the Centers for Medicare and Medicaid Services have been in the past, I don’t look forward to the additional layer of IRS income verification, audits and enforcement.
We could stick closer to home, with the Texas Health and Human Services, the Texas Medical Board, and the Texas Insurance Commission!
Conscience? More “Trust me, I’ll violate my conscience” news:
Tolerance. Diversity. Broad-mindedness. Those are the words.
Bullying. Discriminating. Compelling. Those are the deeds.
The contradictory words and deeds often come from one and the same individuals–and in a case I learned about today, companies. Turns out the words of tolerance, diversity and broad-mindedness only apply to those who comply with the dogma and submit to the will of the speakers.
Here’s an email I received this morning from a pharmacist member of the Christian Medical Association:
“Subject: Forced to resign over mandate to sell the morning after pill.
“Just to let you know that Rite-Aid corporation came out with a stricter policy on July 5, 2013 that requires all employees to accommodate the sale of the morning-after pill to all comers, of either gender and of any age.”
While I don’t believe that Plan B is an abortifacient, I do believe it’s a powerful drug and that adolescents shouldn’t be able to buy it over the counter. I also find it hard to trust someone who will agree to go against their conscience!
A real-life, real medicine tale of the risk that doctors face – and are willing to face – when taking care of our patients under arbitrary and often outdated Medicare regulations. It will only get worse under ObamaCare and the IRS.
He was a slender-framed man, mid- to late-sixties, with a kind of ridden-hard-put-away-wet complexion. It was clear the years had not always been good to him, but being the kind soul that he was, he had plenty of friends. It was a beautiful summer day to spend with friends for a barbecue, but he arrived feeling puzzled why he collapsed at home earlier in the day.
He stopped at the keg and poured himself a beer in a red solo cup, and as he approached his friends with a smile, he did it again, this time which such gusto that his beer went flying and the thud he made when he hit the ground made everyone gasp. He laid motionless for a moment face down on the ground while his friends rushed to his aid. An ambulance was summoned as others rolled him over onto his back. He began to move – slowly at first – then more purposefully. As sirens approached, he asked his friends, “What just happened?’
Read the rest of the story here.
The author’s comments:
It is becoming abundantly clear that conflicts between the [sanctity] of human life will confront the government’s unwillingness to pay for procedures. No where is this more clear than with approval of payment for the implantation of an ICD, which might run in excess of $200K for the procedure at some instituions. As a result, doctors who strive to provide state-of-the-art care to their patients will continue to confront similar ethical dilemmas that risk their legal standing (and credentials) as they care for their sickest arrhythmia patients.
By publishing this case scenario, my hope was to draw attention to these ethical dilemmas that are becoming increasingly prevalent in medicine as a result of these outdated, inconsistent, and incomplete coverage decisions, guidelines for care, and “appropriateness use” criteria. Further, the potential for legal action against physicians y imposes real fear for do
ctors if they stray at all from these outdated decisions. This fear is to the point where it might do actual harm – and even cause death – to patients who are left without appropriate treatment as a result.
In spite of repetitive fraud, in spite of Texas’ laws prohibiting sending money to affiliates of abortionists, in spite of all our work.
Planned Parenthood clinics could be facing a legal fight that could keep them from receiving funding for impoverished Medicaid patients.
When the state passed the Women’s Health Program in 2005, legislators said the intent was to provide more family planning services, but not abortions, to low-income Medicaid patients.
State Sen. Bob Deuell said due to a loophole in the law, Planned Parenthood is part of the program, but thinks they shouldn’t be. As such, he has requested the attorney general clear up the matter.
While Sen. Deuell admits he isn’t in favor of Planned Parenthood, he said his “goal is to provide comprehensive care and — abortion issue aside — the Planned Parenthood clinics don’t provide comprehensive care.”
It could take Attorney General Greg Abbott months to give his opinion.
In a brief HHSC officials sent to Abbott, they told him if the agency limits providers based on the way the law currently reads, the state risks violating Medicaid rules. State health officials said that could result in a loss of federal funding for the program.
It’s possible that I can be bought, and no one’s come up with the right amount of money (or pens or pizzas), yet.
Or maybe, just maybe, I’m honest. Of course not!
I’m assumed to be guilty (where’s the opportunity to prove innocence, much less their duty to prove me guilty?) of all sorts of fraud by authors of the Physician Payments Sunshine Act included in the thousands of pages of PPACA – otherwise known as Obamacare:
From now on, companies must keep track of virtually every payment and gift bestowed on each clinician and report them to the Centers for Medicare & Medicaid Services (CMS), which will report them to the world.
This accounting exercise stems from a provision in the Affordable Care Act (ACA) that seeks to expose the financial dealings between industry and physicians and discourage conflicts of interest for the latter that might skew education, research, and clinical decision-making. Under the ACA provision, called the Physician Payments Sunshine Act, drug and device makers must report any “transfer of value” of $10 or more made to a physician. Transfers of value under $10 — a cup of coffee, say — aren’t reportable unless they add up to more than $100 in a year. Companies also must disclose whether physicians have any ownership stake in them.
Of course lawmakers assume that we’re being bribed – that’s what they do! Why aren’t the limits at least as high as those our Senators and Representatives are allowed? Like Democrat Senator Harry Reid, can we form a “Friends of Dr. Practice” and get more, as long as we don’t accept donations at our office?
BTW, there’s an app available to help doctors keep up with the bribes.
The $1.4 Million previously reported was the part that Texas will receive, not the total. Can you guess how the (very few) media reports (if you can find them) are playing the story?
From the July 30, Houston Chronicle:
Planned Parenthood Gulf Coast Tuesday settled a whistle-blower lawsuit that alleged the Houston nonprofit engaged in fraudulent Medicaid billing for $4.3 million – nearly $3 million more than was announced last week by Texas Attorney General Greg Abbott.
Yes, Planned Parenthood is quoted as claiming that the settlement for the AG’s finding that they are guilty of over $30M in fraud is “baseless” and simply a way to end harassment and to avoid turning over the (altered) medical records of patients. But the spin on the story is that Texas’ Attorney General, Greg Abbott, didn’t report the total and sent out his announcement before the settlement was signed by all parties.
My news search yields some op-eds and stories by Texas’ newspapers and a few more on pro-life sites.
In the meantime, doctors who still accept Medicare (not hospitals or other “providers”) are facing decreased payments and increased hassles.
As President Barack Obama’s health care law moves from theory to reality in the coming months, its success may hinge on whether the best minds in advertising can reach one of the hardest-to-find parts of the population: people without health coverage.
The campaign won’t come cheap: The total amount to be spent nationally on publicity, marketing and advertising will be at least $684 million, according to data compiled The Associated Press from federal and state sources.
Brain drain? In DC? Oxymoron?
Now that the time to sign up for exchange coverage is nearing, a Democratic member, Rep. John Larson (D., Conn.), is saying that “this is simply not fair” – as key staff members head for the exits to avoid Obamacare.
Politico reports that “many on Capitol Hill fear it could lead to a brain drain” and notes that “[t]he problem is far more acute in the House, where lawmakers and aides are generally younger and less wealthy.
I wrote this to the San Antonio Express News, in response to an “Other Views” Commentary a couple of weeks ago that claimed our pro-life HB2 violated the “separation of church and state.” It was rife with errors, easily corrected:
1. Abortion isn’t “private.” It is performed by licensed doctors in licensed abortion facilities, under laws regulating the practice of medicine passed by the elected Legislature of the state of Texas.
2. Women’s health and family planning clinics that offer federal and state funded health and cancer screenings and contraception are prohibited by both state and federal law from performing elective abortion. These clinics aren’t licensed abortion facilities and aren’t affected by HB2.
3. After Pennsylvania, Virginia and Missouri passed laws requiring safety standards similar to those in HB2, most abortion facilities in those states remained open.
4. Abortion facilities are allowed 16 months to come up to standard. If abortion facilities close, it will be because business owners decide not to invest in their facilities.
5. HB2, like earlier Texas laws, protects the mother if her life is endangered by continuing the pregnancy.
6. HB2 doesn’t create any criminal charges for the mother, only for physicians who perform illegal abortions after five months.
HB2 does require doctors who perform abortions to have admitting privileges in case their patients have complications requiring hospitalization and abortion facilities to meet building standards known to improve patient safety.
More, including some philosophy, via Protect the right to life – San Antonio Express-News.
#Stand4Life: As only a woman with first-hand experience can tell us:
If a woman tells her doctor she wants to have a double mastectomy, the doctor won’t assume she’s made a sound decision. He or she will want to review her health history, get a detailed family history, find out if the woman has tested positive for the gene that will put her at increased risk, and so forth.
Similarly, when a woman expresses her desire to have an abortion, the health care provider should not assume she’s making a sound decision. It is their duty to make sure she understands her Carbaby’s development, including a way for her to see an image of her baby. And if that’s not possible, at least an image of a baby at the same developmental stage. Pregnant women deserve exposure to as much information as possible. I would argue that there is no more serious matter than the creation of a new life, save the destruction of it. This is no time to withhold vital information and resources.
As a point of comparison, several years ago my routine screening mammogram showed something abnormal. The immediate follow up diagnostic mammogram confirmed an abnormal mass. The radiologist brought me into her office to discuss the images with me. She showed me the area of concern. Explained the difference in color and shadow and what that meant. She also discussed why the image suggested a mass that was hard, and why that added to her concern. She recommended we move forward with an ultrasound and a fine needle aspiration. Throughout the entire discussion she checked in to make sure I understood everything. She invited questions. During the fine needle aspiration, she showed me the image on the monitor as she was guided with the needle to the area in question. When she withdrew the contents of the mass, she showed it to me and explained, to our great relief, that it appeared that I had nothing more than a benign cyst.
Looking back, I now realize that I knew more about the cyst in my breast than the 3-month old baby who once grew inside me. And that is dreadfully wrong. Not because I knew too much about the cyst. But because I knew too little about my baby.
Edited – title for typo – 8/1/13 at 7:45 AM — BBN
Oh! What a tangled web we weave . . .
Under a wrinkle that dates back to enactment of the law, members of Congress and thousands of their aides are required to get their coverage through new state-based markets known as insurance exchanges.
But the law does not provide any obvious way for the federal government to continue paying its share of the premiums for the comprehensive coverage.
(Or, how I ensure that I never run for office in San Antonio.)
For the last few months, the San Antonio City Council has been considering a “Non-discrimination ordinance” in which they pretty much discriminate against the First Amendment rights of free speech or free exercise of religion. If passed, it would prevent anyone in the City of San Antonio from running for office or being appointed to a citizens’ committee – or from holding office if elected – who advocates for traditional marriage or speaks or writes about their religious belief that homosexuality is a sin. It also looks like a great way to slide into a San Francisco-style attempt to give out same sex marriage licenses.
Sec. 2-552. – Appointed Officials, Boards and Commissions.
(a) Appointments to Boards and Commissions.
When making appointments to boards and commissions, the City shall not discriminate on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, veteran status, age or handicap disability.
(b) Prior Discriminatory Acts.
No person shall be appointed to a position if the City Council finds that such person has, prior to such proposed appointment, engaged in discrimination or demonstrated a bias, by word or deed, against any person, group or organization on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, veteran status, age, or handicap disability.
(c) Discrimination by Appointed Officials – Malfeasance.
(1) No appointed official or member of a board or commission shall engage in discrimination or demonstrate a bias, by word or deed, against any person, group of persons, or organization on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, veteran status, age or handicap disability, while serving in such public position.
(2) Violation of this standard shall be considered malfeasance in office, and the City Council shall be authorized to take action as provided by law to remove the offending person from office.
Once the City tramples on the First Amendment, it’s not so hard to take (more) control of what should be private property and the free citizen’s means to make a living.
Property owners in San Antonio are no different from those in most cities. They don’t really own their property. They merely pay rent in the form of taxes and fees for the right to use it until a majority of their neighbors – or their elected representatives – decide to take control of a portion of it. If you don’t believe me, just try to build a home 1 foot higher than City ordinance allows or buy a house across the street from Schlitterbahn in my town of New Braunfels with the intention of renting it by the night or week to tourists.
But the new San Antonio ordinance goes a little farther. It doesn’t just prohibit action – it forces action by creating a new Class C misdemeanor for discrimination on the basis of gender identity or sexual orientation. So, everyone who sells their home, rents their property or makes a living as a wedding photographer would now be forced to rent or sell to, or work for people engaged in activities that goes against their religion.
SECTION 10. Discriminatory practices in the provision of public accommodations and housing shall be a Class C misdemeanor and, upon conviction, shall be punishable in accordance with Chapter 1, Section 1-5 of the City Code. The penalties contained herein are non-exclusive and the City shall have any and all remedies to which it may be entitled in law or in equity. The exercise of any penalty or remedy by City shall not be deemed as a waiver of any other remedy to which the CITY may be entitled.
City Council member Diego Bernal has said he plans to take out the section about bias. However, nothing’s official, yet. If you would like to let the Council know how you feel before they consider the ordinance on August 2, you can read the actual ordinance, here. That link also has the names of Council members and their phone numbers.