Medicine

A tax for doing nothing

From a blurb on Taranto’s The Best of the Web Today, today:

After the court’s ruling in NFIB v. Sebelius, the mandate, of course, is not an actual legal command, but, as Chief Justice John Roberts put it, merely the establishment of a “a condition–not owning health insurance–that triggers a tax–the required payment to the IRS.”

Every time I think of Justice John Robert’s declaration that the ObamaCare individual mandate is does not carry an individual penalty, but rather, a tax, I become angry. It makes as much sense as his messing up the Oath of Office on January 20, 2009 followed a day later with the “real” oath.

I still don’t get Robert’s logic. It’s a tax, because you only pay fines when you commit an act. Or is it a tax because you pay the IRS?   Whatever, in order to not pay, you have to sign up for the exchanges, which then “ping” the IRS to find out about your income.

Luckily, I have a bit of an attention deficit.*  So, then I start thinking about how much Congress should owe the rest of us because they do nothing – or at least not what we want. The motto ought to be, “It ain’t fine!”

* (: It’s not a disorder if it helps you get through the day.)

UnitedHealthcare drops physicians from Medicare plan – Financial Mines

“Keep your doctor?” NOT!

Physicians across the state are reeling after they were informed that they will no longer be participants in a popular Medicare program.

UnitedHealthcare sent a letter dated Oct. 2 to 810 primary care physicians and 1,440 physician specialists, telling them that the separation from its Medicare Advantage network would be effective Feb. 1, 2014.

The business, a unit of Minnetonka, Minn.-based UnitedHealth Group, said affected physicians have the right to appeal and told them that their agreements for other UnitedHealthcare networks will not be impacted.

The notification came as a surprise to the Fairfield Medical Association, which counts 1,499 physicians in its ranks.

“They’re letting 19 percent of the physicians in the network go,” said Mark Thompson, executive director of the association. “This is where insurance companies are using insurance contracts to interfere with the doctor-patient relationship.”

via UnitedHealthcare drops physicians from Medicare plan – Financial Mines.

ObamaCare begins to “Ping” the IRS for information

What might have been missed in all the emotional media coverage about the troubles people are having with the ObamaCare exchanges and the news that the IRS official shared tax information with the WhiteHouse:

Hall Ingram said a key piece of the healthcare law’s new infrastructure — the federal “data hub” — is working well.

When consumers apply for insurance and tax subsidies through an exchange, the exchange uses the data hub to draw information from several state and federal agencies to confirm applicants’ identity and calculate the subsidies they can receive.

Exchanges have successfully pinged the IRS’s servers to request income information about applicants, and the IRS has been able to respond, she said.

“As far as we can tell, and we are looking on a daily basis, it\’s operating well,” Hall Ingram said.

via GOP grills IRS’s ObamaCare chief – The Hill’s Healthwatch.

BOR: Lies from the Left (I know, it’s redundant)

And BOR is a much better acronym than anything I could make up.

The Burnt Orange Report is Texas’ own quintessential leftist blog, spinning and twisting any stories or facts to make conservatives look bad.

Good little far-left Democrat media tool that the BOR is, it seems almost superfluous to note that the blog is pro-abort. However, the reason I’m bringing BOR to your attention is Part 1 and Part 2 of “Why Texas Women Need Access to Later Term Abortions by someone named Natalie San Luis.

The BOR enjoys bold exaggeration in its fonts, to highlight the most emotional rants. There are the usual facetious arguments that women need abortions after 5 months such as, “wealthy women who have the means can jump over the barriers, but more and more women can’t” and “Amniocentesis, which tests amniotic fluid for fetal abnormalities and genetic problems, is sometimes performed as late as 22 weeks.” (The babies of less than wealthy women and their mothers deserve protection, too. And amniocentesis is usually done much earlier  and is still legal, just as it is at 30 weeks or 35.)

Ms. San Luis would also have us develop sympathy for doctors who fear the liability of making a decision about whether a baby’s birth defect is compatible with life.

After. 20. weeks.

Because: ” Accounting for factors like the woman’s health history and future complications, it is almost impossible to accurately guess the likelihood of fetal survival in each of these cases. “

(Maybe that’s why they can’t get local hospital privileges.)

While I can mock the poor logic of the author, it’s better to catch her repeating easily checked, but false “facts.”

The founder, President and CEO of the San Antonio Abortion facility, Whole Woman’s Health, Amy Hagstrom Miller, is quoted as saying, “We’ve seen a 10 percent increase in second trimester abortions just since the sonogram bill has passed,”.

Besides the fact that there’s only one year of data available “since the sonogram bill has passed” and went into effect in late 2011, the numbers don’t back up that statement, unless it’s local to the San Antonio facility.  According to numbers from the Texas Department of State Health Services, there were 136 fewer 2nd trimester abortions in Texas in 2012 than in 2011.

Year      Total Abortions      2nd Trimester Abortions  1st Trimester Abortions   %1st

2012       66098                          5204                             60882                          92.1
2011       72470                          5340                             67121                          92.6
2010      77592                           5542                             72042                          92.8

(I couldn’t resist showing the steady decrease in abortions in Texas, even though it horrified me to put those large numbers into the calculator.)

Did anyone else notice that there’s no obvious way to make comments on BOR?

Edit 10/10/13 – correcting punctuation, removing my own redundancies — BBN

Obama Stumbles Despite Friendly Press « Commentary Magazine

After explaining his “history,” of posturing and hiding unpopular legislation by attaching it to another Bill, President Obama truly stumbles:

“And you know, we don’t get to select which programs we implement or not.”

via Obama Stumbles Despite Friendly Press « Commentary Magazine.

Iguess it depends on the meaning of “select,” because as the article notes,

“Obama chooses which parts of which laws he wants to implement and enforce at will, as if Congress were a supercommittee brainstorming ideas rather than a coequal branch passing laws . . “

‘Gestapo’ tactics meet senior citizens at Yellowstone » Local News » NewburyportNews.com, Newburyport, MA

Not even allowed to take pictures!

Rangers systematically sent visitors out of the park, though some groups that had hotel reservations — such as Vaillancourt’s — were allowed to stay for two days. Those two days started out on a sour note, she said.

The bus stopped along a road when a large herd of bison passed nearby, and seniors filed out to take photos. Almost immediately, an armed ranger came by and ordered them to get back in, saying they couldn’t “recreate.” The tour guide, who had paid a $300 fee the day before to bring the group into the park, argued that the seniors weren’t “recreating,” just taking photos.

“She responded and said, ‘Sir, you are recreating,’ and her tone became very aggressive,” Vaillancourt said.

The seniors quickly filed back onboard and the bus went to the Old Faithful Inn, the park’s premier lodge located adjacent to the park’s most famous site, Old Faithful geyser. That was as close as they could get to the famous site — barricades were erected around Old Faithful, and the seniors were locked inside the hotel, where armed rangers stayed at the door.

“They looked like Hulk Hogans, armed. They told us you can’t go outside,” she said. “Some of the Asians who were on the tour said, ‘Oh my God, are we under arrest?’ They felt like they were criminals.”

via ‘Gestapo’ tactics meet senior citizens at Yellowstone » Local News » NewburyportNews.com, Newburyport, MA.

NEJM “I want” ethics

In the Abolition of Man, C.S. Lewis notes that, “When all that says ‘it is good’ has been debunked, what says ‘I want’ remains.”

Last week, the New England Journal of Medicine published a “Perspectives” column, “Life or Death for the Dead Donor’s Rule?,” in which the authors  illustrate Lewis’ point with their redefinition of non-maleficence to better serve a re-defined autonomy.

They would convince us that there is no harm in hastening the death of a dying patient even by intentionally causing it if he or his surrogates ask. They ignore a 2500 year old First Principle of Medical ethics,focused on the health of the patient in front of us: “Cure when possible, but first do no harm, ”

Autonomy, like all rights, is a negative right: the patient has the right to refuse invasive medical interventions that will harm him or that he does not want. Patients and surrogates, if they can compel the use of medical skills and invasive technology, can only do so for the medical benefit of the patient himself.

Illogically, in these times of reducing costs, the authors would have us consider taking a patient from the ICU to the OR “and then take him back to where life support would be withdrawn.” The return to the ICU is nothing but our own “medical charade.”

The Abolition of Man can be read online, here, or you can buy the Kindle version at Amazon.com.

I want to thank Nancy Valko, who runs an email list covering a range of traditional ethics issues, her email alerting me to this editorial.

“Choosing Wisely” doesn’t

Back in September, WingRight promoted a program, “Choosing Wisely,” an initiative by the American Board of Internal Medicine. Well, the other shoe dropped.

For years, I’ve told patients that we need to periodically screen for hypertension and diabetes because most people don’t feel bad when their blood pressure or blood sugar is high. The Center for Disease Control reports that about a fifth of people with high blood pressure and that nearly a third of diabetics are undiagnosed.

But these facts didn’t impress the Society of General Internal Medicine, which released their “Choosing Wisely” list suggesting that doctors not ask non-insulin dependent diabetes patients to check their sugars at home or schedule “routine general health checks for asymptomatic adults,” including the ‘health maintenance’ annual visit”  The SGIM claims that these common medical practices cause more harm than good — or is it that they cost more money than they save?

Even the CDC is victim to the #ShutDown #TemperTantrum!

Someone was paid to put this notice on the Centers for Disease Control website! On the home page, it’s on a red background! (But don’t worry: they also have a reminder to sign up for ObamaCare.)

Due to the lapse in government funding, only web sites supporting excepted functions will be updated unless otherwise funded. As a result, the information on this website may not be up to date, the transactions submitted via the website may not be processed, and the agency may not be able to respond to inquiries until appropriations are enacted.

Updates regarding government operating status and resumption of normal operations can be found at http://www.usa.gov.

via CDC – Diabetes Public Health Resource – Data & Trends.

Update, 7:30 PM 10/7/13: The National Institutes of Health also has a disclaimer.

The New Face of Prejudice – WSJ.com

I’ll let you read the translation byJames Taranto’s Best of the Web Today (in the Wall Street Journal) of this little bigoted “memo” against the Republicans, the Tea Party and Evangelicals sent out by “Democracy Corps'”  Stan Greenberg and James Carville on your own ( The “memo” is also available for download online in pdf) , but you probably won’t have too much trouble anticipating it from this excerpt:

We expected that in this comfortable setting or in their private written notes, some [participants] would make a racial reference or racist slur [sic] when talking about the African American President. None did. They know that is deeply non-PC and are conscious about how they are perceived. But focusing on that misses how central is race to the worldview of Republican voters. They have an acute sense that they are white in a country that is becoming increasingly \”minority,\” and their party is getting whooped by a Democratic Party that uses big government programs that benefit mostly minorities, create dependency and a new electoral majority. Barack Obama and Obamacare is [sic] a racial flashpoint for many Evangelical and Tea Party voters.

How could anyone take seriously a memo co-authored by these two men? Especially one that is supposed to explain Republicans, using “word cloud” graphic, featured above? Mr. Taranto didn’t, but found at least one author on Bloomberg who did.

If you aren’t a subscriber, consider signing up for the free daily email from The Best of the Web.

1996: Virgin Islands beach reopened

Judge orders Virgin Islands beach reopened

January 4, 1996

Web posted at: 12:45 a.m. EST

ST. CROIX, U.S. Virgin Islands (CNN) — A federal judge Wednesday ordered the National Park Service to reopen the Buck Island Reef National Monument despite the ongoing federal budget crisis.

Two Virgin Island residents sued in federal district court to have the park reopened, arguing they were being hurt by the closure of the beach at Buck Island. They said the shutdown had denied them the ability of “freely enjoying a cherished natural resource.” They further argued that the Park Service had violated the federal Open Shorelines Act by closing the beach.

The National Park Service argued it had no choice because the budget crisis had forced it to reduce the normal staff of “two to three employees” to one employee and one volunteer.

via CNN – Virgin Islands beach reopened – Jan. 4, 1995.

Feds “own” or “run” too much – Update

It’s not just that this is the first time that US citizens have been barred from the Lincoln Memorial due to a government shutdown, the National Parks service is barring us from  scenic drives and overlooks on public and state highways, open beaches and the waters around them, and private businesses that are paying tenants of “government” lands and waters.

One former Secretary of the Interior, Gale Norton, flatly states that these decisions are political and most likely being made in the White House.

Perhaps, instead of blaming one Party or another (or increasing government involvement in something as vital and intimate as the delivery of medical care), it’s time to decide whether our government is responsible enough to own and control so much of our lands.

Update: more closings

1. The City Tavern in Philadelphia, because the Feds own the building, not the business.

2.Nauset Knoll Motor Lodge, which leases land in Cape Cod National Seashore.

3. All sorts of fishing, rafting and hiking. Search the news on any of these topics – there are too many to post.

4. Government sponsored travel, such as the President’s Asian trip. But it also will block scientific conferences. 

Edited Oct 4, 2013 at 2 PM to change the picture to one that I own.

White House Ordering Hundreds of Privately Run, Privately Funded Parks to Close

The order to shut down business that pay money to the Federal government rather than cost money came from ” ‘above the department’, which I presume means the White House” . . .

“My company, based in North Phoenix, operates nearly over 100 US Forest Service campgrounds and day use areas under concession contract. Yesterday, as in all past government shutdowns, the Department of Agriculture and US Forest Service confirmed we would stay open during the government shutdown. This makes total sense, since our operations are self-sufficient (we are fully funded by user fees at the gate), we get no federal funds, we employ no government workers on these sites, and we actually pay rent into the Treasury.”

via The PJ Tatler » BREAKING: White House Ordering Hundreds of Privately Run, Privately Funded Parks to Close.

Experts Suggest Software Problems, Not Just Demand, May Be Behind Marketplace Glitches – Kaiser Health News

“This is not a glitch. A glitch is a minor problem,” said Robert Laszewski, a consultant and former insurance executive. “The real story is that the Obamacare computer systems simply are not working.”

via Experts Suggest Software Problems, Not Just Demand, May Be Behind Marketplace Glitches – Kaiser Health News.

Study: 20,000 a Year Will Go Without Abortions Due to Texas Law

Texans paid for this study by the University of Texas College of Liberal Arts, Texas Policy Evaluation Project, founded to “evaluate” the effect of the 2011 State budget cuts on Family Planning, ignoring the deep cuts on everything else the State funded. (Speaking of ignoring: the website hasn’t updated the information on Family Planning since the 2013 Legislature added over $200 Million dollars to the program.)

Tx-PEP, as they call themselves, got some publicity on a San Antonio radio station, WOAI, today, complaining that women will have to “go without” elective abortions.

A pro choice activist group says the strict new abortion restrictions which were approved by the Texas Legislature in July will result in more than 22,000 Texas women per year being unable to undergo an abortion, 1200 WOAI news reports.

“Women particularly in rural areas and outside of cities who want to terminate a pregnancy, will have no recourse because there will be no late term providers left,” Jody Jacobsen of the Texas Policy Evaluation Project, told 1200 WOAI news.

Elective abortions are “elective.” These are not abortions to save the life of the mother. They are abortions due to “choice.”

Of course, the Texas Policy Evaluation Project doesn’t admit that none of the current abortionists are in rural areas. In other words, anyone seeking an elective abortion today must go to a big city and may be inconvenienced.

Forget any pretense at impartiality:

  The laws do not cover women who are less than twenty weeks gestation, and abortions will still be available to them.

  But Jacobsen says it’s all a matter of personal freedom.

  “Who is Rick Perry to tell me what decisions I should or should not have made, or what any other woman should or should not have made,” she said.

Special penalties in USVI during shutdown

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?

The Government Shutdown Goes Caribbean

Shutdown 2013: Furloughed Workers Signing Up As Tourists Guides (Demonstrating in Union shirts)

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.

via Shutdown 2013: Furloughed Workers Signing Up As Tourists Guides, Sans Pay – Skift.

Padre Island National Seashore Closes (even the Gulf water!)

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.

via Padre Island National Seashore Closes After Government Shutdown | Corpus Christi, TX | KRISTV.com |.

Nationalization: One step at a time

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

Health Exchanges Debut With Websites Down, Delays – Businessweek

The Obama administration needs some breathing room, said Kathleen Sebelius, the HHS secretary, at a briefing with reporters yesterday.

via Health Exchanges Debut With Websites Down, Delays – Businessweek.

Gohmert Refuses to Take Subsidy Others Don’t Get #MakeDCListen

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.”

via Gohmert Refuses to Take Subsidy Others Don’t Get : U.S. Congressman Louie Gohmert.

ObamaCare isn’t answer for Texas #MakeDCListen

President Obama and all of his appointed Secretaries and czars, most certainly his White House staff, with their high salaries, ought to be forced to accept a “Bronze Plan” on the Federal health care exchange, with either the regular or no Federal subsidy.

While it appears that Obama and the Senate Dems have no intention of compromising, I hope that Republicans win the one year delay – but Health and Human Services Secretary Kathleen Sebellius says ObamaCare will go into effect tomorrow, even if the government shuts down.

ObamaCare is certainly not the answer for my State of Texas. Like the rest of the Country Texans have already started paying increased taxes to pay for a scheme that will help no one until January 1, 2014. Even then, it will hurt many and help very few.

75% of Texans are insured or at least were until this year. They are already worse off under ObamaCare, with higher premiums, higher taxes, and an increased risk of paying taxes on the insurance they do have.

The great majority of uninsured won’t be better off under ObamaCare: a)1/3 to 1/4 of uninsured in Texas are illegal aliens, b) Half of the uninsured in Texas make over $50K a year, c) Texas voters have decided that we won’t expand Medicaid to healthy adults without children who aren’t subjected to any means testing other than annual income.

Senate Dems Sauntering Toward #HarryReidsShutdown #DCtime

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.

Compromise or computers: ObamaCare delay inevitable

 “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.

Abortionists file suit against (only 2) new Texas regulations

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.

Criticizing Cruz

Update, January 25, 2016 Read about the endorsement from Governor Perry

“I wanted to talk about him, who he was, see if I could get a handle on Ted Cruz the man, not Cruz the caricature I’d seen through the political lens. What I found was a very different person than what I had been led to believe.”

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

Federal budget: No real Republican divide

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?

“Choosing Wisely: Five Things Physicians and Patients Should Question”

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.

Dr. Jeffrey Singer: The Man Who Was Treated for $17,000 Less – WSJ.com

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.