The Pitch for The Fix

In his weekly radio address, President Obama cynically encouraged the passage of the “Doctor’s Fix”. This is the recurring piece of legislative legerdemain in which Congress can claim to be pursuing “sustainability”, and fiscal discipline while in fact wasting the treasure of every American. Established law demands that physician payments for medical services decrease in proportion to the deficit produced by Medicare spending. This year, that law requires a 21% reduction in payments to physicians.

During the development of the Obamacare legislation, calculations about the fiscal impact of the plan were based upon the expectation that payments to physicians would be reduced as the law demands. Every one of those lawmakers who voted for Obamacare knew that it would be followed by a “fix” that would reverse the 21% cut in payments to doctors. Given the fact that the law has been circumvented each year since it’s passage, it is hardly surprising that President Obama is pushing for the “Doctor-Fix”. He is in august company, including Democrats and Republicans alike. Who could possibly object to legislation that “supports seniors and doctors”. It is the perfect way to force even the most rigorous “small government” conservatives into compliance. Just imagine the campaign propaganda value of being able to claim that you opponent “voted against your family doctor”.

In this year’s instance, the doctor fix has been folded into a larger piece of legislation that will pump an additional $50 billion into state and local government coffers in the hopes of preventing those governments from laying off public sector union members, particularly teachers. This at a time when public sector hiring is outpacing the private sector by a factor of ten. Government is nourished, while the private sector that pays for government is starved.

As expected, the American Medical Association is playing its part in this annual charade. Their physician website states:

“We are pleased to see President Obama stand with seniors and their physicians today to help stop a looming Medicare meltdown,” said AMA President J. James Rohack, MD. “Already, 31 percent of primary care physicians are limiting care to Medicare patients, according to a new online survey of physicians who treat Medicare patients. Congress’ mismanagement of the Medicare program must end to protect and preserve access to health care for today’s seniors and the baby boomers who begin aging into Medicare next year. “

In one elegant paragraph, Dr. Rohack has praised Obama as a powerful advocate for physicians and patients, while presenting the Congress as the great impediment to progress in the “reform” of health care. The fact is that the AMA, in conjunction with Congress, has been the great engineer of the arcane and impenetrable mystery of medical billing and pricing. The AMA creates the codes, the relative value scales, and the price structure that helps to keep the cost of health care high. The present lobbying effort for the doctor fix, if it continues to pass year after year, will add more than 2 trillion dollars to our national deficit over the next 10 years. The “reform” that the AMA is seeking is a simple one: “Pay for everyone’s healthcare using tax dollars, and don’t even think about cutting payment to any doctor or hospital.” This is neither sustainable nor fiscally disciplined.

Passing the “doctor fix” does not fix anything. It merely serves to give the false impression that Medicare works for another year. It serves to impoverish Americans through confiscatory taxation while promising health care to the poor. The good news is that even the most dedicated statists in Congress are beginning to feel the level of anger among taxpaying Americans. Having passed “Obamacare”, and the “Cap and Trade” legislation, it is apparent that our lawmakers are losing some of that happy-go-lucky spirit that helped to quadruple the deficit in less than two years. Much of that legislation was passed with the votes of lawmakers like Bart Stupak who declared his retirement within days of his vote. The Democrats may be running out of soldiers who are willing to fall on their own swords for the cause of the great socialist utopia.

The President has delivered his pitch, and as has been characteristic for him, the pitch proved to be loopy, awkward, vaguely feminine, and well short of the plate. Where is the phone?

Governor Christie

The Governor of New Jersey explaining governance to a sensitive reporter.

How Long Shall We Live?

When people consider the great triumphs of modern science and technology, it is natural to include medical advancements as among the greatest. The tremendous boon to human welfare produced by medicine goes without question.

The legacy of western medicine is indeed a long one, and we here in the 21st century tend to think of it in terms of scientific breakthroughs, such as the germ theory of infectious disease, surgical antisepsis, the microscope, antibiotics, genetics and so on. Even among these selected topics one could call up endless examples of particular developments that have contributed to our understanding and treatment of disease and disability.

However, there is a breakthrough of philosophy and science that overshadows all of these particular examples; a breakthrough that in fact brought about all these others, and it is the one we are most inclined to forget given the course of contemporary medicine.

Perhaps the chief benefit that we think of when considering the wonders of modern medicine is the lengthening of our life expectancy. We live longer, because medical care has gotten so good at treating what was once un-treatable. There was a time when cancers of the gut were un-treatable. The symptoms of the cancer were understood to signal the unstoppable progression from changing bowel habit, to bleeding, to obstruction and to death. Today, we are able to detect the cancer early, remove it through a series of tiny incisions, send the patient home after a few days, supplement surgery with chemotherapy, and expect that more than half of those patients will live at least another five years.

This is an example of a medical treatment directed at a disease of later life. It is one of the more recent developments in medicine. Whereas in prior eras, medical innovation gained most of its ground in the management of disease on a broader scale, such as vaccination against small pox, water waste management in the prevention of cholera, mosquito abatement to prevent malaria and yellow fever, and the surgical breakthroughs that attend the disasters of war, medicine became more personally targeted beginning in the 1960s, when for the first time health care was directed at a particular group of beneficiaries, namely those over 65 years of age.

In times past, medical research was directed for the benefit of humanity at large. Antisepsis, vaccination, blood banking, bacteriology, and antibiotics didn’t have a particular class of people to whom it was directed. Certainly the weakest among us derived the greatest benefit from these breakthroughs. This is why the primary effect was to reduce infant and childhood mortality, and the mortality of women in childbirth. It was not until the introduction of Medicare in 1965 that research and clinical application began to be directed at a particular class, namely those over 65. Being directed at a particular class, healthcare thereby became a political tool of the first order.

It is instructive to look at what 45 years of Medicare has wrought in terms of life expectancy, and compare it to the effects of medical advancement in general. If we look at the changing life expectancy in the United States during the last century, we see that it grew by about 7 years every 20 years beginning in 1900. A child born in 1900 could be expected on average to live about 49 years. By 1920 that had risen to 56 years, by 1940 to 63 years, and by 1960 the average life expectancy for a newborn would reach 70 years.

If we look at the life expectancy of a 65 year old during those same periods, we see that between 1900 and 1960 it had only risen by a little over 2 years. Clearly this shows us that the major effects of medicine and hygiene on life expectancy happened because infants and children were surviving to adulthood. Over that 60 year period, the medical benefit to the young outpaced the benefit to the elderly by a factor of 14.

So now let us examine the great benefit to the elderly that has been gained by that great juggernaut of state sponsored mercy: Medicare. Let us for the sake of simplicity drop from consideration the first 5 years of Medicare. Let us give Medicare a running start, beginning instead with 1970, looking again at 20 year increments. Between 1970 and 1990, thanks to the investment of 891 billion dollars, life expectancy had risen for a 65 year old by a very unremarkable 2 years! Even more startling is the observation that this is the exact same trend seen in the pre-medicare years. Between 1930 and 1950, life expectancy for a 65 year old increased by 2 years, with negligible expenditure of public monies.

What is particularly depressing to consider is the fact that the 20 year period between 1980 and 2000 shows the curve flattening out. As Medicare expenditures rose approximately 14% per year, we spent approximately 2.5 trillion dollars, and life expectancy for a 65 year old rose by less than 2 years.

Perhaps there is more here than mere life expectancy. Maybe we should consider the much touted benefit of “quality of life” that moderns are always emphasizing. Thanks to Medicare, the elderly are more likely to spend a significant portion of their last years sitting in doctor’s offices, medical laboratories, and medical imaging centers. The elderly are more likely to live their last months in a nursing home, their last days in a hospital, and their last hours alone. And as if this is not bad enough, the elderly are more likely to spend their last days desperately fleeing from their own mortality, seeking cures for the incurable, spending what little treasure remains in their purses. Running from the reality of their impending death, they are more likely to meet death in a state of utter spiritual unpreparedness. Where is the quality of life in any of this?

In Psalm 90, we can glimpse the life expectancy of the Hebrews over 3000 years ago. They were very good at diet, exercise (all that wandering and warfare), hygiene, and quarantine of infectious illnesses:

10 The years of our life are seventy,
   or even by reason of strength eighty;
yet their span is but toil and trouble;
   they are soon gone, and we fly away.

It is evident that Medicare has been one gigantic folly. We have mortgaged the lives of the next two generations and beyond so that we might create for ourselves the illusion that death is to be avoided precisely at that time in life when we should be preparing ourselves to meet it. We don’t live any longer today than King David did. There are just more of us living that long because in the last century, long before Medicare, we started draining swamps, putting up mosquito netting, washing our hands before birthing babies, vaccinating our children against smallpox, and keeping those children away from power looms and coal mines. None of that required the first penny in taxes, nor the first byte of an electronic medical record.

And what is the real breakthrough in philosophy (science) that I hinted at when I began? What is the world view that spawned all of this interest in helping the sick, that began with the unchanging declaration of the intrinsic dignity of the human person? It was nothing less than the greatest inflection point in human history: the life, death, and resurrection of Jesus Christ. Before Christianity, there were no hospitals. Before Christianity, no one was the least bit interested in the care of the poor, the sick, and the dying on any large scale. Medical care was a private matter for those who could afford the services of the learned. From the beginning, the hospital was a regular part of the local church, precisely because Christians sought to comply with Jesus’ own admonition to “care for the least of these”; that “whatsoever you do to the least of these, you do to me”. The gospel is the foundation stone of the hospital, and soon thereafter it became the foundation stone of that other gift of the church, the university, from which would flow all the science and technology that would lead to modern medical care.

And what do our modern statist leaders see as the greatest advancement in modern medical care? That would be the abandonment of the gospel, the washing away of any mention of God, any mention of Christian morality, and certainly any mention of an eternal destiny. We have stood death on its head. We flee from it in later life, when we should be going out to meet it, and through contraception and abortion we accept death during infancy when we should be struggling without compromise to keep it away.

How long shall we live? Most likely three-score and ten years, four score if we are strong. This will likely not change, given that it hasn’t changed in over 3000 years. Perhaps the better question would be: How long shall we live a lie?

The Doctor’s Fix

This evening I visited the official website of the American Medical Association to see what 18% of American physicians are thinking about. The lead story on the home page is the “Doctor Fix”. It is a perfect example of the AMA’s role as the idiot clown of socialist medical care.

Many years ago, the AMA actually represented physicians in America. They used to be concerned with the practice of authentic medical care, the kind we used to have, where a doctor and a patient have a sacred relationship based upon the intrinsic dignity of the human person. That all changed around 1965.

The AMA had strenuously resisted the socialization of medical care under five presidents. They fought Lyndon Johnson and the Democrats in congress when Medicare was in the offing. In spite of their best efforts, and thanks to some of the most bald-faced misrepresentations by Congress, Medicare passed in 1965.

Because our economy was booming at the time (thanks to the cut in marginal tax rates under Kennedy), there was plenty of cash on hand to pay the bills the nascent Medicare system was generating. In fact, in an effort to win the compliance of the medical community, doctor bills were paid without any real review of pricing. Since the basic economic principle of price control at the point of sale had been removed, prices increased dramatically.

Not surprisingly, the AMA got on board. It seemed as if the care of the elderly was just like having a license to print money. To the government, it wasn’t too much trouble to bury the cost in the depths of a budget cycle swimming in extra cash. Sadly for everyone, economic realities demanded attention. Five years of Medicare, and a very expensive Southeast Asian war took their toll, and during Nixon’s first term it became apparent that something had to be done about the unexpectedly high cost of caring for the elderly.

In addition to the idiocy of price controls under Nixon, the administration was forced to establish some standards for billing and payment for medical services. The AMA got into the game early by participating in the development of a standard coding system. Under this system, each medical diagnosis was given a code number, and each medical treatment was given a code number. Payment for services is based upon the diagnostic code harmonizing with the treatment code. For example, if the diagnosis is asthma, you don’t pay for an leg amputation. All that was needed was law establishing how much would be paid for each service. It was a central planner’s dream come true.

The AMA positioned itself perfectly in this process. In fact, they got the copyrights to all of the coding and billing books because the coding is proprietary to the AMA. Those copyrights earn the AMA $70 million annually in licensing fees. Not only do they work with the federal government on the codes, they are even there to lobby for the prices paid. It is the perfect insider deal, and absolutely none of it has anything to do with freedom in the marketplace.

And now, over 40 years later, when Obamacare was rocketing through a seemingly illiterate congress, the AMA (in a move surprising to absolutely no one) signed on. There was just one little problem. Madame Pelosi and Prince Harry had assured America that what Obamacare promised would be delivered without one extra penny of expense. In order to get past the Congressional Budget Office, the bill assumed that the government would be in compliance with law that mandates decreased physician payments in the event of a budgetary shortfall. The effect this year would mean a 21% reduction in payment. Obamacare assumed a 21% reduction this year.

What was not mentioned is the fact that the mandatory reduction of payment has been circumvented annually for quite some time. Congress has added in money each year to keep physician payment stable. But Obamacare has added 31 million souls to the roles of the entitled. That is a lot of additional doctoring and a whole lot of additional doctor bills. It is estimated that adding in the money for the doctor fix will add 2 trillion dollars to the budget deficit over the next 10 years.

And what does the AMA have to say about all this? They have a simple answer: Make the doctor fix permanent! In other words, pay us what we ask even if you have to tax America into poverty for the next 3 generations.

The leaders of the AMA, and the 18 percent of American physicians who are members of this alliance of socialist fools is like a heroin addict who isn’t the least bit interested in reality. All they know is they’ve got to have the fix. They will steal from the taxpaying public, and bring the goods to their dealer without the slightest thought for the mess they have created and the disaster into which they are headed. Soon the dealer will grow bored with their junkie. The dealer will soon find the AMA is all used up and go looking for a new fool. Perhaps they will relax restrictions on the entry of foreign doctors who might be interested in the American dream. The first one is fee kid!

It is an old story.

The Tea Party Speech

This past April 15th, I had the honor of speaking at the Tea Party Rally in Hartselle Alabama. I’m still not sure why Ed Henry (my choice to be the Dist. 9 state representative) asked me to do this.

The place was packed with several hundred of the most decent, friendly, caring, and loving people a person could hope to meet. Here are the Youtube videos:

Tea Party 1

Tea Party 2

Tax Dollars for Abortion

During the non-debate concerning the present administration’s health care initiative, one of the key sticking points was the inclusion of funding streams that supported abortion services. Rep. Bart Stupak (D-MI) presented himself as the unswerving champion of the pro-life objections. We were all lead to believe that he would prevent passage if abortion provisions were not removed. As we all now know, this was mere smoke and mirrors since it was Mr. Stupak’s deceitful work that made passage possible. He claimed to have “accepted Mr. Obama’s assurance” that an Executive Order would prevent tax dollars from funding abortion.

Now comes the next stage in President Obama’s unyielding march to state sponsored and state operated population control. On April 23rd, Rep. Yvette Clark (D-NY) from the 11th congressional district, along with 17 other sponsors, presented the “Global Sexual and Reproductive Health Act of 2010” to the floor of the U.S. House of Representatives. This bill calls for the use of foreign aid funds (obtained from the taxation of American citizens) to “support safe abortion services, including referrals, and support the training of abortion providers and the necessary equipment and commodities for surgical and medical abortion”. This bill also has language that calls for “sexual and reproductive health care for young people” from the ages of 10 to 25 years of age.”

The Helms Amendment, passed in 1973 prohibits the use of foreign aid funds for the provision of abortions. It states that “no foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.”. The Ipas organization, which promotes abortion states on it’s web site that passage of this new bill would signal the end of the Helms Amendment.

Who is the champion of this bill? Brooklyn representative Clark is a New York native, of Jamaican heritage, who is the perfect champion the Obama administration’s stated agenda. She is a wholehearted supporter of the healthcare legislation that we are to believe will not fund abortion because the President signed a document without legal merit. Her official website states that her “love for humanity has allowed her to become an effective leader and an outspoken advocate on numerous issues of great importance”. Love for humanity indeed.

More alarming still is the fact that Rep. Clark is the recipient of an honorary Doctorate of Law degree from St. Francis College. This 150 year old Catholic college in Brooklyn presents itself as the heir to the great Franciscan charisms that affirm life. I’m certain that the Women’s Studies minor offered by this college, with its “sexual role” content must cause the angelic saint great sorrow.

With A Pinch Of Salt

One of the most unfortunate side effects of socialized medical care is the relentless intrusion into the private lives of Americans that it produces. The latest example is the salt content of your food. This issue was preceded by the national threat of excess saturated fats, under utilization of motorcycle helmets, and second hand contact with tobacco products.

These laws are proposed, and the news reported in terms that would suggest great personal concern for those poor unfortunates who like to salt their food. I’m certain that there are a great many doctors, nurses and dieticians who are genuinely concerned about the salt in the diets of their patients. They are usually concerned because the patient will show some signs of elevated blood pressure or cardiac dysfunction. This concern is good and noble. It is a concern that produces professional and fraternal advice to the unhealthy. It is not coercive. It is a corporal work of mercy.

But why do legislators and big-city executives like Mayor Bloomberg Of New York care about my sodium intake? The answer is simple: It is about the money. You see, we spend a great deal of healthcare money taking care of hypertensives with congestive heart failure. We need to intervene because the state has a financial interest in stopping the madness of table salt. A healthier population means less money spent on medical care, and more money available for other important civic works such as enforcement of laws banning grocery bags, and educational programs for transgendered guest workers.

The whole mess begins with the idea that medical care is expensive. It is thought to be so expensive that we have to create several gigantic bureaucracies and an incomprehensible tax code to pay for it. As readers of this blog who have watched the medical pricing video know, medical care is outrageously priced, but very reasonably paid for. If people were paying directly for their own care, I am confident that Michael Bloomberg wouldn’t be rounding up all the salt shakers in Manhattan. He might take a personal interest in the blood pressure of a friend, or a family member. He might suggest that they use the salt shaker less, but most likely he would not be threatening them with fines and jail for making their lox more savory.

This is just another example of the counterfeit virtues that flow from Marxist-materialist government. Concern for the individual is replaced by concern for the economy. Individual liberty (to season your own food) is replaced with the state’s power to coerce, and justified because they have been taxing you to pay for the overpriced medical care of people you will never meet.

Now, every time you think about how much you pay in taxes, you can also seethe at the otherwise happy soul who likes his steak a little salty. Love of neighbor is replaced with indignation because that neighbor carries a few extra pounds, and happens to enjoy a cigar in the evening. How unkind it is to think less of people because of their minor habits of life.  It is inhuman, it is unjust, and is in fact diabolical.

If it is reasonable to stop restaurants from offering salt shakers to their patrons, why isn’t it reasonable to prevent fair-skinned people from working out of doors between the hours of noon and three. Skin cancer is epidemic, and costs the taxpayers millions of dollars in medical expenditures. Should red headed people be prevented by law from owning farms because of their risk of melanoma? Shall we compel women to have babies earlier in life because it is a medical certainty that this reduces the lifetime risk of breast cancer?

Actually, if taken to its logical conclusion, this materialist world view would produce a very different policy. By reducing salt intake, we are lengthening life expectancy. Furthermore, we are lengthening those years in which people are more likely to be retired from productive (taxable) work, and more likely to be visiting doctors for medical care. It is better for the future of the economy if people are allowed to use the salt shaker, and perhaps even smoke after dinner. How does that policy differ in the moral sense from such gems of socialized health care as: “persons over the age of 65 will not be eligible for organ transplantation.”? The same principle is involved: a financial value to the state is assigned for both the procedure, and its recipient.

This is what happens when you attempt to produce justice after you have begun with an injustice. A confiscatory tax policy aimed at redistributing wealth and producing certain accepted behaviors is unjust. Adding more laws only compounds the injustice.

I am sure the day is not far off when we will see police blotter reports detailing arrests and convictions for “possession of table salt with intent to distribute.”

Show Trial Suspended!

As we reported here several weeks ago, Congressman Henry Waxman (D-CA) became so angered by four large American industries that he had requested their CEOs to present themselves for public scourging.

Shortly after passage of the health care bill, several corporations including John Deere, Caterpillar, AT&T, and Verizon published reports to their shareholders of the expected impact of the new laws on the profitability of these companies. The negative effects ranged in the hundreds of millions of dollars in the first year. These reports were issued in accordance with the fiduciary responsibilities of the respective corporations. The Securities and Exchange Commission requires it.

Henry Waxman did not appreciate this sort of candor however, and arranged to have these CEO trotted our for a good old fashioned show trial. It was scheduled for April 21st, however  it appears that the inquisition has been suspended in light of vague statements made by both parties.

A memo from the Committee on Energy and Commerce conceded that  “companies acted properly and in accordance with accounting standards in submitting filings to the Securities and Exchange Commission in March and April.” The Committee even conceded that the reports were “required” by law!

Truth and law notwithstanding, Representatives Waxman, Locke, and Stupack are keeping the pressure on companies to keep whistling as they walk past the grave yard. They managed to extract statements from these companies that Obamacare “may” produced savings of $3,000 per employee over 10 years time “if implemented properly”. Those estimates were based upon the ability of employers to offer their employees Health Savings Accounts, as well as upon some measure of tort reform, neither of which are likely given that Obamacare forces employees into government run health care, and away from HSAs. Tort reform? What tort reform?

So the coercive utopians of Washington continue their idiotic march to totalitarianism, and (as is always the case) insist that no one speak a negative word about the latest five-year-plan for the motherland.

We Are Back!!

As many of you may already know, this website was attacked approximately two weeks ago, stripped bare, and the access corrupted. Thanks to the diligence of our friends at Creative Rhetoric, the site was re-established earlier this week, and I am once again working to re-populate it with useful content.

I consider it an honor that anyone would consider this site important enough to attack.

I look forward to resuming our conversation about medical care, human dignity, and limited government.

God bless you,

Patrick W. Lappert, MD

Video: The Medical Billing Lie

Help educate others. Share this video with your friends and family. Help everyone learn about one of the most pressing problems in healthcare today.