Don't forget to vote today for Amendment 2. Remind your patients, family and staff to say Yes2SaveLives by voting for Amendment 2.
Washington Post
By Andrew Villegas and Mary Agnes Carey
Monday, November 1, 2010; A19
While most people are focused on the midterm elections Tuesday, the American Medical Association is gearing up for the lame-duck congressional session scheduled to start Nov. 15. Unless Congress intervenes, payments to doctors for treating Medicare patients will be cut by 23 percent on Dec. 1 and another 6.5 percent on Jan. 1.
Cecil B. Wilson, an internist from Winter Park, Fla., who became AMA president in June, is pressing for a 13-month patch that would prevent the Medicare physician cuts. In April, the Congressional Budget Office said that blocking the cuts until January 2012 would cost about $15 billion. A long-term formula fix, through 2020, would cost about $276 billion, it said.
The AMA argues that a 13-month reprieve from the reductions would give it time to work with Congress to overhaul the Medicare payment formula. In recent years, the payment formula has called for cuts, but each time lawmakers have stepped in to block them before they took effect or shortly afterward. The AMA could use a win on the issue. The organization was sharply criticized by some physicians for endorsing the new health-care law without getting the formula straightened out in return.
If Congress doesn't block the looming payment cuts, "this will be a catastrophe," Wilson said, with more and more doctors leaving the program and seniors having a harder time getting in to see doctors.
Whatever happens in the lame-duck session, the new Congress is likely to have more doctors. There are 16 physicians in Congress, but dozens more are running for the House or Senate this year. That might provide more sympathy for the AMA on the issue, but the cost of fixing the formula may still be viewed as prohibitive.
Edited excerpts of the interview with Wilson follow.
Q: What's your strategy in the lame-duck session to get the Medicare physician payment cuts canceled?
A: Our strategy is to say to Congress, "What we want from you is to stabilize Medicare payments to physicians for the next 13 months to get us through 2011." And then that will give us an opportunity working with the new Congress to develop a means of getting rid of the formula, putting in a formula or a payment mechanism that recognizes increased costs of care.
Q: But isn't it highly unlikely that's going to happen? What if Congress goes for a shorter-term fix or doesn't address the payment reduction at all?
A: There is no disagreement in Congress this formula is not working. . . . What we're saying to them and what we want seniors to say to them is, "You're threatening our access to care. If physicians cannot keep their doors open because Medicare now only pays about half the direct cost of running a practice, then we're going to lose access to care." It will be gut-wrenching for physicians to say, "I can no longer continue to see new Medicare patients." . . . But that's where we are, and if you're talking about a 30 percent cut if Congress does nothing by Jan. 1, this will be a catastrophe.
Q: The AMA has an item on its Web site helping physicians think through this very issue - should you stay in Medicare or not? Do you think that if you don't get a 13-month fix, doctors will simply say, "I'm out of this program?"
A: As a matter of fact, I participated in a webinar [recently] in D.C. Four hundred physicians across the country were involved in the webinar, in which we talked to them about their options. The reality is between now and the end of December physicians have to make a decision about their status related to Medicare. So we are trying to provide information to [them] so they can make a wise decision. Our concern, of course, is that if Congress in the lame-duck session does not address this problem, or they address it in ways that are disruptive to physicians' practices, more physicians are going to say, "You know, I'm just out of here. I cannot keep my doors open and provide care for other patients."
Q: But your efforts so far haven't worked, and now we're in a very severe fiscal situation. Maybe the AMA doesn't have the clout it used to have in Congress?
A: Well, this is not about the AMA; this is about senior citizens who need care. I can just tell you from my own [experience in] Winter Park, Fla., the conversation in the grocery store lines [or] at the shopping mart is, "Do you know any physician who is still taking new Medicare patients?" And the answer is no.
- Kaiser Health News
Kaiser Health News (www.kaiserhealthnews.org) is an editorially independent news service of the Kaiser Family Foundation, a nonpartisan health care policy organization that is not affiliated with Kaiser Permanente.
Requiem for the Pelosi Democrats
Veteran Democratic Rep. Brian Baird says that job creation should have been priority 'number one, two and three.'
By JOHN FUND
Washington Wall Street Journal
It took Democrats in the House of Representatives 40 years to become out-of-touch enough to get thrown out of office in 1994. It took 12 years for the Republicans who replaced them to abandon their principles and be repudiated in 2006. Now it appears that the current Democratic majority has lost voter confidence in only four years.
How did this happen? And what does the increasing speed of voter backlash mean for Republicans who will likely take control next Tuesday?
For answers, I decided to chat up Rep. Brian Baird, a six-term Democrat from Washington state. Even though he's never won re-election with less than 56% of the vote, Mr. Baird is retiring because the brutal congressional commute makes it impossible for him to see his twin five-year-old boys grow up. He's not sticking around, like so many former members of Congress, to lobby inside the Beltway. That allows him to be candid about Congress and his party.
"It's been an authoritarian, closed leadership. That style plus a general groupthink mentality didn't work when Tom DeLay called the shots," Mr. Baird says. "We've made some of the same damn mistakes, and we were supposed to be better. That's the heartbreak."
Mr. Baird, 54, is a loyal Democrat who voted for all of Speaker Nancy Pelosi's legislative priorities, including the stimulus bill, cap and trade and ObamaCare. But he admits all three have serious flaws.
Mr. Baird recalls that he was "very excited" when his party took control of Congress in 2006, but he saw ominous signs early on. Before the 2006 election, he says, Mrs. Pelosi had 30 members working on a rules package to make the House more ethical and deliberative. "We abandoned all that work after the election, and leaders told us we should trust them to clean things up. I don't know a single member of the Democratic caucus who saw the final rules package before they voted on it."
Democrats also watered down efforts to practice fiscal responsibility. "We initially had numbers a bit more honest than the Republicans—we at least included war costs in the budget," he says. "Now we're authorizing programs for three years instead of five in an attempt to pretend we're saving money."
When President Obama was elected in 2008, Mr. Baird was again optimistic that Democrats could bring real reform. But fierce Republican partisanship and the White House decision not to focus on job creation as its "number one, two and three" priority dashed that hope.
"Obama decided we weren't going to have a highway transportation bill because it might have required a gas tax increase," he recalls. After passing a misdirected stimulus bill, Mr. Obama made the fatal error of pushing forward with other priorities: cap and trade, financial services reform, ObamaCare. Each became compromised quickly.
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"You don't get real reform by pandering to every special interest. With cap and trade we wound up with a bill that didn't accomplish much, was enormously complicated and expensive." Mr. Baird is especially upset that "good solid members will lose this fall because they took a tough vote for a cap-and-trade bill that never made it through the Senate." He has told environmental groups that they lost sight of the goal of reducing carbon emissions by focusing on the minutia of regulation to achieve it.
For some of the shortcomings of financial regulatory reform, Mr. Baird blames the disillusioning battle over ObamaCare. "When the House had to pass the Senate version of health care unchanged, some members asked why should they invest the mental effort in mastering the details" of financial reform. Mr. Baird found parts of the bill mind-numbing.
Although he voted for it, he says he was troubled that Fannie Mae and Freddie Mac, the entities at the heart of the housing meltdown, weren't addressed. They have clearly exercised undue influence on Capitol Hill, he notes. "When I was first elected I was puzzled why they were holding events in my honor as a mere freshman. I asked myself, why is a federal entity so involved in political activity?"
Regarding health care, his specialty, Mr. Baird gave House Democrats real heartburn. He voted against the first version of ObamaCare in November 2009, because the Congressional Budget Office and the Centers for Medicare and Medicaid Services hadn't yet analyzed the bill's impact on insurance premiums and medical costs.
"What the hell were we doing voting on this? I had labor groups come to me and insist the bill was so important we couldn't wait to know what was in it," he recalls. "I asked them if they were handed a new union contract and told it was so important they had to agree to it without reading it, would they go along?" They continued to insist he vote for the bill and threatened him with a primary challenger.
Mr. Baird had developed his own health-care proposal that drew on his 23 years of experience as a licensed clinical psychologist treating patients with cancer and brain injuries. His plan would have provided universal health care but held down costs through vouchers for the poor, medical savings accounts for the middle class, and reform of malpractice insurance.
He admits to being frustrated that ideas like his never got a fair hearing in a Congress dominated by inertia and interest groups. "Our problems are now so grave we can't afford petty partisanship and closed thinking," he tells me.
The health-care bill experience spurred Mr. Baird to push harder for a "72-hour rule" that would require all non-emergency legislation to be posted online, in final form, for at least 72 hours before a floor vote. "Members are too often asked to make decisions on bills that can be longer than telephone books, and are given only a few hours to actually read them," he complains. "Both parties are guilty, and both should stop doing it."
Mrs. Pelosi eventually allowed a 72-hour pause before the final passage of ObamaCare, and Mr. Baird is pleased that Republicans have agreed to adopt the 72-hour rule if they take the House majority. He just hopes they honor it even when it's inconvenient.
Mr. Baird stands by his vote for ObamaCare, noting that something had to be done for those denied insurance due to pre-existing conditions. But he acknowledges that the bill carried within it the seeds of its unpopularity. These include the nightmare mandate that all companies report to the IRS all of their business-to-business transactions over $600, so the government can capture unreported business income. At a recent forum with small business owners in his district, Mr. Baird was stunned at the complexity of the rules they now must follow.
"I warned my fellow Democrats that the insurance companies they were whacking could increase premiums just before the midterm election and blame them for it," he sighs. "I pointed out that the major benefits wouldn't kick in till 2014, but the costs were up front. I asked them, where was the political win? There was no real answer."
In his new book, "Character, Politics and Responsibility," Mr. Baird argues that in order to afford caring for the needy, liberals will have to challenge "unsustainable entitlements." "I would eliminate the concept of entitlements and move to needs-based social insurance," he says. "The key is to both promote personal responsibility while lowering expenditures by not promising or giving money or other benefits to those who don't need it."
Although Mr. Baird believes that Republicans blocked compromise on ObamaCare and that tea party activists raised false fears, he acknowledges the political harm that Democrats have done themselves. "It looks like we're going to lose the House, possibly badly, and could lose the Senate," Mr. Baird laments. "We will lose a lot of centrists while the people in the party some voters are most mad at survive in safe districts."
"A lot of rethinking is needed" after Democrats take their drubbing, Mr. Baird says, especially since he anticipates "a huge number of retirements" from Democrats unwilling to serve in the minority. He proposes that the House elect an independent speaker who would help drain partisanship from the body. Britain's House of Commons uses such a model.
Democrats, he says, will also have to recognize why they lost touch with voters. "Back in September, we had pollsters and strategists from my party tell members that the mass of people didn't care about the deficit. The mind-boggling lack of reality coming from some of the people who give us so-called advice is stunning."
I ask Mr. Baird what he would tell the incoming class of freshmen Republicans if given the chance to address them before the new Congress convenes. He summarized his bottom line:
"Governing isn't as easy as you think. Many of you have taken pledges that are contradictory—to balance the budget and cut taxes, for example. You must be honest about the numbers, since our annual deficit now exceeds all discretionary spending combined. If you set as your goal to roll back the size of government, you have an obligation to answer the tough questions and show real courage, not just appeal to ideology. Treat the voters like adults."
Mr. Fund is a columnist for WSJ.com.
Insurance Commissioners Loom Large In Health Law
NPR News by SARAH VARNEY
Steve Poizner, California's insurance commissioner, forced health plans to scale back double-digit rate hikes. But people still don't know his name.
Voters don't give much thought to who runs their state department of insurance. But as key provisions of the new federal health law begin to take effect, the insurance commissioner will become the king of a much bigger kingdom.
Voters in four states, including Georgia and California, will directly elect an insurance chief on Tuesday. And in nearly three dozen other states, whoever is elected governor will name the commissioner.
Fame does not come easy to even the most heroic insurance commissioner. California's current chief forced health plans to scale back double-digit rate hikes, and still he's the white knight no one can name.
Steve Poizner is the California insurance commissioner, and whoever replaces him — and other insurance chiefs around the nation — could change your life.
"With the insurance market reforms, it's really going to be important for states to take a proactive role in responding to any problems that come up and making sure plans are complying with the law," says Sabrina Corlette, a health policy researcher at Georgetown University.
New Consumer Protections
She says that under the federal health law, state insurance chiefs will have a long list of new consumer protections to enforce. For example, starting in 2014, health plans can't charge women or sicker people more.
They're also helping to write the regulations for their own expanded powers. Congress left it up to an obscure group — the National Association of Insurance Commissioners — to essentially decide critical details, such as what health plans can claim as actual medical care vs. administration and profit.
Corlette says this decision made these humble regulators very popular with industry lobbyists at their spring meeting.
"I was stunned to discover that there were about 17 consumer representatives that were focused on health care, compared to over 1,000 different insurance industry representatives," she says.
Consumer advocates and industry officials say once the rules are written, state regulators will have to crack down on health plans looking to exploit fuzzy rules or weak enforcement. At the same time, if they're too heavy-handed, the plans might leave the market.
State Impact On Federal Health Overhaul
All of which means state insurance chiefs could very well play a key role in whether the federal health overhaul flies or flops. Laurie Sobel, a senior attorney with the consumer advocacy group Consumers Union, says it matters how the insurance commissioners view the new federal health law.
"If you have one that really doesn't want to enforce it, then consumers are going to need to fight it every step of the way," Sobel says.
The two candidates vying to become California's chief regulator have starkly different views on how best to protect consumers. Assemblyman Mike Villines, the Republican in the race, is a skeptic about whether the government can fix a system he admits is broken.
"When you start to get into mandating behavior and you have to tell the insurance companies there are these for-sure things in here that you have to do — I think that Californians and the nation is not quite ready for that," Villines says.
His opponent, Democratic Assemblyman Dave Jones, says the federal overhaul will offer critical protections and new choices to consumers.
"I plan to use the office both formally and informally, to take a very assertive role in terms of health insurance reform," Jones says.
Bad News For Reformers?
Overseeing the national rule-writing effort is Kansas Insurance Commissioner Sandy Praeger. She's up for re-election — a Republican in a solidly red state and running unopposed. With no challenger, she's instead spending her time worrying about all the details her group must decide.
"I don't want to get thrown under the bus," Praeger says. "We don't want to be blamed if this isn't working. So we've got a huge responsibility to try to get it right.
But many Republican candidates for governor think the law is just wrong. And in some states, those candidates — who could end up appointing new insurance chiefs — want to repeal the federal health overhaul.
With Democrats on the ropes nationwide, that could be bad news for reformers.
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