Doctors Speak to Congress on behalf of Patient Care

Dr. Jane Orient, executive director of AAPS, congressmen Dr. Burgess (TX-R)  and Dr. Amerling testified last week before the House in support of freedom of choice for doctors and patients.

This clip is just shy of an hour long but is well worth the time to watch. The PPACA is tragically misnamed: it neither protects patients, nor will it bring down costs. Entitlements are driving federal and state budgets over the cliff, and the PPACA adds significantly to the momentum.These three doctors provide explanations for why this is true.

The new law is specifically designed to disrupt the direct doctor-patient relationship which is the foundation of private practice medicine. This fact is illustrated by what Dr. Berwick, the current head of Medicare, wrote in his book New Rules:

Today, this isolated [doctor-patient] relationship is no longer tenable or possible. Health care has become an industry, with numerous loci of authority well beyond the doctor’s office. In many ways, the relationship of the patient to the doctor is less important. Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care.

In place of a direct doctor-patient relationship, Berwick advocates (and the PPACA strengthens) our current dysfunctional third party payment system which places a bureaucrat into the middle of our medical decisions. More and more, doctors are being required to make treatment decisions based on population-based clinical guidelines rather than the customized needs of individual patients.

Regulatory requirements  are making it more difficult for physicians to survive as small businesses, driving physicians to either retire early or work as employees. It is possible that the physician-as-employee model is less expensive (which is not the same as more efficient or cost-effective,) but shifting to that model should occur voluntarily through a free market, not by the government stacking the deck against the option of private medicine.

For more details on how the new health care control law will take away freedom of choice without solving problem of rising costs, watch the video clip below.
If you prefer to read their statements instead of watch, you can find them here: Dr. Orient's, Dr. Amerling's. I don't have a link to Br. Burgess' statement, but he comes first in the video after a brief introduction by Dr. Orient.

Advancing Liberty, Creating Change, Part 2

See here for Part 1

Randy Barnett was the speaker I came to hear at the recent symposium, Advancing Liberty, Creating Change, --and he did not disappoint.

Mr. Barnett is a constitutional law professor, author of Restoring the Lost Constitution, argued before the Supreme Court in Gonzalez v. Raich (a key case in Commerce Clause precedent), written multiple amicus briefs in support of the unconstitutionality of the individual mandate, and is now the legal representative for the NFIB in the appeals case of Florida v. HHS (the same case in which Docs4PatientCare has filed an amicus brief).

Barnett briefly summarized how the case against the mandate developed, illustrating how a small number of people can make a big difference. A conversation between Barnett and someone from the Heritage Foundation led to a paper on the unconstitutionality of the individual mandate. The paper was published just before the bill was passed Dec. 23, 2009, setting out the terms of the debate, and providing Senate Republicans with a basis to place on record a constitutional objection to the mandate.

Currently, there are five individual mandate legal challenges on expedited repeal. The government has ramped up the seriousness with which it is defending the mandate by having the Solicitor General argue the case at the appeals level. This is a very unusual move as the government's top lawyer usually only becomes involved, if at all, when a case is before the Supreme Court.

Barnett expects the cases on appeal will wrap up around August or September allowing for a petition to the Supreme Court in the fall. Oral argument would then be heard by SCOTUS in January of 2012 with a decision by the end of its term in June. You can read Barnett's estimate of how the judges may rule in his article Commandeering the People.

Barnett emphasized the importance of having a viable alternative to the PPACA pass in the House. It doesn't have to become law, but something must exist as an expression of Congress' will and a potential means to prevent the total dislocation of health care reform. He also maintains that if we win, the gains are important but not that large. If we loose this battle, however, we lose the nature of this country as one of limited government (and I would argue, because of the gigantic regulatory power delegated by the PPACA, Rule by Law takes a crippling blow.)

At the reception after the talks ended, I spoke briefly with Mr. Barnett, thanking him for all of his work defending health care freedom. He recommended the ACA Litigation Blog as a good source of information for those interested in following this case closely. The site also has links to the official documents of the 5 legal challenges making their way to the Supreme Court.

If you are interested in delving further into the constitutional issues, I would recommend starting with three documents: Judge Vinson's ruling of FL v. HHS (which provides a concise and cogent summary of the history of Commerce Clause cases), Barnett's brief to the 9th Circuit Court of Appeals (which presents the key arguments of the unconstitutionality of the mandate consistent with current legal precedent), and his article "Commandeering the People" which takes a closer look at the role of the Necessary and Proper Clause in light of the current constitutional debates.

To rid ourselves of this onerous law, popular discontent must be the dominant mood of the country. To maintain discontent, we must avoid resignation by keeping the hope of affecting a change alive. One way to do this is to announce to each other support for repeal by wearing or displaying the Black Ribbons. The more Black Ribbons that are out there, the more people can see they are not alone, that there is hope of change.

Let's make a difference, now.

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Advancing Liberty, Creating Change

Two days ago I had the wonderful opportunity to attend a symposium co-hosted by the Institute for Humane Studies and the Mercatus Center. Held on the 25th floor of the Hotel Nikko, the views were as stunning as the speakers were inspiring.

The formal part of the symposium was opened by economist Dr. David Henderson who described the almost miraculous success of the Liberal Party in Canada which, through real and significant cuts in government spending, brought Canada back from the precipice of economic disaster. In 1995, the WSJ called the Canadian dollar the "peso of the north" and Moody's put Canadian credit on watch. At that time, Canada had a debt-to-GDP ratio of 70%. Following these cuts and important changes in unemployment benefits, Canada then ran budget surpluses from 1997 until the international recession of 2008. The big lessons from this Canadian experience for U.S. politicians are the following:

You can cut spending and still get reelected.

You can cut spending and the world does not fall apart.

You can cut spending and grow the economy.

As our Congress continues the Budget Debates, let's work to remind them that these truths will also hold for health care spending.

Next, Adam Thierer spoke on the very important battle to preserve internet freedom. Although his talk was equally fascinating as the others, it wasn't as directly relevant to health care so I refer you to his written body of work for the details of his ideas.

Adam was followed by Matt Mitchell, speaking on the growing problem of unsustainable trends in state government spending and debt. The two largest contributors to this problem are Medicaid and the effects of public employee retirement benefits. From his talk, I took away two key points.

Unions in the private sector increase the wages of some workers at the expense of other workers, but are limited in what they can demand from their employers because of business' need to make a profit. (What came to my medical mind was the fact that a successful parasite doesn't kill off its host.) If profits decrease too much, the business (and the jobs) will disappear. Unions in the public sector don't have customers paying for goods and services--they have taxpayers, who can't choose to go away. Also, in the public sector, unions get to vote for and select the people with whom they negotiate for their benefits. In the private sector, unions don't get to vote for their employers (other than with their feet.) The fundamental incentives for public unions have no brakes. To improve the situation, we need to change the rules and alter the incentives. Tweaking the numbers will never be enough.

With regard to Medicaid, Matt showed that the problem goes beyond the incentives for expansion that the current system holds. (Because of Federal matching funds which shift state costs to the country as a whole, States have the incentive to continually expand Medicaid programs.) He also pointed out that whenever government funds a program, it creates a powerful vested constituency which pushes for continued spending and expansion. Data shows that when the Federal government reduces payments for state programs--the programs don't shrink or go away. The states just continue to fund them through state debt or raising taxes. A looming danger of the PPACA is the enormous new entitlement constituency it creates, not only through the expansion of Medicaid, but also through insurance premium subsidies.

The formal talks were punctuated with opportunities to talk personally with the speakers and fellow attendees. It was an exciting chance to meet face-to-face several people whose works I have admired from afar, or have met only in the cyber-world of Yahoo groups. In spite of the very real and significant challenge to individual rights which our country currently is facing, the general mood of the speakers and the audience was decidedly optimistic. I left encouraged and inspired, knowing that people of such intellectual caliber and integrity are fighting for the cause of freedom.

(Report on the symposium will be continued next post.)

Update: New paper out from the Mercatus Center-"Public Sector Unionism: a Reivew"
Update: Paper on-line by David Henderson CANADA’S REVERSED FISCAL CRISIS

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Cookie Cutter Medicine

Patient Diana Hsieh relates her personal experience with a health problem to illustrate why "cookie cutter" medicine and government "quality control" through adherence to clinical guidelines is bad for your health.



For a more technical discussion, don't miss the following posts by two practicing physicians who regularly blog on health care policy.

"Dangers of strict adherence to clinical guidelines" by Doug Perendia

and

"Who Writes these guidelines anyway?" by Dr. Rich Fogoros

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Medicare "As Is" is Not an Option

The Budget War has reignited the Medicare War with both Republicans and Democrats fearful of angering Seniors (and potential Seniors) about diminished access to blank-check health care.

Polls show people want Medicare to continue "as is" --but this is not a fiscal possibility.

Medicare must be changed, and both Pres. Obama and Rep. Ryan offer ways to change it.

The President calls for top-down restriction of care by a government-appointed panel of experts. Ryan's plan calls for restriction of government payment to individuals and more individual choice.

Neither plan ends Medicare --just Medicare as it currently exists.

Neither plan supports Seniors' ability to pay for care when Medicare won't.

The debate must continue.

More information here, here and here.

Just ask

5 Questions from WTRC Films on Vimeo.

Black Ribbon Project Goes to Washington

D4PC "Crash Card" report:

(Although not visible in this photo--every doctor proudly wears a Black Ribbon.)

Charging the Hill

Dr. Hal Scherz's Field Report from the Capitol

Speaker of the House John Boehner prioritized a meeting with the leadership of Docs4PatientCare just before meeting with President Obama in the midst of the political fight over the Government shut down.

On April 6 & 7, a group of leaders from Docs 4 Patient Care went to Washington for meetings on Capitol Hill with Senators, Congressmen and their staff, for policy meetings and to participate in a healthcare symposium with the Galen Institute.

Docs4PatientCare staging outside the
Capitol to "Charge the Hill" on behalf
of the Doctor-Patient Relationship.

On this trip to DC, as compared to previous ones, we had no trouble arranging meetings with Senators and Congressmen. That is because after 2 years of work, they recognize that we are a bona fide organization and worthy of their time.

We would have had meetings with many more Senators and Congressmen then we did, had it not been for an imminent government shutdown, which occupied most of their time and attention.

Nonetheless, the highlight of our trip in many respects was our 30 minute meeting with Speaker of the House, John Boehner, which immediately preceded his first meeting with President Obama over the budget impasse.

Most of the time, groups come to DC with their hand out, trying to get a bigger slice of the federal pie. They gain entry into these offices because they have spent an enormous amount of money through lobbyists, who are hired guns, but have no real skin in the game.

We were received differently, because we are different.

New Congressman and
Docs4PatientCare member,
Dr. Dan Benishek came to
Washington to prevent the
trampling of the Doctor-
Patient Relationship.

We did not come asking for anything except for the opportunity to help them fix healthcare. We told them who we were (although many already knew), and what we had done. We shared with them our successes in the 2010 elections- helping Congressmen Dan Benishek MD, get elected in Michigan, and Joe Walsh in Illinois.

We shared with them our Prescription for Healthcare Reform and that we believed that with our expertise, we could help them with the healthcare message far better than policy experts or media professionals. We explained how our organization worked- which is not to have lobbyists, but instead to develop personal relationships between doctors and their elected officials in Congress.

We offered to help with Congressional testimony and to give assistance in healthcare matters that affect our patients and us every day, because as opposed to the faux doctors who gave up taking care of patients in favor of becoming bureaucrats, we are on the front lines daily. Finally, we shared a vision of what we can do in 2012 to help put people into Congress and the White House who will be serious about fixing healthcare in America. This can be done through the media but is better accomplished through the influence that we have on the 2000-10,000 patients that each of us sees in our offices and clinics.

We informed them about our new web site and how we had transformed it into the trusted source for healthcare information by keeping it current with updated daily content. Many of them already knew about this and had been following us.

This was a powerful message.

Speaker Boehner and everyone else that we met with acknowledged just how powerful it was. They all appreciated that we were there and had given up time at our practices and with our families and traveled to DC at our own expense. They all told us essentially the same thing:

1. We need a continued presence in Washington and we need to bring doctors from as many Congressional districts as possible.
2. We need to build our membership. There is a palpable need for a group like Docs 4 Patient Care, but the best way for people to notice us is to have as many members as possible.
3. We need to work to change control of Congress and the White House in 2012, otherwise, the prospects for healthcare will be bleak.

D4PC's rising influence after
the mid-term elections.

In addition to the meeting with Speaker Boehner, we met with the GOP healthcare leadership team in the House (Boehner, Cantor, McCarthy) and the Senate (McConnell). We met with Senator John Barrasso MD from Wyoming and his team, the team of Sen. Tom Coburn MD and Sen. Rand Paul MD. Also with 3 of the 5 freshmen GOP physician Congressmen- Scott DesJarlais (TN), Andy Harris (MD), and Dan Benishek (MI). We chatted with John Fleming MD (LA), Joe Wilson (SC) and John Culberson (TX). We also met with the healthcare specialists for Reps. Mike Burgess and Michelle Bachman.

We had an excellent healthcare symposium with the Galen Institute and Congressman Tom Price MD, helped out by delivering an impassioned speech about why this healthcare law is a disaster for America and what we must do to get rid of it.

The Heritage Foundation is one of our most important strategic partners and we were hosted to an afternoon session by Bridgett Wagner, the Director of Coalition Relations and attended by Galen Institute President Grace-Marie Turner to discuss Docs 4 Patient Care, healthcare policy issues and strategy, and Grace-Marie's new and excellent book- Why Obamacare is Wrong For America; an essential must read book for anyone who hopes to understand this difficult and convoluted subject.

Just a couple of other items to share-

Congressman Tom Price presents
the case to repeal ObamaCare.

We have filed an amicus brief in Virginia in support of the Virginia case against the Federal Government which challenges the mandate that people must purchase healthcare insurance in the Affordable Care Act. We are looking to get involved with other court actions in the near future.

We are in the process of forming Docs 4 Patient Care state chapters. We have chapters in Arizona, Colorado, and Illinois. We formally launched the Georgia Chapter this week. We are looking to have 20 state chapters by the end of 2011.

So there you have it.

Docs 4 Patient Care is very much real and vibrant.

We need those of you that have never joined as a member to do so- what more do we have to do to prove ourselves to you? Just go to our web site- docs4patientcare.org now and click on Become a Member.Those of you who have not sent in dues for this year- you are not a member, so please renew by clicking on the same link. (unless you signed up as a Gold Member since September).

We cannot succeed without every one of you. We will do the heavy lifting if you do not want to - just help us do it by supporting us. No one else will help you (or your patients) if you don't start now, by becoming a member.

Those who want to get into the fight- just let us know and we will give you something to do.

Thank you.

DEFUND, REPEAL, & REPLACE

The full framework of our plan for America can be viewed here. We invite all Americans to join us in the true effort to reform healthcare.