Rogue FMA Board Member Goes Too Far

A truly sad day for organized medicine when passion turned into blind hatred.
The attempted "apology" is pathetic and I hope that our leadership is taking the appropriate corrective action.
Our FMA deserves better and now is the time to come together to reconsider our position.
Yours
Bernd




Posted on Fri, Jul. 24, 2009
Doctor criticized over Obama e-mail

BY ADAM C. SMITH
St. Petersburg Times

A prominent St. Petersburg doctor and conservative activist has drawn a flood of criticism for e-mailing an image depicting President Obama as a witch doctor with a loin cloth, exotic head dress and bones in his nose.
``ObamaCare, coming soon to a clinic near you,'' reads the caption on the e-mail forwarded earlier this week by St. Petersburg neurosurgeon David McKalip.

Several popular liberal blogs, including Talking Points Memo, Huffington Post and Daily Kos, highlighted McKalip's e-mail Thursday and castigated him for racism. McKalip said he was flooded with calls from people attacking him over the e-mail, which he said he had forwarded to ``a limited group'' of about 150 people.

``I am not a racist. I am simply a person speaking up to make sure patients don't get hurt by the government and by insurance companies,'' said McKalip, who earlier this month organized ``tea party'' rallies across Florida denouncing Obama's healthcare overhaul proposals.

``Because I've been so effective in pointing out how the government plans are going to hurt patients in very serious ways the only way they can neutralize my message is to discredit me personally.''

McKalip, who has written guest columns for the St. Petersburg Times on tax and healthcare issues, teaches at the University of South Florida and is president-elect of the Pinellas County Medical Association and a board member of the Florida Medical Association -- which denounced McKalip's e-mail and urged him to apologize to President Obama.

He has become an increasingly visible political activist, founding advocacy groups including Cut Taxes Now, the Florida Taxpayers Alliance and Doctors for Patient Freedom.

McKalip noted that he helped organize a career counseling day several years ago for African-American Boy Scouts and blamed liberal activists for promoting the witch doctor image more than he ever did. He called the e-mail ``satire,'' but later Thursday night released a statement apologizing directly to Obama.

``I recognize that this image is offensive and hope that the nation refocuses on assuring all Americans have access to high-quality, affordable healthcare with no party interfering in the patient-physician relationship,'' McKalip said.

He is expecting protesters outside his office soon. The Daily Kos site is encouraging people to lodge complaints against him with his affiliated hospitals, USF, and the state Department of Health.

Adam C. Smith can be reached at asmith@sptimes.com

AMA Supports Reform

Kudos to Dr.Cecil Wilson, President Elect of the AMA, whose letter to the editor was published in todays Miami Herald.
He should be applauded for standing up for what we know is right: comprehensive healthcare reform benefiting all Americans.
Thank you Dr. Wilson for your commitment to our profession and the public health.

Bernd Wollschlaeger,MD,FAAFP,FASAM
AMA Member & Outreach Recruiter
============================================================================
AMA to Miami Herald: AMA Supports Reform

July 23, 2009 (published)

Miami Herald
Letter to the Editor

Floridians without health-insurance coverage are in dire straits (Report: 3,560 Floridians will lose health insurance every week, July 16). For their sake, we must achieve meaningful healthcare reform that provides all Americans with access to affordable, high-quality coverage.

The American Medical Association is committed to health reform this year that covers the uninsured, improves quality and ensures patients get the best value from healthcare spending. Important progress has been made with the House and Senate vigorously working on legislation. The AMA will stay actively engaged to make certain health reform that will improve the health of America's patients is accomplished.

The uninsured crisis playing out in Florida is one that can be seen all across America.

We must seize the opportunity this year to pass comprehensive health reform.

Cecil B. Wilson, MD
President-elect, American Medical Association

AMA and Healthcare Reform

Attached todays press release from the AMA regarding its support for H.R. 3200. Obviously, our AMA is supporting the legislation which DOES contain a stripped down version of the public health insurance option. I wonder why their press release omits this important fact? Maybe, to avoid stirring up discussion and potential opposition from the hardliners within our AMA? Nevertheless, the press release is also a small baby step into the right direction and I hope that its not followed by two steps backwards. We will see.For more information about the bill see http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BILLSUMMARY-071409.pdf .
Yours
Bernd


NEWS FROM THE AMA

FOR IMMEDIATE RELEASE

July 16, 2009



AMA SUPPORTS H.R. 3200, “America’s Affordable Health Choices Act of 2009”

House Bill Expands Access to High Quality, Affordable Health Care for Americans



WASHINGTON– Today, the American Medical Association sent a letter to House leaders supporting H.R. 3200, “America’s Affordable Health Choices Act of 2009.”



“This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform,” said J. James Rohack, M.D., AMA president. “We urge the House committees of jurisdiction to pass the bill for consideration by the full House.” H.R. 3200 includes provisions key to effective, comprehensive health reform, including:



* Coverage to all Americans through health insurance market reforms
* A choice of plans through a health insurance exchange
* An end to coverage denials based on pre-existing conditions
* Fundamental Medicare reform, including repeal of the flawed sustainable growth rate (SGR) formula
* Additional funding for primary care services, without reductions on specialty care
* Individual responsibility for health insurance, including premium assistance to those who need it
* Prevention and wellness initiatives to help keep Americans healthy
* Initiatives to address physician workforce concerns



“The status quo is unacceptable,” Dr. Rohack said. “We support passage of H.R. 3200, and we look forward to additional constructive dialogue as the long process of passing a health reform bill continues. This is an important step, but one of many steps in the process. The AMA is actively engaged with Congress and the administration to achieve health reform that best meets the needs of patients and physicians. We are committed to passing health reform this year consistent with principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.”


# # #

Healthcare Reform Debate: Shall We Include Single-Payer In The Debate?

Dear Friends and Colleagues:

Attached an editorial from yesterdays Seattle Times written by Dr. John Geyman is professor emeritus of Family Medicine at the Universityof Washington, past president of Physicians for a National Health Program, and a member of the Institute of Medicine.
He argues that legislators are "only considering options that build on the present system."He adds that "after months of work, legislative committees in Congress have brought forth drafts of proposals that the Congressional Budget Office (CBO) is starting to score in terms of cost and effectiveness. As expected, the costs of these incremental proposals are high BECAUSE they are based on the CURRENT dataset of health care costs and on data provided by insurance company actuaries. "He is correct that legislators refuse to even consider a single-payer option and that the CBO has yet to score such an option and how it would compare to the models proposed during the current debate.
He ends the editorial with the following challenge: " President Obama has brought forward the concept of audacity of hope. Is it too audacious now to hope that the legislators we elect to Congress can see beyond their campaign contributions and the lobbying efforts by corporate stakeholders to require that single-payer be scored?"

Yours
Bernd




The Seattle Times
July 6, 2009
A pay-go option for health-care reform
By John Geyman

As Congress recessed for the July Fourth holiday, the debate over
health-care reform was reaching a fever pitch. Now the top domestic issue
for the Obama administration, the biggest questions are how much a reform
bill will cost and how to pay for it, quite aside from how effective a
"reform package" will be.

Skyrocketing costs that are out of control are the hallmark of our present
system. Yet legislators have already acceded to pressures and dollars from
stakeholders in the present system (within which costs are revenue) and are
only considering options that "build on the present system."

After months of work, legislative committees in Congress have brought forth
drafts of proposals that the Congressional Budget Office (CBO) is starting
to score in terms of cost and effectiveness. As expected, the costs of these
incremental proposals are high. The first number of $1.6 trillion over 10
years (while still leaving 36 million Americans uninsured) sent these
committees back to the drawing board. At the moment, leading Senate
Democrats are hailing $1 trillion over 10 years as potentially doable.

After presiding over huge deficits during their eight years in power,
Republicans are now demanding "pay as you go" (pay-go) policies. Together
with Blue Dog Democrats, they are threatening to act as spoilers of any
health-care-reform bill on its price tag alone.

Given the dimensions of these difficult economic times including a $1.8
trillion deficit for 2009, $5 trillion in new federal debt over this year
and next, and rising unemployment, pay-go makes good sense. And the
president is making the case that his health-care plan must pay for itself.

Conventional "wisdom" (as generated by the mainstream corporate media) says
that any health-care reform will cost a lot, and that there is no pay-go
option. But there is.

Single-payer financing (public financing coupled with a private delivery
system, a reformed "Medicare for All"), as embodied in Rep. John Conyers'
bill (HR 676 in the House) with its 83 co-sponsors, will yield savings of
some $400 billion a year. That's enough to assure universal coverage for all
Americans while eliminating all co-pays and deductibles ? the ultimate
pay-go. Single-payer will give us far more efficient, affordable, effective
and reliable health care than our present multipayer system. Health insurers
have known for years that they can't compete on a level playing field with
single-payer, and have only been surviving by favorable tax policies and
other subsidies from the government.

This recent testimony before the U.S. Senate Committee on Commerce, Science
and Transportation by Wendell Potter, former head of corporate
communications at Cigna, says it all: "I know from personal experience that
members of Congress and the public have good reason to question the honesty
and trustworthiness of the insurance industry. Insurers make promises they
have no intention of keeping, they flout regulations designed to protect
consumers, and they make it nearly impossible to understand or even to
obtain information we need."

Many studies over the past two decades, including those by the CBO, the
Government Accountability Office (GAO) and the nonpartisan Economic Policy
Institute, have concluded that single-payer can assure universal coverage
and still save money. HR 676 needs to be brought out of the closet and put
on the table for CBO scoring against other options being considered in
Congress, all of which cost much more and fail to provide universal
coverage.

President Obama has brought forward the concept of audacity of hope. Is it
too audacious now to hope that the legislators we elect to Congress can see
beyond their campaign contributions and the lobbying efforts by corporate
stakeholders to require that single-payer be scored?

(Dr. John Geyman is professor emeritus of Family Medicine at the University
of Washington, past president of Physicians for a National Health Program,
and a member of the Institute of Medicine.)

http://seattletimes.nwsource.com/html/opinion/2009424809_guest07geyman.html

Insurance Mandate Gains Support

Attached a letter to President Obama supporting an employer mandate SUPPORTED by the President and CEO of Walmart and the Service Employees International Union (SEIU), the largest healthcare employees union in the US.
This serves as evidence that those of us who do support an insurance mandate DO NOT belong to the extreme left-wing fringes as claimed by our colleagues in organized medicine!
Yours
Bernd


"We are for shared responsibility. Not every business can make the same contribution, but everyone must
make some contribution."

June 30, 2009
President Barack Obama
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear President Obama,
As the Congress considers legislation reforming our health care system, many difficult choices lie ahead.
During the debate, we must keep our eyes trained on one clear imperative: reforming health care is
necessary not just to improve the health of all Americans, but also to remove the burden that is crushing
America’s businesses and hampering our competitiveness in the global economy.
As the nation’s largest private employer, the nation’s largest union of health care workers with over one
million members, and a think tank that has been a leader on health care policy, we have worked closely in
support of health care reform since 2006, when we came together to help break the stalemate that had
defined the health care debate for too long. Now, to move the debate forward once again, we are coming
together to advance what we believe are important proposals that should be included in the current efforts
to reform our nation’s health care system.
We believe now is the time for action on this vital issue. We commend the leadership of elected officials
who are committed to enactment of reform, and we appreciate the commitment to inclusion and
transparency which has been present thus far.
We are entering a critical time during which all of us who will be asked to pay for health care reform will
have to make a choice on whether to support the legislation. This choice will require employers to
consider the trade off of agreeing to a coverage mandate and additional taxes versus the promise of
reduced health care cost increases.
Today, health care costs more because we don’t cover everyone – the average family premium costs an
additional $1,100 because our system fails to provide continuous coverage for all Americans. And losing
coverage pushes people already dealing with financial hardship to the verge of financial collapse. One
accident or unexpected illness can financially ruin them. In 2008, half of all people filing for home
foreclosure cited medical problems as a cause.
A large and growing uninsured population also cripples our broader economic growth. The higher taxes
and premiums needed to meet rising health care costs threaten to consume the benefits of nearly all
economic growth over the next four decades, according to research published in the journal Health
Affairs. And the U.S. economy is losing up to $244 billion every year in lost productivity due to the
uninsured according to a new analysis by the Center for American Progress.
From a business perspective, health reform could not be more critical. A majority of Americans—158
million—receive their coverage through their job or their spouse’s job, according to the Kaiser Family
Foundation. But few businesses will be able to keep up with the pace at which premiums are rising.
Premiums are expected to rise by 20 percent in less than four years, according to research by professors at
Harvard University -- costing 3.5 million workers their jobs, and cutting insured workers’ average annual
incomes by $1,700.
Fiscally, the growing cost of health care is poised to drive our federal budget over a cliff. A recent report
by the Senate Finance Committee found that by 2017, “health care expenditures are expected to consume
nearly 20 percent of the GDP.” In his former role as Director of the Congressional Budget Office (CBO),
current Office of Management and Budget Director Peter Orszag testified to Congress that, “the single
most important factor influencing the federal government’s long-term fiscal balance is the rate of growth
in health care costs.”
We believe payment reform and efficiency initiatives need to be at the center of healthcare reform. The
President and the Congress have put forward good ideas to improve the productivity of our health care
sector. These policies need to be strengthened and adopted because health care reform without controlling
costs is no reform at all.
We are for shared responsibility. Not every business can make the same contribution, but everyone must
make some contribution. We are for an employer mandate which is fair and broad in its coverage, but any
alternative to an employer mandate should not create barriers to hiring entry level employees. We look
forward to working with the Administration and Congress to develop a requirement that is both sensible
and equitable.
Support for a mandate also requires the strongest possible commitment to rein in health care costs.
Guaranteeing cost containment is essential. One way to ensure savings was recently advanced by former
Senate Majority Leaders Howard Baker, Tom Daschle and Bob Dole, “Implement pre-specified targets
for spending growth and enact a “trigger” mechanism that automatically enforces reductions,” (Crossing
Our Lines, Bipartisan Policy Center) President Obama suggested strengthening the role of Med Pac to
help enforce spending discipline.
With smart, targeted policies, we can create a financially-viable health care system that enables workers
to change jobs without losing their care, and allows businesses to become more nimble. Health care costs
will no longer stand in the way of their ability to retool for the 21st century. Focusing on health care cost
savings – and demonstrating a strong commitment to achieving these savings– would make this bill a win
/ win for employers, individuals and America’s competitiveness.

Respectfully,
John Podesta President & CEO Center for American Progress (CAP)
Andrew L. Stern President & CEO Service Employees International Union (SEIU)
Mike Duke President Wal-Mart Stores, Inc.

Is Our AMA in Trouble?

s our American Medical Association in trouble? Well, an article by Nicholas Kristoff published in the New York Times on June 25th provided some food for thought.
Yes, we know now that our AMA's position regarding a public insurance option is a maybe but not an outright no. Nevertheless, the heated debate within our organization and the ideological rigidity displayed by some has created the impression that the AMA is AGAIN opposed to a meaningful reform of our healthcare system. Right or wrong, the impression counts and its out there.
Furthermore, our membership is indeed dwindling and as an outreach recruiter I can attest to the fact that its getting harder and harder to convince doctors to join or rejoin. For some we are too soft and for others not tough enough. For some we are too much on the right, for others too much on the left. The media reports regarding our recent Annual meeting does not help in that effort either.
In Florida alone our membership decreased by 14%! Having listened and spoken to hundreds of doctors in South Florida I can list a few reasons that our leadership must consider:
1)Doctors in private practice want to have their problems addressed and resolved today, rather than tomorrow. They are afraid that they are being forced to close shop and merge with larger groups , or to end up as hospital employees. I visit private offices every week and many are on the verge of financial insolvency!
2)Far too much time is being wasted on ideologically-motivated debate, and too little on the development and deployment of practical practice solutions. Talk the Talk, or Walk the Walk?
3)Our AMA delegation is comprised of individuals representing their own political interest and are detached from the constituents they supposedly should represent.
Therefore, I have resigned from the AMA delegation and return to where I came from: union style grass-root organizing, listening to our members and to find alternative modalities of membership representation. The Web 2.0 technology demonstrates what a few can do using these tools, and they can successfully bypass the encrusted and inflexible structures of organized medicine.
The time for change has come even for our AMA. The questions remains: will our AMA embrace or resist change? Thats an existential question for our organization and circling the wagons will only hasten our demise.
Looking forward to your comments.

Bern Wollschlaeger,MD,FAAFP,FASAM
AMA Member


June 25, 2009
OP-ED COLUMNIST
The Prescription From Obama’s Own Doctor
By NICHOLAS D. KRISTOF
As a society, we trust doctors to be more concerned with the pulse of their patients than the pulse of commerce. Yet the American Medical Association is using that trust to try to block a robust public insurance option as part of health reform.
In fact the A.M.A. now represents only 19 percent of practicing physicians (that’s my calculation, which the A.M.A. neither confirms nor contests). Its membership has declined in part because of its embarrassing historical record: the A.M.A. supported segregation, opposed President Harry Truman’s plans for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton’s health reform plan.
So I hope President Obama tunes out the A.M.A. and reaches out instead to somebody to whom he’s turned often for medical advice. That’s Dr. David Scheiner, a Chicago internist who was Mr. Obama’s doctor for more than two decades, until he moved into the White House this year.
“They’ve always been on the wrong side of things,” Dr. Scheiner told me, speaking of the A.M.A. “They may be protecting their interests, but they’re not protecting the interests of the American public.
“In the past, physicians have risked their lives to take care of patients. The patient’s health was the bottom line, not the checkbook. Today, it’s just immoral what’s going on. It’s abominable, all these people without health care.”
Dr. Scheiner, 70, favors the public insurance option and would love to go further and see Medicare for all. He greatly admires Mr. Obama but worries that his health reforms won’t go far enough.
Dr. J. James Rohack, the president of the A.M.A., insisted to me that his group is committed to making health insurance accessible for all Americans, and that its paramount concern is patient health.
“When you don’t have health insurance, you live sicker and you die younger,” he said. “And that’s not something we’re proud of as Americans.”
He added that the A.M.A. is not necessarily opposed to a public option, and I have the impression that it might accept a pallid one built on co-ops. Dr. Rohack wouldn’t repudiate his association’s letter to the Senate Finance Committee warning against a new public plan. That letter declared: “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers.”
I don’t mind the A.M.A. lobbying on behalf of doctors in the many areas where physicians and patients have common interests. The association is dead right, for example, in calling for curbs on lawsuits, which raise medical costs for everyone.
An excellent study published in 2006 in The New England Journal of Medicine found that for every dollar paid in compensation as a result of lawsuits against doctors, 54 cents goes to legal and administrative costs.
That’s an absurd waste of money. Moreover, aggressive law leads to defensive medicine, in the form of extra medical tests that waste everybody’s money. Tort reform should be a part of health reform.
Yet when the A.M.A. uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal. Doctors work hard to keep us healthy when we’re in their offices, and that’s why they win our trust and admiration — yet the A.M.A.’s lobbying has sometimes undermined the health of the very patients whom the doctors have sworn to uphold.
I might expect the American Association of Used Car Dealers to focus exclusively on wallet-fattening, but we expect better of physicians.
In fairness, most physicians expect better as well, which is why the A.M.A. is on the decline.
“It’s what has led to the decline of the A.M.A. over the last half century,” said Dr. David Himmelstein, a Massachusetts physician who also teaches at Harvard Medical School. “At this point only one in five practicing doctors are in the A.M.A., and even among its members about half disagree with its policies.” To back that last point, Dr. Himmelstein pointed to surveys showing a surprising number of A.M.A. members who support a single-payer system.
For his part, Dr. Himmelstein co-founded Physicians for a National Health Program, which now has more than 16,000 members. The far larger American College of Physicians, which is composed of internists and is the second-largest organization of doctors, is also open to a single-payer system and a public insurance option. It also quite rightly calls for emphasizing primary care.
The American Medical Student Association has issued a sharp statement disagreeing with the A.M.A.
The student association declared that it "not only supports but insists upon a public health insurance option."
Look, a public option is no panacea, and it won’t automatically set right the many shortcomings in our health system. But if that option is killed in gestation, then we’re back to Square 1 and there’s little hope of progress in solving the vast challenges confronting us.
So, President Obama, don’t listen to the A.M.A. on this issue. Instead, for starters, call your doctor!

Prescription Drug Overdose

On June 23, 2009 Florida Gov. Charlie Crist has signed legislation aimed at curbing the growing black market of illegal prescription drugs flowing from South Florida pain clinics across the eastern United States. The new law, passed nearly unanimously in the Legislature, will require doctors and pharmacists to record patient prescriptions for most drugs in a state-controlled database.
Its about pain to reign in on the explosive growth of "pain clinics" in South Florida operated by unscrupulous owners, some associated with the criminal underworld and organized crime.
The number of overdose deaths are soaring, too!
Unfortunately, the prescription drug monitoring program cannot be implemented until the end of 2011 and so far funding is pending.
As physicians we must continue to push for the comprehensive implementation of such program because our patients and fellow citizens are being harmed by drug dealers in a white coat.
Lets not be complacent but proactive. We just won ONE battle but not the war against drugs.
Yours
Bernd
Posted on Tue, Jun. 30, 2009

Prescription drug overdose deaths soar in Florida

BY SCOTT HIAASEN
shiaasen@MiamiHerald.com

Florida continues to see a rapid rise in fatal overdoses caused by prescription-drug abuse -- a trend fueled by a cottage industry of cash-only pain clinics -- while deaths from illegal drugs wane, according to a report from the state's medical examiners released Tuesday.
Nearly 1,000 deaths were caused in 2008 by the potent painkiller oxycodone -- a 33 percent increase from 2007, the report says. Four years ago, only 340 deaths statewide were attributed to oxycodone, the most popular drug in the black-market pill trade supplied by pain clinics.

Conversely, deaths from cocaine overdoses declined by 23 percent, to 648 in 2008.

Overall, prescription drugs accounted for 75 percent of the drugs found in overdose victims last year, the report says.

''The magnitude and severity of prescription drug abuse calls for strong, coordinated action,'' said Bill Janes, the director of the state's Office of Drug Control, in a written statement.

Florida took a step in that direction when the Legislature passed a law creating a statewide database to monitor prescription sales and increasing oversight of pain clinics, which operate with little scrutiny.

The prescription database is designed to detect addicts and drug dealers buying pills from multiple doctors -- often by faking ailments or medical records -- a practice known as ``doctor shopping.''

''It's almost impossible to monitor different people shopping doctors,'' said Dr. Joshua Perper, Broward County's medical examiner. ``A person can get hundreds or thousands of pills.''

This can also lead to dangerous drug combinations. Perper said the most common overdoses involve mixing several drugs, with oxycodone and anti-anxiety drugs such as Xanax and Valium among the most common combinations.

Though the new prescription monitoring law takes effect Wednesday, the database is not expected to begin operating until late next year.

Broward has become the nation's capital of illegal prescription drug trafficking, police say, with nearly 100 storefront pain clinics feeding a black market in pain pills stretching through Kentucky, Ohio, Tennessee, West Virginia and Massachusetts. Florida leads the nation in oxycodone sales -- largely because of these clinics -- according to U.S. Drug Enforcement Administration data.

In 2008, Perper's office detected oxycodone in 171 Broward County overdose deaths -- more than twice the number found in 2005.

The highest number of oxycodone overdoses were reported in Pinellas and Pasco counties, where the drug was detected in 308 deaths last year.

The medical examiner in that district, Dr. Jon Thogmartin, attributes the unusually high number to advanced detection techniques employed by his lab.

''Prescription drugs have really begun, to a significant degree, to replace illicit drugs,'' Thogmartin said.

Thogmartin said many victims overdose on pills prescribed to them by licensed doctors.

To health advocates, this shows that doctors practicing as pain-management specialists need more training and more oversight from the state medical board.

''It's unacceptable to open up a practice and call yourself a pain management physician and start writing prescriptions,'' said Dr. Laura Brown, a Bradenton physician on the board of the American Society of Interventional Pain Physicians. ``That's not pain management.''

Resignation from the Florida AMA Delegation

I herewith notify you about my decision to resign from the AMA delegation for the reason stated in my e-mail sent to the delegation on June 15th.
I am saddened that I am forced taking this step but our AMA delegation does not represent the diverse opinions of the AMA members it claims to represent.
Furthermore, no attempts are being made to change that!
Therefore, I think its for the benefit of our FMA to select another AMA Delegate at the upcoming FMA Annual meeting who conforms with the political ideology of this delegation. I certainly do NOT!
Hopefully, my decision will not affect our friendship and I look forward seeing you again soon.
Yours truly,
Bernd

Medicare Fraud Continues!

Crackdown on Medicare fraud

On several occasions I reported on this blog http://floridadocs.blogspot.com/ about the audacious and callous Medicare fraud and abuse activity here in South Florida. During my tenure as DCMA President I met twice with representatives and senior executives of First Coast Service Options (FCSO) , the regional Medicare administrator, to discuss and understand why on one hand doctors in South Florida are being nickeled and dimed for legitimate services rendered but on the other hand billions of dollars are being paid out for obvious fraudulent claims. The most egregious example is the ongoing payment for HIV infusion “treatments” which, according to the court testimony of a leading HIV treatment expert, are obsolete, replaced for years by more effective oral antiretroviral drugs and not being utilized in clinical practice anymore. In most cases unscrupulous clinic owners, aided and abetted by medical doctors, set up such HIV Infusion clinics, recruited Medicare recipients suffering from HIV/AIDS and billed Medicare for services never rendered, In a series of award winning articles published in the Miami Herald Jay Weaver pointed out the continuous payment for those “services “ despite assurance made by First Coast Service Options that the payment were ceased. In a meeting with FCSO I personally received assurances that “ no such checks are being issued anymore.” Obviously, thats not the truth. I a recent article published on Saturday, June 27th 2009 http://www.miamiherald.com/news/front-page/v-print/story/1116390.html Experts estimate Medicare loses at least $60 billion to fraud every year, with Miami-Dade County at the center of the national crisis. I a recent crackdown agents broke up a Miami-based ring that allegedly schemed to defraud Medicare of $100 million by filing false claims for obsolete HIV therapy across five states. Two of the eight suspects have fled to Cuba.The organization, which was paid $30 million by the federal health insurance program, exported a fraudulent local business enterprise to Georgia, Louisiana, North Carolina and South Carolina by using empty storefronts and post office boxes, authorities said. What is being done to stop the bleeding of precious Medicare dollars? Well, I personally have written letters to the editors of local newspapers pointing out the obvious mismanagement of funds by FCSO. I have written to each and every member of the congressional delegation from Florida and only ONE responded advising me to contact the Officer of Inspector General to file a complaint! Thats it! Meanwhile, Medicare still considers such treatment "reasonable and necessary" and continues to pay hundreds of millions of dollars for fraudulent claims every year. FCSO refuses to consider the one and ONLY option: stop payment of ALL HIV infusion therapy claims in Florida/South Florida. The response: We can't because patients who actually need the treatment would be denied services -- a policy no-no at Medicare. But experts have testified that no one needs this treatments anymore!! If any patient would require such treatment it would be an exception and Medicare could consider payment on a case by case basis! Lets be clear: Medicare officials know the claims are fraudulent. Medicare says it has adopted technology to block false claims for HIV infusion treatment, yet the government program still misses hundreds of millions of dollars annually. To add insult to injury on September 12th, 2008 the Centers for Medicare & Medicaid Services (CMS) announced that First Coast Service Options, Inc. (FCSO) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Florida, Puerto Rico, and U.S. Virgin Islands. This represents not only a contract renewal but EXPANSION! In a press release CMS emphasized that “ with this award, CMS continues its progress in reengineering the way in which the government contracts for claims administration for the largest part of the Medicare program. CMS is seeking the best value, from a cost and technical perspective for this critical function.” The “best value” they probably get from FCSO is the waste of Medicare dollars! But they do not stop here! FCSO will be financially awarded too! In the same press release CMS officials emphasized that “ the contract for FCSO includes a base period and four one-year options and will provide FCSO with an opportunity to earn award fees based on its ability to meet or exceed the performance requirements set by CMS.” So they can earn extra dollars on the fraudulent claims amount?

So what can be done:

1)Call, e-mail or write your representative and/or Senator to hold FCSO responsible for every dollar wasted.
2)Petition the Office of Inspector General of the US Department of Health & Human Services at HHSTips@oig.hhs.gov to investigate FCSO business activities.
3)Force FCSO to repay each and every dollar of fraudulent claims paid and hold company executives legally accountable for their actions (or inactions)

In times of financial crisis we all have to act in a cautious manner exercising our duties , obligations and responsibilities as citizens. The blatant abuse of the Medicare system has to stop!

Yours
Bernd

Does our AMA delegation represent our interests?

Copy of an E-mail to FMA AMA Delegates:

Dear Friends and Colleagues:
I regret that I was unable to stay until the end of the meeting and especially that I missed the opportunity to witness our President's speech.
But I had to return to Miami to attend to my ever increasing patient load at my my family medicine office and my voluntary teaching commitments at the University of Miami.
I shared my frustrations regarding our delegation with our Delegation Chair and Vice-Chair and now with you:
During my almost fifteen year of service for organized medicine I now witness an increasing intolerance towards open discussion, political extremism and radicalization within our delegation.
Fear mongering, political stereotyping and demagoguery is now prevailing in the so-called " discussions", whereas the attempt to introduce opinions based on rational thoughts, tolerance for the diversity of opinions and the ability to reach a consensus is being marginalized. As a consequence hardly anyone dares to introduce his/her ideas or thoughts. I observed that many carefully gauge the political thermometer and based on the prevailing mood introduce their thoughts.Voice volume has replaced the value of rational consideration.
Most of us are more concerned to fall into political lockstep because otherwise they may not get elected into desired position within the AMA or jeopardize their delegate status. As an AMA Top-Outreach -Recruiter I speak to many different people trying to convince them to join our organization. In the last year I have witnessed a steady drop in AMA membership numbers within Florida. This does not surprise me anymore, because our AMA Delegation has lost touch with the members they supposedly should represent. Delegates often articulate the MOST extreme political opinions and even question the legitimacy of BELONGING to the AMA! How shall I recruit members if members of our delegation are openly ridiculing our AMA policies and leadership? Unless our delegation changes its behavior I cannot serve as a delegate in its midst.
This is a painful realization after years of service for an organization I admire and respect. But I have lost hope that our AMA delegation can be the platform for pragmatic political action especially in those exciting and challenging times.
Our leadership alone has the opportunity and responsibility to change that!
Change has to include: 1) Open debate and sanctioning of incendiary language,2) Respect for diverse opinions, 3) Fully transparent resolution development process, 4) Candidate and Leadership development based on personal qualification and not years of service.
These are the minimum requirements needed to avoid the political implosion of or Delegation.
Many will disagree with me but I honestly do not care how many times I am going to be called Fascist, Communist or Socialist. Those using this language are demagogues and wannabe "thinkers."
I remain focused on growing our AMA as a professional organization and NOT as a trade association. I remain focused to motivate a diverse spectrum of practicing physicians to join and rejoin our AMA. If these goals are not OUR goals then I have to part with you.

Yours truly,


Bernd

President's Speech to AMA House of Delegates

President Obama Speech to AMA. June 15th 2009

From the moment I took office as President, the central challenge we have confronted as a nation has been the need to lift ourselves out of the worst recession since World War II. In recent months, we have taken a series of extraordinary steps, not just to repair the immediate damage to our economy, but to build a new foundation for lasting and sustained growth. We are creating new jobs. We are unfreezing our credit markets. And we are stemming the loss of homes and the decline of home values.
But even as we have made progress, we know that the road to prosperity remains long and difficult. We also know that one essential step on our journey is to control the spiraling cost of health care in America.
Today, we are spending over $2 trillion a year on health care – almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren’t any healthier. In fact, citizens in some countries that spend less than we do are actually living longer than we do.
Make no mistake: the cost of our health care is a threat to our economy. It is an escalating burden on our families and businesses. It is a ticking time-bomb for the federal budget. And it is unsustainable for the United States of America.
It is unsustainable for Americans like Laura Klitzka, a young mother I met in Wisconsin last week, who has learned that the breast cancer she thought she’d beaten had spread to her bones; who is now being forced to spend time worrying about how to cover the $50,000 in medical debts she has already accumulated, when all she wants to do is spend time with her two children and focus on getting well. These are not worries a woman like Laura should have to face in a nation as wealthy as ours.
Stories like Laura’s are being told by women and men all across this country – by families who have seen out-of-pocket costs soar, and premiums double over the last decade at a rate three times faster than wages. This is forcing Americans of all ages to go without the checkups or prescriptions they need. It’s creating a situation where a single illness can wipe out a lifetime of savings.
Our costly health care system is unsustainable for doctors like Michael Kahn in New Hampshire, who, as he puts it, spends 20 percent of each day supervising a staff explaining insurance problems to patients, completing authorization forms, and writing appeal letters; a routine that he calls disruptive and distracting, giving him less time to do what he became a doctor to do and actually care for his patients.
Small business owners like Chris and Becky Link in Nashville are also struggling. They’ve always wanted to do right by the workers at their family-run marketing firm, but have recently had to do the unthinkable and lay off a number of employees – layoffs that could have been deferred, they say, if health care costs weren’t so high. Across the country, over one third of small businesses have reduced benefits in recent years and one third have dropped their workers’ coverage altogether since the early 90’s.
Our largest companies are suffering as well. A big part of what led General Motors and Chrysler into trouble in recent decades were the huge costs they racked up providing health care for their workers; costs that made them less profitable, and less competitive with automakers around the world. If we do not fix our health care system, America may go the way of GM; paying more, getting less, and going broke.
When it comes to the cost of our health care, then, the status quo is unsustainable. Reform is not a luxury, but a necessity. I know there has been much discussion about what reform would cost, and rightly so. This is a test of whether we – Democrats and Republicans alike – are serious about holding the line on new spending and restoring fiscal discipline.
But let there be no doubt – the cost of inaction is greater. If we fail to act, premiums will climb higher, benefits will erode further, and the rolls of uninsured will swell to include millions more Americans.
If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. In thirty years, it will be about one out of every three – a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.
And if we fail to act, federal spending on Medicaid and Medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation’s defense. In fact, it will eventually grow larger than what our government spends on anything else today. It’s a scenario that will swamp our federal and state budgets, and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our federal and state budgets.
To say it as plainly as I can, health care reform is the single most important thing we can do for America’s long-term fiscal health. That is a fact.
And yet, as clear as it is that our system badly needs reform, reform is not inevitable. There’s a sense out there among some that, as bad as our current system may be, the devil we know is better than the devil we don’t. There is a fear of change – a worry that we may lose what works about our health care system while trying to fix what doesn’t.
I understand that fear. I understand that cynicism. They are scars left over from past efforts at reform. Presidents have called for health care reform for nearly a century. Teddy Roosevelt called for it. Harry Truman called for it. Richard Nixon called for it. Jimmy Carter called for it. Bill Clinton called for it. But while significant individual reforms have been made – such as Medicare, Medicaid, and the children’s health insurance program – efforts at comprehensive reform that covers everyone and brings down costs have largely failed.
Part of the reason is because the different groups involved – physicians, insurance companies, businesses, workers, and others – simply couldn’t agree on the need for reform or what shape it would take. And another part of the reason has been the fierce opposition fueled by some interest groups and lobbyists – opposition that has used fear tactics to paint any effort to achieve reform as an attempt to socialize medicine.
Despite this long history of failure, I am standing here today because I think we are in a different time. One sign that things are different is that just this past week, the Senate passed a bill that will protect children from the dangers of smoking – a reform the AMA has long championed – and one that went nowhere when it was proposed a decade ago. What makes this moment different is that this time – for the first time – key stakeholders are aligning not against, but in favor of reform. They are coming together out of a recognition that while reform will take everyone in our health care community doing their part, ultimately, everyone will benefit.
And I want to commend the AMA, in particular, for offering to do your part to curb costs and achieve reform. A few weeks ago, you joined together with hospitals, labor unions, insurers, medical device manufacturers and drug companies to do something that would’ve been unthinkable just a few years ago – you promised to work together to cut national health care spending by two trillion dollars over the next decade, relative to what it would otherwise have been. That will bring down costs, that will bring down premiums, and that’s exactly the kind of cooperation we need.
The question now is, how do we finish the job? How do we permanently bring down costs and make quality, affordable health care available to every American?
That’s what I’ve come to talk about today. We know the moment is right for health care reform. We know this is an historic opportunity we’ve never seen before and may not see again. But we also know that there are those who will try and scuttle this opportunity no matter what – who will use the same scare tactics and fear-mongering that’s worked in the past. They’ll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors. We’ve heard it all before – and because these fear tactics have worked, things have kept getting worse.
So let me begin by saying this: I know that there are millions of Americans who are content with their health care coverage – they like their plan and they value their relationship with their doctor. And that means that no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.
If we do that, we can build a health care system that allows you to be physicians instead of administrators and accountants; a system that gives Americans the best care at the lowest cost; a system that eases up the pressure on businesses and unleashes the promise of our economy, creating hundreds of thousands of jobs, making take-home wages thousands of dollars higher, and growing our economy by tens of billions more every year. That’s how we will stop spending tax dollars to prop up an unsustainable system, and start investing those dollars in innovations and advances that will make our health care system and our economy stronger.
That’s what we can do with this opportunity. That’s what we must do with this moment.
Now, the good news is that in some instances, there is already widespread agreement on the steps necessary to make our health care system work better.
First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we have already begun to do this with an investment we made as part of our Recovery Act.
It simply doesn’t make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere. As Newt Gingrich has rightly pointed out, we do a better job tracking a FedEx package in this country than we do tracking a patient’s health records. You shouldn’t have to tell every new doctor you see about your medical history, or what prescriptions you’re taking. You should not have to repeat costly tests. All of that information should be stored securely in a private medical record so that your information can be tracked from one doctor to another – even if you change jobs, even if you move, and even if you have to see a number of different specialists.
That will not only mean less paper pushing and lower administrative costs, saving taxpayers billions of dollars. It will also make it easier for physicians to do their jobs. It will tell you, the doctors, what drugs a patient is taking so you can avoid prescribing a medication that could cause a harmful interaction. It will help prevent the wrong dosages from going to a patient. And it will reduce medical errors that lead to 100,000 lives lost unnecessarily in our hospitals every year.
The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening. It means going for a run or hitting the gym, and raising our children to step away from the video games and spend more time playing outside.
It also means cutting down on all the junk food that is fueling an epidemic of obesity, putting far too many Americans, young and old, at greater risk of costly, chronic conditions. That’s a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted. And that’s a lesson that we should work with local school districts to incorporate into their school lunch programs.
Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. It will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. And it will take employers following the example of places like Safeway that is rewarding workers for taking better care of their health while reducing health care costs in the process. If you’re one of the three quarters of Safeway workers enrolled in their "Healthy Measures" program, you can get screened for problems like high cholesterol or high blood pressure. And if you score well, you can pay lower premiums. It’s a program that has helped Safeway cut health care spending by 13 percent and workers save over 20 percent on their premiums. And we are open to doing more to help employers adopt and expand programs like this one.
Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions – cancer, cardiovascular disease, diabetes, lung disease, and strokes – can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health. That is starting to change with an investment we are making in prevention and wellness programs that can help us avoid diseases that harm our health and the health of our economy.
But as important as they are, investments in electronic records and preventive care are just preliminary steps. They will only make a dent in the epidemic of rising costs in this country.
Despite what some have suggested, the reason we have these costs is not simply because we have an aging population. Demographics do account for part of rising costs because older, sicker societies pay more on health care than younger, healthier ones. But what accounts for the bulk of our costs is the nature of our health care system itself – a system where we spend vast amounts of money on things that aren’t making our people any healthier; a system that automatically equates more expensive care with better care.
A recent article in the New Yorker, for example, showed how McAllen, Texas is spending twice as much as El Paso County – not because people in McAllen are sicker and not because they are getting better care. They are simply using more treatments – treatments they don’t really need; treatments that, in some cases, can actually do people harm by raising the risk of infection or medical error. And the problem is, this pattern is repeating itself across America. One Dartmouth study showed that you’re no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending one.
There are two main reasons for this. The first is a system of incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I’m talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can’t spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it’s not truly necessary. It is a model that has taken the pursuit of medicine from a profession – a calling – to a business.
That is not why you became doctors. That is not why you put in all those hours in the Anatomy Suite or the O.R. That is not what brings you back to a patient’s bedside to check in or makes you call a loved one to say it’ll be fine. You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers – and that’s what our health care system should let you be.
That starts with reforming the way we compensate our doctors and hospitals. We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up – because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes – so that we are not promoting just more treatment, but better care.
And we need to rethink the cost of a medical education, and do more to reward medical students who choose a career as a primary care physicians and who choose to work in underserved areas instead of a more lucrative path. That’s why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren’t drowning in debt when they enter the workforce.
The second structural reform we need to make is to improve the quality of medical information making its way to doctors and patients. We have the best medical schools, the most sophisticated labs, and the most advanced training of any nation on the globe. Yet we are not doing a very good job harnessing our collective knowledge and experience on behalf of better medicine. Less than one percent of our health care spending goes to examining what treatments are most effective. And even when that information finds its way into journals, it can take up to 17 years to find its way to an exam room or operating table.
As a result, too many doctors and patients are making decisions without the benefit of the latest research. A recent study, for example, found that only half of all cardiac guidelines are based on scientific evidence. Half. That means doctors may be doing a bypass operation when placing a stent is equally effective, or placing a stent when adjusting a patient’s drugs and medical management is equally effective – driving up costs without improving a patient’s health.
So, one thing we need to do is figure out what works, and encourage rapid implementation of what works into your practices. That’s why we are making a major investment in research to identify the best treatments for a variety of ailments and conditions.
Let me be clear: identifying what works is not about dictating what kind of care should be provided. It’s about providing patients and doctors with the information they need to make the best medical decisions.
Still, even when we do know what works, we are often not making the most of it. That’s why we need to build on the examples of outstanding medicine at places like the Cincinnati Children’s Hospital, where the quality of care for cystic fibrosis patients shot up after the hospital began incorporating suggestions from parents. And places like Tallahassee Memorial Health Care, where deaths were dramatically reduced with rapid response teams that monitored patients’ conditions and "multidisciplinary rounds" with everyone from physicians to pharmacists. And places like the Geisinger Health system in rural Pennsylvania and the Intermountain Health in Salt Lake City, where high-quality care is being provided at a cost well below average. These are islands of excellence that we need to make the standard in our health care system.
Replicating best practices. Incentivizing excellence. Closing cost disparities. Any legislation sent to my desk that does not achieve these goals does not earn the title of reform. But my signature on a bill is not enough. I need your help, doctors. To most Americans, you are the health care system. Americans – me included – just do what you recommend. That is why I will listen to you and work with you to pursue reform that works for you. And together, if we take all these steps, we can bring spending down, bring quality up, and save hundreds of billions of dollars on health care costs while making our health care system work better for patients and doctors alike.
Now, I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That’s a real issue. And while I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.
These changes need to go hand-in-hand with other reforms. Because our health care system is so complex and medicine is always evolving, we need a way to continually evaluate how we can eliminate waste, reduce costs, and improve quality. That is why I am open to expanding the role of a commission created by a Republican Congress called the Medicare Payment Advisory Commission – which happens to include a number of physicians. In recent years, this commission proposed roughly $200 billion in savings that never made it into law. These recommendations have now been incorporated into our broader reform agenda, but we need to fast-track their proposals in the future so that we don’t miss another opportunity to save billions of dollars, as we gain more information about what works and what doesn’t in our health care system.
As we seek to contain the cost of health care, we must also ensure that every American can get coverage they can afford. We must do so in part because it is in all of our economic interests. Each time an uninsured American steps foot into an emergency room with no way to reimburse the hospital for care, the cost is handed over to every American family as a bill of about $1,000 that is reflected in higher taxes, higher premiums, and higher health care costs; a hidden tax that will be cut as we insure all Americans. And as we insure every young and healthy American, it will spread out risk for insurance companies, further reducing costs for everyone.
But alongside these economic arguments, there is another, more powerful one. It is simply this: We are not a nation that accepts nearly 46 million uninsured men, women, and children. We are not a nation that lets hardworking families go without the coverage they deserve; or turns its back on those in need. We are a nation that cares for its citizens. We are a people who look out for one another. That is what makes this the United States of America.
So, we need to do a few things to provide affordable health insurance to every single American. The first thing we need to do is protect what’s working in our health care system. Let me repeat – if you like your health care, the only thing reform will mean is your health care will cost less. If anyone says otherwise, they are either trying to mislead you or don’t have their facts straight.
If you don’t like your health coverage or don’t have any insurance, you will have a chance to take part in what we’re calling a Health Insurance Exchange. This Exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that’s best for you and your family – just as federal employees can do, from a postal worker to a Member of Congress. You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package. And one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market so that force waste out of the system and keep the insurance companies honest.
Now, I know there’s some concern about a public option. In particular, I understand that you are concerned that today’s Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs. These are legitimate concerns, but ones, I believe, that can be overcome. As I stated earlier, the reforms we propose are to reward best practices, focus on patient care, not the current piece-work reimbursement. What we seek is more stability and a health care system on a sound financial footing. And these reforms need to take place regardless of what happens with a public option. With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations about the Sustainable Growth Rate formula that’s based on politics and the state of the federal budget in any given year. The alternative is a world where health care costs grow at an unsustainable rate, threatening your reimbursements and the stability of our health care system.
What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. I’ll be honest. There are countries where a single-payer system may be working. But I believe – and I’ve even taken some flak from members of my own party for this belief – that it is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I’m trying to bring about government-run health care, know this – they are not telling the truth.
What I am trying to do – and what a public option will help do – is put affordable health care within reach for millions of Americans. And to help ensure that everyone can afford the cost of a health care option in our Exchange, we need to provide assistance to families who need it. That way, there will be no reason at all for anyone to remain uninsured.
Indeed, it is because I am confident in our ability to give people the ability to get insurance that I am open to a system where every American bears responsibility for owning health insurance, so long as we provide a hardship waiver for those who still can’t afford it. The same is true for employers. While I believe every business has a responsibility to provide health insurance for its workers, small businesses that cannot afford it should receive an exemption. And small business workers and their families will be able to seek coverage in the Exchange if their employer is not able to provide it.
Insurance companies have expressed support for the idea of covering the uninsured – and I welcome their willingness to engage constructively in the reform debate. But what I refuse to do is simply create a system where insurance companies have more customers on Uncle Sam’s dime, but still fail to meet their responsibilities. That is why we need to end the practice of denying coverage on the basis of preexisting conditions. The days of cherry-picking who to cover and who to deny – those days are over.
This is personal for me. I will never forget watching my own mother, as she fought cancer in her final days, worrying about whether her insurer would claim her illness was a preexisting condition so it could get out of providing coverage. Changing the current approach to preexisting conditions is the least we can do – for my mother and every other mother, father, son, and daughter, who has suffered under this practice. And it will put health care within reach for millions of Americans.
Now, even if we accept all of the economic and moral reasons for providing affordable coverage to all Americans, there is no denying that it will come at a cost – at least in the short run. But it is a cost that will not – I repeat, not – add to our deficits. Health care reform must be and will be deficit neutral in the next decade.
There are already voices saying the numbers don’t add up. They are wrong. Here’s why. Making health care affordable for all Americans will cost somewhere on the order of one trillion dollars over the next ten years. That sounds like a lot of money – and it is. But remember: it is less than we are projected to spend on the war in Iraq. And also remember: failing to reform our health care system in a way that genuinely reduces cost growth will cost us trillions of dollars more in lost economic growth and lower wages.
That said, let me explain how we will cover the price tag. First, as part of the budget that was passed a few months ago, we’ve put aside $635 billion over ten years in what we are calling a Health Reserve Fund. Over half of that amount – more than $300 billion – will come from raising revenue by doing things like modestly limiting the tax deductions the wealthiest Americans can take to the same level it was at the end of the Reagan years. Some are concerned this will dramatically reduce charitable giving, but statistics show that’s not true, and the best thing for our charities is the stronger economy that we will build with health care reform.
But we cannot just raise revenues. We also have to make spending cuts in part by examining inefficiencies in the Medicare program. There will be a robust debate about where these cuts should be made, and I welcome that debate. But here’s where I think these cuts should be made. First, we should end overpayments to Medicare Advantage. Today, we are paying Medicare Advantage plans much more than we pay for traditional Medicare services. That’s a good deal for insurance companies, but not the American people. That’s why we need to introduce competitive bidding into the Medicare Advantage program, a program under which private insurance companies offer Medicare coverage. That will save $177 billion over the next decade.
Second, we need to use Medicare reimbursements to reduce preventable hospital readmissions. Right now, almost 20 percent of Medicare patients discharged from hospitals are readmitted within a month, often because they are not getting the comprehensive care they need. This puts people at risk and drives up costs. By changing how Medicare reimburses hospitals, we can discourage them from acting in a way that boosts profits, but drives up costs for everyone else. That will save us $25 billion over the next decade.
Third, we need to introduce generic biologic drugs into the marketplace. These are drugs used to treat illnesses like anemia. But right now, there is no pathway at the FDA for approving generic versions of these drugs. Creating such a pathway will save us billions of dollars. And we can save another roughly $30 billion by getting a better deal for our poorer seniors while asking our well-off seniors to pay a little more for their drugs.
So, that’s the bulk of what’s in the Health Reserve Fund. I have also proposed saving another $313 billion in Medicare and Medicaid spending in several other ways. One way is by adjusting Medicare payments to reflect new advances and productivity gains in our economy. Right now, Medicare payments are rising each year by more than they should. These adjustments will create incentives for providers to deliver care more effectively, and save us roughly $109 billion in the process.
Another way we can achieve savings is by reducing payments to hospitals for treating uninsured people. I know hospitals rely on these payments now because of the large number of uninsured patients they treat. But as the number of uninsured people goes down with our reforms, the amount we pay hospitals to treat uninsured people should go down, as well. Reducing these payments gradually as more and more people have coverage will save us over $106 billion, and we’ll make sure the difference goes to the hospitals that most need it.
We can also save about $75 billion through more efficient purchasing of prescription drugs. And we can save about one billion more by rooting out waste, abuse, and fraud throughout our health care system so that no one is charging more for a service than it’s worth or charging a dime for a service they did not provide.
But let me be clear: I am committed to making these cuts in a way that protects our senior citizens. In fact, these proposals will actually extend the life of the Medicare Trust Fund by 7 years and reduce premiums for Medicare beneficiaries by roughly $43 billion over 10 years. And I’m working with AARP to uphold that commitment.
Altogether, these savings mean that we have put about $950 billion on the table – not counting some of the longer-term savings that will come about from reform – taking us almost all the way to covering the full cost of health care reform. In the weeks and months ahead, I look forward to working with Congress to make up the difference so that health care reform is fully paid for – in a real, accountable way. And let me add that this does not count some of the longer-term savings that will come about from health care reform. By insisting that reform be deficit neutral over the next decade and by making the reforms that will help slow the growth rate of health care costs over coming decades, we can look forward to faster economic growth, higher living standards, and falling, not rising, budget deficits.
I know people are cynical we can do this. I know there will be disagreements about how to proceed in the days ahead. But I also know that we cannot let this moment pass us by.
The other day, my friend, Congressman Earl Blumenauer, handed me a magazine with a special issue titled, "The Crisis in American Medicine." One article notes "soaring charges." Another warns about the "volume of utilization of services." And another asks if we can find a "better way [than fee-for-service] for paying for medical care." It speaks to many of the challenges we face today. The thing is, this special issue was published by Harper’s Magazine in October of 1960.
Members of the American Medical Association – my fellow Americans – I am here today because I do not want our children and their children to still be speaking of a crisis in American medicine fifty years from now. I do not want them to still be suffering from spiraling costs we did not stem, or sicknesses we did not cure. I do not want them to be burdened with massive deficits we did not curb or a worsening economy we did not rebuild.
I want them to benefit from a health care system that works for all of us; where families can open a doctor’s bill without dreading what’s inside; where parents are taking their kids to get regular checkups and testing themselves for preventable ailments; where parents are feeding their kids healthier food and kids are exercising more; where patients are spending more time with doctors and doctors can pull up on a computer all the medical information and latest research they’d ever want to meet that patient’s needs; where orthopedists and nephrologists and oncologists are all working together to treat a single human being; where what’s best about America’s health care system has become the hallmark of America’s health care system.
That is the health care system we can build. That is the future within our reach. And if we are willing to come together and bring about that future, then we will not only make Americans healthier and not only unleash America’s economic potential, but we will reaffirm the ideals that led you into this noble profession, and build a health care system that lets all Americans heal. Thank you.

"Medical Fascism:' Fact or Fiction?

I was initially surprised but then dismayed reading in an e-mail message and later on a web site posting by the same author that the

" the greatest threat to American patients in the history of our country.. is the rise of Medical Fascism. Some may wonder - what happened to socialized medicine, isn't that the great threat? While it is true that there are attempts to socialize medical care, the fact is that the power players in Washington are ready to set the rules and then hand the keys of health care spending over to large health insurance companies. This is the definition of fascism: the state decides what corporations will do and the corporations do their bidding while making a profit. As it turns out the very corporations making the profit also control the government."

In a different e-mail the author also calls upon the Florida Medical Association to support a series of public events to " Join up with your local tea party group for marches across the nation on Medical freedom planned by July 4th. Let Congress know you want medical freedom, not medical fascism."

I am concerned not only because I witnessed the devastating effect of REAL Fascism in Europe but because I feel very strongly that the inappropriate use of such a term applied to current politics is an insult to the sacrifice of American patriots who fought in WWII to liberate Europe from Fascism and an affront to the millions of victims of Fascist genocide and mass murder.

What is Fascism? Well, according to Merriam-Webster's Online Dictionary Fascism is " a political philosophy, movement, or regime (as that of the Fascisti) that exalts nation and often race above the individual and that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of opposition."
According to Robert O. Paxton, a professor emeritus at Columbia University, he defines fascism in his book "The Anatomy of Fascism" as:

"A form of political behavior marked by obsessive preoccupation with community decline, humiliation or victimhood and by compensatory cults of unity, energy and purity, in which a mass-based party of committed nationalist militants, working in uneasy but effective collaboration with traditional elites, abandons democratic liberties and pursues with redemptive violence and without ethical or legal restraints goals of internal cleansing and external expansion."

NONE of these descriptions define our current political system, in which we have democratically elected a President, democratically elected our representatives on state and national level and maintain the separation of power to PREVENT the emergence of authoritarian and dictatorial rule.
I therefore URGE the leadership of the Florida Medical Association NOT to endorse or support any activities intended to promote the dissemination of such falsehoods which are intended to incite anger and fear and which will separate but not unite us.
I wholeheartedly support the freedom of expression. Nevertheless, such freedom implies responsibility to abstain from any incitement, too.
Our leadership has to decide if we want to represent all doctors in our State, even if we may have different political, social and religious views, or if we want to amplify the radical view of a minority!!
Thats the choice and so far I have not heard ONE of our leaders distancing him- or herself from the opinion expressed by the author who introduce the term "Medical Fascism."
I definitely do so here in public and I will continue reminding others to do the same.

Yours truly,

Bernd Wollschlaeger,MD,FAAFP, FASAM

Prescription Drug Legislation

Dear Friends and Colleagues:

Three local Republican Representatives ( Adam Hasner of Boca Raton, Anitere Flores of Miami, Ellyn Bogdanoff of Fort Lauderdale) voted either against the bill to create a prescription drug database in Florida and/or sent a letter to Gov. Charlie Crist on Thursday, asking him to veto a bill one of their fellow GOP leaders sponsored.
This bill will create a statewide prescription drug monitoring system to track those ''doctor shopping'' for addictive pills.
So why do they oppose it? In the letter those Republicans argue that " the sensitive personal and medical information contained
in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida."
This argument is ludicrous! Does that mean we will also stop using ATMs and Internet banking because our data could be misused by cyber terrorists or criminals? When do politicians learn that fear-based politics is leading us nowhere? We need to save lives and also stop those drug-dealers in a white coat who claim to be doctors! They are not! They are drug dealers and they know it!
I URGE you to contact the offices of those three lawmakers listed below to ask them to withdraw their opposition to the legislation.

Make your call today!!!


* Adam Hasner
o Capitol Office:
o 322 The Capitol
o 402 South Monroe Street
o Tallahassee, FL 32399-1300
o Phone: (850) 488-1993
o District Office:
o 33 NE 4th Avenue
o Delray Beach, FL 33483-4528
o Phone: (561) 279-16
o

* Ellyn Bogdanoff

* Capitol Office:
* 418 The Capitol
* 402 South Monroe Street
* Tallahassee, FL 32399-1300
* Phone: (850) 488-0635
* District Office:
* 1421 South Andrews Avenue
* Fort Lauderdale, FL 33316-1839
* Phone: (954) 762-375

* Anitere Flores
o Capitol Office:
324 The Capitol
402 South Monroe Street
Tallahassee, FL 32399-1300
Phone: (850) 488-2831
District Office:
Suite 205 C
1405 SW 107th Avenue
Miami, FL 33174-2523
Phone: (305) 227-7626

Prescription Drug Legislation Faces Opposition

Attached an article from the Palm Beach Post regarding the prescription drug legislation. I hope that our organization speaks up in FAVOR of the legislation and AGAINST the request to torpedo this bill.
This legislation is the first step towards curbing the narcotic abuse.
The argument that " the sensitive personal and medical information contained in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida," is ludicrous!
Does that mean we will also stop using ATMs and Internet banking because our data could be misused by cyber terrorists or criminals?
When do politicians learn that fear-based politics is leading us nowhere?
We need to save lives and stop those drug-dealers in a white coat who claim to be doctors! They are not! They are drug dealers and they know it!
Please visit South Florida to understand the enormity of the problems. The number of pain clinics skyrocketed almost 100 % since last year! The nations TOP 30 narcotic drug prescriber's practice in Dade and Broward county! Hard to believe but its true. Doctors can be drug dealers, too!!
Yours
Bernd

============================================================================

Drug database access worries some in Florida House

By MICHAEL C. BENDER

Palm Beach Post Capital Bureau

Thursday, May 07, 2009

TALLAHASSEE — Thirteen state House Republicans sent a letter to Gov. Charlie Crist on Thursday, asking him to veto a bill one of their fellow GOP leaders sponsored.

Ten of the 13 lawmakers voted against the bill to create a prescription drug database in Florida. Three of the Republicans - Adam Hasner of Boca Raton, Anitere Flores of Miami and Dean Cannon of Winter Park - did not vote on the original bill.

The bill, sponsored by House budget co-chairman Marcelo Llorente, R-Miami, is aimed at curbing drug abuse. It was approved unanimously in the Senate and on a 113-10 vote in the House.

But a similar database was recently hacked in Virginia, according to TheWashington Post. House Republicans cited that story in their letter to Crist.

"This request is based on a well founded fear that the sensitive personal and medical information contained in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida," according to the letter.

Crist's press office did not comment.

Llorente said the bill (SB 462) creates a task force that will "ensure the protection of personal information."

"The tragic deaths of almost 10 Floridians a day must stop," Llorente said. "I urge the governor to sign this bill expeditiously in an effort to end the practice of doctor shopping."

In addition to Hasner, other local Republican lawmakers signing the letter were Reps. Ellyn Bogdanoff of Fort Lauderdale and Carl Domino of Jupiter.

Tamiflu and Public Health

I am gravely concerned about the generous use (or abuse) of Tamiflu. Lately, I have been pressured by patients to prescribe Tamiflu " just in case to have it at home." I often deny the request to avoid the prophylactic use of Tamiflu and argue as follows:
• The " regular flu" kills approximately 36,000 Americans annually and I still have a hard time convincing people to get their flu shot. In comparison,17 countries have reported 653 cases of H1N1 and 17 Mexicans have died.In the US 160 cases have been confirmed and only one patient has died in the US so far!
• Outside Mexico the virus does not appear to be severe, and this virus might not be any more virulent than normal seasonal flu infections.
• Scientists are encouraged by initial analyses of the DNA sequence of the virus, which has found it lacks the traits that led to the death of nearly 50m people in the 1918 Spanish flu outbreak.
• A WHO medical health officer, said the biggest concern was that the virus could mutate and become resistant to Tamiflu, the anti-viral drug. This could be accelerated by the indiscriminate use of Tamiflu fueled by doctors who mean well but may cause greater harm to the public health by prescribing the drug to any one requesting it.
• The Centers for Disease Control in Atlanta, Georgia, says 98% of existing H1 flu strains were resistant to Tamiflu in the last flu season. Scientists are struggling to understand why this is.Dr Nikki Shindo, a WHO medical health officer, said that he worst-case scenario is the virus will mutate and become Tamiflu-resistant. The best-case scenario is that it causes only mild illness and continues to respond to Tamiflu.

What Can We Do?

Please DO NOT prescribe Tamifu unless their is a reasonable concern that the patient suffers from the flu and diagnostic testing was initiated (nasal swab). For more information about proper testing procedures see http://www.cdc.gov/h1n1flu/.
Tamiflu overuse can lead to resistance and the drug itself can cause significant side affects and even serious reactions (see http://www.drugs.com/sfx/tamiflu-side-effects.html)

I hope someone will listen and please forward this e-mail to anyone interested.

Yours
Bernd

Swine Flu, 04/26/2009

Investigation and Interim Recommendations:

Swine Influenza (H1N1)



CDC, in collaboration with public health officials in California and Texas, is investigating cases of febrile respiratory illness caused by swine influenza (H1N1) viruses. As of 11 AM (EDT) April 25, 2009, 8 laboratory confirmed cases of Swine Influenza infection have been confirmed in the United States. Four cases have been reported in San Diego County, California. Two cases have been reported in Imperial County California. Two cases have been reported in Guadalupe County, Texas. Of the 8 persons with available data, illness onsets occurred March 28-April 14, 2009. Age range was 7-54 y.o. Cases are 63% male.

The viruses contain a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in the U.S. or elsewhere. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. The H1N1 viruses are resistant to amantadine and rimantadine but not to oseltamivir or zanamivir. It is not anticipated that the seasonal influenza vaccine will provide protection against the swine flu H1N1 viruses.

CDC has also been working closely with public health officials in Mexico, Canada and the World Health Organization (WHO). Mexican public health authorities have reported increased levels of respiratory disease, including reports of severe pneumonia cases and deaths, in recent weeks. CDC is assisting public health authorities in Mexico by testing specimens and providing epidemiological support. As of 11:00 AM (EDT) April 25, 2009, 7 specimens from Mexico at CDC have tested positive for the same strain of swine influenza A (H1N1) as identified in U.S. cases. However, no clear data are available to assess the link between the increased disease reports in Mexico and the confirmation of swine influenza in a small number of specimens. WHO is monitoring international cases. Further information on international cases may be found at: http://www.who.int/csr/don/2009_04_24/en/index.html

Clinicians should consider swine influenza infection in the differential diagnosis of patients with febrile respiratory illness and who 1) live in San Diego or Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during the 7 days preceding their illness onset.

Patients who meet these criteria should be tested for influenza, and specimens positive for influenza should be sent to public health laboratories for further characterization. Clinicians who suspect swine influenza virus infections in humans should obtain a nasopharyngeal swab from the patient, place the swab in a viral transport medium, refrigerate the specimen, and then contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory. CDC requests that state public health laboratories promptly send all influenza A specimens that cannot be subtyped to the CDC, Influenza Division, Virus Surveillance and Diagnostics Branch Laboratory.

Persons with febrile respiratory illness should stay home from work or school to avoid spreading infections (including influenza and other respiratory illnesses) to others in their communities. In addition, frequent hand washing can lessen the spread of respiratory illness.

CDC has not recommended that people avoid travel to affected areas at this time. Recommendations found at http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx will help travelers reduce risk of infection and stay healthy.

Clinical guidance on laboratory safety, case definitions, infection control and information for the public are available at:http://www.cdc.gov/swineflu/investigation.htm.

* Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers: http://www.cdc.gov/swineflu/guidelines_labworkers.htm
* Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting: http://www.cdc.gov/swineflu/guidelines_infection_control.htm
* Interim Guidance on Case Definitions for Swine Influenza A (H1N1) Human Case Investigations: http://www.cdc.gov/swineflu/casedef_swineflu.htm

Morbidity and Mortality Weekly Reports Dispatch (April 24) provide detailed information about the initial cases at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm


For more information about swine flu: http://www.cdc.gov/swineflu

Drug Dealers in a White Coat

Miami Herald, Letter To The Editor

Posted on Mon, Apr. 13, 2009
Public health should be legislative priority



Re the April 8 editorial Belatedly, Florida takes on prescription-drug dealers: The unprecedented concentration of ''pain clinics'' in our community contributes to out-of-control opioid abuse, narcotic-drug dealing and endangers public health. It requires the concerted efforts of law enforcement, political leadership and the medical community to root out this problem. Several steps can be taken right now:
• Impose a moratorium on dispensing narcotics in physician's offices unless the prescribing physician is board certified in anesthesiology and pain medicine and operates within a licensed and certified facility to be approved by a designated agency.

• Make mandatory monthly inspections of all pain clinics in South Florida. Skilled inspectors can be trained to randomly audit charts and on-site pharmacies and monitor patient flow.

• Conduct criminal background checks of all operators and their financial backers, which will be reviewed and updated quarterly.

• Implement a prescription-drug monitoring system to identify drug-seekers and doctor-shoppers.

• Require the Board of Medicine to suspend the license of any physician who violates the standards of care as it pertains to inappropriate prescription of narcotics.

Let's act together to rid our community of these narco-cowboys. Let's protect our families, friends and patients from such predators. We can't be afraid to call them by their name: drug dealers in white coats.

BERND WOLLSCHLAEGER, MD, president, Dade County Medical Association, North Miami Beach

Every American is entitled to affordable healthcare!

Saturday, April 4, 2009


Letter To The Editor

“Every American is entitled to affordable healthcare!”


The Miami Herald Editorial Board is correct: every American should have access to affordable healthcare delivered by a physician of their choice. But expanding coverage only increases the volume of healthcare services and costs! This shortsighted focus misses the bigger picture.
We have to realign our payment system and reward quality and not the quantity of medical services rendered. The current reimbursement system is centered on a volume-based model and must shift towards a value-based system instead. We have to rebuild our primary care system and reward family physicians who spent valuable time with patients teaching healthy lifestyle and nutrition to prevent the incidence of chronic diseases. We should motivate and reward physicians to integrate their practices within collaborative practice models or groups. Utilizing shared Electronic Health Records based on Web 2.0 technologies physicians can communicate easily and securely. Such systems can measure and compare their performance, create a framework for quality and not quantity based reimbursement. Furthermore, physicians will learn to work within a team of medical professionals to optimize the treatment outcome for their patients.
As a result of the above outlined steps we can finally provide a Patient Centered Medical Home with a high degree of personalized care coordination, access beyond the acute care episode, and identification of key medical and community resources to meet the patients’ needs.
We as physicians have the choice to proactively change the delivery of healthcare today! We have the tools available to make this happen. Lets not miss this opportunity!

Bernd Wollschlaeger,MD,FAAFP,FASAM - President, Dade County Medical Association
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com

=======================================================================================

MIAMI HERALD

Posted on Fri, Apr. 03, 2009
Health insurance out of balance

Among the many issues on America's healthcare-reform agenda, one deserving a high priority should be to level the playing field for people looking to buy health insurance. As it now stands, insurers have most of the advantages. Example: rejecting potential customers because of ''preexisting conditions.'' Congress and President Barack Obama should put a stop to this practice. Meanwhile, Florida Insurance Commissioner Kevin McCarty should ask the Legislature for reforms.
Patients blacklisted

In a Page One story last Sunday, Miami Herald reporter John Dorschner described how some insurers use secretive underwriting guidelines to blacklist people with certain ailments or who take certain drugs. For example, one insurer's guideline recommends rejecting people who have diabetes, multiple sclerosis, schizophrenia, Parkinson's Disease, Hepatitis C or AIDS/HIV. Other guidelines suggest automatic denial of people who take the anti-clotting drug Plavix or Seroquel, of those who use prescribed anti-psychotic medications, and anyone who uses certain medications for sleep apnea.

Insurers should not be expected to automatically enroll anyone who applies for a policy. They must be able to determine the amount of risk they are taking on in order to price policies appropriately and to earn a profit. Insurers also need to be able to protect themselves from people who lie about ailments in order to get coverage. At the same time, though, honest consumers should get a fair shake, which means not having to demonstrate a level of pristine health that virtually no one can attain. Without the right rules in place, insurers would cover only healthy people and have no risk at all.

Insurers say that their underwriting rules are based on standards set by the industry and by the state and federal governments. This is where change should begin. President Obama has said he wants to make insurance much more affordable and that having nearly 50 million Americans without health coverage is unacceptable. He stops short, however, of embracing universal healthcare.

A bit of progress

In December, some of the country's top insurers said they were willing to stop using preexisting conditions as a basis for pricing policies in return for laws requiring universal coverage. This, at least, is a start. Universal healthcare may, or may not, be the best solution, but it is clear that too many Americans have been squeezed out of the insurance market -- and that must change.

Commissioner McCarty can get the ball rolling by asking the Legislature to adopt underwriting guidelines that protect consumers. Congress should help President Obama make health insurance available to every American.